Bässler R, Birke F
Institute of Pathology, City and Academic Hospital, Fulda, Federal Republic of Germany.
Virchows Arch A Pathol Anat Histopathol. 1988;412(3):231-9. doi: 10.1007/BF00737147.
In 5 cases of invasive ductal and lobular carcinoma of the breast multiple epithelioid and giant cell containing granulomas were detected, localized mainly in circumferential regions, but also in the center of the carcinomas. These granulomas were interpreted as sarcoid-like stromal reactions, occurring as sarcoid-like lesions in uni- and bilateral primaries, in a recurrent tumour, and also in axillary lymph nodes. Histopathologically, these granulomas were not quite uniform, some of them corresponding to typical sarcoidosis, others showing marked proliferations of epithelioid or giant cells or containing fibrinoid exudate or necroses. The granulomas were surrounded by dense infiltrates of mononuclear cells. Tuberculosis and mycosis was excluded. There were no hints of generalized sarcoidosis. Pathogenetically, these are reactions in the tumour stroma of varying intensity, and are not caused by necroses of the tumour tissue nor by microbial infections. Such tumour-associated sarcoid-like stroma reactions are interpreted as a T-cell mediated immune response to an antigen expression of the carcinoma acting as the local trigger; in 2 cases they were connected with sarcoid-like lesions of the axillary lymph nodes. Their occurrence in bilateral carcinoma of the breast points to an immunological disposition for this special kind of host-versus-tumour response. The intensity of these changes in a recurrent tumour reflects an immunological hypersensitivity reaction. The pathogenetic and differential diagnostic aspects of epithelioid granulomas of the female breast in chronic granulomatous mastitis, panniculitis, foreign body reaction, rare infections, and in therapeutically induced sarcoidosis are described and discussed.
在5例乳腺浸润性导管癌和小叶癌中，检测到多个含有上皮样细胞和巨细胞的肉芽肿，主要位于周边区域，但也见于癌灶中心。这些肉芽肿被解释为类肉瘤样间质反应，在单侧和双侧原发性肿瘤、复发性肿瘤以及腋窝淋巴结中均表现为类肉瘤样病变。组织病理学上，这些肉芽肿并不完全一致，有些对应于典型的结节病，另一些则表现为上皮样细胞或巨细胞明显增生，或含有纤维蛋白样渗出物或坏死灶。肉芽肿被单核细胞密集浸润所包围。已排除结核病和霉菌病。没有全身性结节病的迹象。从发病机制上讲，这些是肿瘤间质中不同强度的反应，不是由肿瘤组织坏死或微生物感染引起的。这种与肿瘤相关的类肉瘤样间质反应被解释为针对作为局部触发因素的癌抗原表达的T细胞介导的免疫反应；在2例中，它们与腋窝淋巴结的类肉瘤样病变有关。它们在双侧乳腺癌中的出现表明这种特殊的宿主-肿瘤反应存在免疫倾向。复发性肿瘤中这些变化的强度反映了免疫超敏反应。本文描述并讨论了慢性肉芽肿性乳腺炎、脂膜炎、异物反应、罕见感染以及治疗性诱导的结节病中女性乳腺上皮样肉芽肿的发病机制和鉴别诊断方面。
