1、月儿 mmm 知足常乐 sxzyy 小樱 猪猪 xianren leee,血管肉瘤？ 海绵状血管瘤 乳腺血管肉瘤 乳腺的血管性肿瘤很少是良性的。 分化比较好的海绵状区域，和分化较差的纤维硬化区域，倾向血管肉瘤。 没见过，学习了 我没见过这种的,猜是血管肉瘤,因为在乳腺良性的血管瘤少见.本例肿瘤组织浸润至乳腺及脂肪组织中,纵横交叉的血管,内衬扁平的内皮细胞,核分裂少见,要考虑血管肉瘤. zhabglei：您提的病例真好，很典型，是乳腺的血管肉瘤。图辛不多，从病人表观到大体，再从低倍到高倍，无重复，染色鲜艳、清晰。看者省时，值得提供病例者学习。,490918 hadi 马甲 高倍镜 风雨天使 持刀
2、客,海绵状血管瘤?总感觉不恶，分化好 血管肉瘤,镜见很容易被误诊 形态并不恶性 你遇见敢报吗？反正我是不敢！ 我记得纪老师说过,乳腺的血管肿瘤无良性，所以我可以放心诊断：血管肉瘤。请用“矛盾的普遍性和特殊性去看问题”，反对讲神话来误导大家，不是所有人都能看得懂神话的。,csgcsg sawu,乳腺的血管性肿瘤无良性。乳腺血管瘤少见但的确存在有：cavernous hemangiomacapillary hemangiomaatypical hemangiomavenous hemangiomaangiomatosis,Vascular tumor of Breast,Vascular tumo
3、r of Breast,term,VESSEL .n(船 、容器 、脉管 ) Vascular.a（ 血管的 ） BLOOD VESSELS angio （脉管, 包被 ） H（a）em （血红素 ） Hemangioma (Mostly hamartomas ) (Hem)angiosarcomas Endothelial cells endothelioma Hemangioendothelioma Pericytes (Perivascular cells) perivascular epithelioid cell tumor (PEComa). Arteries carry bloo
4、d from the heart . aneurysm,WHO 2003 classification of Tumours of the Breast,Adapted from WHO, Tumours of the Breast and Female Genital Organs. IARCPress, 2003,1. Epithelial tumours,1.20 Lobular neoplasia1.20.1 Lobular ca in situ1.21 Intraductal proliferative lesions1.21.1 Usual ductal hyperplasia1.
5、21.2 Flat epithelial atypia1.21.3 Atypical ductal hyper- plasia1.21.4 Ductal carcinoma in situ1.22 Microinvasive ca1.23 Intraductal papillary neoplasms1.23.1 Central papilloma1.23.2 Peripheral papilloma1.23.3 Atypical papilloma1.23.4 Intraductal papillary car- cinoma1.23.5 Intracystic papillary ca1.
6、24 Benign epithelial proliferations1.24.1 Adenosis including vari- ants1.24.1.1 Sclerosing adenosis1.24.1.2 Apocrine adenosis1.24.1.3 Blunt duct adenosis1.24.1.4 Microglandular adenosis1.24.1.5 Adenomyoepithelial adenosis1.24.2 Radial scar / complex sclerosing lesion1.25 Adenomas1.25.1 Tubular adeno
7、ma1.25.2 Lactating adenoma1.25.3 Apocrine adenoma1.25.4 Pleomorphic adenoma1.25.5 Ductal adenoma,1.1 IDC1.2 ILC1.3 Tubular1.4 Invasive cribriform1.5 Medullary1.6 Mucinous ca and other tumours with abundant mucin1.6.1 Mucinous ca1.6.2 Cystadenocarcinoma and col cell mucinous ca1.6.3 Signet ring cell
8、ca1.7 Neuroendocrine tuomurs1.7.1 Solid neuroendocrine ca1.7.2 Atypical carcionid tumour1.7.3 Small cell / oat cell ca1.7.4 Large cell neuroendocrine ca1.8 Invasive papillary ca1.9 Invasive micropapillary ca1.10 Apocrine ca1.11 Metaplastic carcinomas1.11.1 Pure epithelial metaplastic ca1.11.1.1 Squa
9、mous cell ca1.11.1.2 Adenoca with spin- dle cell metaplasia1.11.1.3 Adenosquamous ca1.11.1.4 Mucoepidermoid ca1.11.2 Mixed epithlial/ mesen- chymal metaplastic ca1.12 Lipid-rich ca1.13 Secretory ca1.14 Oncocytic ca1.15 Adenoid cystic ca1.16 Acinic cell ca1.17 Glycogen-rich clear cell ca1.18 Sebaceou
10、s ca1.19 Inflammatory ca,2. Myoepithelial lesions,2.1 Myoepitheliosis2.2 Adenomyoeithelial adenosis2.3 Adenomyoepithelioma2.4 Malignant myoepithelioma,3. Mesenchymal lesions,3.1 Haemangioma3.2 Angiomatosis3.3 Haemangiopericytoma3.4 Pseudoangiomatous stromal hyperplasia3.5 Myofibroblastoma3.6 Fibroma
11、tosis (aggressive)3.7 Inflammatory myofibroblastic tumour3.8 Lipoma3.8.1 Angiolipoma,3.9 Granular cell tumour3.10 Neurofibroma3.11 Schwannoma3.12 Angiosarcoma3.13 Liposarcoma3.14 Rhabdomyosarcoma3.15 Osteosarcoma3.16 Leiomyoma3.17 Leiomyosarcoma,Breast Tumors with Vascular (and Pseudovascular) Diffe
12、rentiation,Angiomatosis Hemangioma Perilobular Hemangioma Hemangiopericytoma Post-irradiation Atypical Vascular Lesion (skin of breast) Venous Hemangioma (Pseudoangiomatous stromal hyperplasia) Angiosarcoma,Definition Very rare diffuse benign vascular process of the breast Alternate/Historical Names
13、 Diffuse angiomatosis Diagnostic Criteria Very rare, only five cases reported Do not make this diagnosis without consultation Diffuse process Surrounds ducts and lobules No invasion into lobules Large irregular vascular spaces No muscular wall May have occasional anastomoses Lined by flat endotheliu
14、m without atypia May have both blood and lymphatic channels Differential Diagnosis Angiosarcoma Benign breast vascular lesions,Angiomatosis of the Breast,Definition Benign vascular lesion of the breast large enough to be detected clinically Alternate/Historical Names Atypical hemangioma Capillary he
15、mangioma Cavernous hemangioma Venous hemangioma,Hemangioma of the Breast,Diagnostic Criteria,By definition, detectable by palpation or mammography Rarely over 2 cm Grossly circumscribed May merge microscopically with surrounding tissue Does not invade and destroy lobules Most are cavernous Less freq
16、uently capillary type Anastomoses infrequent, not complex Fibrous septa divide lesion into lobules Stroma may calcify Large feeder vessels may be seen at periphery Atypical hemangioma has features as above but with: Increased anastomoses, or Cytologic atypia Venous hemangioma Dilated channels Walls
17、contain smooth muscle at least partially May be considered a vascular malformation,Differential Diagnosis,Angiosarcoma Pseudoangiomatous stromal hyperplasia Other benign vascular lesions of the breast,Perilobular Hemangioma of the Breast,Definition Benign microscopic vascular lesion of the breast Al
18、ternate/Historical Names Atypical perilobular hemangioma Diagnostic Criteria Incidental microscopic lesion Frequently within the lobular stroma May involve extralobular or periductal stroma Cluster of vascular channels Capillary to small cavernous vessels Usually no cytologic atypia Occasional lesio
19、ns with atypical features May have focal anastomoses May have hyperchromatic nuclei Must lack extensive complex anastomoses, papillary endothelial tufting, mitotic figures,Differential Diagnosis,Angiosarcoma Pseudoangiomatous stromal hyperplasia Other benign vascular lesions of the breast,Both are u
20、sually incidental findings,Definition Microscopic or clinically apparent breast lesion of variable cellularity featuring dense collegenous stroma punctuated by slit like spaces Alternate/Historical Names Nodular myofibroblastic stromal hyperplasia of the mammary gland Pseudoangiomatous hyperplasia o
21、f mammary stroma Diagnostic Criteria May be a circumscribed mass or microscopic incidental finding Dense hyalinized collagen bundles May expand intralobular stroma Surrounds ducts and lobules Usually circumscribed but merges with surrounding stroma Anastomosing pseudovascular slit like spaces punctu
22、ate collagen bundles No true vascular lining or structure No erythrocytes in spaces Spaces often lined by spindle cells with range of cellularity Classically almost inconspicuous, discontinuous flat bland cells One male case described with multinucleated cells Classical areas also present in all cel
23、lular cases described Spectrum of increased cellularity Cells associated with spaces more numerous and larger Nuclei may be larger and vesicular Increased cellularity may obscure or obliterate pseuovascular spaces May show marked cellularity with bundles and fascicles of cells May predominate over c
24、ollagenous stroma CD34 positive but CD31 and Factor VIII negative,Pseudoangiomatous Stromal Hyperplasia （PASH ）,Clinical,Age 14-67 years In males, reported in 63% of cases of gynecomastia, ranging from microscopic to extensive Female cases both palpable masses and microscopic lesions Reported as an
25、incidental microscopic lesion in up to 23% of specimens removed for other purposes in females 5/40 cases recurred in one series of female patients None recurred aggressively or metastasized 1 case with multiple bilateral lesions,PASH Immunohistology,CD3416/17 Vimentin20/20 Actin12/19 Desmin4/20 PR E
26、R CD31 Factor 8 S100 Keratin,Positive positive positive Positive Positive Usually negative Negative Negative Negative Negative,Differential Diagnosis,Angiosarcoma Myofibroblastoma Perilobular hemangioma Hemangioma,Both contain anastomosing spaces containing CD34+ cells,Both are usually incidental fi
27、ndings,Angiosarcoma of the Breast,Definition Malignant neoplasm of the breast exhibiting blood vascular differentiation Diagnostic Criteria All grades are characterized by infiltration of breast parenchyma by cells exhibiting vascular differentiation Low grade tumors Prominent freely anastomosing va
28、scular channels Papillary growth and endothelial tufting minimal to absent Cytologic atypia may be difficult to identify even after extensive sampling Intermediate grade tumors Freely anastomosing vascular channels Papillary growth and endothelial tufting May have focal solid areas with polygonal or
29、 spindle cells High grade tumors Prominent solid areas of clearly malignant cells Polygonal and spindled cells Blood lakes and necrosis are common Vascular channels may be difficult to identify May require extensive sampling, especially at edge of lesion Demonstration of vascular nature may require
30、immunohistology,Clinical,Mean age mid-thirties Lower age associated with higher grade Approximate 5 year survival: Low grade 76% Intermediate grade 70% High grade 15%,GRADING,Angiosarcoma of the Breast Immunohistology,CD31 is the most specific vascular endothelial marker Carcinomas and stromal cells
31、 are negative Reaction with histiocytes may be confused with sheets of neoplasm Most sensitive marker in high grade cases CD34 is relatively specific Carcinomas are negative Frequent, extensive benign stromal cell reactivity may make interpretation difficult Less sensitive than CD31 in high grade ca
32、ses, but exceptions to this rule do occur Factor VIII related antigen Less sensitive than CD31 and CD34 in neoplasms,Differential Diagnosis,Perilobular hemangioma Hemangioma Angiomatosis Pseudoangiomatous stromal hyperplasia High grade carcinoma or other neoplasm Post-irradiation atypical vascular l
33、esion,Stewart F. W. Tumors. of the Breast , Washington D.C. A.F.I.P.1950. p107,A benign angioma of the breast had never been documented to constitute a palpable or symptom-producing breast tumor.,Steingaszner LC, Enzinger FM, and Taylor HB. Cancer 18:352-361,1965,That rare exceptions to this bad pro
34、gnosis do occur even with this vicious tumor is illustrated by two patients who survived seven and 14 years postoperatively; these are the first reported examples of probable cures.,Cancer 24;1021-1026,1969,Gulesserian & Lawton 搜集了39 例angiosarcoma of breast ，其中14例开始被误诊为haemangioma.,Rosen & Ridolf: 5
35、55例乳腺癌切除标本中发现有haemangioma 7例(1.2%，镜下发现，1977) Lesueur: 尸检标本中发现haemangioma32个（高达11%，1983）25个1.5mm,2个最大为4mm.,summary,乳腺血管肿瘤良性太少见 组织学：分化好的难以鉴别良恶 可靠点：大小（5mm?）,月儿 shubin xhyong 清茶,好片子，血管肉瘤（I级）。 血管肿瘤，长在乳腺肉瘤 肿物有边界吗？脂肪是周边的还是肿瘤组织内的成分，很多薄壁血管，有点充血，可见夹杂很多脂肪细胞，虽然是血管比较小，但是每一个血管都是完整的，并没有出血不完整的血管围成的裂隙样结构。细胞虽然有点异型性，但
36、是我认为不影响诊断 考虑：血管脂肪瘤 脂肪是肿瘤组织内的，肿瘤边界不清,微小一部分 :血管肉瘤的依据是啥，不敢诊断噢 leee :乳腺高分化血管肉瘤： 1.好发于年轻人，平均34岁，本例35岁； 2.乳腺的血管肉瘤一般分化好，或为海绵状血管瘤样，或为毛细血管瘤样，本例为后者； 3.血管分化虽好，但内皮细胞仍有异型性，有的核明显增大。注意有的仅为单个细胞浸润，且有的有小腔，腔内有一个红细胞，显示为原始的瘤性血管； 4.良性的毛细血管瘤常呈分叶状分布，本例为弥漫浸润性生长，边界不清。经全面、仔细观察了清茶发给我的图片，根本未见到乳腺组织，全是皮下脂肪，故说是乳腺的血管瘤，就有点误导了。何况乳腺也有
37、血管脂肪瘤啊。 现认为是胸部皮下血管脂肪瘤，不是乳腺血管肉瘤。清茶 :重取材及大体标本照相,Leee:此例清茶用Email给我发了10多幅图，再全面、仔细观察，并查阅文献，认为是皮下组织的血管脂肪瘤，不是乳腺的血管肉瘤。详情请清茶再说说。月儿 :学习，看来得先搞清部位哦 zhang (zhangshandong) :Histopathology,Volume 52(1), January 2008, p 3044 Vascular proliferations of the breast,Abstract,Vascular proliferations of the breast are un
38、common but potentially diagnostically challenging lesions. Clinically apparent processes are more likely to be malignant; however, a range of benign entities which must be differentiated from angiosarcoma also exists. This review discusses first, breast lesions of apparent vascular origin, then beni
39、gn and histologically bland perilobular, cavernous and capillary haemangiomas.Subsequently, more diagnostically challenging, atypical haemangiomas, papillary endothelial hyperplasia, angiomatosis and angiolymphoid hyperplasia with eosinophilia (epithelioid haemangioma) are considered. In addition, l
40、esions with low-grade malignant potential such as haemangiopericytomas and epithelioid haemangioendotheliomas may rarely present in the breast. However, primary angiosarcomas and radiation-associated vascular lesions are reviewed in depth, as these entities are of greatest clinical and pathological
41、significance.,怡然 hongchen2002 Shubin 月儿 月新 王不留行 zhanglei gee,血管肉瘤 境界很清-良性(不会是血肿机化吧?) 在大血管内，良性。 符合血肿机化，良性 乳头状血管肉皮瘤！ 是血栓机休的过程，不是恶性的，恶性血管瘤是指有浸润的血管瘤。 良性Masson瘤。周边是否为乳腺组织？,William B. Castle October 21, 1897 August 9, 1990,“An expert is a person who tells you a simple thing in a confused way, in such a fashion as to make you think the confusion is your fault.“,hemangioma,well-differentiated,Middle differentiated,poorly differentiated,
