摘要目的 探讨乳腺粗针穿刺活检中淋巴造血系统肿瘤的临床病理特征及其与浸润性癌的鉴别要点.方法 收集2011至2016年就诊于复旦大学附属肿瘤医院,乳腺粗针穿刺活检诊断为淋巴造血系统肿瘤的病例72例患者资料,总结临床病理特征.组织学分型参照2017年第4版WHO淋巴造血组织肿瘤分类,采用免疫组织化学染色和分子生物学检测对相关抗原和基因进行检测.结果 (1)72例粗针穿刺标本中,女性71例,男性1例,中位年龄54岁;右乳32例(44. 4%),左乳40例(55. 6%). 7例既往有淋巴瘤病史.最常见的临床表现是受累乳腺出现单发、无痛性肿块.活检确诊后63例患者行全身治疗,9例行肿块切除术后全身治疗. (2)不同类型的淋巴瘤各具形态特征.共同的形态特征为单一的异型淋巴样细胞浸润在乳腺间质中呈结节状或弥漫生长,肿瘤细胞失黏附性,缺乏腺样或巢状上皮样结构,乳腺正常导管和小叶结构基本保存.少数肿瘤呈单排条索状分布,需与浸润性癌鉴别. ( 3) 72例肿瘤均表达白细胞共同抗原,不表达上皮标志物. 72例肿瘤以B细胞性肿瘤为主,包括弥漫性大B细胞淋巴瘤(DLBCL)63例(87. 5%;包括EB病毒阳性的DLBCL 3例,非特指60例),Burkitt淋巴瘤2例,套细胞淋巴瘤1例,黏膜相关淋巴组织结外边缘区淋巴瘤1例,前驱B淋巴母细胞淋巴瘤/白血病1例,外周T细胞淋巴瘤(非特指)2例,鼻型结外NK/T细胞淋巴瘤1例,髓细胞肉瘤1例. 63例DLBCL中,22例(34. 9%)为生发中心B细胞(GCB)亚型,41例(65. 1%)为非生发中心B细胞(non-GCB)亚型.结论 粗针穿刺标本可用于乳腺淋巴瘤的病理诊断.乳腺淋巴造血系统肿瘤病理类型多为 B 细胞性非霍奇金淋巴瘤,以 DLBCL 最为常见,其中non-GCB亚型又多于GCB亚型.

abstractsObjective To investigate the clinicopathologic features and differential diagnosis of breast lymphoma in core needle biopsy. Methods Seventy-two cases of breast lymphoma in core needle biopsy between 2011 and 2016 were extracted from the pathology database of Fudan University Shanghai Cancer Center. The clinicopathologic features were analyzed. The histological diagnosis of the tumors was based on the WHO classifications of tumors of hematopoietic and lymphoid tissues. Immunohistochemistry and molecular methods were performed to detect related antigens and genes. Results Seventy-one patients were female and one was male. The median age was 54 years. The tumors were located in the right breast in 32 (44. 4%) patients and in the left breast in 40 (55. 6%) patients. Seven patients had a previous history of lymphoma. Most of the cases presented as a single and painless breast mass. Sixty-three patients received systemic treatment, and nine patients received systemic therapy after excision. The common morphological feature was that single tumor cells infiltrated the stroma, without cohesiveness between tumor cells, and lacking glandular or nested epithelioid structures. The normal ductal and lobular structures of the mammary gland were typically preserved. The tumor cells in some cases were distributed in single rows, and should be differentiated from invasive carcinoma. All cases were positive for LCA, negative for CK. Sixty-eight cases were classified as B-cell lymphoma, including 63 cases ( 87. 5%) of diffuse large B-cell lymphoma (DLBCL; including 3 cases of EBV-positive DLBCL and 60 cases of DLBCL,NOS), two cases of Burkitt lymphoma, one case of mantle cell lymphoma, one case of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue and one case of precursor B lymphoblastic leukemia/lymphoma. The remaining cases included two peripheral T-cell lymphoma (NOS), one extranodal NK/T cell lymphoma, nasal type and one myeloid sarcoma. In 63 cases of DLBCL, 22 cases (34. 9%) expressed germinal center B-cell-like (GCB) phenotype and 41 cases (65. 1%) showed non-germinal center B-cell-like (non-GCB) phenotype. Conclusions Core needle biopsy could be the preferred method for diagnosis of breast lymphoma. Diffuse large B-cell lymphoma is the most common histologic type of breast lymphoma, and non-GCB subtype is more frequent than GCB subtype.