乳腺分叶状肿瘤中胶原纤维形态特点及相关临床病理学研究
发布时间：2018-10-23 17:47
【摘要】：背景:乳腺分叶状肿瘤是乳腺间质来源的肿瘤。该肿瘤病理学上又分为良性、交界性及恶性三类,即使分级为良性也具有复发的倾向。恶性分叶状肿瘤手术后更易于复发和发生血行转移,是仅次于乳腺癌的第二位常见的乳腺恶性肿瘤。该肿瘤临床表现易与纤维腺瘤混淆,尤其是良性分叶状肿瘤,病理学上也常常误诊为纤维腺瘤,待手术后复发方考虑为分叶状肿瘤。该病确诊主要依据其组织病理学特点,然而由于肿瘤组织的异质性,目前尚无公认有效并广泛应用的免疫组织化学指标及其他特殊染色指标,临床诊断工作中易出现组织学低估而导致手术方式不恰当的现象。胶原纤维作为间质的主要成分,是乳腺分叶状肿瘤组织学特点及功能状态的重要体现,与该肿瘤的发生发展或许存在内在联系。该课题对乳腺分叶状肿瘤中胶原纤维Masson特殊染色结合I型胶原纤维等免疫组织化学染色及临床特点进行研究,期望肿瘤中胶原纤维形态特点能够成为有效协助诊断及分级的新指标。目的:通过Masson三色染色及I型胶原纤维免疫组织化学染色,研究乳腺分叶状肿瘤间质中胶原纤维的组织学的形态特点及I型胶原纤维的表达分布特点,结合相关临床资料并与纤维腺瘤的特点进行对比,探究胶原纤维的形态学特点在乳腺分叶状肿瘤的分级及鉴别诊断中的作用。同时,通过探究纤维腺瘤及各个分级乳腺分叶状肿瘤中CD34及Ki67的表达及染色特点,探究表达水平与病理学特点的关系,验证其辅助诊断的意义。方法:追溯山东大学齐鲁医院2009年1月1日至2016年12月31日就诊于乳腺外科并进行手术治疗的病例,共收集70例乳腺分叶状肿瘤标本(恶性5例,交界性12例,良性53例),另收集8例乳腺纤维腺瘤进行对照研究。将收集的肿瘤病例的石蜡包埋组织切片复习、诊断,进行Masson三色染色,比较其胶原分布的形态结构、数量范围、分布特征。进行I型胶原纤维的免疫组织化学染色,联合Masson三色染色的整体形态学特点进行探究该分型的表达及分布特征。通过查阅文献,筛选出相关的免疫组织化学检验指标CD34及Ki67,判读并统计染色结果,结合相关临床及病理资料,分析其于两不同分级肿瘤中表达的差异性。结果:1.乳腺分叶状肿瘤的各个分级之间,Masson三色染色中的胶原纤维的形态学特征及I型胶原纤维的表达特征有显著差异。①良性分叶状肿瘤的胶原纤维束聚集行成连贯、平行排列的纤维条索,表现出显微镜下可见的走向趋势,且胶原纤维条索由分叶基底部向腺上皮下方聚集增多;②恶性分叶状肿瘤间质中胶原纤维排列稀疏,分布弥散,纤维束纤细之间不连续,无明显一致走向,无浓聚趋势;③交界性分叶状肿瘤间质中的胶原纤维表现出一定程度的改变跨度,受肿瘤恶性程度的影响,整体介于良性和恶性之间;④胶原纤维的形态结构、数量范围及分布特征三项指标于纤维腺瘤及各个分级的分叶状肿瘤之间均有显著差异。⑤不同分级的肿瘤中,Masson三色染色中胶原纤维的着色强度无显著性差异。⑥I型胶原纤维的免疫组织化学染色为有效染色方法,其各个分组间的显色特征可见明显差异:良性分叶状肿瘤中的染色特点与胶原纤维的Masson染色的形态结构、数量范围及分布特征基本一致,部分见染色密集程度由分叶基底部向腺上皮下方逐渐浓聚,而恶性间质组织中该指标的表达更稀疏而弥散,无明显极性。交界性间质组织中显色特点有一定跨度,整体介于良性及交界性分叶状肿瘤之间。⑦不同分级之间I型胶原纤维的免疫组织化学染色强度未表现出显著性差异(p0.05)。2.CD34及Ki67于不同分级的纤维上皮性肿瘤间有一定差异,对乳腺分叶状肿瘤的诊断的有指导意义。①随着分级提高,间质中CD34的阳性比率有一定升高的趋势。纤维腺瘤与良性分叶状肿瘤及分叶状肿瘤整体之间的阳性率有显著性差异(P值0.05)。②随着分级的增加,Ki67的阳性率提高,纤维腺瘤及分叶状肿瘤各个分级之间均有显著性差异(p0.05)。结论:1.不同分级的乳腺分叶状肿瘤中胶原纤维的形态结构、数量范围及分布规律有显著差异,可作为鉴别诊断的有效指标;2.在乳腺分叶状肿瘤的诊断中,Masson三色染色效果好,是胶原纤维清晰易辨的诊断手段;I型胶原纤维的免疫组化染色可作为辅助;3.CD34对于分叶状肿瘤与纤维腺瘤的鉴别诊断有参考意义;4.Ki67阳性指数随着肿瘤分级的增加而提高,可作为各分级分叶状肿瘤之间及其与纤维腺瘤的鉴别诊断依据。
[Abstract]:Background: The lobular carcinoma of the breast is a tumor of the origin of the mammary gland. The tumor pathology is divided into benign, borderline and malignant three types, even if the grade is benign, it also has the tendency of recurrence. It is the second most common malignant tumor next to breast cancer, which is more prone to recurrence and blood transfer after the malignant phyllodes tumor operation. The clinical manifestations of the tumor are easily confused with fibroadenoma, especially benign phyllodes tumors, which are often misdiagnosed as fibroadenoma. The diagnosis of the disease is mainly based on its histopathological characteristics, however, due to the heterogeneity of tumor tissue, there is no universally accepted and widely used immunohistochemical index and other special staining index. In clinical diagnosis, there is a phenomenon of improper histological evaluation leading to improper operation. As the main component of the stroma, the collagen fiber is an important expression of the histological characteristics and functional status of the phyllodes of the breast, which may be related to the development of the tumor. In this study, we studied the immunohistochemical staining and clinical features of collagen fibers Mason special staining combined with type I collagen fibers in phyllodes tumors of the breast, and expected the morphological characteristics of collagen fibers in tumors to be a new index to effectively assist in diagnosis and classification. Objective: To study the morphological characteristics of collagen fibers and the distribution characteristics of I-type collagen fibers in the mesenchymal tumors of the breast by means of Masson's three-color staining and immunohistochemical staining of I-type collagen fibers. To investigate the morphological characteristics of collagen fibers in the classification and differential diagnosis of phyllodes tumors of the breast. At the same time, the relationship between expression level and pathological characteristics was studied by exploring the expression and staining characteristics of CD34 and Ki67 in the lobar tumors of fibrous adenoma and grading breast, and the significance of its auxiliary diagnosis was verified. Methods: From January 1, 2009 to December 31, 2016 in Qilu Hospital of Shandong University, we collected 70 cases of breast phyllodes tumor (malignant 5 cases, borderline 12 cases, benign 53 cases). A comparative study of 8 cases of breast fibroadenoma was carried out. The paraffin-embedded tissue sections of the collected tumor cases were reviewed and diagnosed. Masson three-color staining was performed to compare the morphological structure, number range and distribution characteristics of the collagen distribution. Immunohistochemical staining of type I collagen fibers was performed, and the overall morphological characteristics of the combined Masson three-color staining were used to explore the expression and distribution characteristics of the typing. Through consulting the literature, we screened CD34 and Ki67 related to immunohistochemistry, interpreted and counted the results of staining, combined with relevant clinical and pathological data, and analyzed the difference between them in two different grade tumors. Result: 1. There was a significant difference between the morphological characteristics of collagen fibers and the expression of type I collagen fibers between the various stages of breast phyllodes tumors. The bundles of collagen fibers in the benign and lobulated tumors were collected in a coherent and parallel arrangement of the fiber strands, showing the tendency to strike under the microscope, and the collagen fibers were collected from the bottom of the leaf base to the lower part of the glandular epithelium, and the collagen fibers in the mesenchymal tumors were sparse. The distribution dispersion and fiber bundle are discontinuous, there is no obvious consistent trend, there is no tendency of rich tendency, the collagen fibers in the mesenchymal tumor stroma at the junctional phyllodes show a certain degree of change span, which is affected by the degree of malignancy of the tumor, and the whole is between benign and malignant; The morphological structure, number range and distribution characteristics of the collagen fibers were significantly different between the fibrous adenoma and the lobulated tumor of each grade. There was no significant difference in the staining intensity of collagen fibers in Masson tricolor staining in different grades of tumors. The immunohistochemical staining of the type I collagen fibers is an effective staining method, and the color development characteristics among the various groups are obviously different: the staining characteristics in the benign phyllodes tumors are basically consistent with the morphological structure, the number range and the distribution characteristics of the Mason staining of the collagen fibers, The intensity of staining is gradually concentrated under the glandular epithelium at the bottom of the leaf base, and the expression of the index in the malignant interstitial tissue is more sparse and diffuse without obvious polarity. The development characteristics of borderline interstitial tissue have a certain span, which is between benign and borderline phyllodes tumors. The immunohistochemical staining intensity of type I collagen fibers between different grades showed no significant difference (P0.05). The positive rate of CD34 in mesenchyme increased with the increase of grade. There was a significant difference in the positive rate between fibrous adenoma and benign phyllodes tumor and lobar tumor (P <0.05). With the increase of classification, the positive rate of Ki67 increased, and there was a significant difference between the grading of fibrous adenoma and lobar tumor (P0.05). Conclusion: 1. There were significant differences in the morphological structure, number range and distribution of collagen fibers in lobar tumors of different grades, which could be used as an effective index for differential diagnosis. In the diagnosis of breast phyllodes tumors, Masson's three-color staining effect is good, and it is a clear and easy way to differentiate collagen fibers. Immunohistochemical staining of type I collagen fibers can be used as auxiliary. 4. The positive index of Ki67 increases with the increase of tumor grade, and can be used as the basis for differential diagnosis between lobar tumors and fibrous adenoma.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9
本文编号：2290015
[Abstract]:Background: The lobular carcinoma of the breast is a tumor of the origin of the mammary gland. The tumor pathology is divided into benign, borderline and malignant three types, even if the grade is benign, it also has the tendency of recurrence. It is the second most common malignant tumor next to breast cancer, which is more prone to recurrence and blood transfer after the malignant phyllodes tumor operation. The clinical manifestations of the tumor are easily confused with fibroadenoma, especially benign phyllodes tumors, which are often misdiagnosed as fibroadenoma. The diagnosis of the disease is mainly based on its histopathological characteristics, however, due to the heterogeneity of tumor tissue, there is no universally accepted and widely used immunohistochemical index and other special staining index. In clinical diagnosis, there is a phenomenon of improper histological evaluation leading to improper operation. As the main component of the stroma, the collagen fiber is an important expression of the histological characteristics and functional status of the phyllodes of the breast, which may be related to the development of the tumor. In this study, we studied the immunohistochemical staining and clinical features of collagen fibers Mason special staining combined with type I collagen fibers in phyllodes tumors of the breast, and expected the morphological characteristics of collagen fibers in tumors to be a new index to effectively assist in diagnosis and classification. Objective: To study the morphological characteristics of collagen fibers and the distribution characteristics of I-type collagen fibers in the mesenchymal tumors of the breast by means of Masson's three-color staining and immunohistochemical staining of I-type collagen fibers. To investigate the morphological characteristics of collagen fibers in the classification and differential diagnosis of phyllodes tumors of the breast. At the same time, the relationship between expression level and pathological characteristics was studied by exploring the expression and staining characteristics of CD34 and Ki67 in the lobar tumors of fibrous adenoma and grading breast, and the significance of its auxiliary diagnosis was verified. Methods: From January 1, 2009 to December 31, 2016 in Qilu Hospital of Shandong University, we collected 70 cases of breast phyllodes tumor (malignant 5 cases, borderline 12 cases, benign 53 cases). A comparative study of 8 cases of breast fibroadenoma was carried out. The paraffin-embedded tissue sections of the collected tumor cases were reviewed and diagnosed. Masson three-color staining was performed to compare the morphological structure, number range and distribution characteristics of the collagen distribution. Immunohistochemical staining of type I collagen fibers was performed, and the overall morphological characteristics of the combined Masson three-color staining were used to explore the expression and distribution characteristics of the typing. Through consulting the literature, we screened CD34 and Ki67 related to immunohistochemistry, interpreted and counted the results of staining, combined with relevant clinical and pathological data, and analyzed the difference between them in two different grade tumors. Result: 1. There was a significant difference between the morphological characteristics of collagen fibers and the expression of type I collagen fibers between the various stages of breast phyllodes tumors. The bundles of collagen fibers in the benign and lobulated tumors were collected in a coherent and parallel arrangement of the fiber strands, showing the tendency to strike under the microscope, and the collagen fibers were collected from the bottom of the leaf base to the lower part of the glandular epithelium, and the collagen fibers in the mesenchymal tumors were sparse. The distribution dispersion and fiber bundle are discontinuous, there is no obvious consistent trend, there is no tendency of rich tendency, the collagen fibers in the mesenchymal tumor stroma at the junctional phyllodes show a certain degree of change span, which is affected by the degree of malignancy of the tumor, and the whole is between benign and malignant; The morphological structure, number range and distribution characteristics of the collagen fibers were significantly different between the fibrous adenoma and the lobulated tumor of each grade. There was no significant difference in the staining intensity of collagen fibers in Masson tricolor staining in different grades of tumors. The immunohistochemical staining of the type I collagen fibers is an effective staining method, and the color development characteristics among the various groups are obviously different: the staining characteristics in the benign phyllodes tumors are basically consistent with the morphological structure, the number range and the distribution characteristics of the Mason staining of the collagen fibers, The intensity of staining is gradually concentrated under the glandular epithelium at the bottom of the leaf base, and the expression of the index in the malignant interstitial tissue is more sparse and diffuse without obvious polarity. The development characteristics of borderline interstitial tissue have a certain span, which is between benign and borderline phyllodes tumors. The immunohistochemical staining intensity of type I collagen fibers between different grades showed no significant difference (P0.05). The positive rate of CD34 in mesenchyme increased with the increase of grade. There was a significant difference in the positive rate between fibrous adenoma and benign phyllodes tumor and lobar tumor (P <0.05). With the increase of classification, the positive rate of Ki67 increased, and there was a significant difference between the grading of fibrous adenoma and lobar tumor (P0.05). Conclusion: 1. There were significant differences in the morphological structure, number range and distribution of collagen fibers in lobar tumors of different grades, which could be used as an effective index for differential diagnosis. In the diagnosis of breast phyllodes tumors, Masson's three-color staining effect is good, and it is a clear and easy way to differentiate collagen fibers. Immunohistochemical staining of type I collagen fibers can be used as auxiliary. 4. The positive index of Ki67 increases with the increase of tumor grade, and can be used as the basis for differential diagnosis between lobar tumors and fibrous adenoma.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9
【参考文献】
相关期刊论文 前2条
1 张正权;张程;符德元;;Wnt/β-catenin信号通路在乳腺癌中的研究进展[J];国际外科学杂志;2015年03期
2 黄斌;孙丽君;仇玲玲;洪亮;金利刚;;乳腺叶状肿瘤18例临床病理及免疫组化分析[J];实用肿瘤学杂志;2008年03期
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