由于前哨淋巴结检查成为常规,淋巴结中良性异位乳腺组织的发现有所增加。我们报告了一名76岁的双侧乳腺癌女性的四个淋巴结中的导管原位癌(DCIS)图像。右侧肿块切除术显示浸润性小叶和导管内混合性癌,加上DCIS。在腋窝淋巴结清扫术中分离出19个淋巴结,其中4个显示固体和筛状DCIS。肌球蛋白和p63免疫组化技术阳性,提示“转移性DCIS”的错误诊断。先前已经报道了另外三例淋巴结中的DCIS,都有一层明显的肌动蛋白肌上皮细胞,肌球蛋白或p63。生物学,淋巴结DCIS的这些图像是不可信的,并且已经提出了三个主要假设来解释这些发现:医源性机械运输,可逆DCIS,淋巴结原发DCIS。我们认为第一个是最合理的解释。我们的案子是独一无二的,同时观察到罕见的发现。更多新病例,以及对先前病例的其他免疫组织化学技术和分子检测,需要找到对这一组织学发现的明确解释。
Since sentinel lymph node examination became routine, findings of benign ectopic breast tissue in lymph nodes have increased. We report images of ductal carcinoma in situ (DCIS) in four lymph nodes in a 76-year-old woman with bilateral breast carcinoma. The right lumpectomy showed intermixed invasive lobular and ductal carcinoma, plus DCIS. 19 nodes were isolated in the axillary lymphadenectomy, 4 of which displayed solid and cribriform DCIS. Myosin and p63 immunohistochemical techniques were positive, suggesting an erroneous diagnosis of \"metastatic DCIS\". A further three cases of DCIS in lymph nodes have been previously reported, all with a distinct layer of myoepithelial cells with actin, myosin or p63. Biologically, these images of DCIS in lymph nodes are not credible and three major hypotheses have been proposed to explain these findings: Iatrogenic Mechanical Transport, Revertant DCIS, and primary DCIS of lymph nodes. We consider the first one the most plausible explanation. Our case is unique as several, rare findings are simultaneously observed. More new cases, together with additional immunohistochemical techniques and molecular testing on previous cases, are needed to find a definitive explanation of this histologic finding.