乳腺肿瘤手术治疗联合内镜腋窝淋巴结清扫的体会

目的评估乳腔镜辅助乳腺癌改良根治术同时进行腋窝淋巴结清扫治疗乳腺癌的疗效。方法对4例乳腺癌病例行保乳乳腺癌改良根治术．腋窝脂肪溶解抽吸后进行乳腔镜腋窝淋巴结清扫。结果全部患者均顺利完成手术，术中冷冻切片报告：标本切缘均无癌细咆残留，术后石蜡切片病理为乳腺浸润性导管癌4例。手术时间120～140rain，平均127．3min：手术出血量15～20m1，平均18．4ml；每侧取淋巴结10-13个，平均11个。术后病侧乳房形态保持良好，伤口小而隐蔽．手术效果满意。术后随访12～24个月，无瘤复发。结论在腔镜下行保乳乳腺癌切除术联合腋窝淋巴结清扫是安全可行的．具有常规手术无法达到的良好的美容效果。该术式对保护上肢功能、保持胸部良好的外观形状及提高患者的生存质量均是一种较好的手段．是治疗Ⅰ、Ⅱ期乳腺癌一种合理有效术式。     

保乳标本乳腺切缘及前哨淋巴结的冷冻制片专家共识

保乳手术的术中冷冻切片分析(frozen section analysis, FSA)对临床意义重大，对病理医师和病理技术员的要求较高。由于保乳手术乳腺切缘数量多，且脂肪组织不易冷冻，而前哨淋巴结周围的脂肪组织难以剔除干净以及存在内部脂肪化等问题，给冷冻制片带来一定的难度。因此，该共识是在大量临床实践的基础上，总结出关于保乳标本乳腺切缘及前哨淋巴结冷冻制片的技术要点和切片方法，旨在为病理技术员提供更全面且有价值的技术指导及规范化操作，从而获得高质量的冷冻切片。     

子宫静脉内平滑肌瘤病临床病理与生物学行为分析

目的观察和分析子宫静脉内平滑肌瘤病（intravenous leiomyomatosis of the uterus,IVL）的临床和病理学特征,期望更好地了解其生物学行为,为临床和病理诊断提供帮助。方法回顾分析29例IVL的临床和病理资料,采用LABC法免疫组化检测desmin、SMA、CD10、vimentin、CD34、ER、PR表达。结果所有患者术前均诊断为子宫平滑肌瘤或子宫腺肌病,无1例怀疑为静脉内平滑肌瘤病。手术中,29例均行冷冻切片检查且均正确诊断为子宫静脉内平滑肌瘤病;所有病例术后经石蜡包埋病理切片检查确诊。28例全子宫切除标本中,肿块均沿脉管腔穿出宫旁或浆膜下。获访的18例患者中,1例患者在肌瘤剥出术后两次复发,行全子宫＋双侧附件切除术后随访至今无复发,其余患者随访无复发。免疫组化染色显示脉管内的肿瘤细胞desmin、SMA均阳性;脉管内皮细胞CD34阳性。结论正确认识这种少见肿瘤的大体和剖面特点可减少误诊率,术中冷冻切片检查有助于提高术中诊断率和正确选择处理方式;由于肿瘤有潜在的复发性,患者术后长期随访十分必要。     

甲胎蛋白异质体L3对低浓度甲胎蛋白肝癌诊断的临床意义

目的探讨在低浓度甲胎蛋白（AFP）肝病患者中,甲胎蛋白异质体L3（AFP-L3）的百分含量（AFP—L3％）对肝癌的早期诊断和疗效评估的临床意义。方法收集245例血清低AFP含量（5～40ng／m1）的肝病患者样本（其中肝硬化患者100例、肝癌患者145例）,检测AFP—L3％,并对其中100例肝硬化患者和20例肝癌术后患者分别进行3个月和12个月的随访。结果以AFP—L3％≥10％作为阳性判断标准,100例肝硬化患者中阳性为23例,经3个月随访后其中8例诊断为肝癌;145份肝癌患者血清AFP-L3％阳性率为46．2％（67／145）。低浓度AFP肝癌组的AFP—L3％水平显著高于低AFP肝硬化组（t=7．318,P=0．001〈0．01）;20例肝癌患者术后有5例AFP．L3％仍为阳性,其在12个月内的生存率为0,而术后AFP—L3％阴性患者生存概率为15／15。结论AFP—L3％在低浓度AFP肝病患者中对肝癌的早期诊断和术后疗效评估都具有一定的临床意义。     

肝细胞肝癌中丙型肝炎病毒C区,E区,NS3区,NS4区…

本文报道研究丙型肝炎病毒抗原在肝细胞肝癌细胞内的定位分布情况。以丙型肝炎病毒的Ｃ、Ｅ、ＮＳ３、ＮＳ４区四种单克隆抗体用免疫组化方法检测了１３９例肝细胞肝癌的肝脏标本，结果总的阳性率为１５．１％。２１例阳性标本中，Ｃ区单抗检测阳性占８０．９％（１７／２１），Ｅ区内３３．３％（７／２１），ＮＳ３，ＮＳ４区均占５７．１％（１２／２１），表明应用多区段单抗有助于提高ＨＣＤ抗原的检出率。阳性物质主要存在于胞     

乳腺癌保乳根治术并腔镜下腋窝淋巴结廓清术应用

目的探讨乳腺癌保乳根治术并腔镜下腋窝淋巴结廓清术的效果及安全性。方法2003年8月至2006年8月在中国医科大学附属盛京医院第一微创外科住院的5例乳腺癌（年龄38～61岁,平均年龄51岁）行保乳根治术并腔镜下腋窝淋巴结廓清术患者,对其资料进行回顾分析。结果5例乳腺癌患者行保乳根治术并腔镜下腋窝淋巴结廓清术均获成功,所有切除乳腺标本经术中冰冻病理证实切缘肿瘤细胞阴性。平均手术时间150min,术中及术后均无并发症发生。结论保乳根治术并腔镜下腋窝淋巴结廓清术治疗乳腺癌能够达到良好的手术效果且更安全。     

人肝癌及肝硬变中IGF—2及HBxAg表达的对比研究

对６０例肝细胞癌、癌旁肝组织和４７例肝硬变石蜡切片进行ＩＧＦ－２和ＨＢｘＡｇ免疫组化染色。结果表明，在ＨＢｘＡｇ阳性的肝癌和肝硬变中ＩＧＦ－２阳性率分别为１００％（３２／３２例）和９４．６％（３５／３７例），而ＨＢｘＡｇ阴性组分别为８２．１％（２３／２８例）和６０％（６／１０例）。ＩＧＦ－２在肝癌中的阳性强度明显高于癌旁肝和肝硬变。ＩＧＦ－２的分布形态有：（１）胞浆包涵体样、（２）全胞浆、（３）核     

胰腺癌组织中内分泌细胞及其意义研究

４２例胰腺癌嗜银和亲银染色发现１９例４５．２％含内分泌细胞（ＥＣ），其中ＥＣ阳性率≥５０％４例；高分化腺癌ＥＣ阳性率（５／２０例，２５％）低于中、低分化腺癌（１２／１９例，６３．２％）和粘液癌（２／２例，１００％），组织学分级Ｉ级病例ＥＣ阳性率（５／１８例，２７．８％）低于Ⅲ级病例（７／８例，８７．５％）；ＥＣ阳性病例间质肥大细胞数明显高于ＥＣ阴性病例；发生转移病例ＥＣ阳性率（８／１４例，５７．１     

乳腺癌HER2蛋白表达阳性者的基因状态分析

目的探索中国大陆女性乳腺癌HER2蛋白过表达人群中HER2基因状态、蛋白表达与基因扩增的一致性、17号染色体非整体性的发生情况及其意义。方法采用PathVysion^TM探针试剂盒,以荧光原位杂交（FISH）方法,分析经免疫组织化学（IHC）方法（HercepTest^TM试剂盒）确认的120例HER2蛋白表达阳性（IHC2＋者42例,IHC3＋者78例）的乳腺癌石蜡切片标本的HER2基因状态和17号染色体非整体性的发生率。结果HER2表达IHC2＋的标本中,基因扩增率76．19％（32／42）,其中低度扩增（比值2～4）26．19％（11／42）,中度扩增（比值4—10）41．62％（20／42）,高度扩增（比值〉10）2．38％（1／42）;IHC3＋的标本中,基因扩增率91．03％（71／78）,其中低度扩增11．54％（9／78）,中度扩增61．54％（48／78）,高度扩增17．95％（14／78）。全部病例中具有17号染色体非整体性者69．17％（83／120）,包括亚二体性（17号染色体平均数≤1．75）11．67％（14／120）、低多体性（17号染色体平均数2．26～3．75）43．33％（52／120）和高多体性（17号染色体平均数≥3.76）14．17％（17／120）。IHC2＋病例中17号染色体非整体性59．52％（25／42）,包括亚二体性7．14％（3／42）、低多体性42．86％（18／42）和高多体性9．52％（4／42）;IHC3＋病例中17号染色体非整体性74．36％（58／78）,包括亚二体性14．10％（11／78）、低多体性43．59％（34／78）和高多体性16．67％（13／78）。IHC2＋者FISH阳性以HER2基因中、低度扩增为主,而IHC3＋者则呈中、高度基因扩增的趋势,两者差异有统计学意义（P=0．0003）。IHC3＋中,7例FISH阴性中6例有17号染色体非整体性;IHC2＋中,10例FISH阴性中5例有17号染色体非整体性。结论在本组中国大陆女性乳腺癌人群中,IHC3＋与FISH阳性的一致性较高;IHC2＋者FISH阳性率高于国外研究者的数据;HER2蛋白阳性乳腺癌中17号染色体非整体性发生比例较高;IHC2＋和3＋者都具亚二体性、低多体性和高多体性特征,且两者均以低多体性为常见;IHC2＋者的HER2基因扩增多为中、低度扩增,而IHC3＋中FISH阳性者则以高比值者居多。IHC3＋而FISH阴性的主要原因为17号染色体非整体性。     

人乳腺癌HPV感染的超微结构和DNA分子原位杂交研究

目的：对乳腺癌的HPV感染进行形态学定位研究。方法：对46例乳腺癌切除标本及7例良性病变标本进行透射电子显微镜以及HPV DNA分子原位杂交检测。结果：透射电镜下，14例（30．40％）乳腺癌细胞核内有HPV样病毒颗粒，颗粒直径30－50nm，或弥漫散布，或聚集成团呈假结晶状排列。颗粒圆形或略不规则，含有HPV样颗粒的癌细胞核异型性较明显。7例良性病变细胞核内未见到HPV样颗粒。HPV DNA分子原位杂交显示，21例（45．65％）乳腺癌细胞核内HPV31／33 DNA阳性，1例软肉瘤样化生性癌细胞核同时有HPV31／33及HPV16／18阳性；1例纤维腺癌（14．29％）也显示HPV31／33 DNA阳性（X^2=2．7431，P＜0．05）。电镜下85％病毒样颗粒阳性病例中可检测到HPV DNA存在，两种检测结果符合率达73．91％。结论：乳腺肿瘤内存在未组装的、裸型病毒样颗粒。该研究对阐明乳腺癌的发病原因以及对乳腺癌的预防和治疗均有重要意义。     

Intraoperative evaluation of lumpectomy margins by imprint cytology with histologic correlation: a community hospital experience

BACKGROUND: Several well-controlled studies have demonstrated significantly increased local recurrence rates in patients with low-stage breast carcinoma treated with breast conservation therapy in whom focally positive margins were not reexcised. Imprint cytology is a rapid technique for evaluating surgical margins intraoperatively, thus allowing reexcisions to be performed during the initial surgery. The large majority of studies on the use of intraoperative imprint cytologic examination of breast conservation therapy margins have been performed at university-based academic centers. OBJECTIVE: To evaluate the utility of intraoperative imprint cytologic evaluation of breast conservation therapy margins in a community hospital setting. METHODS: We retrospectively reviewed the intraoperative imprint cytology margins of 141 lumpectomy specimens that had been obtained from 137 patients between May 1997 and May 2001. RESULTS: We evaluated 758 separate margins. On a patient basis, the sensitivity was 80%, the specificity was 85%, the positive predictive value was 40%, the negative predictive value was 97%, and the overall accuracy was 85%. There were no cytologically unsatisfactory margins. CONCLUSION: Imprint cytology is an accurate, simple, rapid, and cost-effective method for determining the margin status of breast conservation therapy specimens intraoperatively in the community hospital setting. This method allows a survey of the entire surface area of the lumpectomy specimen, which is not practical using frozen section evaluation.     

Oestrogen receptor staining of paraffin-embedded breast carcinomas following short fixation in formalin: a comparison with cytosolic and frozen section receptor analyses

This paper describes an improved immunohistochemical method for demonstrating oestrogen receptor (OR) protein in paraffin-embedded sections of tissue fixed for 1.5 h in formalin. Thirty-two cases of infiltrating ductal breast carcinoma were stained with a monoclonal anti-OR antibody (H222), using a standard streptavidin-biotin method, following pretreatment with pronase. OR counts in paraffin sections were compared with those of frozen sections and with cytosolic values determined by a dextran-coated charcoal method. Twenty-seven of the carcinomas were OR-positive in paraffin sections. There was concordance between the paraffin section and the frozen section-determined receptor status in 30 cases (94 per cent) and a strong correlation was observed (r = 0.76; P less than 0.0001). Similarly, OR counts in paraffin sections correlated with cytosolic OR values (r = 0.60; P less than 0.001) and there was concordance in 97 per cent of cases. The percentage of positively-stained tumour cells in paraffin sections ranged from 0 to 94 per cent with staining intensities comparable to those seen in frozen sections. Staining of paraffin sections identified more OR-positive tumours than either frozen section staining or cytosolic assay. This study validates immunohistochemical OR analysis in formalin-fixed, paraffin-embedded breast carcinomas using a commercial anti-OR antibody.     

Estimation of estrogen receptor content in fine-needle aspirates from breast cancer using the monoclonal antibody 1d5 and microwave oven processing: Correlation with paraffin embedded and frozen sections determinations

We describe a method of immunocytochemically assessing estrogen receptor (ER) status on alcohol-fixed smears obtained by fine-needle aspiration (FNA) from breast cancer patients, using a commercially available monoclonal antibody (1D5) with microwave oven processing. A series of 31 cases of aspirates from breast cancer were analysed and the results were compared with assessment by ER immunocytochemical assay using the same procedure on formalin-fixed tissue and with assessment by ER-ICA assay on frozen sections. The results were scored semiquantitatively using a five grade scoring system. Of the 31 cases examined, 21 were positive at least by two methods and 10 were negative for all three determinations. The results obtained in the ER immunocytochemical assay on aspirates and paraffin-sections using the antibody 1D5 and those obtained on frozen sections using the antibody H222 were closely similar. In only one case was it not possible to interpret the reaction in the cytological specimen because there was a strong background in the smear. In general, we obtained more intense positivity with the antibody 1D5 in aspirates and formalin-fixed material than with the antibody H222 in frozen sections. The scoring results of the three methods were almost identical. We conclude that the application of ER method on alcohol-fixed smears will eliminate the need for using a special fixation procedure and will provide several advantages, such as: improvement in morphological concomitant analysis, utilization whenever malignancy is found without necessity to re-aspirate the patient, and adequacy of archival material. © 1995 Wiley-Liss, Inc.     

Immunohistochemical detection of c-erbB-2 protein in human benign and neoplastic prostate.

Both the polyclonal anti-c-erbB-2 peptide antiserum pAB 60 and the monoclonal anti-c-erbB-2 protein antibody mAB-1 detect the c-erbB-2 protein in human breast adenocarcinomas. We investigated c-erbB-2 expression in adult human benign hyperplastic and neoplastic prostates, using the avidin-biotin complex immunoperoxidase method. Formalin-fixed, paraffin-embedded specimens of benign hyperplastic prostate (13), prostatic adenocarcinoma (22), and prostatic adenocarcinoma lymph node metastases (two) were tested with pAB 60. Ten formalin-fixed, paraffin-embedded specimens of prostate adenocarcinoma, 11 frozen sections of benign hyperplastic specimens, and eight frozen sections of prostate adenocarcinoma were tested with mAB-1. Our results demonstrated consistent detection of c-erbB-2 immunohistochemically in frozen sections of both benign and malignant prostate. Preincubation of pAB 60 with the immunizing peptide blocked subsequent reactivity with prostatic tumor tissue, indicating specificity. However, fixation and processing protocols significantly affected the reactivity of the antigenic determinants detected by these antibodies, as mAB-1 was nonreactive with formalin-fixed, paraffin-embedded prostatic tissues. Differential reactivity of pAB 60 with malignant rather than benign glands was maximized by exposure of the specimen to the antibody at 4 degrees C rather than 22 degrees C. The most frequently observed staining pattern with both antibodies was cytoplasmic. However, mAB-1 produced distinctly membranous staining in two frozen specimens of benign hyperplasia and one specimen of prostate cancer.     

Intrahepatic expression of hepatitis C virus antigens in chronic liver disease

Localization of hepatitis C virus (HCV) antigens was studied in fresh frozen and formalin-fixed, paraffinembedded liver tissue by immunoperoxidase using monoclonal antibodies to nucleocapsid protein and polyclonal human immunoglobulin G purified from plasma containing antibodies to structural and non-structural antigens of hepatitis C virus. The results observed using monoclonal antibody to HCV core were similar to those of polyclonal IgG against HCV antigens in the majority of cases and both correlated well with HCV status as defined by ‘nested’ polymerase chain reaction. HCV antigens were detected in both hepatocytes and mononuclear cells. Using polyclonal human IgG, a small proportion of biliary epithelial cells were also positive in 6/29 patients. In most of the specimens examined, relatively few cells (1–5 per cent) were found to be positive for HCV antigens. The cryostat sections, using polyclonal IgG against HCV antigens, exhibited greater immunohistochemical staining, suggesting that the fixation and processing of the tissue may be a major factor in the conservation and the outcome of HCV antigen(s) findings. However, the results using monoclonal antibodies may reflect the specificity of antigen expression.     

Tumor bed extending to margins in breast cancer specimens after neoadjuvant chemotherapy: Incidence and clinical significance

BackgroundPathologic examination of post-neoadjuvant chemotherapy (NAC) breast surgical specimens includes assessment of margins. It has been recommended that tumor bed (TB) changes extending to margins should be documented; however, its' incidence and clinical significance have not yet been established. The aim of our study was to gather prognostic data on this histological finding.DesignWe retrospectively identified all cases where TB was reported at margin. Cases where margins were also positive for invasive carcinoma or DCIS were excluded.ResultsFrom 2016 to 2019, 115 cases of NAC treated breast cancers were identified with 21 having at least one margin positive for TB after initial surgery (incidence of 18.3 %). Five cases were estrogen receptor (ER)-/HER2-, 9 were HER2+ and 7 were ER+/HER2-. Nineteen patients underwent partial mastectomy and 2 underwent total mastectomy. Nine patients had a pathological complete response (pCR).Ten cases had more than one positive margin for TB. None of the 21 patients underwent a second surgery for margin re-excision. Twenty patients received adjuvant therapy. With an average follow-up of 28.1 months, there has been one local recurrence. Four other patients developed metastatic disease, one of which died of the disease. The rates of locoregional and distant recurrence and mortality were statistically similar to those from patients whose margins were negative for TB.ConclusionsOur results suggest low risk of local recurrence when a positive margin for TB is not re-excised. Further data and follow-up will be needed to confirm the adequacy of conservative management in this setting.     

Schnellschnitttelepathologie im klinischen Alltag eines Brustzentrums

For an intraoperative frozen section service, the period from surgeon's sample excision to the time of transmitting the diagnosis by the pathologist, should not last longer than 20 min. In a period of 16 months we performed 389 frozen sections by telepathology (298 patients) in our breast cancer center, using the Leica telepathology system (TPS 1.5). In 173 out of the 389 sections, an invasive carcinoma was diagnosed (312 frozen sections with the aim to verify malignancy and 77 to verify a tumor-free retroareolar resection margin). The overall error rate amounted to 7 out of 389 sections (about 2%; false-negative in 5 cases, false-positive in 2 cases) and is equivalent to the error rate without telepathology. The mean time for diagnosis per case was 15 min. For the future, it is desirable that hospitals without their own pathologists also perform frozen sections within an adequate time by using telepathology systems.     

Automated immunohistochemical estrogen receptor in fixed embedded breast carcinomas. Comparison with manual immunohistochemistry on frozen tissues

Estrogen receptor (ER) status of breast carcinomas determines prognosis and treatment. Biochemical ER assays are expensive and time-consuming and require fresh tumor. Immunohistochemical ER was assessed in 68 breast carcinomas, by an automated method using routinely processed formalin-fixed paraffin-embedded tissues, and manually with the use of snap-frozen tissues with a monoclonal anti-ER and peroxidase-antiperoxidase technique. The paraffin sections were digested with DNase to enhance development of signal. Positive nuclear ER was obtained in 9 (13%) fixed tissues and 36 (53%) frozen tissues. The sensitivity, specificity, and predictive value of a positive test result, as compared with the biochemical assay, were 25%, 100%, and 100% for the paraffin section technique, and 89%, 88%, and 89% for the frozen sections. Although it is specific, lack of sensitivity, resulting from loss of ER with fixation and room temperature handling, renders this immunohistochemical technique unacceptable on fixed tissues. However, ER immunostain on frozen tissue is an acceptable alternative to biochemical assay.     

Detection of surface antigen 17-1A in breast and colorectal cancer

Substantial progress has been made in detecting cell surface or intracytoplasmatic antigens to identify spread tumor cells with monoclonal antibodies (MAbs). The 17-1A antigen is already used as a target for specific immunotherapy in colorectal cancer. The purpose of this study was to compare the expression of 17-1A antigen in colorectal tumors versus breast cancers. MAb against the epithelial-specific antigen (ESA) and a routine staining technique were used to detect the 17-1A antigen in 100 cases of colorectal and 111 cases of breast cancer. The antigen expression of each tumor entity was examined by light microscopy on paraffin sections. Thirty six of the formalin-fixed paraffin sections of breast cancer were compared with their corresponding frozen sections. Evaluation was realized by a histological score (grade 0-9) considering the distribution and the staining intensity. We found an antigen expression of 17-1A in colorectal cancer quantified at 7.1+/-1.8 and at 4.5+/-2.5 for breast cancer in our score. Comparing paraffin sections and frozen sections in the 36 cases of breast cancer, the score was 5.5+/-2.3 in the paraffin and 8.1+/-1.9 in the frozen section group. Our results confirmed the high expression of 17-1A cases of in colorectal carcinoma. Furthermore, 17-1A is expressed in the majority of breast carcinomas, revealing a high difference between paraffin and frozen sections. As a result, a specific immunotherapy with MAbs against 17-1A antigen in minimal residual stages of breast cancer might be considered.