摘要
目的探讨乳腺梭形细胞/肉瘤样化生性癌的临床病理学特征、二维超声及超声造影表现与鉴别诊断.方法对1例62岁女性乳腺梭形细胞/肉瘤样化生性癌患者进行常规二维超声、超声造影、穿刺活检、手术切除、病理HE染色、免疫组化检测,并与相关文献对比分析.结果患者肿块位于右侧乳腺腺体层深面、胸大肌间隙,常规超声表现为以囊性为主的囊实混合回声肿块,超声造影表现为不均匀高增强伴不规则无增强区;病理提示肿瘤细胞主要由梭形细胞构成,杂乱分布,其间夹杂少许新生毛细血管,并伴肿瘤细胞液化坏死,间质平滑肌细胞及炎性细胞侵润可见.免疫表型:肿瘤细胞表达vimentin、SMA、CK,不表达CD34、CD56、S-100、CK7、HCK、ER、PR、EMA、desmin、BCL-2及P36,Ki-67增殖指数为75%.结论乳腺梭形细胞/肉瘤样化生性癌极为罕见,肿块常巨大,边缘多规整,常伴有囊性变,常规超声可发现病灶及其基本形态特征,超声造影可观察肿块微血管灌注情况指导穿刺,确诊需结合病理组织学、免疫表型的检测.
Objective To investigate the clinical and pathological characteristics of spindle cell/sarcoma of the breast, and to evaluate the expression and differential diagnosis of conventional ultrasound and contrast-enhanced ultrasound.Methods 1 cases of breast spindle cell/sarcoma were treated with conventional ultrasound, contrast-enhanced ultrasound, biopsy, surgical resection, pathological HE staining, immunohistochemistry test and review of the literature. Results The female patient was 62 years old. The mass was located between the right side of the mammary gland layer and pectoralis major muscle, conventional ultrasound showed a predominantly cystic echo mass that mixed cystic and solid, contrast-enhanced ultrasound showed inhomogeneous high enhanced with irregular enhanced area. The tumor cells were mainly composed of spindle cells, random distribution, interspersed with a few new capillaries, and necrosis in tumor cells. Stromal smooth muscle cells and inflammatory cells infiltration were visible. Immunohistochemically, the tumor cells expressed vimentin, SMA, CK, but the tumor cells did not express CD34, CD56,S-100, CK7, HCK, ER, PR, EMA, desmin, BCL-2 and P36. The proliferation index of the Ki-67 was 75%. Conclusion Spindle cell/sarcoma of the breastis is extremely rare. The mass is often huge and edge warping and associated with cystic degeneration. There is no obvious specificity of conventional ultrasound and contrast-enhanced ultrasound. The diagnosis should be combined with histopathological and immunohistochemical detection.
作者
梁羽
陈琴
邓惋月
邱金鸾
李敏
LIANG Yu;CHEN Qin;DENG Wanyue;QIU Jinluan;LI Min(Department of Ultrasound, Sichuan Provincial People’s Hospital,Chengdu 610072,China)
出处
《西部医学》
2019年第6期962-965,共4页
Medical Journal of West China
关键词
乳腺肿瘤
梭形细胞
肉瘤样化生性癌
超声造影
Breast neoplasms
Spindle cells
Sarcoma carcinoma metaplastic
Contrast enhanced ultrasound
