乳腺叶状囊肉瘤（叶状肿瘤）组织发生及组织分化.docVIP

乳腺叶状囊肉瘤（叶状肿瘤）组织发生及组织分化 　 作者：史凤毅， 叶海军， 刘英杰 【摘要】 目的 探讨乳腺叶状囊肉瘤的病理形态、组织发生和命名。 方法 回顾性从1953～1999年间11所医院70多万份外检资料中，筛选出62例，进行免疫组化观察。 结果 发病年龄13～66岁（平均38岁），病程1周～20年（平均42个月）。肿瘤的恶性间叶成分的组织分化呈多样性。免疫组化观察的51例叶状囊肉瘤、8例巨大纤维瘤、5例纤维腺瘤中Vim标记均阳性，51例叶状囊肉瘤中、Act、S-100、lys、 Des分别有28、19、3、1例阳性，8例的巨大纤维腺瘤中仅Act阳性1例。 结论 免疫组化标记对于鉴别肿瘤的良、恶性有意义，Plt;0.05，尤其二种以上标记阳性时具有显著意义，Plt;0.01。发现28例叶状囊肉瘤具有肌纤维性质，其中11例明显起源与肌上皮细胞有关。全部肿瘤镜下均无包膜。肿瘤的恶性间叶成分对于瘤内和瘤外正常乳腺腺上皮成分呈特殊的浸润方式。如将叶状囊肉瘤称为腺肌纤维肉瘤则能覆盖96.07%的病例（49/51例）。叶状囊肉瘤实质上是一种起源于腺管周多能性纤维和肌上皮细胞，具有腺上皮、平滑肌和纤维组织等多向分化的肿瘤。 【关键词】 乳腺;叶状囊肉瘤;腺肌纤维性肉瘤 Histopathologic origin and differentiation of the breast cystosarcoma phylloides 　　【Abstract】Objective To study the histopathologic structures， origin， name of cystosarcoma phylloides and to explore possible pathogenesis in the developments of the tumors. Methods In retrospective study of 62 cases with cystosarcoma phylloides coming from more than 0.7 million patients who had been with immunohistochemical examined. Results The patients ages varied from 13 to 66 years (mean 38 years) and disease course differed from 1 week to 20 years (mean 42 months). The histopathologic structures show rather complicated in 62 tumors.51 cystosarcoma phylloides， 8 great adenofibroma，5 adenofibroma stained positively with viemetin. In 51 cystosarcoma phylloides， positive staining for actin， S-100， lysozyme，desmin were found in 28，19，3， 1cases respectively . In 1 case of 8 great fibroadenoma stsined positively with actin. Conclusion Immunohistochemistry staining with act or S-100 has significant effect(0.5gt;Pgt;0.01) on differential diagnosis of cystosarcoma phylloides from great fibroadenomas.To find that there are fibromuscular features in 28 of 51cystosarcoma phylloides. 11 are from myoeipthelial cell in this 28 cystosarcoma phylloides. This study revealed lack of capsule in all the tumors and special invasive way to destroy the glandular epithelium of normal mammary gland in all tumors. Depending on rule of named tumor and result of this experime