乳腺之腺脂肪瘤：錯構瘤變型之個案報告

Breast Adenolipoma-A Variant of Hamartoma

乳腺之腺脂肪瘤（adenolipoma）為少見乳腺錯構瘤（hamartoma）之變型。此腫瘤之邊界清楚，由乳腺小葉與纖維及脂肪組織混合組成。過去之病例報告，使用細針抽取細胞學或岩芯針切片檢查時，常無法獲致病理診斷，此肇因於錯構瘤之組織形態與正常乳腺組織無法區分。我們報告一例發生在51歲女性乳腺之腺脂肪瘤。病患於乳房攝影篩檢時發現乳房腫塊。乳房超音波疑為纖維腫瘤或錯構瘤。臨床診斷疑似葉狀瘤（phyllodes tumor）。起初以岩芯針切片觀察到正常乳腺小葉與纖維組織，但無法獲致確切診斷。後續腫瘤切除確診為腺脂肪瘤。本案例說明此少見乳腺錯構瘤診斷上之困難及岩芯針切片用於診斷此疾病之限制。臨床上本病有復發及合併惡性報告之病例，因而正確診斷有其重要性，而完整聯結臨床及影像上之發現與病理組織所見乃正確診斷之要件。

Breast adenolipomas are benign variants of hamartomas. They are well-circumscribed lumps composed of lobular mammary glands admixed with varying amounts of fibrous tissue and fat. Most of the reports on hamartoma by pathologists using routine diagnostic methods such as fine needle aspiration and core needle biopsy are inconclusive due to the histological similarity of hamartoma with normal breast tissue. In this paper, we discuss a case of adenolipoma in the breast of a 51-year-old woman. A lump was revealed by mammography. Sonographic evaluation indicated possible involuted fibroadenoma or hamartoma. Although initial core needle biopsy showed benign mammary parenchyma in fibrotic stroma, diagnosis remained uncertain. Subsequently, lumpectomy was performed confirming adenolipoma. This case study underscores the difficulties encountered in the pre-operative diagnosis of hamartoma as well as the limitations of core needle biopsy in detecting such an uncommon disease. Prudent use of clinical and imaging information in conjunction with pathohistological evidence is crucial in correct diagnosis of this disease entity.