淋巴细胞性乳腺病的临床病理分析

摘要

目的 探讨淋巴细胞性乳腺病(lymphocytic mastopathy,LM)的临床病理特征及其鉴别诊断.方法 观察3例LM的临床病理特点和CD3、CD19和CD20抗体的EnVision免疫组化染色结果,并作相应的基因重排检测.结果 3例中有1例为56岁男性,另2例分别为48和36岁.均以乳腺肿块为主要症状,无有关家族史记载,也无糖尿病史.大体上为灰白色质地稍硬的肿块,边界欠清.镜下见乳腺小叶萎缩甚至消失,小叶区域或周围由多量的淋巴细胞浸润,甚至形成淋巴滤泡.残存的小叶及导管周围也有大量淋巴细胞浸润,也见有血管周围淋巴细胞浸润,其淋巴细胞无明显异型性.间质纤维结缔组织明显增生并伴有玻璃样变,但导管上皮未显增生.免疫组化提示多数浸润的淋巴细胞可出现CD3、CD19或CD20阳性.IgH和TCR基因重排呈胚系状态.结论 LM临床上相对少见,尽管乳腺小叶或导管周围出现明显的淋巴细胞为主的浸润,但并不支持这种病变可能是B细胞性非霍奇金淋巴瘤的前驱病变这一观点,通过免疫组化和基因重排的结果有助于鉴别诊断.%Purpose To elucidate the clinicopathologic features and differential diagnosis of lymphocytic mastopathy ( LM ). Methods The clinical and pathological characteristics were observed in 3 cases of LM. Immunohistochemical staining of CD3 , CD19 and CD20 using EnVision method as well as gene rearrangement analysis were performed. Results A 56-year-old male and two ( 48- and 36-year-old, respectively ) female patients without any family history or diabetes mellitus were enrolled in this study. All the specimens contained a distinct and palpable firm mass. The cut surface revealed a white to pale grey mass indistinguishable from the surrounding tissue. Microscopically, the distinct atrophy, even disappearance of lobules with plenty of lymphocytic infiltrates were disclosed. An exuberant periductal, perilobular and perivascular lymphocytic infiltrates were identified. Immunohistochemical results showed that the infiltrated lymphocytes were homogeneously positive for CD3 , CD19 and CD20. Gene rearrangement of IGH and TCR revealed germline configuration. Conclusions LM is a relatively rare entity. It does not appear to be a B cell neoplasm though predominate lymphocytes are found surrounding the lobules or ducts. The combination of immunohistochemisry with gene rearrangement analysis is helpful to warrant distinction from other breast lesions.