Zusammenfassung
Mit der durch Dabelow eingeführten stereomikroskopischen Technik und einem sogen. Lochverfahren wurde eine dreidimensionale Untersuchung von Morphologie und Histogenese der durch Mastopathie veränderten menschlichen Brustdrüse ermöglicht. Die Hauptveränderung besteht demnach in Evolution und Involution abnormer Milchgänge, hervorgerufen durch ungewöhnliche hormonelle Stimulation des Organes. Die Morphologie der menschlichen Mastopathie wird wie folgt postuliert:
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1.
Abnorme Milchgänge werden differenziert und erzeugen eine Involution der Lobuli mit begleitender Stromafibrose.
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2.
Die abnorme Milchgangsproliferation wird am deutlichsten in ausgereiften Adenoseknoten. Die sogen. sklerosierende Adenose besteht aus Bündeln von Kanälchen, welche teilweise parallel angeordnet, teilweise geknotet sind.
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3.
In den meisten Fällen findet sich eine aus blind endigenden Kanälchen aufgebaute sogen. Adenose. Jene findet sich auch in perikanalikulären Fibroadenomen und bei Gynäkomastie.
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4.
Die stereomikroskopische Analyse des Verzweigungsmusters der Kanälchen erinnert an das Bauschema einer Gladiolenwurzel. Fibroadenomknoten entsprechen denmach überwiegend dem Typus einer sogen. Adenose; sie besitzen nicht die Charaktere echter Geschwülste.
Summary
With the stereomicroscopic technique of Dabelow in combination with punch sampling method, a three-dimensional approach to the morphology and histogenesis of human mastopathic breast was made possible. This afforded evidence that the key alteration is the evolution and involution of abnormal ducts (ductules) which were induced by a dyshormonal stimulation of the organ. The morphogenesis of human mastopathia is postulated as follows:
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1.
Abnormal ducts may develop and differentiate to form lobules and involute with stromal fibrosis.
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2.
Abnormal duct proliferation is seen best in the florid type of nodular adenosis in which typical sclerosing and blunt-duct adenosis are common. Stereomicroscopically, sclerosing adenosis consists of bundles of ductules that run parallel forming whorls and knots. Lobular formation is seen rarely in this lesion.
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3.
For the most part blunt duct adenosis is composed of irregularly extended ductules and they were noted frequently in the florid type of adenosis. Organized dichotomous branching observed in the pericanalicular type of fibroadenoma and gynecomastia may also be recognized as blunt-duct adenosis histologically.
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4.
Stereomicroscopically the intracanalicular type of fibroadenoma resembles gladiola bulbs. These structures were interpreted histologically as complexly folded, multilayered ducts with a peculiar mesenchymal reaction. A similar structure was noted at the periphery of milk ducts. The three-dimensional structure of peripheral intracanalicular fibroadenoma suggests that the lesion is related to adenosis rather than to a neoplasm.
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Clinical Investigator, Veterans Administration Hospital, San Francisco, California, U.S.A., Former Postgraduate Student, Faculty of Medicine, Tokyo Medical and Dental University, Japan.
This investigation was carried out at the Department of Pathology, Faculty of Medicine, Tokyo Medical and Dental University from 1958 to 1960 and was partially supported by a special research grant of the Japanese Ministry of Education.
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Tanaka, Y., Oota, K. A stereomicroscopic study of the mastopathic human breast. Virchows Arch. Abt. A Path. Anat. 349, 195–214 (1970). https://doi.org/10.1007/BF00544572
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DOI: https://doi.org/10.1007/BF00544572