Invasive Breast Carcinoma Arising in Microglandular Adenosis: Two Case Reports

Microglandular adenosis (MGA) is a rare benign disease that shows an infiltrative growth pattern of small glands, and it may progress to include atypia and carcinoma. Here we report two cases of breast carcinoma arising in MGA. Case 1 was a 44-year-old woman with a previous history of ductal carcinoma in situ in her right breast. During a follow-up, a 1.8 cm mass-like lesion was found in her left breast. An excisional biopsy suggested that the lesion was breast carcinoma. Case 2 was a 57-year-old woman with a 2.9 cm mass in her right breast. A core needle biopsy of the lesion suggested invasive carcinoma. Both patients underwent modified radical mastectomy with sentinel lymph node biopsy. Both tumors lacked a myoepithelial cell layer and stained positively for S-100, lysozyme, and α1-antitrypsin, which is typical of MGA. Both cases showed invasive carcinoma arising in MGA.     

乳腺微腺性腺病伴产基质的癌的临床病理分析

[目地]探讨乳腺微腺性腺病（MGA）的临床特点、病理诊断及转归。[方法]分析MGA患者的临床病理材料,并复习相关文献。[结果]组织学上乳腺组织内见腺管弥漫性增生,排列紊乱,分布于间质及脂肪组织中,增生的腺管被覆单层立方或扁平上皮。缺乏肌上皮细胞。部分区域腺管上皮明显异型,并见核分裂,其周围缺乏基底膜,间质见多灶性黏液软骨样基质形成,诊断为乳腺微腺性腺病伴产基质的癌。免疫组化表达：上皮和间质S-100（＋）,上皮EMA（＋）、CK7（＋）、AE1,AE3（＋）,而ER、PR、CerbB-2、SMA、MSA、Calponin、P63均阴性,Laminin、Ⅳ型胶原、网状纤维染色部分区域阴性。[结论]乳腺微腺性腺病是一种少见的病变．本身可能就是一种癌前病变且与乳腺癌关系密切。     

乳腺癌癌旁腺病的病理形态观察

本文研究了本院５１例乳腺癌并存腺病的改变，并重点观察乳腺癌癌旁腺病上皮增生、不典型增生与癌的关系进行病理组织学探讨。结果全组８６％以上腺病性导管上皮出现不典型增生，２９．４％显示增生、不典型增生与癌的移行过渡。由此提出腺病（尤其当出现导管上皮重度增生、不典型增生时）与乳腺癌发生有关。     

The benefit of superb microvascular imaging and shear wave elastography in differentiating metastatic axillary lymphadenopathy from lymphadenitis

PurposeThe purpose of this study is to detect and compare the diagnostic performances of vascularity index (VI) via superb microvascular imaging (SMI) and shear wave elastography (SWE) in metastatic axillary lymphadenopathy and lymphadenitis.Materials and methodsThe study is based on 45 female patients who were ultrasonographed due to swelling in the axilla and underwent SWE and SMI before tru-cut biopsy, between August 2019 and February 2021. The patients had a total of 53 lymph nodes (LNs), 38 of these were metastatic and 15 were lymphadenitis.ResultsThe results showed that mean volumes, value of cortex thickness, elasticity and velocity values, and mean VI values were significantly higher in metastatic LAP group compared to lymphadenitis group. Correlation analysis showed that both VI (r: 0.44) and elastography (r: 0.52) values were positively correlated with the cortex thickness, while elastography values were strongly correlated with volume (r: 0.42) and short diameter (r: 0.40). For differentiating lymphadenitis and metastatic LAP, the optimal cut-off VI value was 8.55 while the optimal cut-off elastography value was 31.8 kPa.ConclusionIn conclusion, combined grayscale ultrasonography evaluation of lymph nodes with SWE and SMI increase the diagnostic performance in distinguishing lymphadenitis-metastatic LAP.     

脱模画图法设计乳腺切线野照射

乳腺癌切线野照射是一常用的放疗技术。在模拟机下定位直观、准确，但一些基层医院尚未购置模拟机。本文介绍脱模画图法设计乳腺切线野投照角度、投照范围的方法。     

乳腺癌121例X线影像分析

目的进一步提高早期乳腺癌的X线诊断水平。方法收集经手术病理证实为乳腺癌的121例,对其高频X线形像表现进行回顾性综合分析。结果121例乳腺癌中,按乳腺X线实质分型,Ⅳb45例,Ⅱb33例,Ⅳc29例;乳腺微小癌63例,早期乳腺癌57例;X线在现为肿块密度高74例,其中有毛刺者62例,恶性钙化灶66例,血管异常相81例,皮肤增厚33例。本组病例经高频X线对乳腺癌的诊断与病理诊断符合率达98.2％。结论高频X线对乳腺癌,尤其对乳腺微小癌有很大的诊断价值。     

乳腺癌行乳腺切除术后的乳房幻觉

医学文献里人们对乳腺癌行乳腺切除术后发生的乳房幻觉很少作描述。为了查明这些幻觉的发生率及其影响因素,查明行乳腺切除术后的妇女有多少想重建乳房,本文对收回的256份中较完整的187份调查表作一分析。     

Reproductive Factors and Subtypes of Breast Cancer Defined by Estrogen Receptor,Progesterone Receptor,and Human Epidermal Growth Factor Receptor 2: A Register-Based Study From Korea

BackgroundThe relationship between reproductive breast risk factors and breast cancer survival in patients with different breast cancer subtypes is not well known.MethodsWe examined a large-sized, retrospective study of 23,882 subjects from the Korean Breast Cancer Registry. The breast cancer subtype was determined by immunohistochemical staining for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2). Information regarding reproductive factors, including breastfeeding, age at first birth (AFB), and parity, was gathered. Multivariate Cox regression analysis was used to estimate the association among breast cancer subtypes, such as luminal A, luminal B, Her-2/neu overexpressing, and triple negative breast cancer (TNBC), and breast cancer survival as dependent variables and adjusting for age and stage.ResultsHigh parity (≥ 5) increased the recurrence risk of luminal A and B breast cancer (hazard ratio [HR], 1.95; 95% confidence interval [CI], 0.96-3.97; P = .0055 and HR, 1.12; 95% CI, 0.42-3.02, respectively; P = .0073) in breast cancer–specific survival (BCSS), but 1 to 3 child births decreased the recurrence risk of luminal A breast cancer (HR, 0.56; 95% CI, 0.34-0.91; P = .0055) and luminal B breast cancer (HR, 0.32; 95% CI, 0.17-0.61; P = .0073) in BCSS. Early AFB (< 20 years) increased the recurrence risk of luminal A breast cancers (HR, 1.61; 95% CI, 0.62-4.26; P = .039) in BCSS and of TNBC (HR, 1.31; 95% CI, 0.78-2.21; P = .0006) in overall survival. Her-2/neu overexpressing breast cancer had no correlation with parity and AFB in breast cancer survival.ConclusionsHigh parity (≥ 5) and early AFB (< 20 years) were correlated with worse clinical outcomes in patients with luminal breast cancer, but not with other subtyped breast cancers.     

早期乳腺癌保乳治疗12例临床治疗体会

目的：总结早期乳腺癌保乳治疗的临床治疗体会。方法：回顾性分析1999年1月至2004年12月保乳治疗的12例早期乳腺癌患者的手术资料、术后近期并发症及随访情况。结果：12例手术均顺利，无术后并发症，11例坚持完成术后放疗及化疗，随访至今未见局部复发与远处转移，1例失访。除1例乳房过小者外，其余10例对术后乳房外形及生活质量满意。结论：保乳治疗是早期乳腺癌很好的治疗方法，不仅同样可以根治肿瘤，而且能够提高生存质量。     

原代乳腺癌细胞对β-榄香烯体外敏感性研究

目的:探讨β-榄香烯在乳腺癌临床治疗中的作用。方法:采用手术切取的乳腺癌组织制备原代乳腺癌细胞悬液,MTT法体外药敏实验检测原代乳腺癌细胞对β-榄香烯及数种临床常用化疗药的不同敏感性,并进行比较分析。结果:原代乳腺癌细胞对β-榄香烯的敏感性低于5-FU、ADM及MMC,且有显著性差异(P<0.01);乳腺癌细胞对β-榄香烯具有中度敏感性而与常用化疗药物相近,且无显著性差异(P>0.05)。结论:β-榄香烯对乳腺癌的临床治疗具有中度敏感性可作为二线药。     

扪不到肿块的乳腺癌──附10例报告

本文报告了我院从１９７９年１月～１９９４年５月检出本病１０例，占同期收治乳腺癌３３７例的２．７％。全组病例均行手术治疗。本病属临床可检出乳腺癌最早阶段，症状、体征较少，早期诊断有一定困难。本组误诊率达５０％。作者强调重视有乳腺癌危险因素的高危人群，注意发现乳房早期异常现象，经过Ｘ线摄片、乳导管造影、涂片细胞学检查等方法能检出更多的早期癌。从而提高乳腺癌的治愈率及生存率。     

Exclusion of Patients With Brain Metastases in Published Phase III Clinical Trials for Advanced Breast Cancer

Metastatic HER2-positive (HER2+) and triple-negative breast cancer (TNBC) confer a 30% or higher risk of developing brain metastases (BrM), but BrM is typically an exclusion criteria for clinical trials, which limits the generalizability of trial results to these patients. We therefore analysed trends in the enrollment of patients with BrM, as well as the use of outcomes specific to the central nervous system (CNS), in phase III clinical trials evaluating systemic therapy for patients with advanced HER2+ and/or TNBC. Notably, 10 of the 34 trials (29%, 95% confidence interval = 15.1%-47.5%) evaluated CNS-specific outcomes and trials that completely excluded patients with BrM were significantly less likely to meet their primary endpoint (n = 6/17, 35%) than those that permitted conditional enrollment (n = 13/15, 87%) (P = .005), suggesting that enrollment of patients with BrM is not detrimental to trial success.     

76例乳腺癌术后放疗

 从1985年1月～1990年1月，我们对76例乳癌术后患者进行了放疗。Ⅱ期54例、Ⅲ期18例、Ⅳ期4例。放疗采用60钴γ线或6mv一x线、10～12mev电子线。照射胸壁、内乳、锁骨上、腋下等区域。放疗剂量45～50Gy/4.5～5周，5年生存率Ⅱ期80.6％（25/31）、Ⅲ期33.3％（3/9）、Ⅳ期25％（1/4）。我们认为放疗对Ⅱ期以上的患者可降低复发率、提高生存率     

希罗达作为二线药物治疗晚期乳腺癌10例报告

目的 观察希罗达作为二线药物治疗晚期乳腺癌的疗效及安全性。方法 对10例具有可测量病灶的晚期乳腺癌患者采用希罗达（2510mg/m^2，每天1次，连服14天，21天为1个周期）单药治疗2－4个周期。所有患者既往均接受过1种以上化疗方案的化疗，其中7例患者接受过阿霉素和（或）紫杉醇治疗。结果 10例患者中3例接受了希罗达2个周期化疗，7例完成4个周期化疗。PR3例，MR1例，SD1例，PD5例。最常见的不良反应为恶心、皮肤色素沉着、厌食、疲劳和腹泻。Ⅲ度不良反应仅见于少数患者，其中腹泻1例、中性粒细胞减少1例、总胆红素升高4例。结论 希罗达作为二线药物治疗晚期乳腺癌的疗效较好且不良反应较轻，有望成为紫杉类或蒽环类药物治疗失败的乳腺癌患者的理想治疗药物。     

乳腺病变的PCNA、p53表达及其应用价值研究

目的：探讨乳腺良、恶性病变与ＰＣＮＡ、ｐ５３之间的关系及其在临床中的应用价值。方法：６０例乳腺癌原发灶,１６例乳腺增殖症及９例乳腺癌旁异型小叶蜡炔采用ＬＳＡＢ法标记ＰＣＮＡ,ｐ５３。结果：ＰＣＮＡ,ｐ５３阳性率在三种病变中有非常显著性差异。当ＰＣＮＡ表达强度为（＋＋￣＋＋＋）时,其阳性率与乳腺癌病理分级淋巴结有否转移及转移数目呈正相关。ｐ５３的表达与组织分化,淋巴结转移情况无明显关系。结论：ＰＣＮ     

乳腺囊性增生病及癌变基因表达与细胞动力学关系的研究

应用流式细胞术和免疫荧光染色技术，对４８例正常乳腺、乳腺囊性增生病和囊性增生癌变的石蜡包埋组织行ＤＮＡ倍体和癌基因ｃ－ｅｒｂＢ－２、抑癌基因Ｐ５３蛋白表达测定，结果表明，从正常乳腺组织到囊性增生癌变的发展过程中，ＤＩ值和ＳＰＦ值以及ＤＮＡ异倍体出现率呈明显增高趋势。癌变组织的。－ｅｒｂＢ－２和Ｐ５３表达显著增高，并与ＳＰＦ和ＤＮＡ异倍体率的增加正相关。提示乳腺囊性增生病的多多数（ＤＩ、ＳＰＦ、ｃ－ｅｒｂＢ－２、Ｐ５３）分析呈阳性，临床应按早期癌处理。     

乳腺癌改良根治术与Halsted根治术的疗效比较

本文复习了我院７２例改良根治术治疗的乳腺癌患者，与同时期Ｈａｌｓｔｅｄ根治术７３例作比较。ＭＲＭ组５年、１０年生存率分别为８１．０４％和５０．５９％，ＲＭ组分别为７５．５７％和５５．３３％。经统计学处理，两组无显著性差异（Ｐ＞０．０５）。同时对腋淋巴结清除数目与局部复发率分别进行比较，两组也无显著差异。作者认为对可手术的乳腺癌，除非肿瘤累及胸大肌或腋淋巴结转移较大而影响手术操作外，ＭＲＭ为可行术式。     

Simultaneous inhibition of deubiquitinating enzymes (DUBs) and autophagy synergistically kills breast cancer cells

Breast cancer is one of the leading causes of cancer death among women in the United States. Patients expressing the estrogen and progesterone receptor (ER and PR) and human epidermal growth factor 2 (HER-2) tumor markers have favorable prognosis and efficacious therapeutic options. In contrast, tumors that are negative for these markers (triple-negative) have a disproportionate share of morbidity and mortality due to lack of a validated molecular target.Deubiquitinating enzymes (DUBs) are a critical component of ubiquitin-proteasome-system degradation and have been shown to be differentially expressed and activated in a number of cancers, including breast, with their aberrant activity linked to cancer prognosis and clinical outcome. We evaluated the effect of the DUB inhibitors b-AP15 and RA-9 alone and in combination with early- and late-stage lysosomal inhibitors on cell viability in a panel of triple negative breast cancer (TNBC) cell lines.Our results indicate small-molecule DUB inhibitors have a profound effect on TNBC viability and lead to activation of autophagy as a cellular mechanism to compensate for ubiquitin-proteasome-system stress. Treatment with sub-optimal doses of DUB and lysosome inhibitors synergistically kills TNBC cells. This supports the evaluation of DUB inhibition, in combination with lysosomal inhibition, as a therapeutic approach for the treatment of TNBC.