From the Departments of Pathology and Laboratory Medicine (Towne, Ginter).
Radiology (Michaels), Weill Cornell Medicine, New York, New York.
Arch Pathol Lab Med. 2022 Jan 2;146(2):213-219. doi: 10.5858/arpa.2020-0497-OA.
CONTEXT.—: Mucocele-like lesion of the breast (MLL) is an uncommon entity, and recent studies show low rates of upgrade from core needle biopsy (CNB) to excision.
OBJECTIVE.—: To evaluate features associated with upgrade of MLLs diagnosed on CNB.
DESIGN.—: Seventy-eight MLLs diagnosed on CNB from 1998-2019 and subsequent excisions were reviewed. Histologic parameters evaluated included the presence of atypia, presence and morphology of calcifications, and morphologic variant (classic [C-MLL], duct ectasia-like [DEL-MLL], or cystic mastopathy-like [CML-MLL]).
RESULTS.—: Overall, 45 MLLs lacked atypia and 33 were associated with atypia (atypical ductal hyperplasia, 32; atypical lobular hyperplasia, 1). Most were C-MLLs (61) with fewer DEL-MLLs (14) and CML-MLLs (3). Half showed both coarse and fine calcifications, with fewer showing only coarse or fine calcifications, and some showing none. Subsequent excision or clinical follow-up was available for 25 MLLs without atypia-of which 2 (8.0%) were upgraded to ductal carcinoma in situ (DCIS)-and 23 with atypia, of which 4 (17.4%) were upgraded to DCIS. No cases were upgraded to invasive carcinoma. All upgraded cases showed coarse calcifications on CNB, and all upgraded cases were associated with residual calcifications on post-CNB imaging.
CONCLUSIONS.—: Most MLLs present as calcifications and nearly half are associated with atypia. Upgrade to DCIS is twice as frequent in MLLs with atypia versus those without. A predominance of coarse calcifications and the presence of residual targeted calcifications following core biopsy may be associated with higher upgrade rates.
乳腺黏液样瘤样病变（MLL）是一种不常见的疾病，最近的研究表明，从核心针活检（CNB）升级为切除的比例较低。
评估与 CNB 诊断的 MLL 升级相关的特征。
回顾了 1998 年至 2019 年期间通过 CNB 诊断的 78 例 MLL 病例及其随后的切除术。评估的组织学参数包括存在非典型性、钙化的存在和形态以及形态学变异（经典型 [C-MLL]、导管扩张样 [DEL-MLL] 或囊性乳腺病样 [CML-MLL]）。
总体而言，45 例 MLL 缺乏非典型性，33 例与非典型性相关（非典型性导管增生，32 例；非典型性小叶增生，1 例）。大多数为 C-MLL（61 例），DEL-MLL（14 例）和 CML-MLL（3 例）较少。半数表现为粗、细两种钙化，少数仅表现为粗钙化或细钙化，有些则无钙化。25 例无非典型性的 MLL 有后续切除或临床随访资料，其中 2 例（8.0%）升级为导管原位癌（DCIS）；23 例有非典型性，其中 4 例（17.4%）升级为 DCIS。无病例升级为浸润性癌。所有升级病例在 CNB 上均表现为粗钙化，且所有升级病例在 CNB 后影像学上均存在残余钙化。
大多数 MLL 表现为钙化，近一半与非典型性有关。与无非典型性的 MLL 相比，有非典型性的 MLL 升级为 DCIS 的比例增加了一倍。粗钙化为主，核心针活检后存在靶向残余钙化可能与更高的升级率相关。
