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目的分析“癌肉瘤”样恶性叶状肿瘤(CMPT)的诊断陷阱并文献复习。方法对1例CMPT的临床特点、HE染色和免疫组化特点并结合文献进行分析。结果 CMPT形态学上具有间质细胞双向分化的特征并缺乏叶状结构;肿瘤组织中上皮样间质细胞高表达CD34,梭形间质细胞低表达或不表达;由于形态上具有典型上皮样区域,且肿瘤细胞疏松区常见炎细胞浸润,在细针穿刺、冷冻及常规病理时,需排除炎症性病变和浸润性癌;其与乳腺导管周间质肿瘤在形态和免疫组化上部分重叠。结论 CMPT可能是一种与恶性叶状肿瘤和导管周上皮样间质肿瘤相关的特殊而罕见的乳腺恶性纤维上皮性肿瘤,或是导管周间质肿瘤向恶性叶状肿瘤转化的中间过程。
Objective To analyze the diagnostic pitfalls and literature review of “Carcinosarcoma” malignant phyllodes tumor (CMPT). Methods One case of clinical features of CMPT, HE staining and immunohistochemical characteristics combined with literature analysis. Results The morphology of mesenchymal cells in CMPT was characterized by the bi-directional differentiation of mesenchymal cells and the lack of leaf-like structure. The epithelial-like stromal cells in the tumor tissues expressed CD34 and spindle-shaped interstitial cells with low or no expression. Due to the morphologically typical epithelioid region , And common inflammatory cell infiltration in the loose area of tumor cells. In the fine needle aspiration, freezing and routine pathology, it is necessary to rule out inflammatory lesions and invasive carcinoma; it partially overlaps with the ductal interstitial tumor in morphology and immunohistochemistry. Conclusion CMPT may be a special and rare malignant fibrous epithelial tumor associated with malignant phyllodes tumor and ductal epithelial-like stromal tumor, or an intermediate process of transforming ductal tumors into malignant phyllodes tumors.