摘要
目的:探讨乳腺骨肉瘤(mammary osteosarcoma,MOS)的临床病理特征、诊断与鉴别诊断。方法:结合形态学观察及影像学所见,分析了1例MOS患者资料并复习相关文献。结果:患者50岁。以"左乳无痛性包块"入院。B超示包块呈强回声光团,其内回声不均,矿化灶后方形成声影。肿块切除活检后行左乳改良根治术。巨检见硬壳骨性包块,剖面灰白色,边界不清。镜检肿瘤主要由多边形细胞及胖梭形细胞构成,两种细胞具有多形性及非典型性,核分裂活跃,产生的嗜酸性骨样组织及基质表明其骨源性。部分区域呈软骨分化,空泡状细胞被弥漫或灶性钙化灶分隔;部分多核骨母细胞分散于肿瘤性骨小梁中;肿瘤中央区域可见灶性坏死,边缘区可见内陷的腺管结构及梭形细胞边界浸润。免疫组织化学染色显示肿瘤细胞vimentin呈阳性,但不表达CK。结论:MOS是一种罕见的产生骨的乳腺间叶性恶性肿瘤。需要与伴间叶分化的化生性癌(软骨、骨)及浸润性癌伴骨分化等相鉴别。
Objective： To investigate the clinicopathologic features,diagnosis and differential diagnosis of mammary osteosarcoma（ MOS）. Methods： One case of MOS was analyzed on morphological observation and image findings with review of the literature. Results： The patient was a 50- year- old lady. She was admitted to the hospital for a painless lump found in her left breast. Ultrasonogram revealed a hyper- echoic mass with an internal heterogeneous echo accompanied by obvious posterior shadowing due to mineralized focuses. After an excisional biopsy,a modified radical mastectomy was performed. Grossly,the tumor was described as a crushed bony neoplasm with a grayish-white cut surface and an ill- defined margin. Microscopically,the neoplasm was consisted predominantly of polygonal cells and plump spindle- shaped cells,which had pleomorphic and atypical with high level mitotic activites. Both cells created eosinophilic osteoid tissues or osseous matrixes which indicating their osteogenic origin. Partly with cartilaginous differentiation,some vacuolated cells separated by scattered of calcified area. And some multinucleated giant cells interspersed in tumorogenic bone trabeculae. Necrotic foci in central aera and a few entrapped tubular structures in peripheral were observed. Meanwhile,some infiltrating spindle cells were found at the verge of the tumor. Immunohistochemically,the neoplastic cells were positive for vimentin but negative for CK. Conclusion： MOS is a rare malignant mesenchymal tumor of breast with marked osteoid formation. It should be distinguished from some mimics such as metaplastic breast carcinoma with osteoid / chondroid differentiation and invasive carcinoma with bone / cartilage component etc.
出处
《现代肿瘤医学》
CAS
2014年第12期2880-2883,共4页
Journal of Modern Oncology
关键词
乳腺肿瘤
骨肉瘤
临床病理
鉴别诊断
breast neoplasm
mammary osteosarcoma
clinicopathology
differential diagnosis
