副乳腺癌诊治研究

目的：探讨副乳腺癌的临床特点及诊治方法。方法：应用PubMed及CNKI期刊全文数据库检索系统,以“副乳腺、副乳腺癌、诊断、治疗”等为关键词,检索1990-2013年相关文献。纳入标准：1）副乳腺癌的临床及病理;2）副乳腺癌的诊断及鉴别;3）副乳腺癌的治疗及预后。根据纳入标准符合分析文献43篇。结果：副乳是一种男女都能够出现的先天性发育异常,女性患者多见。副乳腺癌病变部位异常,临床表现常以腋下肿块为首发症状,易被漏诊和误诊。肿瘤生长迅速,发现较晚且副乳癌区域淋巴结丰富,发生转移早,确诊时患者常处于临床晚期阶段。副乳腺癌的预后比乳腺癌差。诊断时需要与腋窝淋巴结转移性乳腺癌、淋巴结肿大和汗腺癌等疾病鉴别。副乳腺癌在病理及影像学表现方面有其独特性,能够为诊治提供帮助。结论：副乳腺癌临床较为少见,预后较差。诊断主要依据影像学资料和术后病理。治疗应遵循以手术为主的综合治疗,手术方法推荐副乳腺区扩大切除加腋窝淋巴清除。争取早期诊断是改善预后的关键。     

c—erbB—2在不同乳腺病变组织中的表达及其临床意义的研究

目的：探讨c-erbB-2癌基因蛋白在乳腺组织中的表达及对乳腺癌早期诊断的价值。方法：采用免疫组化方法检测170例不同乳腺病变的c-erbB-2表达水平，结果：c-erbB-2癌基因的表达与液淋巴结转移（P＜0．01）和乳腺癌组织学类型有，特别是它在癌前病变中有表达，结论： 0-erbB-2癌基因蛋白既可做乳腺癌早期诊断指标，也可作为预后因素的判断。     

乳腺化生性癌8例临床病理分析

目的：探讨乳腺化生性癌的临床病理特征、鉴别诊断及预后。方法：对我院8例乳腺化生性癌进行临床表现、组织病理学和免疫表型观察。结果：2例为鳞状细胞癌,6例为癌肉瘤,其中2例伴软骨化生。免疫组化检测鳞状细胞癌表达p63、CKH,癌肉瘤上皮成分表达Ckpan,间叶成分表达Vimentin,伴软骨分化者表达S-100。2例淋巴结转移,完整随访6例,3例复发,1例存活,2例死亡。结论：原发于乳腺的化生性癌较罕见,诊断需与乳腺浸润性导管癌3级、乳腺原发性肉瘤、恶性叶状肿瘤等相鉴别。免疫组化Ckpan、Vimentin、S-100、p63、CKH等是一组有用的标记物。     

隐匿性乳腺癌7例临床分析及文献复习

背景与目的：隐匿性乳腺癌是临床较少见的特殊类型乳腺癌,本文拟就其诊断、治疗和预后作一探讨。方法：选择自1990年5月-2001年5月在我院胸外科收治的7例隐匿性乳腺癌的临床资料进行回顾性分析。结果;本组全为女性,占同期乳腺癌的0.59%,临床症状以腋下肿块为首发症状,体查双乳均未解及明显肿块。术前行腋下肿块或细针穿刺,均找到癌细胞。本组全作乳腺钼靶X线照片,1例考虑乳腺癌可能。3例作双乳B超检查,1例考虑乳腺癌。本组5例行Halsted根治术,2例行良改根治术,术后4例在乳腺大体标本找到原发病灶,3例为浸润性导管癌,1例为导管内癌。术后2例予辅助化疗加放疗,5例予辅助化疗,4例予口服三苯氧胺治疗。本组全部随访,均仍生存,3例生存巳超过2年半,最长1例生存巳达7年。结论：临床上对女性腋窝肿块应高度警惕隐性乳腺癌的可能,术前予细针穿刺、腋下肿块活检（或加ER、PR检测）对帮助诊断有好处;乳腺钼靶照片和乳腺B超对乳腺原发病灶的检出率较低,多需术后乳腺大体标本病理切片确诊。治疗方法多采用乳腺癌根治术或改良根治术,术后辅以化疗、放疗等综合治疗,预后优于或相似于乳腺内肿块且伴有腋下淋巴结转移的乳腺癌。     

42例早期乳腺癌的临床分析

目的：探讨早期乳腺癌的临床特点及诊断方法。方法：对我院自2007年4月-2009年10月42例有完整临床资料的早期乳腺癌患者进行回顾性分析。结果：42例早期乳腺癌：T0期癌17例,微小癌25例。早期乳腺癌DR诊断出T0癌15例,微小癌18例,彩超诊断出T0癌12例,微小癌17例。结论：对于有乳腺癌高危因素和或有乳腺异常表现的患者采取乳腺DR及彩超联合检查能提高早期乳腺癌诊断率。     

副乳腺癌17例临床病理特征及预后分析

目的:探讨副乳腺癌患者的临床病理特征、诊断、治疗及预后。方法:回顾性分析我院乳腺科2007年1月至2017年12月收治的17例副乳腺癌患者的临床病理资料、诊疗及预后情况，随机抽取同期85例乳腺癌患者对照分析。结果:17例副乳腺癌患者占同期15 500例乳腺癌的0.11%，中位年龄48岁，绝经患者5例，7例有肿瘤家族史，6例行改良根治术，余下患者行保留乳房的腋下肿瘤扩大切除加腋窝淋巴结清扫术。组织学类型最常见为浸润性导管癌14例，其他类型3例。分子分型最常见为Luminal A 9例，Luminal B 2例，HER-2型2例，三阴型4例。病理分期最常见为III-IV期12例。副乳腺癌患者3年无病生存率（disease free survival,DFS）为27.9%，明显低于常规乳腺癌3年DFS 70.8%（P＜0.05），与腋窝淋巴结阳性的乳腺癌患者相比，无统计学差异。结论:副乳腺癌发病率低，发病部位隐匿，易出现漏诊和误诊，易出现淋巴结转移，预后较常规乳腺癌差。     

乳腺黏液癌7例临床病理分析

目的：探讨乳腺黏液癌的临床及病理特征,对其诊断、病理分型和鉴别诊断进行讨论。方法：对7例乳腺黏液癌患者进行回顾性分析,同时复习相关文献。结果：本组黏液腺癌占同期乳腺癌的4.73%,中位年龄42岁,绝经前患者占71.43%,病灶大小1.0-6.5cm。单纯型黏液癌均无腋窝淋巴结转移,混合型转移率为33.33%。结论：国内30-50岁女性,临床诊断为良性纤维瘤的乳房肿块,需警惕为乳腺黏液癌。乳腺黏液癌生长缓慢,预后较好。     

副乳腺癌(附3例报告)

本文报告3例腋下副乳腺癌。临床均查见副乳腺存在,副乳腺组织与乳房无关。镜捡除乳腺癌组织外,见有腺小叶结构和管内癌成分。本病治疗同乳腺癌,预后较差。     

乳腺微小癌的临床诊断

目的探讨肿块直径＜1.0 cm乳腺微小癌的临床诊断方法.方法对194例乳腺微小癌的临床检查,钼靶X线检查以及超声检查结果进行综合分析.结果临床检查:194例乳腺微小癌均为单发;肿块质地硬、活动差、边界不清的临床诊断阳性率高于肿块质地韧、软、活动好、边界清者;腋下触及淋巴的结临床诊断阳性率低于腋下未触及淋巴结者.钼靶X线检查:肿块影和细砂钙化与结构不良及腺体致密的钼靶X线表现相比,诊断阳性率高,平均年龄大.超声检查:数字彩色超声检查诊断乳腺微小癌阳性率高于普通B型超声检查.超声诊断可疑癌和乳腺癌的平均年龄大于超声诊断纤维瘤和增生结节的平均年龄.结论严格掌握乳腺微小肿块的临床诊断标准,高度注意钼靶X线片肿块影及细砂钙化表现,对腺体结构不良及腺体致密者不能轻率诊断良性.数字彩色超声检查可提高乳腺微小癌检查的阳性率.     

乳腺巨纤维腺癌18例临床诊治探讨

目的：探讨乳腺巨纤维腺瘤的诊断和治疗方法。方法：通过对１８例乳腺巨纤维腺瘤的临床表现，进行术前检查以及术中快速冰冻检查，术后经病理证实为乳腺纤维腺瘤，以乳房肿块切除为主要手术方式，不必行乳房单纯切除术，术中应注意保护正常腺体。结果：乳腺巨纤维腺瘤临床较少见，因属于良性肿瘤，预后较好。结论：乳腺巨纤维腺瘤临床表现多样，易与乳腺癌、乳腺叶状囊肉瘤误诊，诊断和治疗的错误可能加重患者及家属的心理负担，因而     

A case of carcinoma originating from accessory breast tissue of the axilla

We report a case of carcinoma originating from accessory breast tissue of axilla and review 33 reported cases of carcinoma in heterotopic breast tissue. Although the incidence of accessory breast cancer is not high, early diagnosis and treatment are necessary, keeping in mind the possibility of this carcinoma when subcutaneous nodules of uncertain origin are found around the breast. Surgical treatment which must at least include wide local extirpation including the surrounding tissues and dissection of the axillary lymph nodes is necessary and adjunctive chemotherapy and irradiation appear to be useful.     

Coexistence of breast cancer and tuberculosis in axillary lymph nodes: a case report and literature review

Coexistence of breast cancer and tuberculosis (TB) of the breast and/or axillary lymph nodes is uncommon. In this article, we present a case of tuberculous axillary lymphadenitis existing simultaneously with invasive ductal carcinoma of the left breast. We also conducted an extensive literature review of English language studies published on the coexistence of breast cancer and TB of the breast and/or axillary lymph nodes from 1899 to 2011 using the PubMed and Google Scholar databases. Twenty-nine cases of coexisting breast cancer and TB of the breast and/or axillary lymph nodes have been published to date, including a 74-year-old female diagnosed with left breast cancer and TB of the axillary lymph nodes. A tumor in the right breast was detected in 14 patients and in the left breast in 12 patients between the ages of 28 and 81 years, but no data were available regarding the side on which the tumor occurred in three patients. Eighteen patients underwent a modified radical mastectomy, five patients underwent a radical mastectomy, two a lumpectomy and an axillary lymph node dissection (ANLD), two a quadrantectomy (Q) and an ALND, and two an applied excision. TB was detected at the axilla in all 21 patients in patients with no TB of the breast, and TB was also detected in the axilla in five of eight patients with breast TB. Both a tumor and TB lymphadenitis were detected following an axillary dissection in 14 patients, and both cancer metastasis and TB lymphadenitis were detected at the same lymph nodes in six of these patients. The simultaneous occurrence of these two major illnesses in the breast and/or axillary lymph nodes can produce many problems with respect to diagnosis and treatment. Accurate diagnoses are necessary for down-staging carcinoma of the breast and for identifying curable disease.     

Is dissection of the internerve tissue during axillary lymphadenectomy for breast cancer necessary?

AIMS: The study evaluates the necessity of dissecting the tissue between the long thoracic and thoracodorsal nerves (internerve tissue) during axillary dissection in breast cancer surgery. By reviewing the lymph node yield and the metastatic rate in the internerve tissue, we examine whether the internerve tissue could be left in situ to minimize the risk of nerve injury. METHODS: A prospective study was conducted on 30 consecutive women undergoing axillary lymphadenectomy for breast cancer. The internerve tissue remaining was excised separately after a routine axillary dissection and was examined by the same pathologist. RESULTS: Twenty (67%) of 30 internerve specimens contained lymph nodes; the internerve nodes were positive for carcinoma in three cases (10%). In one case the lymph node in the internerve tissue was the only metastatic node in the axilla. CONCLUSIONS: There is a significant incidence of lymph nodes (67%) and axillary node metastases (10%) in the tissue lying between the long thoracic and thoracodorsal nerves. Therefore excision of this internerve tissue is strongly recommended in order to optimize decision making regarding adjuvant treatment and oucome in women with operable breast cancer.     

Breast cancer metastasis and lymph node lymphocyte-macrophage interaction

A lymphocyte-macrophage interaction, known as the lymphocyte clustering phenomenon, was studied in axillary lymph node preparations from 27 breast cancer patients. The study was carried out in primary tissue cultures of lymph nodes and the lymphocyte-macrophage interactions were quantitated with respect to cancer positive and cancer negative axilla. The results indicate that there is a significantly higher (p< 0.025) lymphocyte-macrophage interaction in negative node preparations from negative axilla of infiltrating ductal carcinoma patients. This new approach to lymph node lymphocyte evaluation may provide assistance in determining the extent of the disease process.     

Tuberculosis of axillary lymph nodes with primary breast cancer

A rare case of tuberculosis of axillary lymph nodes occurring with primary breast cancer is presented. A 78-year-old woman with no history of pulmonary tuberculosis was admitted to our hospital to undergo examination for a lump in her right breast. The tumor was in the upper outer quadrant of the right breast. On palpation, the tumor was 1.2 cm in diameter and axillary lymph node swelling was noted. Mammography disclosed a spiculated mass and swelling and calcification of the axillary lymph nodes. Sonography showed an irregular hypoechoic mass in the right breast and lymph node swelling in the right axilla, indicating breast cancer with axillary lymph nodes metastases. Chest X-ray showed clustered calcifications in the right axilla and a granular shadow in the right upper lobe. Breast conserving therapy was carried out. Invasive papillotubular carcinoma of the right breast and granulomas with calcification of lymph nodes, compatible with tuberculosis, was diagnosed. Tubercle bacillis were detected by culture of lymph nodes. This case suggests that X-ray is useful for diagnosing lymph node tuberculosis. Lymph node tuberculosis should be suspected when lymph node swelling is noted and X-ray shows clustered calcifications in axillary lymph nodes.     

Synchronous bilateral male breast cancer: a case report

Synchronous bilateral breast cancer is extremely rare in men and has not, up to date, been reported in Korea. A 54-year-old man presented with a palpable mass in the right breast. The right nipple was retracted and bilateral axillary accessory breasts and nipples were present. On physical examination, a 2 cm-sized mass was palpated directly under the right nipple, and, with squeezing, bloody discharge developed in a single duct of the left nipple. There was no palpable mass in the left breast, and axillary lymph nodes were not palpable. Physical examination of external genitalia revealed a unilateral undescended testis on the left side. Synchronous bilateral breast cancer was diagnosed using mammography, ultrasonography, and core-needle biopsy. Histopathological examination revealed invasive ductal carcinoma in the right breast and ductal carcinoma in situ in the left breast. Bilateral total mastectomy, sentinel lymph node biopsy, and excision of accessory breasts in the axilla were performed.     

Determination of axillary nodal status in surgery of breast carcinoma: A prospective study of thirty-five patients

Thirty-seven axillary status of patients with breast carcinoma was studied with preoperative and peroperative palpation before mastectomy and total axillary dissection. Special attention was paid to the clinical supiciousness and size of axillary nodes. The preoperative axillary palpation gave false diagnosis of axillary content 27% of the time and peroperative, 19%. Of all 249 nodes studied, 54 were found to contain malignant growth in routine histological examination. Mean diameter of malignant nodes was 12.4 mm and of benign nodes, 6.3 mm. The most clinically suspect axillary lymph node gave correct diagnosis of axillary status in 72 % of the cases. The 2 most suspect lymph nodes together were positive in 89%. There was no case with histologically positive axilla where none of the 3 most suspect lymph nodes was malignant. We conclude that at least the 3 most suspect axillary lymph nodes must be removed for histological examination to be sure that axillary metastasizing of breast carcinoma can be found by routine histological examination.     

乳腺癌新辅助治疗后前哨淋巴结活检术应用的研究进展

腋窝淋巴结清扫术(axillary lymph node dissection,ALND)是新辅助治疗(neoadjuvant treatment,NAT)后腋窝淋巴结标准的处理方式.然而,ALND不能使NAT后腋窝淋巴结病理性完全缓解(pathologic complete response,pCR)的患者获益.现已证实,对于临床诊断腋窝淋巴结阴性(cN0)患者,前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)可对其腋窝淋巴结进行准确评估,使部分患者免于接受ALND.目前多家研究机构着力将SLNB引入NAT后cN0的乳腺癌的治疗中,并在提高其检出率,降低假阴性率等方面获得了长足的进步.本文对近年来SLNB应用于NAT后cN0乳腺癌治疗的相关研究成果及诸多用于提高其准确性的方法进行阐述.