1乳腺型肌纖維母細(xì)胞瘤課件

Mammary-typemyofibroblastoma乳腺型肌纖維母細(xì)胞瘤Mammary-typemyofibroblastoma

一、Definition定義Abenignmesenchymalneoplasm良性間葉性腫瘤composedofspindle-shapedcellswithfeaturesofmyofibroblasts,由梭形有肌纖維母細(xì)胞特征的細(xì)胞構(gòu)成的embeddinastromathatcontainscoarsebandsofhyalinizedcollagen間質(zhì)內(nèi)含有玻璃樣變的粗大膠原纖維條帶

andconspicuousmastcells可見大量的肥大細(xì)胞andadmixedwithavariableamountofadiposetissue.并伴有數(shù)量不等的脂肪組織。thetumourishistologicallyidentiacaltomyofibroblastomaofbreast.其組織學(xué)特點(diǎn)與乳腺的肌纖維母細(xì)胞瘤相似。andconspicuousmastcells二、Epidemiology流行病學(xué)Lesionhaveariseninadultswithanagerangeof35to67years(median55.5years)andamalepredilection(8males,2females).發(fā)病年齡見于35-67成年人（平均55.5）

男性多見（8例男性，2例女性）Theextrammarylocationofsomemyofibroblastomashasonlyrecentlybeendefinedwhen10caseswerereported.乳腺外的肌纖維母細(xì)胞瘤直到最近才有10例報(bào)告。二、Epidemiology流行病學(xué)Therefore,conclusionsrelatedtoepidemiologycouldalterwithincreasedtumourrecognition因此隨著對(duì)腫瘤認(rèn)識(shí)的增加，流行病學(xué)方面也會(huì)發(fā)生改變。1乳腺型肌纖維母細(xì)胞瘤課件三、sitesofinvolvement受累部位Themostcommonlocationofmammary-typemyofibroblastomaistheinguinal/groinarea.乳腺型肌纖維母細(xì)胞瘤最常見于會(huì)陰/腹股溝區(qū)域。Otherreportedsitesincludeabdominalwall，buttock,backandvaginalwall.其他部位有腹壁，臀部，背部和陰道壁。三、sitesofinvolvement受累部位Lesionsarisemostcommonlyinsubcutaneoustissue.最常見的發(fā)病部位是皮下組織。However,caseshavearisendeeptoabdominalwallmuscle，intheposteriorvaginalwallandinaparatesticularlocation.但也可位于腹壁肌肉，陰道后壁和睪丸旁。Thereisanapparentpredilectionformyofibroblastomastoarisealongtheputativeanatomic“milk-line”thatextendsfromaxillatomedialgroin.肌纖維母細(xì)胞瘤明顯好發(fā)于從腋窩至腹股溝中部的“白線”Lesionsarisemostcommonlyin四、Clinicalfeatures臨床特點(diǎn)Thetumoursgenerallypresentaseitherpainlessmassesorincidentallesionsthataredetectedduringsurgicalproceduressuchasinguinalherniarepair.多為無痛性的腫塊或由外科進(jìn)行腹股溝疝修補(bǔ)術(shù)時(shí)偶然發(fā)現(xiàn)隱匿腫塊。Occasionallesionsaretenderorpainful偶爾病變區(qū)觸痛或疼痛。四、Clinicalfeatures臨床Tumourshavebeendescribedtobepresentforuptoayearbeforeclinicalpresentation.腫瘤就診前可能已經(jīng)存在達(dá)1年之久Therearenoimagingdata無影像學(xué)資料數(shù)據(jù)Tumourshavebeendescribedto五、Aetiology病因?qū)WUnknown病因不明Ithasbeenpostulatedthatmyofibroblastomasarisinginthebreastmayberelatedtoapatient’shormonalstatus,hesettingofgynaecomastiaandanti-androgentherapy.

據(jù)推測發(fā)生于乳腺的肌纖維母細(xì)胞瘤與患者的激素水平有關(guān).這種情況多見于老年男性。如：男性乳腺發(fā)育和抗雄激素治療的患者。五、Aetiology病因?qū)WMammary-typemyofibroblastomaofsofttissuearisesmostcommonlyinolderadultmales.軟組織的乳腺型肌纖維母細(xì)胞瘤常見于老年男性Theapparentpredilectionfororiginofmyofibroblastomasalongaputativemilk-linesugeststhepossibelexistenceofhormonally-responsivemesenchymaltissue明顯好發(fā)于從腋窩至腹股溝中部的解剖學(xué)“白線”區(qū)域。暗示這一區(qū)域存在對(duì)激素敏感的間葉組織細(xì)胞。Mammary-typemyofibroblastom六、Macroscopy肉眼大體觀Reportedlesionsrangedinsizefrom2to13cm(median5.8cm).已報(bào)告病例的腫塊直徑從到13cm，平均5.8cmThetumourarewellcircumsribedandfirm.界清，質(zhì)硬Thecolourcanbevariable(white,pink,tanorbrown)色澤多變，可為白色，粉紅色，，黝黑色棕褐色六、Macroscopy肉眼大體觀Thecutsurfacemaybewhorledornodular.切面可呈漩渦狀或結(jié)節(jié)樣Soft“mucoid”-appearingareasreflectingmyxoidchangewerepresentinonecase一例病變質(zhì)軟、粘液變。Thecutsurfacemaybewhorled七、Histopathology組織學(xué)Tumoursareunecapsulatedbutwellcircumscribed.腫瘤無包膜，但是分界清楚Theyarecomposedofanadmixtureofspindlecellsandadiposetissue由梭形細(xì)胞與脂肪細(xì)胞混合構(gòu)成Andaremorphologicallyidenticaltomammarymyofibroblastoma形態(tài)類似于乳腺肌纖維母細(xì)胞瘤七、Histopathology組織學(xué)Thespindlecellshistologicallyresemblemyofibroblasts梭形細(xì)胞特點(diǎn)類似于肌纖維母細(xì)胞andarecharacterizedbyovaltotaperednuclei其核形從梭形至卵圓形withfinelydispersedchromatin，smallnucleoli核內(nèi)染色質(zhì)均勻散布，常見小核仁ThespindlecellshistologicalEosinophilictoamphophiliccytoplasm胞漿從嗜伊紅到嗜雙色性Andpoorlydefinedcytoplasmicborders胞質(zhì)界限不清Thespindlecellsarefrequentlywavyincontour梭形細(xì)胞的輪廓常呈波浪樣andgenerallyarearrangedinvariablysizedfascicles一般排列成不同大小的束狀EosinophilictoamphophiliccyThestromaiscollegenouswithbroadbandsofcoarsehyalinizedcollagenthatoftenadoptazig-zagpattern基質(zhì)為邊緣粗糙的，帶狀的，玻璃樣變的膠原帶，膠原帶，常形成Z字鋸齒樣圖案Stromalmastcellsareusuallynumerous基質(zhì)內(nèi)常有大量肥大細(xì)胞Epithelioidchangeofthelesioncells病變細(xì)胞常呈上皮樣變Andfocalnuclearatypiawithenlargednucleiandmultinucleationhavebeendescribed.局灶上皮樣細(xì)胞核不典型性，伴核增大，多核ThestromaiscollegenouswithSuchmorphologicvariationiswellrecongnizedinmayofibroblastomaofbreast以上形態(tài)學(xué)的變化在乳腺肌纖維母細(xì)胞瘤已有清楚的認(rèn)識(shí)。SuchmorphologicvariationisThebloodvesselsinmyofibroblastomaaregenerallynotconspicuous，beingsmall肌纖維母細(xì)胞瘤腫塊內(nèi)的血管不明顯，常為小血管Andcommonlyhavingaperivascularlymphocyticinflitrate并且，血管周圍有淋巴細(xì)胞滲出。Thebloodvesselsinmyofibrobincontrasttotheprominentmediumtolargevesselswithmarkedlyhyalinizedwallsthatarecharacteristiccellularangiofibroma與之不同的是，細(xì)胞性血管纖維瘤內(nèi)有醒目的中等血管和大血管,并且血管壁顯著地玻璃樣變Orthelargebranching“haemangiopericytomatous”bloodvesselsthatareseeninlipomatoushaemangiopericytoma而脂肪瘤樣血管外周細(xì)胞瘤組織內(nèi)有大的分支狀“血管外周細(xì)胞瘤樣”血管。twopotentialmorphologicmimics.以上二種腫瘤在形態(tài)學(xué)上與肌纖維母細(xì)胞瘤有相似之處。incontrasttotheprominent八、Immunophenotype免疫表型Asischaracteristicofthebreastcounterpart，thetypicalimmunphenotypeofextramammarymyofibroblastomaisdiffuseco-expressionbythespindlecellsofdesminandCD34.乳腺外的肌纖維母細(xì)胞瘤的免疫表型對(duì)應(yīng)于乳腺肌纖維母細(xì)胞瘤（雙陰性），乳腺外的肌纖維母細(xì)胞瘤的梭形細(xì)胞彌漫性，雙表達(dá)desmin（肌間線蛋白）和CD34Expressionofsmoothmuscleactinisseeninathirdofcase1/3的梭形細(xì)胞表達(dá)SMA(平滑肌動(dòng)蛋白)。八、Immunophenotype免疫表型九、Prognosticfactors預(yù)后Alltumourshavefollowedabenigncoursefollowingmarginallocalexcision.在腫塊切除后，遵循良性腫瘤的經(jīng)過However,thereportedfollow-uptimeislimited(upto26months)只是術(shù)后隨訪時(shí)間有限（最長達(dá)26個(gè)月）九、Prognosticfactors預(yù)后九、鑒別診斷細(xì)胞性血管纖維瘤（cellularangiofibroma）孤立性纖維性腫瘤（solitaryfibroustumour）血管肌纖維母細(xì)胞瘤（angiomyfibroblastoma）梭形細(xì)胞脂肪瘤（spindlecelllipoma）九、鑒別診斷1乳腺型肌纖維母細(xì)胞瘤課件1乳腺型肌纖維母細(xì)胞瘤課件1乳腺型肌纖維母細(xì)胞瘤課件1乳腺型肌纖維母細(xì)胞瘤課件1乳腺型肌纖維母細(xì)胞瘤課件1乳腺型肌纖維母細(xì)胞瘤課件Mammary-typemyofibroblastoma乳腺型肌纖維母細(xì)胞瘤Mammary-typemyofibroblastoma

一、Definition定義Abenignmesenchymalneoplasm良性間葉性腫瘤composedofspindle-shapedcellswithfeaturesofmyofibroblasts,由梭形有肌纖維母細(xì)胞特征的細(xì)胞構(gòu)成的embeddinastromathatcontainscoarsebandsofhyalinizedcollagen間質(zhì)內(nèi)含有玻璃樣變的粗大膠原纖維條帶

andconspicuousmastcells可見大量的肥大細(xì)胞andadmixedwithavariableamountofadiposetissue.并伴有數(shù)量不等的脂肪組織。thetumourishistologicallyidentiacaltomyofibroblastomaofbreast.其組織學(xué)特點(diǎn)與乳腺的肌纖維母細(xì)胞瘤相似。andconspicuousmastcells二、Epidemiology流行病學(xué)Lesionhaveariseninadultswithanagerangeof35to67years(median55.5years)andamalepredilection(8males,2females).發(fā)病年齡見于35-67成年人（平均55.5）

男性多見（8例男性，2例女性）Theextrammarylocationofsomemyofibroblastomashasonlyrecentlybeendefinedwhen10caseswerereported.乳腺外的肌纖維母細(xì)胞瘤直到最近才有10例報(bào)告。二、Epidemiology流行病學(xué)Therefore,conclusionsrelatedtoepidemiologycouldalterwithincreasedtumourrecognition因此隨著對(duì)腫瘤認(rèn)識(shí)的增加，流行病學(xué)方面也會(huì)發(fā)生改變。1乳腺型肌纖維母細(xì)胞瘤課件三、sitesofinvolvement受累部位Themostcommonlocationofmammary-typemyofibroblastomaistheinguinal/groinarea.乳腺型肌纖維母細(xì)胞瘤最常見于會(huì)陰/腹股溝區(qū)域。Otherreportedsitesincludeabdominalwall，buttock,backandvaginalwall.其他部位有腹壁，臀部，背部和陰道壁。三、sitesofinvolvement受累部位Lesionsarisemostcommonlyinsubcutaneoustissue.最常見的發(fā)病部位是皮下組織。However,caseshavearisendeeptoabdominalwallmuscle，intheposteriorvaginalwallandinaparatesticularlocation.但也可位于腹壁肌肉，陰道后壁和睪丸旁。Thereisanapparentpredilectionformyofibroblastomastoarisealongtheputativeanatomic“milk-line”thatextendsfromaxillatomedialgroin.肌纖維母細(xì)胞瘤明顯好發(fā)于從腋窩至腹股溝中部的“白線”Lesionsarisemostcommonlyin四、Clinicalfeatures臨床特點(diǎn)Thetumoursgenerallypresentaseitherpainlessmassesorincidentallesionsthataredetectedduringsurgicalproceduressuchasinguinalherniarepair.多為無痛性的腫塊或由外科進(jìn)行腹股溝疝修補(bǔ)術(shù)時(shí)偶然發(fā)現(xiàn)隱匿腫塊。Occasionallesionsaretenderorpainful偶爾病變區(qū)觸痛或疼痛。四、Clinicalfeatures臨床Tumourshavebeendescribedtobepresentforuptoayearbeforeclinicalpresentation.腫瘤就診前可能已經(jīng)存在達(dá)1年之久Therearenoimagingdata無影像學(xué)資料數(shù)據(jù)Tumourshavebeendescribedto五、Aetiology病因?qū)WUnknown病因不明Ithasbeenpostulatedthatmyofibroblastomasarisinginthebreastmayberelatedtoapatient’shormonalstatus,hesettingofgynaecomastiaandanti-androgentherapy.

據(jù)推測發(fā)生于乳腺的肌纖維母細(xì)胞瘤與患者的激素水平有關(guān).這種情況多見于老年男性。如：男性乳腺發(fā)育和抗雄激素治療的患者。五、Aetiology病因?qū)WMammary-typemyofibroblastomaofsofttissuearisesmostcommonlyinolderadultmales.軟組織的乳腺型肌纖維母細(xì)胞瘤常見于老年男性Theapparentpredilectionfororiginofmyofibroblastomasalongaputativemilk-linesugeststhepossibelexistenceofhormonally-responsivemesenchymaltissue明顯好發(fā)于從腋窩至腹股溝中部的解剖學(xué)“白線”區(qū)域。暗示這一區(qū)域存在對(duì)激素敏感的間葉組織細(xì)胞。Mammary-typemyofibroblastom六、Macroscopy肉眼大體觀Reportedlesionsrangedinsizefrom2to13cm(median5.8cm).已報(bào)告病例的腫塊直徑從到13cm，平均5.8cmThetumourarewellcircumsribedandfirm.界清，質(zhì)硬Thecolourcanbevariable(white,pink,tanorbrown)色澤多變，可為白色，粉紅色，，黝黑色棕褐色六、Macroscopy肉眼大體觀Thecutsurfacemaybewhorledornodular.切面可呈漩渦狀或結(jié)節(jié)樣Soft“mucoid”-appearingareasreflectingmyxoidchangewerepresentinonecase一例病變質(zhì)軟、粘液變。Thecutsurfacemaybewhorled七、Histopathology組織學(xué)Tumoursareunecapsulatedbutwellcircumscribed.腫瘤無包膜，但是分界清楚Theyarecomposedofanadmixtureofspindlecellsandadiposetissue由梭形細(xì)胞與脂肪細(xì)胞混合構(gòu)成Andaremorphologicallyidenticaltomammarymyofibroblastoma形態(tài)類似于乳腺肌纖維母細(xì)胞瘤七、Histopathology組織學(xué)Thespindlecellshistologicallyresemblemyofibroblasts梭形細(xì)胞特點(diǎn)類似于肌纖維母細(xì)胞andarecharacterizedbyovaltotaperednuclei其核形從梭形至卵圓形withfinelydispersedchromatin，smallnucleoli核內(nèi)染色質(zhì)均勻散布，常見小核仁ThespindlecellshistologicalEosinophilictoamphophiliccytoplasm胞漿從嗜伊紅到嗜雙色性Andpoorlydefinedcytoplasmicborders胞質(zhì)界限不清Thespindlecellsarefrequentlywavyincontour梭形細(xì)胞的輪廓常呈波浪樣andgenerallyarearrangedinvariablysizedfascicles一般排列成不同大小的束狀EosinophilictoamphophiliccyThestromaiscollegenouswithbroadbandsofcoarsehyalinizedcollagenthatoftenadoptazig-zagpattern基質(zhì)為邊緣粗糙的，帶狀的，玻璃樣變的膠原帶，膠原帶，常形成Z字鋸齒樣圖案Stromalmastcellsareusuallynumerous基質(zhì)內(nèi)常有大量肥大細(xì)胞Epithelioidchangeofthelesioncells病變細(xì)胞常呈上皮樣變Andfocalnuclearatypiawithenlargednucleiandmultinucleationhavebeendescribed.局灶上皮樣細(xì)胞核不典型性，伴核增大，多核ThestromaiscollegenouswithSuchmorphologicvariationiswellrecongnizedinmayofibroblastomaofbreast以上形態(tài)學(xué)的變化在乳腺肌纖維母細(xì)胞瘤已有清楚的認(rèn)識(shí)。SuchmorphologicvariationisThebloodvesselsinmyofibroblastomaaregenerallynotconspicuous，beingsmall肌纖維母細(xì)胞瘤腫塊內(nèi)的血管不明顯，常為小血管Andcommonlyhavingaperivascularlymphocyticinflitrate并且，血管周圍有淋巴細(xì)胞滲出。Thebloodvesselsinmyofibrobincontrasttotheprominentmediumtolargevess