Yang Guangzhi, Guo Li, Jin Hua, Li Jing, Ding Huaye
Department of Pathology, the General Hospital of Beijing Military Command, Beijing 100700, China.
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Zhonghua Bing Li Xue Za Zhi. 2014 Jul;43(7):437-41.
To investigate the pathology, diagnosis and differential diagnosis of carcinomas arising in fibroepithelial neoplasms of the breast.
Morphological observation and immunohistochemistry using MaxVision method were performed in fifty-four cases of carcinoma arising from fibroepithelial neoplasms of the breast from January 2003 to February 2014.
Thirty-eight cases of carcinoma arose from fibroadenomas. Twelve cases were classical lobular carcinoma in situ (LCIS). Twenty-one cases were ductal carcinoma in situ (DCIS), including four cases of low-grade, ten cases of intermediate-grade, six cases of high-grade and one case of apocrine. One case was mixed DCIS and LCIS. Three cases were infiltrating ductal carcinoma (IDC) accompanied with DCIS. One case was spindle cell metaplastic carcinoma. Sixteen cases arose from phyllodes tumours. Six cases arose from benign phyllodes tumours, including four cases of low-grade DCIS, one case of high-grade DCIS, and one case of classical LCIS with micro-invasion (diameter 0.9 mm). Three cases arose from borderline phyllodes tumours, including one case of classical LCIS, one case of intermediate-grade DCIS, and one case of invasive lobular carcinoma (ILC) with LCIS. Seven cases arose from malignant phyllodes tumours, including two cases each of low-grade DCIS and intermediate-grade DCIS, one case of high-grade DCIS, one case of apocrine DCIS, and one case of mixed IDC with DCIS. By immunohistochemistry, LCIS and ILC were diffusely positive for ER and PR. Low-grade DCIS was diffusely positive for ER and PR ( > 90%), intermediate-grade DCIS was 70%-90% positive, high-grade DCIS was negative for ER and 20%-30% positive for PR, apocrine DCIS was both negative, and IDC was 40%-90% positive. The spindle cell metaplastic carcinoma was negative for ER and PR, but showed diffuse or scattered positivity for CK5/6 and p63.
Carcinomas arising from fibroepithelial neoplasms of the breast are rare, showing unusual clinical presentation, and are characterized by in situ or invasive carcinomas in a background of fibroepithelial neoplasms. The accurate diagnosis depends on the recognition of the background fibroepithelial neoplasms and assessment of the nature of the epithelial proliferation, supplemented by immunohistochemistry when necessary.
探讨乳腺纤维上皮性肿瘤中发生的癌的病理、诊断及鉴别诊断。
对2003年1月至2014年2月间54例乳腺纤维上皮性肿瘤中发生的癌进行形态学观察及采用MaxVision法的免疫组化检测。
38例癌起源于纤维腺瘤。12例为经典型小叶原位癌（LCIS）。21例为导管原位癌（DCIS），包括4例低级别、10例中级别、6例高级别及1例大汗腺型。1例为DCIS与LCIS混合型。3例为浸润性导管癌（IDC）伴DCIS。1例为梭形细胞化生癌。16例癌起源于叶状肿瘤。6例起源于良性叶状肿瘤，包括4例低级别DCIS、1例高级别DCIS及1例伴微浸润（直径0.9mm）的经典型LCIS。3例起源于交界性叶状肿瘤，包括1例经典型LCIS、1例中级别DCIS及1例伴LCIS的浸润性小叶癌（ILC）。7例起源于恶性叶状肿瘤，包括2例低级别DCIS、2例中级别DCIS、1例高级别DCIS、1例大汗腺型DCIS及1例IDC与DCIS混合型。免疫组化显示，LCIS及ILC的ER和PR弥漫阳性。低级别DCIS的ER和PR弥漫阳性（>90%），中级别DCIS阳性率为70% - 90%，高级别DCIS的ER阴性、PR阳性率为20% - 30%，大汗腺型DCIS两者均阴性，IDC阳性率为40% - 90%。梭形细胞化生癌的ER和PR阴性，但CK5/6和p63呈弥漫或散在阳性。
乳腺纤维上皮性肿瘤中发生的癌罕见，临床表现不寻常，其特征为在纤维上皮性肿瘤背景下出现原位癌或浸润癌。准确诊断依赖于对背景纤维上皮性肿瘤的识别及上皮增生性质的评估，必要时辅以免疫组化。
