乳腺原发非何杰金淋巴瘤临床病理及免疫组化分析（附8例报告）

收集８例乳腺原发性非何杰金淋巴瘤进行回顾性研究。６例临床诊断乳腺癌并行根治术，其中４例术中冰冻切片，均误诊为髓样癌和低分化癌。７例作了免疫组化检查，ＬＣＡ全部阳性，其中６例Ｌ２６阳性，１例ＵＣＨＬ１阳性，余１例为髓外浆细胞瘤，提示乳腺恶性淋巴瘤多数为Ｂ淋巴细胞性。研究结果显示：本病在临床和病理诊断中易误诊为乳腺癌，免疫组化有助于鉴别诊断。     

5例乳腺原发性恶性淋巴瘤临床病理学观察

目的：观察乳腺原发性恶性淋巴瘤（PBL）的临床病理特点。方法：采用HE和免疫组化技术对5例PBL进行病理组织学观察。结果：5例BPL临床都被误诊为乳腺癌,术后随访4年,其中1例于术后1年死亡,余4例存活。PBL的病理组织学特征为边界清楚的肿块,HE切片显微镜观察见淋巴瘤细胞灶性浸润导管／小叶上皮,免疫组化染色瘤细胞LCA、CD20阳性。结论：淋巴瘤细胞灶性浸润导管／小叶上皮是PBL的重要特征,应也乳腺典型髓样癌;乳腺假淋巴瘤鉴别。     

5例乳腺原发性恶性淋巴瘤临床病理学观察

目的:观察乳腺原发性恶性淋巴瘤(PBL)的临床病理特点.方法:采用HE和免疫组化技术对5例PBL进行病理组织学观察.结果:5例PBL临床都被误诊为乳腺癌,术后随访4年,其中1例于术后1年死亡,余4例存活.PBL的病理组织学特征为边界清楚的肿块,HE切片显微镜观察见淋巴瘤细胞灶性浸润导管/小叶上皮,免疫组化染色瘤细胞LCA、CD20阳性.结论:淋巴瘤细胞灶性浸润导管/小叶上皮是PBL的重要特征,应与乳腺典型髓样癌、乳腺假淋巴瘤鉴别.     

原发性乳腺弥漫性大B细胞淋巴瘤13例临床分析

目的 探讨原发性乳腺弥漫性大B细胞淋巴瘤（PB-DLBCL）的临床特征、诊断和治疗。方法 回顾性分析2010年1月至2015年11月13例PB-DLBCL患者的临床资料。13例均接受手术治疗,其中4例行乳腺癌改良根治术,1例行单侧乳腺切除术,8例行乳腺肿块切除术。结果 13例均为女性,6例发生于右乳,6例发生于左乳,1例发生于双乳。肿块大小1.5 cm～8.0 cm。术前2例诊断为乳腺纤维腺瘤,1例诊断为巨纤维瘤,10例诊断为乳腺癌。13例患者均经免疫组化检测确诊为PB-DLBCL。Ann Arbor分期：Ⅰ期10例,Ⅱ期3例。12例术后给予CHOP或R-CHOP方案化疗,1例放弃治疗。随访1个月～5年,2例复发,2例死亡,其余病例均无复发生存。结论 PB-DLBCL临床少见,多见于女性。术前检查、术中冰冻病理检查易误诊,免疫组化检查可明确诊断。治疗采用以化疗为主的综合治疗。     

抗人乳腺癌单克隆抗体BG6在乳腺癌诊断和鉴别诊断中的应用

本文应用抗人乳腺癌单克隆抗体BG6对26例临床与病理疑难的乳腺疾病进行免疫组织化学研究。对乳腺的原发或继发癌的鉴别诊断13例中,阳性11例,定为原发瘤;阴性2例则为继发瘤。在难分良、恶性诊断8例中,阳性6例,确诊恶性,其余2例阴性为良性。而在恶性淋巴瘤3例中皆为阴性,1例阳性确诊为未分化癌。这一结果表明,抗人乳腺癌单克隆抗体BG6除有其敏感性外,还具有一定的特异性和选择性。它不仅在乳腺癌的鉴别诊断中有一定的实用价值,而且还可望进一步用于乳腺肿瘤的免疫病理研究。     

乳腺常规超声与超声造影对早期乳腺癌的诊断价值

目的探讨乳腺常规超声与超声造影对早期乳腺癌的诊断价值。方法选取2016年5月至2019年5月间西安交通大学第二附属医院收治的80例早期乳腺癌患者进行回顾性研究,所有患者分别进行常规超声检查和超声造影检查。分析良恶性乳腺肿瘤的特征,并与穿刺或术后病理结果进行比较,分析两种检测方法的诊断价值。结果超声造影结果提示,乳腺恶性肿瘤主要为不均匀增强及周边增强,乳腺良性肿瘤主要为无增强和均匀增强为主。33例患者经常规超声诊断,良性16例,恶性17例,其中误诊10例(4例误诊为良性,6例误诊为恶性); 47例患者经超声造影诊断,良性12例,恶性35例,其中误诊5例(良性误诊2例、恶性误诊3例)。常规超声诊断良恶性乳腺疾病的敏感性、特异性、阳性预测值和阴性预测值分别为64. 7%、75. 0%、73. 3%和66. 7%。超声造影诊断良恶性乳腺疾病的敏感性、特异性、阳性预测值和阴性预测值分别为94. 1%、76. 9%、91. 4%和83. 3%。超声造影的敏感度明显高于常规造影,差异有统计学意义(P <0. 05)。结论常规超声联合超声造影可提高早期乳腺癌的诊断敏感度,在早期乳腺癌的诊断以及良恶性肿瘤的鉴别诊断中有重要的临床应用价值。     

髓样肉瘤3例

目的:探讨髓样肉瘤的临床病理特征、诊断及治疗。方法:报告3例我院诊治的髓样肉瘤,并复习相关文献。结果:3例患者均为中青年,发病部位多为淋巴结,可累及小肠、乳腺等;病理免疫组化特征以MPO、CD68阳性为主,CD3、CD20均阴性,Ki-67表达50%左右。结论:髓样肉瘤在基层医院容易误诊为淋巴瘤等,确诊依据病理活检及免疫组化。目前本病治疗欠规范,应予以化疗为主的综合治疗,尚无成熟化疗方案推荐。     

继发性乳腺恶性肿瘤的临床特点：附34例病历回顾性分析

乳腺癌是女性最常见恶性肿瘤之一，绝人多数乳腺癌都是原发性，继发性乳腺恶性肿瘤（secondarbreastcancer，以下简称SBC）．又称转移性乳腺恶性肿瘤极少见，国内外报道较少，而临床及病理又十分容易被误诊为原发性乳腺癌。本文对我院收治的34例SBC病历进行回顾性分析，供各位同道参考。临床资料我院自1959年1月至1995年1月共诊治乳腺癌7409人，34例经临床和病理诊断为SBC，发生率为0.46％，其中男性7例，女性27例，男：女=1：3.9，年龄11至70岁，平均37.9岁。原发癌按发病顺序是：恶性淋巴瘤19例（55.9％），肺癌6例（17.6％），肉瘤5…     

CK5/6、Chk1表达在乳腺癌诊断及预后评估中的价值分析

目的 探讨CK5/6、Chk1表达在乳腺癌诊断及预后评估中的价值。方法 选取乳腺癌患者90例为研究组，另选取20例乳腺良性病变患者作为对照组。收集患者临床资料，免疫组化法检测乳腺癌及乳腺良性病变组织中CK5/6、Chk1的表达水平，分析与其临床病理特征、诊断和预后的关系。结果 CK5/6、Chk1表达与乳腺癌组织学分级有关(P<0.05),与乳腺癌患者年龄、淋巴结转移、肿瘤大小、组织学分级无关(P>0.05)。CK5/6、Chk1表达阴性患者的总生存率均显著高于阳性表达患者(P<0.05)。乳腺癌患者CK5/6、Chk1表达阳性率显著高于乳腺良性病变组(P<0.05)。ROC曲线分析可知，CK5/6、Chk1诊断乳腺癌AUC分别是0.701,0.729,联合检测AUC为0.803。结论 CK5/6、Chk1表达与乳腺癌临床病理特征有关，可能是影响患者预后的因素，且具有一定的诊断意义。     

乳腺原发性恶性淋巴瘤

乳腺原发性淋巴瘤（Primarymalignantlymphomaofmemammarpgland，PMLMG）是原发于乳腺组织的恶性肿瘤，常被误诊为乳癌。Gross1890年首次对该病进行了描述。1972年，Freeman等[1]首先将其命名为乳腺原发性恶性淋巴瘤，并较详尽的，描述了该肿瘤的组织学类型，并认为与乳腺癌相比具有明显不同的生物学特性，治疗原则与其他乳腺恶性肿瘤也有所不同。近年来，关于PMLMG的报道日渐增多，认为该肿瘤组织学形态、临床表现及免疫组化与乳腺癌有明显的区别。由于本病发病率低，临床诊断相当困难，目前尚无理想的治疗方案，本文就此有关问题作…     

Bilateral synchronous spindle cell, apocrine and scirrhous carcinoma breast cancer in a case or malignant lymphoma

An unusual case of synchronous bilateral breast cancer occurring during combination chemotherapy and radiation to the outside of the breast for malignant lymphoma is reported. Two histologically rare carcinomas, spindle cell carcinoma and apocrine carcinoma, were observed in this case. A 77-year-old woman, who had been treated for stage IIIA non-Hodgkin's lymphoma, developed bilateral breast tumors. Aspiration biopsy cytology findings of the tumor in the left breast showed several clusters of adenocarcinoma cells and some large atypical spindle shaped cells, which suggested spindle cell carcinoma. The cytologic findings of the right breast tumor were highly suggestive of scirrhous carcinoma. A modified radical mastectomy was performed on both breasts. Pathological examination disclosed two separate cancer lesions in the left breast. The lesion which had been detected before the operation, was a spindle cell carcinoma. Another lesion, detected for the first time by pathological examination, was an apocrine carcinoma. The lesion in the right breast was a scirrhous carcinoma. Since non-invasive foci were detected in these three cancer lesions, each lesion was thought to be a primary cancer. All dissected bilateral axillary lymph nodes showed malignant lymphoma. Immuno-histochemistry of the spindle cell carcinoma revealed positive immunoreactivity for cytokeratin, which suggested the epithelial as well as mesenchymal nature of this tumor. Synchronous existence of malignant lymphoma and three independent breast cancers including spindle cell carcinoma and apocrine carcinoma is very rare.     

数字化X线摄影在触诊阴性乳癌中的诊断价值

目的探讨数字化乳腺X线摄影对隐性乳癌的诊断价值。方法回顾性分析我院2004年2月-2006年12月门诊体检中遇到的32例未触及肿块乳癌。术前均行金属丝定位,并经病理证实。结果X线呈现单纯钙化16例,其中癌前病变3例,导管原位癌6例,浸润性导管癌7例;微结节或致密影伴钙化5例,其中癌前病变1例,导管原位癌2例,浸润性导管癌2例;呈现不对称性致密影5例,1例为小叶原位癌,4例为浸润性导管癌;微结节伴浅分叶或毛刺4例,其中1例为导管原位癌,3例为浸润性导管癌;结构紊乱2例,均为浸润性导管癌。结论数字化乳腺X线摄影对诊断未触及肿块的触诊阴性乳癌、提高患者生存率、降低病死率、以及开展保乳手术具有重大价值。     

男性乳腺癌30例诊治体会

目的：探讨男性乳腺癌的诊断和治疗方法。方法：回顾性分析自1990年3月-2007年4月期间收治的30例行手术治疗的男性乳腺癌患者的临床资料。结果：行改良根治术27例，行乳腺癌根治术1例，1例行扩大切除术，1例局部切除术；30例患者中浸润性导管癌27例，导管内癌1例，粘液腺癌1例，不典型髓样癌1例。17例进行了激素受体检测：ER阳性率为88．2％（15／17）；PR阳性率为88．2％（15／17）。C—erb—B2检测15例，阳性率为6．7％（1／15）。淋巴结转移14例（46．7％，14／30），淋巴结转移≥4个占50．0％（7／14）；获随访26例，4例失访，平均随访41．1个月。随访时间超过5年的生存者5例，死亡者4例，随访时间不足5年的无瘤存活者17例。结论：对于男性乳腺肿块应当重视并积极开展超声及穿刺病理学检查，首选改良根治术治疗，并根据患者肿瘤分期、淋巴结状况、激素受体情况等辅以放、化疗或内分泌治疗。     

产生基质的化生性乳腺癌六例临床病理分析

目的 产生基质的化生性乳腺癌(matrix-producing metaplastic carcinoma of the breast,MPMC)较罕见,病理形态非常特殊,容易导致误诊.本研究探讨MPMC临床病理学特征、诊断要点及鉴别诊断.方法 收集2010-01-01-2016-01-01北京大学人民医院MPMC患者6例.患者均为女性,年龄42~73岁,中位年龄49岁.分析6例MPMC的临床特点,观察其组织病理学表现并进行免疫组化染色,同时复习相关文献资料.结果 肿瘤呈结节状生长,部分区域呈浸润性生长方式.结节周围为大片上皮样巢团,中央为黏液软骨样基质,可见坏死.6例上皮样细胞团均为乳腺浸润性导管癌,4例组织学分级呈Ⅲ级改变,2例为Ⅱ级.免疫组化6例患者中有4例ER、PR和C-erbB-2阴性,1例ER阳性,1例C-erbB-2为+,6例CK5/6、S100、CK和Vimentin、EGFR阳性.另做组织化学染色AB-PAS,6例均为阳性.结论 MPMC一种非常罕见的恶性肿瘤,诊断时需与叶状肿瘤等鉴别,免疫组化有助于鉴别诊断.     

Androgen receptors frequently are expressed in breast carcinomas: potential relevance to new therapeutic strategies

BACKGROUND: Several studies have demonstrated the biologic and therapeutic significance of estrogen and progesterone receptors (ER and PR) in breast carcinomas. The aim of the current study was to examine the presence of androgen receptors (AR) in breast carcinomas. METHODS: Two hundred cases of breast carcinoma, consisting of 145 invasive and 55 noninvasive (ductal carcinoma in situ [DCIS]) lesions, were examined using a monoclonal antibody against AR on formalin-fixed, paraffin-embedded archival material. The results were analyzed for correlations with immunohistochemically determined ER, PR, and HER-2/neu expression. RESULTS: Eighty-seven of the 145 cases (60%) of invasive carcinoma and 45 of the 55 cases (82%) of DCIS were AR-positive according to internationally standardized guidelines. The vast majority of Grade 1 carcinomas were positive for AR (90% of invasive Grade 1 carcinomas and 95% of Grade 1 DCIS), whereas in Grade 3 invasive carcinomas and DCIS, positive immunoreactions for AR were observed in 46% and 76% of cases, respectively. Among the cases of Grade 3 carcinoma, 33 invasive carcinomas (39%) and 17 DCIS lesions (68%) were ER-negative but AR-positive. Among Grade 1 carcinomas (invasive and DCIS), not a single case was positive for HER-2/neu, but most cases were intensely positive for AR. In contrast, many invasive Grade 3 carcinomas exhibited agreement between AR status and HER-2/neu status (AR-positive and HER-2/neu-positive, 30.5%; AR-negative and HER-2/neu-negative, 42.5%). CONCLUSIONS: Androgen receptors are commonly expressed in DCIS and in invasive breast carcinoma. A significant number of poorly differentiated carcinomas are ER-negative and PR-negative but AR-positive. Immunohistochemical examination of AR would be desirable because it would provide additional information about steroid receptors in breast carcinomas.     

Frozen Section Diagnosis of Breast Cancer

In Savonlinna Central Hospital, Southeastern Finland, 371 frozen section examinations were made from September 1981 to December 1986 to detect breast cancer. There was one false positive diagnosis (0.7%) among the 147 lesions interpreted as carcinoma. Among the 224 biopsies, which were benign on frozen section investigation, four showed carcinoma in paraffin sections (1.8%). Thus, the diagnostic sensitivity of frozen section method was 97.3% (146/150) and the clinical diagnostic specificity 99.5% (220/221) when the diagnosis in the paraffin sections was used as reference. In the four false negative cases the tumour was small and limited to the breast without any evidence of metastases. Two of them were ductal carcinomas, one was microinvasive lobular carcinoma, and one intraductal non-invasive papillary carcinoma. The false positive case had benign intraductal papillomatosis. Our results suggest that the probability of a false diagnosis in frozen section examination increases with diminishing size of the lesion. We suggest that small lesions (less than 1 cm in diameter, or non-palpable) should not be subjected to frozen section examination to avoid unnecessary loss of neoplastic tissue during the preparation process. Instead surgically radical lumpectomy and careful investigation of paraffin-embedded tissue are recommended.     

Examination of breast conserving therapy in lobular carcinoma

BACKGROUND: Experience with conserving surgery for lobular carcinoma has grown as more breast conserving surgeries have been performed. We examined the results of breast conserving therapy in lobular carcinoma. PATIENTS AND METHODS: We examined the postoperative positive margin rate, presence or absence of additional surgery, presence or absence of local or systemic recurrence and role of breast helical CT in 25 cases of breast conserving surgery performed at this department from 1991 through June 2003. RESULTS: Among the 303 cases of all breast conserving surgeries, there were 63 case with positive margins (20.8%), but there were 15 of 25 positive margin cases (60.0%) among the lobular carcinoma cases. In 8 of the 15 positive margin cases the technique was changed to mastectomy. One case of recurrence in the breast has been observed thus far. Although the positive margin rate and positive margin rate in infiltrating carcinoma cases tended to decline after the introduction of breast helical CT, the rates remained high. CONCLUSIONS: Since the positive margin rate was significantly high at the time of breast conserving surgery for lobular carcinoma, careful selection of technique based on imaging studies such as breast helical CT and MRI along with careful follow-up is considered necessary.     

胃癌切除术切端癌残留的原因,预后及预防

本文报告胃癌切除术切端癌残留２３例，残留率７．２％，食管切端癌残留１６例占６９．６％，十二指肠侧切端癌残留５例占２１．７％，食管侧切端和十二指肠侧切端均有癌残留２例占８．７％。姑息性胃癌切除术的切端癌残留率０．０％，根治性胃癌切除术的切端癌残留率５．２％，二者经统计学检验无显著差异。远侧胃切除切端癌残留率６．４％，近侧胃切除和全胃切除术的切端癌残留率１１．１％，统计学检验无显著差异。２３例切端癌残