Ibrahim R E, Sciotto C G, Weidner N
Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115.
Cancer. 1989 Mar 15;63(6):1154-60. doi: 10.1002/1097-0142(19890315)63:6<1154::aid-cncr2820630619>3.0.co;2-q.
Pseudoangiomatous hyperplasia of mammary stroma (PHMS) is a benign proliferation of keloid-like fibrosis, containing slit-like pseudovascular spaces. Its main importance is its distinction from angiosarcoma; however, the clinicopathologic spectrum of PHMS remains incompletely described. We report two new cases and describe our findings in 200 consecutive breast specimens evaluated for the presence of PHMS. The first patient presented with peau-de-orange change in the overlying breast skin, thus mimicking inflammatory breast carcinoma. Furthermore, this patient's PHMS lesion had been diagnosed and treated inappropriately as a low-grade angiosarcoma. The second case showed the more typical, fibroadenoma-like presentation of PHMS. In addition, PHMS changes occur commonly in routine breast biopsy specimens. In fact, our review of 200 consecutive breast specimens showed PHMS in at least one microscopic focus in 23% of cases. The PHMS changes occurred in younger patients than the control population and were associated with fibrocystic changes, in fibroadenomas, in gynecomastia, in normal breast tissue, and in sclerosing lobular hyperplasia. Ultrastructural and immunohistochemical studies of one case showed that the capillary-like spaces were either acellular or lined by fibroblasts. Pseudoangiomatous hyperplasia of mammary stroma represents a clinicopathologic spectrum, extending from focal, insignificant microscopic changes to cases where PHMS produces a breast mass. Increased awareness of PHMS and its clinicopathologic spectrum will allow its differentiation from other vascular tumors of the breast, especially low-grade angiosarcoma.
乳腺间质假血管瘤样增生（PHMS）是一种瘢痕疙瘩样纤维化的良性增生，含有裂隙样假血管腔隙。其主要意义在于与血管肉瘤相鉴别；然而，PHMS的临床病理谱仍未得到完整描述。我们报告两例新病例，并描述在200例接受PHMS评估的连续乳腺标本中的发现。首例患者乳房皮肤出现橘皮样改变，因而酷似炎性乳腺癌。此外，该患者的PHMS病变曾被误诊为低级别血管肉瘤并接受了不恰当治疗。第二例表现出更典型的PHMS纤维腺瘤样表现。另外，PHMS改变在常规乳腺活检标本中很常见。事实上，我们对200例连续乳腺标本的回顾显示，23%的病例在至少一个显微镜视野中存在PHMS。PHMS改变发生于比对照组更年轻的患者，且与纤维囊性变、纤维腺瘤、男性乳腺增生、正常乳腺组织及硬化性腺小叶增生相关。对一例病例的超微结构和免疫组化研究显示，毛细血管样腔隙要么无细胞衬里，要么由成纤维细胞衬里。乳腺间质假血管瘤样增生代表一种临床病理谱，从局灶性、无显著意义的显微镜下改变到PHMS形成乳腺肿块的病例。提高对PHMS及其临床病理谱的认识将有助于其与乳腺其他血管肿瘤，尤其是低级别血管肉瘤相鉴别。
