[道 case] How to diagnose breast glandoma epithelioma?

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[道 case] How to diagnose breast glandoma epithelioma?

2021-11-25 00:01:49 13 ℃

Teachers in the pathological live lessons in the Sanjia pathology specially extracted the case sharing in the live broadcast, and the most simple and clear form is clearly known as a type of disease. Today, take a look at the content of Zhang Yu's pathological diagnosis of breast gland muscle tumors (AME) pathological diagnosis. Welcome the pathological colleagues to submit, share learning, and work.

definition:

Breast adenoma topochroma is a diblore tumor consisting of intake cells composed of muscle epithelial cells around the adenoped tube and glandular tube arranged by catheterized epithelial cells, more benign.

Clinical features:

1. Activity: Elderly women have multiple years, men are rare.

2, good part: both sides can be affected, mostly in the middle.

3, clinical manifestations: can be touched by a single mass (maximum 10 cm), and even the nipple slurry spill.

Image studies:

1, ultrasound: solid, circular or elliptical mass, usually clear, in a depression, low echo or complex echo in the tumor. 2, molybdenum target: usually a single, boundary, clear, is not easy to distinguish between fibroblasts.

General characteristics:

Single mass, usually clear, multi-stroke, partial vesicle, papillary.

The tumors are shown in tangible, divided, papillary, and cystic changing.

1, two ingredients: cavity epithelial cell + obvious hyperpatocyte 2, low-speed mirror histology: dividend, tubular, spindle cell, papillary, adenopathy variant, mixed form 1 Shape AME: Tumor is nominalous, mainly with muscle epithelial cell ingredients, and there is a small satellite nodule around.

2 tubular AME: adenprophotocyte and muscle epithelial cells surround the inoperative tubular structure, the muscle epithelial cell extruded the lumen of the tube surrounded by the tube.

3 Bulliform Cell AME: Sub-shaped muscle epithelial cells, extruded adenprophyll makes the glandular structure are not obvious.

4 Paste AME: a few AMEs can be tumored in the catheter.

5 adenopathy modification AME

Illustration AME adenopathy variant, CK14 staining muscle episode positive

The illustration is a micro-glandular adenopathy modification AME, P63 staining muscle epithelial positive

3, cytology form:

1 adenproprocyte: there can be sweat gland, squamous cells, sebaceous gland division, mucus epithelial.

2 muscle epithelial cells: heterogeneity variation can have a variety of forms, cytosol transparency, shuttle, epithelial cells, slurry cells, basal cells.

Cellular variability, nuclear split, rare (<2 / 10HPFS)

4, interstitial: collagenized interstitial, cartilage mucosa, can have calcified.

5, accompanying the phenomenon: can be accompanied by infarction (identification with tumor necrosis).

The illustration is infarcted, and there is a congestive belt around it, tumor cells are infarcted by mesothemide and mesothelial cells.

Image as tumor necrosis

6, tumor gland skin, muscle upper skin can have a malignant. Atypical Adenomypithelioma is diagnosed as atypical gland muscle tumors when tumors have parts but not all malignant features. • Meet all the conditions to diagnose malignant muscle tumors • Some conditions diagnose atypical adenomensum 1 adenopide or muscle epithelial ingredient overdose 2 Cell severe shavity 3 wetting growth 4 nuclear split icon (> 3 / 10hpfs) 5 Tumor necrosis (Note: Ki-67> 10% is conducive to diagnosis of atypical adenomicoma) [3]

Malignant AdenomyPithelioma, M-AME:

• You can see the classic adenomensum (AME) area, malignant performance: satisfy the above 5 diagnostic criteria, the malignant constraints are as follows: 1 gland skin malformed: wetting breast cancer (non-special type), wetting lane cancer, special type Breast cancer. 2 muscle epithelial variable: the muscle epithelial carcinoma is characterized by the characteristics of myocardial carcinoma (shuttle epithelial epithelial cells excessively grow, the cytosol is translucent or eosinophilic, the nuclear division, the nuclear split "is easy to see. 3 adenopide and muscle supernathe at the same time carcinoma: rare, usually based on malignant muscle ingredients (having a double phase cell type is the key to identification of chemical cancer). 4 squamous cell carcinoma, low-level gland squamous cell carcinoma, closing cell carcinoma, cancerouscarca, and matrix, there is a report, and it is necessary to fully take care of the AME area. • Divide malignant muscle tumor (M-Ame) into three types according to histological form [3]: 1m-ame in situ: Typical AME structure, wherein the adenoid epithelial component shows the characteristics of in situ cancer. Similar to wrapping / residential papillary carcinoma, when tumor cells are present - low level, there is a catheter in situ carcinoma characteristics, even if there is no intramuscular epithelium to diagnose in situ cancer.

Illustration M-AME in Situ

2M-AME Invasive: M-AME, M-AME, malignant ingredients, muscle ingredients, adenoids, and muscle epithelium.

Illustration M-AME INVASIVE

Diagram shown in M-AME Types in papillary growth mode

3ame with invasive carcinoma: AME coexistence with wetting breast cancer, similar to coli.

Immunohistochemistry: combined with morphology: 1, adenproplood cells: CKPAN, low molecular weight CK positive, EMA, CD117 stove-shaped positive; E-Cadherin adenprophotothelial cell membrane positive, intramuscular cell cytokines weak positive.

2, muscle epithelial cells: negative, it is recommended to use a set of markers, P63 specific strength is high, SMA sensitivity is strong (small specimens can be fixed), Calponin is specific, SMMHC is strong.

3, ER is a genital stove, mainly adenoid; Pr, HER-2 is usually negative.

Molecular testing:

The mammary adenoma acronoma drive gene is related to ER

1, ER positive cases PIK3CA or AKT1 hotspot mutation.

2, ER negative cases PIK3CA or HRAS P.GLN61 hotspot mutation.

Identification diagnosis:

1, tubular adenoma)

Women in childbearing age, often have an envelope; tumor is circular or elliptical, the gland is more open, the rules are obvious; the adrenal skin is obvious, and the muscle proliferation is not obvious; the intensity is rare.

Illustration of tubular adenoma

2, catheter adenoma (Ductal Adenoma)

Multiple hair in the elderly; there is a concentric fiber elastic envelope around the tumor; tumors are elliptical, elongated, branch gland, parallel alignment; the adrenal skin is obvious and the muscle hyperplasia is not obvious; the interstitial is rare.

Illustration catheter adenoma

3, accompanied by muscle pilm in Palm Tumioma (Myoepithelial Cell Proliferation in intraductal papilloma)

The papillary structure is more obvious, and the muscle epithelial cells of proliferation are usually scattered in the focalistic distribution, the morphology is more monopoly, and the gland muscle epithelial hypertrophy is more significant, and the morphology is more varied.

Illustration of the tubes in the tube of the muscle hypertrophy

4, microglandular adenosis microglandular adenosis microdarid glandular disease has only one cytokine, no muscle epithelium, S-100 dyeing positive, IV type collagen-dyed positive.

Diamusal epithelium

Dimic positive (left) illustration of micro-glandular adrenal disease IV type collagen dyeing positive (right)

5, breast polymeric adenoma (Pleomorphic Adenoma Of Breast)

Mammary polymoric adenoma form similar to parotid polymorbent adenoma, with obvious cartilage mucy-like interstitial, double phase tumor cells are relatively unspeakable.

Illustration of breast polymorphous adenoma

References and books:

1.Who Classification of Tumours of the Breast. 5th Edition.

2.Rosen's Breast Pathology. 4th Edition.

3.Rakha E, TAN PH, Ellis I, Quinn C. AdenomYoepithelioma of The Breast: a proposal for classification. Histopathology. 2021 OCT; 79 (4): 465-479. Doi: 10.1111 / his.14380. EPUB 2021 JUN 13 . PMID: 33829532.

4.Wiens N, Hoffman DI, Huang CY, Nayak A, Tchou J. Clinical characteristics and outcomes of benign, atypical, and malignant breast adenomyoepithelioma: a single institution's experience Am J Surg 2020 Apr; 219 (4):.. 651- 654. DOI: 10.1016 / J.amjsurg.2019.03.026. EPUB 2019 APR 1. PMID: 30982573.

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