乳腺X线检查在早期乳腺癌诊断中的价值

目的:探讨早期乳腺癌的X线诊断价值。方法:回顾性分析经手术病理证实的122个乳腺癌(114例)的乳腺X线表现,依据美国放射学会乳腺影像报告和数据系统(Breast imaging reporting and data system,BI-RADS)分类标准,进行乳腺X线判读。结果:122个乳腺癌中导管内原位癌23例(18.9%),浸润性导管癌77例(63.1%),小叶原位癌1例,浸润性小叶癌4例,乳头状癌12例,粘液癌5例。导管内原位癌乳腺X线影像学多不具备典型恶性征象,21例(91%)伴钙化,诊断BI-RADS-4a以上正确率为91%。浸润性导管癌1级多数不具备典型恶性征象,诊断BI-RADS-4a以上正确率为75%。浸润性导管癌2级(33例)和3级(40例)乳腺X线影像有相同的征象,二者较导管原位癌具有较明显的恶性征象,浸润性导管癌2级和3级诊断BI-RADS-4b以上正确率为77%。结论:按照BI-RADS分类标准判读乳腺X线影像在诊断早期乳腺癌中有重要临床意义。     

乳腺癌和癌旁乳腺组织中Notch1基因mRNA及蛋白的表达

目的 检测Notch1基因mRNA及Notch1蛋白在人乳腺癌和癌旁乳腺组织中的表达,分析其临床病理学意义.方法 应用逆转录聚合酶链反应(RT-PCR)方法榆测60例乳腺浸润性导管癌和60例癌旁乳腺组织中Notch1基因mRNA,应用免疫组织化学SP法检测60例乳腺浸润性导管癌、30例导管原位癌及60例癌旁乳腺组织Notch1蛋白的表达,分析Notch1表达水平与乳腺癌临床病理特征的相关性.结果 Notch1基因mRNA在人乳腺浸润性导管癌及癌旁乳腺组织中均有表达.Notch1蛋白在癌旁乳腺组织和导管原位癌中的阳性牢分别为55%(33/60)、70%(21/30),二者差异无统计学意义(P>0.05),在乳腺浸润性导管癌中的阳性率为90%(54/60),明显高于癌旁乳腺组织和导管原位癌的阳性率(P<0.05).乳腺浸润性导管癌Notch1蛋白的高表达与肿瘤的淋巴结转移(P=0.006)、病理学分级(P=0.001)和TNM分期(P=0.022)均呈显著正相关.结论 乳腺浸润性导管癌存在Notch1蛋白的高表达.Notch1蛋白高表达与乳腺癌的恶变演进有关.Notch1基因的表达可能影响乳腺癌的发生、发展.     

肿瘤干细胞相关标记物CD44及CD24在乳腺癌中的表达及其意义

目的探讨肿瘤干细胞相关标记物CD44及CD24在乳腺癌组织中的表达特点、CD44+/CD24-细胞与HER-2、ER、PR、CK5/6表达的相互关系及其与临床病理因素的关系。方法采用免疫组化SP单染及双染法检测42例乳腺导管原位癌及126例乳腺浸润性导管癌组织中CD44及CD24的表达情况,检测126例乳腺浸润性导管癌组织中HER-2、ER、PR、CK5/6表达状况以进行免疫分型。结果 (1)CD44阳性定位于癌细胞膜。在浸润癌中阳性率为56.3%,在导管原位癌中阳性率为85.7%。两者差异有显著性意义(P<0.05)。在不同分化程度的乳腺浸润性癌中,CD44阳性率分别为69.2%、58.1%及44.7%,差异有显著性意义(P<0.05)。(2)CD24阳性表达于非癌性乳腺组织中小管的腔缘;在癌组织中除腔缘阳性外,可出现膜质阳性。在浸润癌中阳性率为32.5%,在导管原位癌中阳性率为64.3%。两者差异有显著性意义(P<0.05)。(3)126例浸润性导管癌中CD44+/CD24-者65例,占51.6%;CD44+/CD24-阳性细胞在Luminal A型为47.5%、Luminal B型为42.9%、HER-...     

Twist转录因子、E-钙黏蛋白和N-钙黏蛋白在乳腺癌中的表达及意义

目的 观察上皮间质转化因子Twist转录因子(简称Twist)和相关蛋白E-和N-钙黏蛋白(cadherin)在乳腺癌中的表达及其与患者临床病理指标的关系.方法 采用免疫组织化学SP法检测56例浸润性导管癌、38例浸润性小叶癌和41例导管内癌以及10例正常乳腺组织中Twist、E-和N-cadherin的表达.结果 (1)三种病理类型乳腺癌组织中,Twist阳性率分别为46.4%(26/56)、79.0%(30/38)和26.8%(11/41),其中浸润性小叶癌中Twist阳性率显著高于浸润性导管癌和导管内癌(分别P=0.002、0.000);E-cadherin阳性率分别为78.6%(44/56)、29.0%(11/38)和80.5%(33/41),其中浸润性导管癌和导管内癌中E-cadherin阳性率显著高于浸润性小叶癌(均P=0.000);N-cadherin阳性率分别为53.6%(30/56)、68.4%(30/56)和31.7%(13/41),其中在浸润性导管癌和浸润性小叶癌中的阳性表达显著高于导管内癌(分别P=0.033、0.001).(2)135例乳腺癌组织中Twist和E-cadherin表达呈显著负相关性(P=0.005,Spearman相关系数-0.239);Twist和N-cadherin 表达呈显著正相关性(P=0.000,Spearman相关系数0.319).(3)乳腺浸润性导管癌差分化组中N-cadherin阳性率显著高于中分化和高分化组(P=0.004).(4)乳腺浸润性小叶癌淋巴结转移组中Twist阳性率显著高于淋巴结未转移组(P=0.037).结论 三种蛋白在三种乳腺癌组织中的表达差异较大.Twist阳性表达与乳腺浸润性小叶癌淋巴结转移相关.N-cadherin阳性率与乳腺浸润性导管癌组织学分级相关.检测这三个指标可为研究乳腺癌的进展和转移机制及评判其生物学行为提供有价值的参考.     

脂肪酸结合蛋白在人乳腺癌组织的表达及意义

目的研究脂肪酸结合蛋白(FABP)mRNA及蛋白质在浸润性乳腺导管癌和乳腺纤维腺瘤的表达及分布,探寻人浸润性乳腺导管癌新的分子标志,为乳腺癌的靶向治疗提供理论依据。方法用半定量逆转录聚合酶链反应、免疫组织化学染色和Western blot等方法检测脂肪细胞型FABP、心型或骨骼肌型FABP、脑型FABP、表皮或牛皮癣型FABP、肝型FABP、小肠型FABP和胃型FABP mRNA及蛋白质在35例浸润性乳腺导管癌,16例乳腺纤维腺瘤组织中的表达变化。结果RT-PCR结果显示A-、B-、I-和G-FABPs mRNA在两种组织的表达差异无统计学意义(P>0.05);但E-、H-和L-FABP mRNA在浸润性导管癌的表达较纤维腺瘤显著升高(P<0.05)。免疫组织化学染色显示,E-、L-和H-FABP在浸润性导管癌的阳性细胞百分数较纤维腺瘤明显上调(P<0.05),分布范围更广。Western blot分析结果进一步证实,E-、L-和H-FABP蛋白质在浸润性导管癌表达明显上调(P<0.05)。结论E-、L-和H-FABP与浸润性乳腺导管癌的发生发展有关,对进一步探寻浸润性乳腺导管癌的分子标志及治疗途径具有理论意义。     

乳腺黏液性病变的病理诊断与鉴别诊断

伴有黏液形成的乳腺病变包括含囊腔内黏液的乳腺纤维囊性变、黏液囊肿样病变(mucocele-like lesion ,MLL)、良性病变和(或)伴有不典型导管上皮增生(atypical ductal hyperplasia,ADH)、导管原位癌(ductal carcinoma in situ,DCIS)、黏液性乳头状病变、黏液癌和其他伴间质黏液样物质的病变.除了这些与细胞外黏液相关的病变外,小叶肿瘤、DCIS和浸润性癌,尤其是浸润性小叶癌含有胞质内黏液,还有间质的黏液样变在许多病变如纤维腺瘤和叶状肿瘤,多形性腺瘤和结节性黏蛋白沉积症均可见,恶性类似病变包括产生基质的癌和鳞癌伴黏液间质.本文重点讨论伴有细胞外黏液形成的黏液性乳腺病变的诊断与鉴别诊断,该组病变在良性病变、不典型增生、原位癌及浸润性癌的鉴别上有一定难度.     

乳腺良恶性病变中CD10表达及意义

目的 探讨CD10免疫标记乳腺肌上皮细胞的可行性。方法 收集50例乳腺良恶性病变的石蜡包埋标本(腺瘤、纤维腺瘤、叶状肿瘤、纤维囊性病、导管内乳头状瘤、乳头腺瘤、导管内癌、小叶内癌、浸润性导管癌、浸润性小叶癌)，采用免疫组化(S-P法)检测CD10在上述病变中的表达。结果 在乳腺良性病变中，CD10阳性的肌上皮细胞连续地环绕在普通型增生的小导管的周围。但在囊性扩张或不典型上皮增生的导管周围，CD10阳性细胞不连续，甚至不见阳性细胞。导管原位癌的癌细胞巢外周的阳性细胞由完整到不完整，甚至完全缺失。在浸润性癌中癌巢周围不见阳性细胞，在早期浸润性癌中可见残存的阳性细胞。除少许癌细胞和肌纤维母细胞表达CD10外，其余癌细胞、肌纤维母细胞、血管平滑肌细胞和上皮细胞均不表达CD10。结论 CD10标记肌上皮细胞具有较高的敏感性和特异性，可以作为肌上皮细胞的有效标记物。     

膜联蛋白A2在乳腺癌及乳腺纤维腺瘤中的表达及意义

目的 研究膜联蛋白A2 (Annexin Ⅱ,ANX A2)在乳腺浸润性导管癌和乳腺纤维腺瘤中表达,以探讨其在乳腺癌发生发展中的作用.方法 分别使用免疫组织化学染色(SP)法和逆转录聚合酶链反应(RT-PCR)法检测乳腺浸润性导管癌和乳腺纤维腺瘤中ANX A2的蛋白表达水平和mRNA表达水平,并分析其在不同病理分级、临床分期及有无淋巴结转移的乳腺浸润性导管癌组织中的表达情况.结果 免疫组化结果显示乳腺浸润性导管癌组织中ANX A2表达高于乳腺纤维腺瘤(P＜0.05),RT-PCR结果也显示乳腺浸润性导管癌中ANX A2 mRNA的表达高于乳腺纤维腺瘤(P＜0.05).乳腺癌中ANX A2的表达与年龄、病理分级、临床分期和淋巴结转移呈正相关.结论 乳腺浸润性导管癌中annexinA2表达明显高于乳腺纤维腺瘤,annexinA2可能是乳腺癌的生物学标记物之一,其在乳腺癌的发生发展中可能扮演重要的角色.     

乳腺浸润性导管癌不同分子分型中CD90的表达及其意义

目的 探讨CD90在乳腺浸润性导管癌中的表达及其与临床病理特征、分子分型的相关性。方法 构建80例乳腺浸润性导管癌和20例乳腺良性病变的组织芯片,采用免疫组化Max Vision法检测乳腺不同病变组织中CD90、ER、PR、Ki-67和HER-2的表达水平,并进一步分析其相关性。结果 CD90在乳腺浸润性导管癌和乳腺良性病变中的阳性率分别为62.5%和20.0%,两者差异有统计学意义(P0.001);CD90表达与乳腺浸润性导管癌淋巴结转移相关(P0.05),与患者年龄、肿瘤大小、TNM分期及组织学分级无关(P0.05);在乳腺浸润性导管癌不同分子亚型中,CD90阳性率以Luminal A型最低(40.0%)、三阴型最高(82.4%),各亚型之间差异有统计学意义(P0.05);CD90与ER(r=-0.342,P0.05)、PR(r=-0.374,P0.05)表达呈负相关,与Ki-67表达之间无相关性(r=0.084,P0.05)。结论 CD90表达与乳腺癌分子分型有关,其高表达提示患者预后不良。     

Yes相关蛋白1在乳腺癌中的表达及临床意义

目的探讨yes相关蛋白1(YAP1)在正常乳腺组织及乳腺癌中的表达及其临床意义。方法采用免疫组织化学Envision法检测133例乳腺浸润性导管癌,37例乳腺导管原位癌及47例癌旁组织中YAP1的表达。结果 (1)YAP1在乳腺癌旁组织中的阳性率(81%)明显高于乳腺癌组织中的阳性率(46%)(P0.05);(2)YAP1在乳腺导管原位癌中的阳性率为43%,与乳腺浸润性导管癌之间的差异无统计学意义(P=0.925);(3)YAP1阳性表达与患者年龄、肿瘤大小及淋巴结转移转移无关,而与乳腺癌的分子分型有关(P0.05)。结论在乳腺癌中YAP1可能作为抑癌基因发挥作用,YAP1的表达对乳腺癌的治疗有一定意义。     

Cytodiagnosis of secretory carcinoma of the breast: a report on two cases

Secretory carcinoma of the breast is a rare (<1%) low grade breast carcinoma which shows distinct features at histology. Diagnosis of this carcinoma at fine needle aspiration cytology (FNAC) is difficult. Two cases of secretory carcinoma of the breast presenting as a breast mass, one in a 24-year-old female and the other in a 40-year-old female are reported, highlighting their appearance at FNAC. In both the cases the aspirates were cellular and consisted of clusters and single cells with uniform round nuclei showing minimal nuclear atypia. Most of the cells had moderate to abundant cytoplasm with prominent intracytoplasmic vacuoles. Many cells showed a plasmacytoid appearance and others were binucleate. A typical amphophilic bubbly cytoplasm of the tumor cells was observed. Both cases were confirmed as secretory carcinoma on histology. The differences in cell morphology at FNAC of secretory carcinoma of the breast from other breast carcinomas, and its utility of making a preoperative diagnosis are discussed.     

Comparison of fine-needle aspiration cytology and core biopsy for diagnosis of breast cancer

Both fine-needle aspiration (FNA) cytology and core biopsy are useful in the diagnosis of breast cancer. In order to compare the sensitivities of these procedures, we reviewed 209 patients with breast cancer who had either FNA, core biopsy, or both, and also either mastectomy or lumpectomy. Sensitivities for FNA and core biopsies for diagnosing breast cancer were calculated and compared. Sensitivity for FNA or core biopsies interpreted as either atypical or malignant was 93.8% for FNA and 90.1% for core biopsy (P > 0.05). Sensitivity for FNA or core biopsies interpreted as malignant was 65.4% for FNA and 88.7% for core biopsy (P < 0.0001). Sensitivities of FNA interpreted as either atypical or malignant were 92.4% for FNA performed by pathologists and 100% for FNA by nonpathologists (P > 0.05). Sensitivities of FNA interpreted as malignant were 75.8% for FNA by pathologists and 20.0% for FNA by nonpathologists (P < 0.00001). Both FNA and core biopsies are sensitive procedures for the detection of breast cancer. There was no significant difference between sensitivity of FNA and core biopsies interpreted as either atypia or malignancy, although the sensitivity of core biopsies interpreted as unequivocal malignancy was greater than that of FNA. FNAs performed by pathologists were more sensitive than FNAs performed by nonpathologists in making an unequivocal diagnosis of breast cancer.     

B超与X线对中国人乳腺癌诊断价值的对照研究

目的 比较X线摄影、B超及两者联合应用对中国人乳腺癌的诊断价值,为临床选择检查方法提供参考。方法 根据体检结果,把473例经病理证实的乳腺占位病人分为可触及肿块与未触及肿块两组,采用诊断性试验的方法分别比较两组中X线摄影、B超及两者联合应用(串联、并联)的诊断准确率。结果 可触及肿物组,灵敏度:并联>B超>X线>串联;特异度:串联>B超>X线>并联。未触及肿物组,灵敏度:并联>X线>B超>串联;特异度:串联>B超>X线,并联。B超、X线乳腺摄影及联合应用的灵敏度与特异度亦无明显差异,结果与病检高度一致。结论 B超应作为中国人乳腺癌诊断的首选检查,联合应用X线检查不能提高诊断效率。     

Carcinoma of the breast with metaplasia to chondrosarcoma: a light and electron microscopic study

Two carcinomas of the breast containing large areas of sarcomatous tissue were studied by light and electron microscopy. In one of these, the sarcomatous element was frankly cartilaginous and in the other, predominantly myxoid but with small cartilaginous-looking foci. By light microscopy, a highly suggestive metaplastic transition could be traced from cells within the epithelial nests to those within the sarcomatous lobules. Ultrastructurally, cells in the former region showed epithelial characteristics and those in the latter region, mesenchymal and/or cartilaginous features. The carcinomatous cells contained desmosomes and formed intercellular spaces lined by microvilli; a few cells showed prominent profiles of rough endoplasmic reticulum. In the first case, the cells in the immediate vicinity of the epithelial nests and those in the fully developed cartilaginous regions showed a progressive dilatation of their endoplasmic reticulum to form large sac-like structures filled with a finely granular and floccular material. The intercellular matrix was electron lucent and contained scattered dense particles, fibrillo-granular material and collagen fibres. Condensation of this material at some distance from the cell resulted in the formation of lacunae. In the second case, the cells in the myxoid areas also showed prominent dilatation of endoplasmic reticulum.     

Nodular hidradenoma of the breast: Report of two cases with literature review

Two cases of nodular hidradenoma of the breast with possibly different origins are reported. Case 1 is of a 58 year-old female wlth a breast mass in the left, outer lower-quadrant. A histogenetical origin in the skin adnexal glands was suspected due to its superficial location and immuno-histochemical findlngs. Case 2 is of a 44-yearold male with a subareolar nodule and nipple discharge. Histological examlnation demonstrated that the tumor was located deep in the breast tissue, was surrounded by dilated mammary ducts and exhibited intraductal extenslons, which are all features mlmicking those of breast cancer. Immunohlsto-chemical positivity against gross cystic disease fluid protein-15 was weakly Identified and negativity for endo-plasrnic reticulum was observed. This case can be interpreted as arising In the mammary ducts. It is well known that various kinds of skin adnexal tumors arise in the breast tissue; however, nodular hidradenoma of the breast is still a rare benign neoplasm. Cllnically, nodular hidradenoma of the breast tends to occur in the nipple or subareolar region of the female breast. It should be kept in mind that nodular hidradenoma may occur in mammary ducts and it should be included when differential diagnoses are made of subare olar breast tumors.     

The significance of the diagnosis of atypia in breast fine-needle aspiration

The diagnosis of atypia in breast fine-needle aspiration (FNA) continues to be an area of debate in cytology practice. The aim of this study was to assess the clinical significance of this term and to evaluate potential morphological criteria, which would determine the patient's outcome. A computer-based search was carried out to retrieve breast FNAs performed between 1990 and 2000 that were diagnosed as atypical. Cases followed by surgical resection were reexamined for the presence of morphological features potentially differentiating benign and malignant lesions. Out of 1,568 breast FNAs, there were 64 cases (4%) with a diagnosis of atypia. Thirty-eight cases had surgical follow-up material that revealed malignancy in 14 cases (37%) and benign lesions in 24 cases (63%). The benign diagnostic categories included fibrocystic change (12/24), fibroadenoma (3/24), tubular adenoma (2/24), and nonspecific findings (7/24). The malignant diagnoses included ductal carcinoma (9/14), lobular carcinoma (3/14), ductal carcinoma in situ (DCIS; 1/14), and tubular carcinoma (1/14). The evaluation of cytological criteria used to differentiate benign from malignant lesions (i.e., cellularity, loss of cohesion, myoepithelial cells, nuclear enlargement, nuclear overlap, prominent nucleoli) revealed significant overlap between benign and malignant cases, particularly in cases of fibroadenoma, tubular adenoma, and proliferative breast disease. The surgical follow-up of four hypocellular cases revealed lobular carcinoma in two cases and ductal carcinoma in the remaining two cases. Our study confirmed that the diagnosis of atypia is clinically significant because it is associated with a high probability of malignancy. No morphological criterion is able to reliably differentiate benign and malignant lesions in cases diagnosed with atypia. Diagnosis of atypia is particularly significant in hypocellular cases. We recommended that breast FNAs with a diagnosis of atypia be evaluated further histologically.     

Intracystic papillary carcinoma of the female breast with secretory activity: The significance of aspiration cytology as diagnostic procedure

We report the case of an intracystic papillary carcinoma of the breast in an elderly woman. Gross and microscopic observations support the contention that intracystic fluid is partly a result of secretory activity by the neoplastic epithelial cells and that, intracystic hemorrhage, which may contribute to it, is a secondary event complicating the primary process. Cytology of the aspirated fluid was negative for malignant cells. It is concluded that in the case of large cystic breast lesions, aspiration cytology may not be helpful in establishing the malignant nature of the lesion and that a negative cytology should be interpreted with caution, always taking under consideration the clinical picture of the disease. A concomitant adenocarcinoma was also present in the opposite breast, the second case reported in the literature. © 1995 Wiley-Liss, Inc.     

Effects on the breast of drugs used in fertility regulation

The action of fertility-regulating drugs on the breast is discussed.Compounds such as steroids act directly on breast tissues, whereasothers, such as clomiphene or gonadotrophin, act indirectly.There can be differential responses of the alveolar and ductalsystems. Tissues of a breast tumour typical of epithelial tissueswere analysed for changes in cytosolic and nuclear receptorsfor oestradkl-17 and progesterone following its exposure tothese steroids. Effects on cell multiplication and receptordensity were identified. The relationship of these findingsto benign breast disease and oral contraceptives is discussed.     

Concomitant angiosarcoma and carcinoma of the breast: a case report

A case of concomitant angiosarcoma and carcinoma of the left breast in a forty-three year old woman is described. Following a diagnosis of angiosarcoma she was treated by simple mastectomy. Five months later, left axillary lymph node biopsy showed metastatic adenocarcinoma. Retrospective examination of the mastectomy specimen disclosed a concomitant but separate adenocarcinoma. The patient remains well after 3 years. The implications of this rare association are discussed and the long survival gives an opportunity to review the prognosis in breast angiosarcomas.