首发为乳腺癌的相关多原发癌23例临床分析

目的探讨首发为乳腺癌的相关多原发癌的诊断、治疗及预后。方法回顾性分析乳腺癌相关多原发癌23例患者的临床资料。首发乳腺癌均经根治性手术,或加术后放疗、化疗、内分泌治疗。结果发生率较高的第2原发癌为肺癌7例,占30.43%;乳腺癌4例,占17.39%;甲状腺癌2例,占8.70%;宫颈癌2例,占8.70%;卵巢癌2例,占8.70%;子宫内膜癌2例,占8.70%。结论多原发癌的治疗、预后与复发转移癌有明显区别,首发乳腺癌需积极治疗,提高对第2原发癌的诊断。     

乳腺癌术后伴原发甲状腺癌17例

<正>乳腺与甲状腺同属下丘脑-垂体内分泌轴调节激素的靶器官,内分泌功能的变化与腺体疾病的发生、发展有着密切的关系~([1]),腺体细胞癌变后仍具有激素受体功能,其原来所依赖的激素,如雌激素、甲状腺激素等仍调节着肿瘤细胞的生长。两腺同属内分泌腺体,发病均与情绪密切相关~([2])。有研究发现乳腺癌能增加第二原发癌(second primary malignancies,SPMs)甲状腺癌的发生率~([3-4]),相对于其他原发癌,乳腺癌病人再发甲状腺癌的概率增加     

Bmi-1基因在甲状腺乳头状癌中的表达及意义

目的 分析Bmi-1基因在甲状腺疾病组织中的表达,探讨Bmi-1与甲状腺乳头状癌转移的相关关系及临床意义.方法 采用RT-PCR法检测8例正常甲状腺、18例结节性甲状腺肿、24例甲状腺乳头状癌组织中Bmi-1基因的表达,运用Fisher确切概率法分别对正常组、结甲组和甲癌组检验,判断Bmi-1在各组中的表达.结果①Bmi-1基因阳性表达在正常甲状腺中仅1例(12.5%),在结节性甲状腺肿中有3例(16.7%),而在甲状腺癌中有19例(79.2%),3组阳性率比较差异有统计学意义(P<0.05);②在24例甲状腺癌中,有淋巴结转移的16例(66.67%),无淋巴结转移的8例(33.33%),2组间比较差异有统计学意义(P<0.05);③以年龄为界,在19例阳性表达的甲状腺癌中,年龄≥45岁的12例(63.16%),<45岁的7例(36.8%),2组间比较差异有统计学意义(P<0.05).结论 ①研究证实Bmi-1基因在甲状腺癌中的阳性率明显高于良性甲状腺疾病和正常甲状腺组织;②Bmi-1的表达与淋巴结的转移及年龄有显著相关性,提示它对判断甲状腺乳头状癌的转移机制及预后有一定的临床价值.     

1358例甲状腺结节的临床与病理特征分析

目的分析甲状腺结节的临床与病理特征,寻找甲状腺癌诊断及其发生淋巴结转移的可能因素。方法行手术治疗的甲状腺结节患者1358例,对其年龄、性别、高血压和甲亢病史、癌灶大小、双侧癌、多灶癌、浸润包膜及合并桥本甲状腺炎等特征进行统计学分析。结果 1358例患者中,女性患者占大多数(约80.3%),45岁以上患者占70.0%。其中,264例为甲状腺癌。对良恶性结节患者进行临床特征分析后发现,年龄及高血压病史与恶性结节的发生相关(P0.05),年龄45岁为甲状腺癌的独立危险因素。所有甲状腺癌患者中,37.5%的患者有颈部淋巴结转移,其发生与年龄、高血压、癌灶大小和浸润包膜相关(P0.05),而年龄45岁和癌灶浸润包膜为甲状腺癌发生颈部淋巴结转移的独立危险因素,在甲状腺乳头状癌患者中也同样如此。结论对于年龄45岁的甲状腺结节患者怀疑甲状腺癌者应密切观察或早期干预,对其中癌灶浸润包膜者给予颈部淋巴结清扫,可能让患者获得更好的预后。     

乳头溢液性乳腺癌的选择性乳腺导管造影表现

目的探讨选择性乳腺导管造影对溢液性乳腺癌的诊断价值。方法回顾性分析病理确诊的39例伴溢液的乳腺癌患者的乳腺导管造影表现。结果 39例中导管内乳头状癌7例,导管内癌13例,浸润性导管癌19例。乳腺导管造影主要表现为:导管内充盈缺损24例(61.5%),导管中断15例(38.5%),僵硬或紊乱31例(79.5%),虫蚀征18例(46.2%),潭湖征4(10.3%),断续征17例(43.6%),狭窄24例(61.5%),扩张22例(56.4%)。对于39例乳腺癌,单纯乳腺钼靶平片诊断符合率为64.1%(25/39),导管造影诊断符合率为87.2%(34/39),高于前者,差异有统计学意义(P0.05)。对于13例导管内癌,单纯乳腺钼靶平片诊断符合率为61.5%(8/13),导管造影诊断符合率为100%,高于前者,差异有统计学意义(P0.05)。结论选择性乳腺导管造影可提高乳腺癌的检出率,对导管内癌的早期诊断更具独特诊断价值。     

桥本病合并甲状腺癌的临床分析

目的探讨桥本病合并甲状腺癌的临床病理特点及手术治疗经验。方法回顾性分析本院1996年至2008年外科手术治疗的24例桥本病与甲状腺癌并存患者的临床病理特征以及手术方式的选择。结果桥本病与甲状腺癌并存发生率为12.8%(24/187),其中乳头状癌16例,滤泡状癌5例,混合性癌3例;微小癌7例,占29.2%;双侧甲状腺癌6例,占25%;中央区淋巴结转移13例,占54.2%。根据患者的术前检查结合术中冰冻确定手术方式,包括甲状腺腺叶及峡叶切除、甲状腺次全切除和甲状腺全切除,所有患者均同期行中央区淋巴结清扫。结论桥本病与甲状腺癌并存发生率较高,桥本病并发甲状腺癌术前确诊率低,尤其应警惕合并微小癌的可能。病史、细针针吸活检、彩色超声等综合分析有利于术前诊断,手术是其最有效的治疗方法。     

乳腺浸润性导管癌组织中ERα-36表达及临床意义

目的:探讨ERα-36在乳腺浸润性导管癌的表达及相关因素。方法:应用免疫组织化学法检测70例乳腺浸润性导管癌组织中ERα-36的表达,比较ERα-36在4种分子亚型中的表达,及其与年龄、肿瘤大小、临床分期、组织学分级、淋巴结转移、ERα-66、PR、Her-2、Ki-67的关系。结果:ERα-36在浸润性导管癌组织的阳性率为52.9%,在luminal A型、luminal B型、Her-2过表达型、三阴性乳腺癌中的阳性率分别为40.9%、30.1%、66.7%、84.6%;ERα-36在三阴性及非三阴性乳腺癌的阳性率分别为84.6%和45.6%,有统计学差异(P<0.05)。ERα-36表达与ERα-66、Ki-67及淋巴结转移有关(P0.05)。结论:ERα-36在三阴性乳腺癌中高表达,提示其可作为三阴性乳腺癌治疗的潜在靶点。     

雌激素受体表达与甲状腺疾病的研究

本文研究甲状腺组织中雌激素受体(ER)的存在以及在不同疾病组织中的分布情况,分析雌激素在甲状腺疾病中的意义。材料与方法1.材料人甲状腺疾病标本64例,包括结节性甲状腺肿22例,甲状腺腺瘤8例,甲状腺癌31例(乳头状癌27例,滤泡状癌3例和磷状细胞癌1例),甲状腺炎3例。10例瘤旁正常甲状腺组织。乳腺癌组织作为ER阳性对照。男16例,女48例,年龄14～70岁,平均年龄44岁。2.方法用甲状腺组织石蜡切片,改良ABC免疫组化法染色,采用Dako公司生产的单克隆抗体。一抗为兔抗雌二醇受体抗体,二抗为生物素标记的羊抗兔抗体,三抗为ABC试剂。主要过程如下…     

甲状腺癌108例临床病理分析

目的探讨甲状腺癌临床病理特点。方法回顾性分析2005-10—2013-10间术后病理诊断为甲状腺癌的108例患者的临床病理资料。结果乳头状癌88例(81.5%,髓样癌10例(9.3%),滤泡癌8例(7.5%),未分化癌1例(0.9%),鳞状细胞癌1例,(0.9%)。男女发病比例为1:3.68。结论甲状腺癌的病理类型对临床的诊断及治疗以及预后有重要意义。     

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目的 探讨甲状腺癌的临床诊治新特点.方法 回顾性分析复旦大学附属肿瘤医院头颈外科 2006年收治的572例甲状腺癌的临床资料.结果 在该组样本中,乳头状癌531例(占92.8%).中央区淋巴结转移301例(占52.6%),侧颈区淋巴结转移117例(占20.5%),远处转移共8例.超声对甲状腺癌原发灶诊断的准确率为88.2%.甲状腺微癌204例(占35.7%),其中167例为普查时超声发现.结论 颈部淋巴结转移率与原发灶直径呈正相关.甲状腺微癌逐渐增多,这可能是甲状腺癌发病率增高的主要原因.     

PAPILLARY THYROID CARCINOMA ARISING IN THYROGLOSSAL DUCT CYSTS: INCIDENCE AND MANAGEMENT

The incidence and pathological features of papillary thyroid carcinoma arising in the thyroglossal duct cysts were reviewed and compared with papillary thyroid carcinoma arising elsewhere in the thyroid gland. In the 30 year period 1964 to 1993 there were 90 thyroglossal duct nodules or cysts treated surgically at the Endocrine Surgical Unit, Royal North Shore Hospital, Sydney, Australia. There were four cases of papillary thyroid carcinoma in this group (4.4%). In the same period 2814 cases presented with clinical single thyroid nodules which were treated surgically. There were 182 cancers in this group of which 121 were papillary thyroid carcinomas (4.3% of total cases). This is identical to the incidence seen in the thyroglossal duct. We conclude that the incidence of papillary thyroid carcinoma arising in the thyroglossal duct is no different to that arising elsewhere in the gland. The difference in number of carcinomas related only to the volume of follicular thyroid tissue present in the gland proper. That being the case, there is no reason to treat these cancers differently from papillary thyroid carcinoma elsewhere in the gland.     

甲状腺功能亢进合并甲状腺癌的诊断和外科治疗

目的 探讨甲状腺功能亢进合并甲状腺癌的诊断及治疗方法.方法 回顾性分析北京协和医院从1983年1月至2009年7月收治的并经外科手术治疗和病理证实的48例甲状腺功能亢进合并甲状腺癌患者的临床资料.结果 甲状腺功能亢进合并甲状腺癌患者占同期甲状腺功能亢进手术患者的2.02%(48/2378),占同期甲状腺癌手术患者的3.03%(48/1584).手术方式包括双侧甲状腺大部切除术(31例)、患侧全切对侧大部切除和区域性淋巴结清扫术(6例)、双侧全切及淋巴结清扫术(11例).术前超声诊断阳性率为61.3%,甲状腺核素显像的诊断阳性率为62.5%;48例患者中获随访40例,时间1～264个月,中位随访时间130.5个月.随访中无甲状腺功能亢进复发病例,2例患者术后第二年出现肺、骨转移.结论 超声检查和核素显像对于术前诊断有重要意义,甲状腺功能亢进合并甲状腺隐匿癌和微小癌的临床诊断较困难,多于手术后病理诊断.甲状腺功能亢进合并甲状腺乳头状癌的患者手术治疗效果良好,预后较好.     

男性乳腺癌38例临床病理分析

目的 分析男性乳腺癌的临床病理及分子分型特点。方法 回顾分析宁波市临床病理诊断中心2013年1月至2019年3月38例男性乳腺癌病例的临床病理和分子分型资料。结果 38例男性乳腺癌病人，占同期乳腺癌病人0.83%，中位年龄68.5（24～88）岁，病灶位于左侧20例，位于右侧18例。其中29例为浸润性导管癌，2例为分泌性癌，1例为实性乳头状癌伴微浸润， 2例为导管内乳头状癌伴微浸润，4例为包裹性乳头状癌（其中2例伴微浸润）。浸润性导管癌组织学分级Ⅰ级2例，Ⅱ级20例，Ⅲ级7例。16例伴淋巴结转移。免疫组化染色：36例ER 阳性，35例PR阳性。分子分型Luminal A型18例，Luminal B型16例，基底细胞型2例。结论 男性乳腺癌少见，发病年龄较晚，临床分期较高，预后较差，且发生第2种原发性癌的可能性增加，加强对其认识，争取早期诊断、治疗及监测非常重要。男性乳腺癌仍须扩大样本量进一步研究。     

Thyroid disorders. Part III: neoplastic thyroid disease.

This paper is part III of the series on thyroid disorders. Thyroid tumors are the most common endocrine neoplasms. Most of these tumors are benign hyperplastic or colloid nodules or benign follicular adenomas. However, 5% to 10% of the lesions that come to medical attention are carcinomas. A major clinical challenge is establishing which nodules are hyperplastic, benign, or malignant. History, clinical findings, ultrasonography, and fine-needle aspiration biopsy are the mainstays for diagnosis. There are 3 main histologic types of thyroid cancer: differentiated, medullary, and anaplastic. Differentiated lesions are subdivided into papillary, follicular, and Hurthle cell carcinomas. In addition, primary lymphoma may occur in the thyroid gland and other cancers may metastasize to the thyroid. An important neoplastic syndrome, multiple endocrine neoplasia type 2 (MEN2), involves medullary carcinoma of the thyroid gland. In 2002 there were 10 cases of thyroid cancer per 100 000 population. During the past 10 years the rate of thyroid cancer has been increasing 5% per year. The overall 10-year survival for papillary carcinoma is 80% to 90%, follicular carcinoma 65% to 75%, and medullary carcinoma 60% to 70%. The prognosis for anaplastic carcinoma is very poor and 5-year survival is rare. The dentist by inspection and palpation of the neck in the area of the thyroid gland may detect single or multiple lesions that may be benign or malignant. Patients with identified nodules or enlarged thyroid glands should be referred for diagnosis and treatment. Patients with thyroid cancer will benefit from the early detection and treatment of their lesions as early detection can lead to a cure or prolongation of their life.     

Diagnosis and treatment of intracystic breast carcinomas

Cystic breast masses are very common in female patients attending breast clinics. Most of them are benign and managed by simple aspiration. We reviewed histology records for the last 12 years to find patients with cystic breast carcinomas and to evaluate special clinical signs that may help to identify patients with this rare entity. Eighteen patients with cystic breast carcinomas were found among 1510 new breast cancer patients (1.19%) who were seen at our Breast Unit during this period. Ten had intracystic papillary carcinoma (0.66% of all breast cancers), seven had cystic degeneration of ductal carcinoma, and one had a mucinous carcinoma. The diagnosis of intracystic papillary carcinoma was based on cyst fluid cytology and breast imaging in most patients and on open breast biopsy in two cases only. The prognosis of our cystic breast carcinoma patients was excellent regardless of the specific histologic type of the tumor. We conclude that cysts in postmenopausal women should be viewed with suspicion. Bloodstained aspirated cyst fluid should be sent for cytology and breast imaging should be carried out in all these cases. Residual mass after cyst aspiration is also an indication for open biopsy.     

Expression of WT1, CA 125, and GCDFP-15 as useful markers in the differential diagnosis of primary ovarian carcinomas versus metastatic breast cancer to the ovary

Metastatic breast carcinoma to the ovary is sometimes difficult to differentiate from primary ovarian carcinoma. This problem is often encountered in breast carcinoma patients who develop adnexal masses. ER and PR can be positive in a high percentage of breast and ovarian carcinomas, and therefore cannot be used in the differential diagnosis of these entities. WT1 and CA125 have been identified as possible markers for ovarian cancer. However, no studies have been done that specifically compare the immunophenotype of breast carcinoma metastatic to ovary with that of primary ovarian cancer. Thirty-nine cases of metastatic breast carcinoma to the ovary, 36 primary breast carcinomas, and 42 primary ovarian carcinomas were examined immunohistochemically for the expression of WT1, CA125, carcinoembryonic antigen, MUC2, MUC1, and GCDFP. The percentage of cells stained and the intensity of staining were recorded. Thirty-two ovarian carcinomas (76%) were positive for WT1, including 31 of 33 (94%) serous carcinomas. Most of them had strong and diffuse staining. None of the breast cancers either primary or metastatic to the ovary expressed WT1. Thirty-eight (90%) ovarian carcinomas were positive for CA125, most of them with strong and diffuse staining. Most breast carcinomas were negative for CA125, with only 6 (16%) of the primary ones and 5 (12%) of the metastatic showing weak and focal positivity. All ovarian carcinomas were negative for GCDFP. Five primary breast cancers (14%) and 17 (43%) metastatic to the ovary were positive for GCDFP. Nine (21%) ovarian carcinomas, 8 (22%) primary breast carcinomas, and 13 (33%) metastatic to the ovary were positive for carcinoembryonic antigen. Almost all tumors examined were positive for MUC1 (100% ovarian carcinomas, 100% primary breast carcinomas, and 95% metastatic breast carcinomas to ovary). MUC2 was positive in 10 (24%) ovarian carcinomas, 3 (8%) primary breast cancers, and 12 (30%) metastases to the ovary. The presence of immunoreactivity for WT1 and CA125 in a carcinoma involving ovary strongly favors a primary lesion. Most ovarian carcinomas are positive for both markers, whereas the majority of metastatic breast carcinomas to the ovary are negative. GCDFP can be complementary in this differential diagnosis.     

芳香化酶在乳腺癌中表达的临床病理学观察

目的研究芳香化酶对乳腺癌增殖和侵袭性的影响,探求乳腺癌局部产生的雌激素与乳腺癌生物学特性的关系。方法应用免疫组织化学方法检测腋淋巴结无转移的原发性乳腺癌组织内芳香化酶的表达,分析其与金属蛋白酶2（matrix metalloproteinases 2,MMP2）、金属蛋白酶9（matrix metalloproteinases 9,MMP9）及肿瘤的大小、分级和雌激素及孕激素受体等的相关性。结果在原发性乳腺癌细胞中芳香化酶的表达弱阳性（＋）者占25．0％、阳性（＋＋）者占29．9％;芳香化酶状态与MMP2、MMP9以及二者的共表达成正相关（P〈0．05）,但与肿瘤的大小、ER与PR表达、月经状态、组织学类型及病理分级无相关性（P〉0．05）;在绝经后患者中芳香化酶的表达与肿瘤的大小成正相关（P〈0．05）,而在绝经前的患者中二者无相关性（P〉0．05）;在ER和（或）PR阳性的肿瘤中芳香化酶的表达与MMP2／MMP9的共表达成正相关（P〈0．05）,而在ER和PR均阴性的肿瘤中二者无相关性（P〉0．05）。结论乳腺癌组织内表达的芳香化酶所产生的局部雌激素环境在部分乳腺癌中可能通过ER通路刺激肿瘤的增殖及增强肿瘤的侵袭性,这一现象在绝经后的患者体内表现更为明显。     

完全腔镜下甲状腺乳头状癌根治术的临床应用价值

目的:探讨完全腔镜下甲状腺乳头状癌根治术的临床应用效果及安全性。方法:选择2010年5月至2015年7月收治的70例确诊为甲状腺乳头状癌并行手术治疗的患者作为研究对象,其中腔镜组33例,开放手术组37例。对比分析两组患者围手术期资料、临床疗效及并发症情况。结果:腔镜组患者术中出血量、引流量、切口长度、术后24 h疼痛评分均显著低于开放组(P0.05),手术时间、术后3个月美容评分均显著高于开放组(P0.05),两组清扫淋巴结数量、总并发症发生率差异均无统计学意义(P0.05)。结论:完全腔镜下甲状腺乳头状癌根治术安全、美观、疗效确切,但手术时间明显延长。     

Differentiated thyroid cancer associated with intestinal polyposis syndromes: A review

Intestinal polyposis syndromes, such as familial adenomatous polyposis (FAP) and Cowden's syndrome, are often associated with extraintestinal manifestations, and while many of these manifestations are benign, malignant extraintestinal manifestations, such as differentiated thyroid cancers, do occur. Although differentiated thyroid cancers (ie, papillary and follicular thyroid carcinomas) are associated with multiple syndromes, they are most commonly associated with intestinal polyposis syndromes. In the general population, the probability of developing thyroid cancer by age 65 years is only .5%. However, 1% to 2% of patients with FAP develop papillary thyroid carcinoma, the most common extraintestinal malignancy in patients with FAP. Also, up to 10% of patients with Cowden's syndrome will develop follicular thyroid carcinoma. The purpose of this review was to provide an overview of FAP, Cowden's syndrome, and Peutz‐Jeghers syndrome, to discuss in detail the associations between intestinal polyposis syndromes and differentiated thyroid cancers, and to provide suggestions for screening and managing these diseases. © 2009 Wiley Periodicals, Inc. Head Neck, 2009