Auger M, Hanna W, Kahn H J
Department of Pathology, Women's College Hospital, Toronto, Canada.
Arch Pathol Lab Med. 1989 Nov;113(11):1231-5.
Cystosarcoma phylloides of the breast is a tumor composed of breast ducts and a cellular stromal component that can be benign or malignant. The origin of the stromal cells is controversial. We undertook an immunohistochemical and ultrastructural study of 11 cases of cystosarcoma phylloides to assess the histogenesis of the stromal component. By light microscopy, 4 were diagnosed as benign, and 7 were diagnosed as malignant. Antibodies to vimentin, desmin, actin, high- and low-molecular-weight keratins, and S100 protein were used for immunohistochemical staining. In the 4 benign cases of cystosarcoma phylloides, the stromal cells stained positively only for vimentin. In the malignant tumors, the spindle cell component stained for vimentin in all the cases. In addition, the malignant stromal cells coexpressed desmin in two cases and keratin and S 100 protein in another case. By electron microscopy the stromal component in the benign case and in two of five malignant cases was composed of a mixture of fibroblasts and myofibroblasts. The entire neoplastic stroma in two other malignant cases showed features of smooth-muscle differentiation, whereas in another case all the stromal cells showed myoepithelial differentiation. Thus, in benign and malignant cystosarcoma phylloides, the stromal component consists of a mixture of fibroblasts and myofibroblasts. Leiomyosarcomas and myoepitheliomas can mimic malignant cystosarcoma phylloides, but immunohistochemistry and electron microscopy can differentiate these entities. This is important since their biologic behavior is different.
乳腺叶状囊肉瘤是一种由乳腺导管和细胞性间质成分组成的肿瘤，可呈良性或恶性。间质细胞的起源存在争议。我们对11例乳腺叶状囊肉瘤进行了免疫组织化学和超微结构研究，以评估间质成分的组织发生。通过光学显微镜检查，4例被诊断为良性，7例被诊断为恶性。使用波形蛋白、结蛋白、肌动蛋白、高分子量和低分子量角蛋白以及S100蛋白的抗体进行免疫组织化学染色。在4例良性乳腺叶状囊肉瘤病例中，间质细胞仅对波形蛋白呈阳性染色。在恶性肿瘤中，所有病例的梭形细胞成分均对波形蛋白呈阳性染色。此外，2例恶性间质细胞共表达结蛋白，另1例共表达角蛋白和S100蛋白。通过电子显微镜检查，良性病例以及5例恶性病例中的2例的间质成分由成纤维细胞和平滑肌成纤维细胞混合组成。另外2例恶性病例的整个肿瘤性间质表现出平滑肌分化的特征，而在另1例中所有间质细胞均表现出肌上皮分化。因此，在良性和恶性乳腺叶状囊肉瘤中，间质成分由成纤维细胞和平滑肌成纤维细胞混合组成。平滑肌肉瘤和肌上皮瘤可酷似恶性乳腺叶状囊肉瘤，但免疫组织化学和电子显微镜检查可区分这些实体。这很重要，因为它们的生物学行为不同。
