乳腺分葉狀腫瘤中膠原纖維形態(tài)特點(diǎn)及相關(guān)臨床病理學(xué)研究
發(fā)布時(shí)間：2018-10-23 17:47
【摘要】：背景:乳腺分葉狀腫瘤是乳腺間質(zhì)來源的腫瘤。該腫瘤病理學(xué)上又分為良性、交界性及惡性三類,即使分級(jí)為良性也具有復(fù)發(fā)的傾向。惡性分葉狀腫瘤手術(shù)后更易于復(fù)發(fā)和發(fā)生血行轉(zhuǎn)移,是僅次于乳腺癌的第二位常見的乳腺惡性腫瘤。該腫瘤臨床表現(xiàn)易與纖維腺瘤混淆,尤其是良性分葉狀腫瘤,病理學(xué)上也常常誤診為纖維腺瘤,待手術(shù)后復(fù)發(fā)方考慮為分葉狀腫瘤。該病確診主要依據(jù)其組織病理學(xué)特點(diǎn),然而由于腫瘤組織的異質(zhì)性,目前尚無公認(rèn)有效并廣泛應(yīng)用的免疫組織化學(xué)指標(biāo)及其他特殊染色指標(biāo),臨床診斷工作中易出現(xiàn)組織學(xué)低估而導(dǎo)致手術(shù)方式不恰當(dāng)?shù)默F(xiàn)象。膠原纖維作為間質(zhì)的主要成分,是乳腺分葉狀腫瘤組織學(xué)特點(diǎn)及功能狀態(tài)的重要體現(xiàn),與該腫瘤的發(fā)生發(fā)展或許存在內(nèi)在聯(lián)系。該課題對(duì)乳腺分葉狀腫瘤中膠原纖維Masson特殊染色結(jié)合I型膠原纖維等免疫組織化學(xué)染色及臨床特點(diǎn)進(jìn)行研究,期望腫瘤中膠原纖維形態(tài)特點(diǎn)能夠成為有效協(xié)助診斷及分級(jí)的新指標(biāo)。目的:通過Masson三色染色及I型膠原纖維免疫組織化學(xué)染色,研究乳腺分葉狀腫瘤間質(zhì)中膠原纖維的組織學(xué)的形態(tài)特點(diǎn)及I型膠原纖維的表達(dá)分布特點(diǎn),結(jié)合相關(guān)臨床資料并與纖維腺瘤的特點(diǎn)進(jìn)行對(duì)比,探究膠原纖維的形態(tài)學(xué)特點(diǎn)在乳腺分葉狀腫瘤的分級(jí)及鑒別診斷中的作用。同時(shí),通過探究纖維腺瘤及各個(gè)分級(jí)乳腺分葉狀腫瘤中CD34及Ki67的表達(dá)及染色特點(diǎn),探究表達(dá)水平與病理學(xué)特點(diǎn)的關(guān)系,驗(yàn)證其輔助診斷的意義。方法:追溯山東大學(xué)齊魯醫(yī)院2009年1月1日至2016年12月31日就診于乳腺外科并進(jìn)行手術(shù)治療的病例,共收集70例乳腺分葉狀腫瘤標(biāo)本(惡性5例,交界性12例,良性53例),另收集8例乳腺纖維腺瘤進(jìn)行對(duì)照研究。將收集的腫瘤病例的石蠟包埋組織切片復(fù)習(xí)、診斷,進(jìn)行Masson三色染色,比較其膠原分布的形態(tài)結(jié)構(gòu)、數(shù)量范圍、分布特征。進(jìn)行I型膠原纖維的免疫組織化學(xué)染色,聯(lián)合Masson三色染色的整體形態(tài)學(xué)特點(diǎn)進(jìn)行探究該分型的表達(dá)及分布特征。通過查閱文獻(xiàn),篩選出相關(guān)的免疫組織化學(xué)檢驗(yàn)指標(biāo)CD34及Ki67,判讀并統(tǒng)計(jì)染色結(jié)果,結(jié)合相關(guān)臨床及病理資料,分析其于兩不同分級(jí)腫瘤中表達(dá)的差異性。結(jié)果:1.乳腺分葉狀腫瘤的各個(gè)分級(jí)之間,Masson三色染色中的膠原纖維的形態(tài)學(xué)特征及I型膠原纖維的表達(dá)特征有顯著差異。①良性分葉狀腫瘤的膠原纖維束聚集行成連貫、平行排列的纖維條索,表現(xiàn)出顯微鏡下可見的走向趨勢(shì),且膠原纖維條索由分葉基底部向腺上皮下方聚集增多;②惡性分葉狀腫瘤間質(zhì)中膠原纖維排列稀疏,分布彌散,纖維束纖細(xì)之間不連續(xù),無明顯一致走向,無濃聚趨勢(shì);③交界性分葉狀腫瘤間質(zhì)中的膠原纖維表現(xiàn)出一定程度的改變跨度,受腫瘤惡性程度的影響,整體介于良性和惡性之間;④膠原纖維的形態(tài)結(jié)構(gòu)、數(shù)量范圍及分布特征三項(xiàng)指標(biāo)于纖維腺瘤及各個(gè)分級(jí)的分葉狀腫瘤之間均有顯著差異。⑤不同分級(jí)的腫瘤中,Masson三色染色中膠原纖維的著色強(qiáng)度無顯著性差異。⑥I型膠原纖維的免疫組織化學(xué)染色為有效染色方法,其各個(gè)分組間的顯色特征可見明顯差異:良性分葉狀腫瘤中的染色特點(diǎn)與膠原纖維的Masson染色的形態(tài)結(jié)構(gòu)、數(shù)量范圍及分布特征基本一致,部分見染色密集程度由分葉基底部向腺上皮下方逐漸濃聚,而惡性間質(zhì)組織中該指標(biāo)的表達(dá)更稀疏而彌散,無明顯極性。交界性間質(zhì)組織中顯色特點(diǎn)有一定跨度,整體介于良性及交界性分葉狀腫瘤之間。⑦不同分級(jí)之間I型膠原纖維的免疫組織化學(xué)染色強(qiáng)度未表現(xiàn)出顯著性差異(p0.05)。2.CD34及Ki67于不同分級(jí)的纖維上皮性腫瘤間有一定差異,對(duì)乳腺分葉狀腫瘤的診斷的有指導(dǎo)意義。①隨著分級(jí)提高,間質(zhì)中CD34的陽(yáng)性比率有一定升高的趨勢(shì)。纖維腺瘤與良性分葉狀腫瘤及分葉狀腫瘤整體之間的陽(yáng)性率有顯著性差異(P值0.05)。②隨著分級(jí)的增加,Ki67的陽(yáng)性率提高,纖維腺瘤及分葉狀腫瘤各個(gè)分級(jí)之間均有顯著性差異(p0.05)。結(jié)論:1.不同分級(jí)的乳腺分葉狀腫瘤中膠原纖維的形態(tài)結(jié)構(gòu)、數(shù)量范圍及分布規(guī)律有顯著差異,可作為鑒別診斷的有效指標(biāo);2.在乳腺分葉狀腫瘤的診斷中,Masson三色染色效果好,是膠原纖維清晰易辨的診斷手段;I型膠原纖維的免疫組化染色可作為輔助;3.CD34對(duì)于分葉狀腫瘤與纖維腺瘤的鑒別診斷有參考意義;4.Ki67陽(yáng)性指數(shù)隨著腫瘤分級(jí)的增加而提高,可作為各分級(jí)分葉狀腫瘤之間及其與纖維腺瘤的鑒別診斷依據(jù)。
[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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.9
本文編號(hào)：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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.9
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 張正權(quán);張程;符德元;;Wnt/β-catenin信號(hào)通路在乳腺癌中的研究進(jìn)展[J];國(guó)際外科學(xué)雜志;2015年03期
2 黃斌;孫麗君;仇玲玲;洪亮;金利剛;;乳腺葉狀腫瘤18例臨床病理及免疫組化分析[J];實(shí)用腫瘤學(xué)雜志;2008年03期
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