乳腺原发性浆细胞瘤2例临床病理分析

摘要

Objective:To study the clinical and pathological characteristics of breast plasma cell neoplasms as well as the diagnosis and differential diagnosis of it. Methods:Two cases of breast plasma cell neoplasms were analyzed pathologically ,and the changes were observed using immunohistochemical method. The related literature was reviewed. Results:One case had primary plasma cell neoplasms on both sides of the breast,and the other was primary breast plasma blastoma. The lump presented no obvious clinical manifestation.Under microscope, most neoplastic plasma cells were similar to normal plasma cells; unusual and untypical rumor cells as well as mitoses were able to be seen. Plasma blastoma displayed proliferating features on large circle cells and ovoid cells which spread widely;vesicular nucleus was in the center of it and nucleolus was obvious; mitoses were easy to see. Two cases showed CD138, CD38, multiple myeloma oncogene-1 and heavy chain IgM. The first case showed light chain κ and the second showed light chain λ. Plasma cell neoplasms showed 20％ positive staining for Ki 67, and plasma blastoma showed 70％ positive staining for Ki-67. Conclusions: Pathological diagnosis of breast plasma cell neoplasm bases on the tissue shape and immunological manifestation. It must be distinguished from plasma cell mastitis and infiltrating lobular carcinoma. Surgical operation combined with radiotherapy may achieve better treatment results.%目的:探讨乳腺原发性浆细胞瘤的临床病理特点以及诊断和鉴别诊断.方法:对2例乳腺原发性浆细胞瘤进行临床病理学分析及免疫组织化学观察,并复习相关文献.结果:1例为乳腺双侧同时原发性浆细胞瘤,另1例为乳腺单侧孤立性原发性浆母细胞瘤.临床表现肿块无明显症状,镜下浆细胞瘤多数与正常浆细胞相似,散在多见异常和不典型瘤细胞,核分裂象可见;浆母细胞瘤有弥漫大片分布的大圆或卵圆形细胞增生,细胞核居中有明显核仁,核分裂象多见.2例均表达CD138、CD38、多发性骨髓瘤致癌蛋白;重链IgM均阳性,例1表达轻链κ,例2表达轻链λ.浆细胞瘤Ki-67 20%阳性,浆母细胞瘤70%阳性.结论:乳腺原发性浆细胞瘤病理诊断的主要依据是组织形态和免疫表型.须与浆细胞乳腺炎及浸润性小叶癌相鉴别,治疗以手术切除结合放射治疗效果较好.