女性乳腺导管原位癌的临床回顾性研究

目的：回顾性分析乳腺导管原位癌（DCIS）的临床特点，为临床选择治疗方法提供参考。方法：经手术治疗和病理确诊的DCIS235例，分析其生存率、健在率、局部复发率和远处转移率情况。结果：1）1958～1992年DCIS发病率为2％～5％。2）年龄和预后无显著性关系，但5年局部复发率有统计学意义，P=0．031。3）肿瘤大小对DCIS预后无影响。4）各术式的生存率、健在率、复发率和转移率无明显差别。5）化疗对DCIS的预后无影响。结论：非普查DCIS患者的发生率为2％～5％，40年内基本稳定。DCIS复发率和转移率低，生存率高。年轻DCIS患者预后不如年老者。各术式的复发率、转移率、生存率和健在率相同。术后辅助化疗无意义。     

女性乳腺导管原位癌的临床回顾性研究

目的:回顾性分析乳腺导管原位癌(DCIS)的临床特点,为临床选择治疗方法提供参考。方法:经手术治疗和病理确诊的DCIS235例,分析其生存率、健在率、局部复发率和远处转移率情况。结果:1)1958～1992年DCIS发病率为2%～5%。2)年龄和预后无显著性关系,但5年局部复发率有统计学意义,P=0.031。3)肿瘤大小对DCIS预后无影响。4)各术式的生存率、健在率、复发率和转移率无明显差别。5)化疗对DCIS的预后无影响。结论:非普查DCIS患者的发生率为2%～5%,40年内基本稳定。DCIS复发率和转移率低,生存率高。年轻DCIS患者预后不如年老者。各术式的复发率、转移率、生存率和健在率相同。术后辅助化疗无意义。     

乳腺导管内癌与乳腺浸润性导管癌的超声特征及病理对照分析

目的探讨乳腺导管内癌与乳腺浸润性导管癌的超声特征及病理情况。方法选取2014年2月至2016年1月间广东省肇庆市第一人民医院收治的45例乳腺导管内癌患者与45例乳腺浸润性导管癌,分析两种乳腺癌患者的超声声像特点与病理情况的差异。结果两种乳腺癌患者的病灶大小、形状、血流信号、病灶周边毛刺与边界情况比较,差异均有统计学意义(均P<0.05)。结论乳腺导管内癌与乳腺浸润性导管癌的超声特征及病理情况上有差异明显,有助于临床疾病的鉴别诊断。     

乳腺导管原位癌的单中心预后分析

背景与目的:目前中国乳腺导管原位癌(ductal carcinoma in situ,DCIS)的发病率逐年升高,而现有治疗策略主要基于欧美大型随机对照研究.探索中国人群中DCIS患者的临床特征、复发模式和预后影响因素,以便优化临床决策.方法:回顾性分析2008年1月—2017年1月复旦大学附属肿瘤医院收治的1185例...     

乳腺导管癌72例诊治分析

目的 探讨各期乳腺导管的手术方式选择。方法 对72例乳腺导管癌患者的诊治过程进行回顾性分析。结果 本组病人行乳腺癌改良根治术44例（61.1%），术后效果均满意，恢复良好。结论 对于大多数I、II期乳腺导管癌和部分Ⅲ期乳腺癌病人，肿瘤或淋巴结融合巳侵犯胸肌，肿瘤距胸肌近或肿瘤位于乳房深部，或乳腺小而肿瘤大时，Halsted根治术仍是可采用的术式。     

乳腺导管原位癌与导管原位癌伴微浸润的临床比较

目的 分析乳腺导管原位癌(DCIS)及原位癌伴微浸润(DCIS-MI)患者治疗模式变化、临床特征、治疗结果及预后因素。方法 回顾性分析中国医学科学院肿瘤医院1999-2013年收治的866例女性患者资料。DCIS患者631例,DCIS-MI患者235例。用Kaplan-Meier法计算局控(LC)、无瘤生存(DFS)、总生存(OS)率,并Logrank检验和单因素预后分析。结果 DCIS及DCIS-MI两组之间OS、LC及DFS相近(P>0.05)。单因素分析显示Her-2阳性为OS及DFS影响因素,保乳未放疗患者LC和DFS劣于全乳切除术患者。结论 导管原位癌和导管原位癌伴微浸润总体生存结果类似,Her-2阳性为OS及DFS预后不良因素,保乳未放疗患者的LC和DFS劣于全乳切除术。     

乳腺导管扩张症32例报告

乳腺导管扩张症是一种较少见的无菌性炎症样特殊类型乳腺病变。临床上主要表现为乳房肿块或 /和乳头溢液 ,极易误诊误治。本院 1989年 3月～ 1999年 6月经手术治疗、病理证实的乳腺导管扩张症 32例 ,就其诊断及治疗问题进行分析。1　临床资料1.1　一般资料　本组 32例均为非哺乳期妇女。年龄 35～ 38岁 ,平均 45岁。病变位于左侧 13例 ,右侧 18例 ,双侧同时发病者 1例。病程 10天～ 10年 ,平均 13 .5个月 ,其中 1年以内者 2 8例 ,占87 5 %。1.2　症状和体征　乳房肿块 2 6例 ,占 81 2 5 % ;乳头溢液 10例 ,占 31 2 5 % ,其中血性溢液 2例 ,…     

Mammographic appearances of mammary duct ectasia that mimic carcinoma in a screening programme

The aim of this study is to demonstrate the spectrum of mammographic appearances of mammary duct ectasia that mimic carcinoma in a breast cancer screening programme. Between February 1989 and March 1993, 40 003 women underwent screening mammography as part of the Western Australia Women's Cancer Prevention Unit screening programme. Fine needle aspiration or excisional biopsy was performed on 1437 women, and 12 cases of cytologically or histologically confirmed mammary duct ectasia were detected. A total of 14 mammographic abnormalities from 12 asymptomatic female patients were biopsied, and confirmed to represent mammary duct ectasia. The mammographic spectrum included eight areas of microcalcification (two of which were extensive), three spiculated masses and three lobulated, partially smooth masses. Five of these women showed no other mammographic stigmata of mammary duct ectasia in either breast. Additional features of mammary duct ectasia, including nipple retraction, retro-areolar duct dilatation or macrocalcification were identified in seven women. Mammographic features of mammary duct ectasia are frequently detected in asymptomatic women undergoing screening mammography and cause no diagnostic dilemma. Occasionally mammary duct ectasia will have a mammographic appearance that is indistinguishable from carcinoma, necessitating breast biospy. In this study 40% of those women with mammary duct ectasia that were submitted for biopsy had no other feature of mammary duct ectasia that could have suggested the pre-operative diagnosis.     

The anatomy of the arteries and veins of the breast

Textbook accounts of this subject are inadequate. This review considers the work of Cooper and Salmon and reproduces some of their figures. Applications in the diagnosis and treatment of cancer are discussed. The largest mammary arteries are the lateral (from the axillary) and the anterior medial and posterior medial (from the internal thoracic). The branches of these arteries do not follow the duct system, but instead form a plexus in the anterior fat layer. Normally there are no hypervascular or hypovascular areas. The contribution of the mammary branches of the posterior (aortic) intercostal arteries is minor. There are superficial and deep sets of veins, the latter associated with arteries. Mammary vessels of living women are demonstrated by infrared photography, thermography, and mammography. In the diagnostic use of these methods there is a tendency to rely upon the concept of normal vascular symmetry, but this is a fallacy.     

三氧化二砷对涎腺导管癌抑制作用的初步观察

目的观察三氧化二砷（As2O3）对人涎腺导管癌（Salivaryductcarcinoma）细胞的抑制作用,探索治疗人涎腺导管细胞癌的新途径。方法建立人涎腺导管癌细胞系,应用不同浓度As2O3在不同时间点作用人涎腺导管癌细胞株,以MTT和形态学分析法观察细胞的变化。结果不同浓度三氧化二砷在不同时间点对人涎腺导管癌细胞均有明娃抑制作用,并呈时间剂量依赖关系,癌细胞异形性逐渐消失,细胞凋亡现象明显,可见凋亡小体。结论As2O3对人涎腺导管癌细胞株具有显著的抑制增殖、诱导分化和促进凋亡作用。     

Clinically and mammographically occult invasive ductal carcinoma diagnosed by ultrasound: The focally dilated duct

A case of clinically and mammographically occult invasive ductal carcinoma presenting as a focally dilated duct on ultrasound is reported. The features of ductal dilatation in benign and malignant conditions on ultrasound are highlighted.     

乳管内视镜在诊断伴乳头溢液的乳腺癌中的应用

目的：研究乳腺导管内视镜在诊断伴乳头溢液的乳腺癌方面的临床应用价值。方法：1997年10月-1999年8月共对393例乳头溢液患者进行乳管内视镜检查,其中发现乳腺癌11例,对此11例患者的乳管内镜下表现进行研究及随访。结果：乳管内视镜下乳腺癌具有较特异的管壁及管腔改变。如斑片样隆起和异常出血。新生物的表现似无特征性。乳管内视镜诊断的敏感度为82%（9/11）,特异度为98.7%。由于乳管镜的定位使得５例未Men及肿块的患者也顺利的进行了手术活检。且病理证实皆为导管内癌（DCIS）伴或不伴灶性浸润。结论：乳管内视镜在诊断乳腺癌方面具有早期诊断、定位病灶、引导活检等多方面应用价值。对于乳管内视镜发现的可疑病灶应该进一步尽早取得组织学确诊。     

THE EXPRESSION OF APOPTOSIS RELATED GENES IN THE PROCESS OF CANCERATION OF ATYPICAL HYPERPLASIA OF MAMMARY DUCT

Objective： To investigate the expression of apoptosis related genes p53 and bcl-2 in atypical hyperplasia of mammary duct and the relationship between the gene expression and oncogenesis of breast. Methods： mRNA of apoptosis related gene p53 and bcl-2 were detected by in situ hybridization in 44 cases of atypical ductal hyperplasia. p53 protein expression was detected by immunohistochemistry. The data were compared with those of 6 cases of benign hyperplasia and 26 cases of breast carcinoma. Results： The expression of p53 mRNA was 66.7% in benign hyperplasia, 40% in atypical ductal hyperplasia （55.6% in mild, 41.7% in medium, 26.1% in severe） and 19.2% in carcinoma （of which 21.4% were intraductal carcinoma and 16.7% were invasive）. The expression of p53 protein was negative in benign hyperplasia, 24% in atypical hyperplasia （mild 11.1%, medium 25%, severe 34.8%）, 38.5% in carcinoma （intraductal carcinoma 35.7%, invasive ductal carcinoma 41.7%）. The expression of bcl-2 was negative in benign hyperplasia, 78.6% in intraductal carcinoma, 83.3% in invasive ductal carcinoma. Conclusion： Loss and mutation of p53 gene and excessive expression bcl-2 mRNA were detected in severe atypical ductal hyperplasia.     

Patient variables that predict atypical cytology by nipple duct lavage

BACKGROUND: Nipple duct lavage (NDL) may be useful for breast cancer risk stratification. Published guidelines recommend that women with a 5-year Gail risk >/=1.7% should consider undergoing lavage for any fluid-yielding ducts, but it is not known whether increased breast cancer risk or nipple fluid production predict lavage atypia. METHODS: One hundred fifty women unselected for breast cancer risk underwent NDL with cannulation of all nipple aspirate fluid (NAF)-producing ducts and at least 1 dry duct. This resulted in 516 lavage samples. The rate of cytologic atypia was compared for NAF-positive ducts and NAF-negative ducts and for women with 5-year Gail risks >/=1.7% and <1.7%. Ducts from breasts with cancer (N = 113) were excluded from the analysis. RESULTS: The cytologic atypia rate was similar for the 240 NAF-producing ducts (19%) and the 163 dry ducts (15%; P = .36). No significant differences were observed when atypia was categorized as mild (13% vs 10%; P = .63) or marked (6% vs 4%; P = .53). Among the 83 patients who were unaffected by breast cancer, atypia was diagnosed in 15 of 44 patients (34%) with a 5-year Gail risk <1.7% and in 11 of 39 patients (28%) with a 5-year Gail risk >/=1.7% (P = .74). CONCLUSIONS: Neither NAF production nor 5-year Gail risk predicted lavage atypia. Limiting NDL to fluid-producing ducts in women with a 5-year Gail risk >/=1.7% significantly reduced the sensitivity of the test for population screening.     

Association between breast cancer genetic susceptibility variants and terminal duct lobular unit involution of the breast

Terminal duct lobular units (TDLUs) are the predominant source of future breast cancers, and lack of TDLU involution (higher TDLU counts, higher acini count per TDLU and the product of the two) is a breast cancer risk factor. Numerous breast cancer susceptibility single nucleotide polymorphisms (SNPs) have been identified, but whether they are associated with TDLU involution is unknown. In a pooled analysis of 872 women from two studies, we investigated 62 established breast cancer SNPs and relationships with TDLU involution. Poisson regression models with robust variance were used to calculate adjusted per‐allele relative risks (with the non‐breast cancer risk allele as the referent) and 95% confidence intervals between TDLU measures and each SNP. All statistical tests were two‐sided; P < 0.05 was considered statistically significant. Overall, 36 SNPs (58.1%) were related to higher TDLU counts although this was not statistically significant (p = 0.25). Six of the 62 SNPs (9.7%) were nominally associated with at least one TDLU measure: rs616488 (PEX14), rs11242675 (FOXQ1) and rs6001930 (MKL1) were associated with higher TDLU count (p = 0.047, 0.045 and 0.031, respectively); rs1353747 (PDE4D) and rs6472903 (8q21.11) were associated with higher acini count per TDLU (p = 0.007 and 0.027, respectively); and rs1353747 (PDE4D) and rs204247 (RANBP9) were associated with the product of TDLU and acini counts (p = 0.024 and 0.017, respectively). Our findings suggest breast cancer SNPs may not strongly influence TDLU involution. Agnostic genome‐wide association studies of TDLU involution may provide new insights on its biologic underpinnings and breast cancer susceptibility.     

乳腺浸润性导管癌组织中HPV16、18E6及MCM7蛋白的表达

目的：检测人乳腺浸润性导管癌及乳腺良性病变中HPV16、18E6和MCM7蛋白的表达,探讨高危型HPV感染和细胞周期复制调控异常与人乳腺癌发生、发展的关系。方法：采用免疫组织化学sP法检测30例正常乳腺、30例乳腺腺病,52例乳腺浸润性导管癌组织中HPV16、18E6和MCM7蛋白的表达。结果：癌组中HPV16、18E6和MCM7蛋白的阳性表达分别为57．69％和96．15％,均显著高于正常组和腺病组（P〈0．02、P〈0．05）。HPV16、18E6与MCM7蛋白阳性表达呈正相关（r=0．5442;P〈0．001）。MCM7蛋白阳性表达与IDC组织学分级、淋巴结转移和肿块大小有关（P〈0．01、P〈0．03、P〈0．01）。结论：高危型HPV16、18感染和MCM7蛋白的高表达导致细胞周期复制调控异常涉及了HPV感染后乳腺癌的发生发展过程。MCM7高表达与乳腺癌细胞的增殖、侵袭和转移有关。二者联合检测可作为评价HPV感染乳腺上皮细胞的增殖状态和评价临床预后的生物学指标。     

原发性肝内胆管囊腺瘤（附14例报告）

目的：探讨原发性肝内胆管囊腺瘤临床病理特点及其治疗方法。方法：回顾分析1976年1月至2003年12月收治14例病例临床资料。结果：14例全部采用肝叶切除术,病理检查发现10例癌变（71.42%）。结论：原发性肝内胆管囊腺瘤以肝叶切除为最佳的治疗方法,并可预防癌变。