隐性乳腺癌：10例临床病理及免疫组织化学研究

隐性乳腺癌是指乳腺未触及肿块而以胶淋巴结或远处转移为首发症状的乳腺癌（OccultBreastCarcinoma，OBC）。本病虽属少见，但常使临床诊断和治疗进退两难，本文就我院近12年来所见10例以液淋巴结转移为首发症状的OBC予以报道，并对其临床病理及免疫组织化学进行讨论分析。材料与方法收集到我院第一附属医院病理科及苏州市病理会诊材料（1983～1994年）OBC共10例。腋淋巴结转移灶及根治术切除标本原发灶均经10％福尔马林固定，常规石蜡切片，HE染色镜检，根治术标本按WHO分类观察，并作了雌激素受体（ER）、孕激素受体（PR）和抗人…     

57例三阴性乳腺癌的临床病理特征分析

目的：探讨三阴性乳腺癌（ TNBC）的临床病理特征。方法回顾性分析57例TNBC患者的临床资料,并以280例非三阴性乳腺癌患者（ NTNBC）作为对照。结果 TNBC组Ⅲ级28例（49.1%）,NTNBC组12例（4.3%）（P〈0.05）。局部复发率在TNBC组及NTNBC组中分别为15.8%及6.8%（P〈0.05）;远处转移率分别为26.3%及14.6%（P〈0.05）。结论乳腺癌TNM分期能够反映TNBC的侵袭性和复发转移的临床特点,TNBC患者更易出现淋巴结转移及远处转移。     

８６９例乳腺癌临床病理特征分析

目的　分析乳腺癌的临床病理特征,以提高临床诊治水平。方法　回顾性分析２００１年１月至２００９年１月我院收治的８６９例乳腺癌患者临床资料,采用免疫组化ＳＰ法检测激素受体状况,结合临床病理特征进行分析。结果　４０～４９岁和５０～５９岁两组病例所占百分比最高,分别为３１.１％和２４.７％。组织学类型以浸润性非特殊型癌最多,占８０.２％（６９７／８６９）。诊断时Ⅰ ～Ⅱ期占８０.１％（６９６／８６９）,其中发病时无淋巴结转移者占６０４％。本组ＥＲ阳性者占６６９％（５８１／８６９）,ＰＲ阳性者占６９.５％（６０４／８６９）,ＨＥＲ-２阳性者占３９.７％（３４５／８６９）。ＥＲ、ＰＲ表达与发病年龄呈明显正相关（Ｐ＜０.０５）,ＨＥＲ-２表达与乳腺癌发病年龄无相关性（Ｐ＞０.０５）。结论　乳腺癌患病年龄较以往提前,早期乳腺癌可行保乳手术,受体阳性患者比例高,可采用内分泌治疗。     

胃泌酸腺腺瘤临床病理特征分析

目的:探讨胃泌酸腺腺瘤（oxyntic gland adenoma，OGA）的临床病理特征、诊断及鉴别诊断、治疗与预后。方法:回顾性分析6例OGA患者临床资料、病理学特征及免疫组化表型特点，并复习国内外相关文献。结果:6例中男、女各3例，平均年龄67岁。病变为无蒂息肉或隆起，主要位于胃底和胃体，均为单发，镜下形态相似，胃黏膜固有层内可见成簇增生的不规则分支、扭曲、相互吻合的腺体，主要有主细胞排列而成，混有不同比例的壁细胞。免疫组化标记显示MUC6、胃蛋白酶原Ⅰ阳性，MUC5AC、Syn、CD56局灶阳性，MUC2阴性，Ki67指数较低。结论:OGA是一种新近被认识的胃肿瘤性病变，具有独特的病理组织学特点，诊断需把握原则并与其他息肉样病变相鉴别。内镜下黏膜切除术(endoscopic mucosal resection,EMR)、内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)切除治疗可获治愈，且预后好。     

274例乳腺癌临床病理分析

目的 总结热带三亚地区乳腺癌的发病情况。方法 回顾性分析274例乳腺癌的病理活检材料。结果 51—60岁101例(37％)为高发年龄组;浸润性导管癌214例(78％);浸润性小叶癌25例(9％);髓样癌18例(6.6％);小叶原位癌8例(2.9％),粉刺癌4例(1.5％),粘液癌4例(1.5％);鳞癌1例。结论 乳腺癌占乳房病变的17.2％,低于国内其它地区,高发年龄段比国内其它地区推迟。     

乳腺癌PCNA表达及临床病理意义

目的：研究PCNA在乳腺癌表达的临床病理意义及其与ER,PR,C-erbB-2蛋白,nm23蛋白表达的相互关系。方法：应用微波修复免疫组化技术S－P法检测了82例乳腺癌中单克隆抗体PCNA的表达。结果：PCNA表达位于核中,乳腺癌中PCNA过表达率为48．78％（40／82）,其过表达与组织低分化,临床分期晚,有淋巴结转移及复发生存期短相关。与病人年龄,肿瘤大小,ER,PR,C－erbB-2蛋白,nm23蛋白表达无关。结论 ：PCNA过表达情况可作为反映乳腺癌低分化及预后差的单独指标。     

352例老年女性乳腺癌临床病理特征分析

[目的]探讨65岁以上老年女性乳腺癌的临床和病理特征。[方法]收集1990年1月至2006年4月收治的352例65岁以上女性乳腺癌患者，分析其临床和病理特征。[结果]352例65岁以上乳腺癌占同期乳腺癌患者的11.6%，最大年龄98岁，中位年龄69岁。主要病理类型为浸润性导管癌（76.4%），有脉管瘤栓的19例，40.3%的患者合并其他疾病。免疫组化显示ER/PR（＋）占63.7%，HER-2（＋＋）～（＋＋＋）占17.4%，HER-2的表达在可手术组与不可手术组有统计学差异（P〈0.05）。[结论]老年乳腺癌患者HER-2状态与分期呈正相关，激素受体表达率高，内分泌治疗效果好；同时治疗时应充分考虑老年乳腺癌患者大多合并其他疾病。     

心脏肿瘤30例临床病理分析

目的：分析30例心脏肿瘤的病理类型、形态学变化及其临床病理特征。方法：采用HE染色、组化及免疫组化SP技术对30例心脏肿瘤进行病理学观察。结果：良性肿瘤25例(83％)，包括心房粘液瘤、心脏横纹肌粘液瘤、心包囊肿；恶性肿瘤5例(17％)，包括血管内皮肉瘤、恶性间皮瘤、恶性淋巴瘤、心包恶性胸腺瘤及转移癌。结论：心脏肿瘤以原发性较多见。而原发性心脏良性肿瘤以心房粘液瘤最多见，其他少见，原发性心脏恶性肿瘤类型较多，组织学形态较复杂，易与继发性肿瘤混淆。选择适当的影像学检查，有效的心脏外科手术、配合以病理形态学观察及免疫组化标记，对原发性心脏肿瘤的诊治很有必要。     

成人分泌型乳腺癌临床病理分析

本文报告了４例成人分泌形乳腺癌。大体多数有推进性边缘，２例可见坏死及囊腔形成。组织学特点表现为大多数肿瘤与周围有纤维分隔，排列成腺泡状、滤泡样、腺样及乳头状结构。核呈泡状，细胞异形性不显著，核分裂相罕见或缺乏。细胞内外均可见红染的分泌物，ＰＡＳ染色阳性。     

胸膜孤立性纤维性肿瘤的临床病理特征分析

目的探讨胸膜孤立性纤维性肿瘤的临床病理特征。方法选取2011年4月至2014年3月间收治的38例胸膜孤立性纤维性肿瘤患者,收集其临床特征及组织病理学资料,免疫组化检测CD34、波形蛋白(Vimentin)、CD68、CD99、平滑肌肌动蛋白(SMA)、Bcl-2、S100和EMA表达。结果38例胸膜孤立性纤维性肿瘤患者中,CD34、Vimentin、CD99、SMA和Bcl-2均在肿瘤细胞胞质内表达,阳性表达率分别为100.0%、100.0%、65.8%、5.3%和78.9%,CD68、S100、EMA呈阴性。结论胸膜孤立性纤维性肿瘤较少见,组织学形态多样,应注意与其他间叶源性肿瘤相鉴别,可结合其组织学形态及免疫组化染色结果确诊。     

110例乳腺间期癌的临床病理特征分析

目的 分析顺义区三轮乳腺癌筛查中110例间期癌患者的临床及病理特征。方法 将顺义区历年乳腺癌发病个案信息与北京市妇幼保健网络信息系统中适龄女性乳腺癌筛查数据进行关联,查询乳腺间期癌患者。将间期癌患者与同时期在我院乳腺中心就诊的乳腺癌患者进行特征比较。结果与门诊收治的原发性乳腺癌相比,间期癌患者年龄偏小、超声肿物较小,差异均有统计学意义（P＜0.05）。与病灶大小相近的门诊收治的乳腺癌患者相比,真正间期癌X线检查恶性钙化和浸润性导管癌的比例均较高,差异均有统计学意义（P＜0.05）。间期癌患者在乳腺癌筛查中转诊X线检查比例很低（0.91%）,而110例间期癌确诊时有103例接受了乳腺X线检查,其中53例（48.2%）存在恶性钙化表现。结论 乳腺癌筛查中,年龄偏小的女性更易发生间期癌。由于间期癌患者中接近50%在诊断时存在X线下恶性钙化表现,因而若在以超声检查为主的乳腺癌筛查过程中结合乳腺X线检查,或许可以避免部分间期癌的发生。     

多病灶乳腺癌临床病理特征分析

目的探讨多病灶乳腺癌不同病灶临床病理特点的异同,以便更好地指导临床治疗。 方法回顾性分析2014年11月至2016年8月南京医科大学第一附属医院乳腺外科收治的41例多病灶乳腺癌患者的临床病理资料。分析多病灶乳腺癌不同病灶的常规病理、免疫组织化学检测结果及分子亚型的异同,并采用χ²检验比较多病灶乳腺癌与同期150例单病灶乳腺癌的病灶直径、组织学分级、淋巴结状态和脉管内癌栓状况。 结果41例多病灶乳腺癌患者中,有2处病灶者32例,3处病灶者8例,4处病灶者1例;病灶直径≤2 cm者18例,>2 cm者23例;不同病灶病理类型相同者33例(80%),不同者8例(20%);不同病灶组织学分级相同者38例(93%),不同者3例(7%);不同病灶免疫组织化学标志物ER、PR、HER-2、Ki67表达水平不同者分别为3例(7%)、6例(15%)、5例(12%)、3例(7%);分子亚型不同者5例(12%)。多病灶乳腺癌与单病灶乳腺癌患者相比,组织学分级3级、淋巴结转移及脉管内癌栓分布的差异均有统计学意义[51%(21/41)比32%(48/150), χ²＝5.154 ,P＝0.023;59%(24/41)比41%(61/150), χ²＝4.163 ,P＝0.041;29%(12/41)比8%(12/150), χ²＝13.257,P<0.001],但病灶直径的差异无统计学意义[56%(23/41)比56%(84/150),χ²＝0.001,P＝0.991)]。 结论多病灶乳腺癌不同病灶可存在不同的临床病理结果,因此,不同病灶均应进行常规病理与免疫组织化学检测,以便完整提供患者病理信息,选择最佳治疗方案。多病灶乳腺癌更易发生淋巴结转移及脉管内癌栓,提示可能预后较差。     

Prospective cost-effectiveness analysis of genomic profiling in breast cancer

BackgroundThe cost-effectiveness of the 70-gene signature (70-GS) (MammaPrint®) has earlier been estimated using retrospective validation data. Based on the prospective 5-year survival data of the microarRAy-prognoSTics-in-breast-cancER (RASTER) study, the aim here was to evaluate the cost-effectiveness reflecting the actual use in clinical practice, including reality-based compliance rates.MethodsCosts and outcomes (quality-adjusted-life-years (QALYs)) were calculated in node-negative (N?) patients included in the RASTER study (n = 427). Sensitivity and specificity of the 70-gene and Adjuvant! Online (AO) were based on 5-year distant-disease-free survival (DDFS). Subgroup analyses were performed for two groups for whom benefit of the 70-gene had earlier been reported: (1) ductal, oestrogen receptor-positive (ER+), tumour diameter 10–30 mm, grade II, age 40–70; (2) ductal, oestrogen receptor-positive, tumour diameter 5–30 mm, grade II/III and age 40–70.ResultsBased on 5-year survival data, the cost-effectiveness of the 70-gene signature versus AO was prospectively confirmed. The total health care costs per patient were €26,786 for the 70-gene and €29,187 for AO. The quality adjusted life years yielded 12.49 and 11.88, respectively. The subgroups retrieved slightly higher life gains and higher costs, but all resulted finally in a favourable position for the 70-gene signature.ConclusionsThe use of the 70-gene signature, as judged appropriate by doctors and patients and supported by a low risk 70-gene signature as an oncological safe choice, was also found to be cost-effective.     

Clinicopathological study of unilateral multiple breast cancer

BACKGROUND: The tendency for breast cancer to form multiple lesions is important to consider when planning breast-conserving surgery. However, many unknowns remain regarding the pathology and prognosis of multiple breast cancer, and therefore it is clinically significant to investigate its clinicopathological properties. METHODS: Over the past 25 years, in the period between April 1972 and March 1997, we investigated the clinicopathological findings including the 5-year and 10-year survival rates of 66 patients treated for unilateral multiple breast cancer. RESULTS: Of the total of 1,334 female patients with unilateral breast cancer who underwent curative surgery at our hospital, we identified 66 (5.0%) patients with unilateral multiple cancer. The incidence of such cancer has been higher in recent years. Of the 66 patients, 50 (75.8%) were premenopausal, and the remaining patients were postmenopausal, but multiple cancer among postmenopausal women is a recent phenomenon. The ER positivity rate of the main lesion in patients with multiple breast cancer was 69.2% and that of PgR was 50.0%. The 5-and 10-year overall survival rate in all 66 patients with multiple breast cancer was 90.8% and 79.7%, respectively. CONCLUSION: In the past, multiple breast cancer was frequently identified in premenopausal women. However, the current findings indicate that its incidence among postmenopausal women has increased in recent years. In addition, prognoses were comparable for patients with multiple or solitary breast cancer, a relevant finding in the planning of breast-conserving surgery.     

Clinicopathological characters of triple negative breast cancer

Objective:To study the clinicopathological characters of triple negative breast cancer (TNBC).Methods:A total of 629 patients with breast cancer were reviewed, who were treated from 2003 to 2007 in Chongqing Cancer Institute. The comparison of clinicopathological features including TNM classification, histological type, tumor location, axillary lymphonodes status and neoadjuvant chemotherapy between TNBC and nontriple negative breast cancer (NTNBC) was performed. The overall response was evaluated by whether the patients achieve complete remission (CR) and partial remission (PR) after chemotherapy. Results:There were 69 TNBCs in the 629 patients with breast cancer. The premenopausal patients, which was found in 49/69 of TNBCs, was more than NTNBCs. The average diameter of tumor in TNBC group was 4.1 em, lager than NTNBC group. TNBC with axillary nodes metastasis occurred in 21 cases, and the axillary nodes metastasis rate was lower than NTNBC. The positive expression rate of p53 in TNBC was 44.9%, and the overall response (CR+PR) was 72.2%. No statistical differences were found regarding the positive expression rate of p53 and the overall response between TNBC and NTNBC. Conclusion:TNBC were a group of primary breast cancers with triple negative, tending to occur in premenopausal women, with larger tumors, lower axillary nodes metastasis rate. TNBC had worse clinical prognosis and currently lacked effective targeted therapies.     

新疆地区1006例不同分子分型乳腺癌的临床病理特征及预后

目的 探讨新疆地区不同分子分型乳腺癌的临床病理特征和预后。方法 收集2008年1月至2010年12月新疆医科大学附属肿瘤医院行手术治疗的1006例女性乳腺癌患者的临床病历资料,根据雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体-2（HER-2）和Ki-67的状态,将乳腺癌分为：Luminal A型、Luminal B型、HER-2过表达型及Basal like型,对比分析不同分子分型乳腺癌患者的临床病理特征、复发转移及预后情况。结果 Luminal A型551例（54.8％）,Luminal B型182例（18.1％）,HER-2过表达型77例（7.7％）,Basal-like型196例（19.4％）。不同分子分型乳腺癌在肿块大小、淋巴结转移数目、临床分期、组织学分级、民族及内分泌治疗的差异均具有统计学意义（P＜0.05）。获得随访的971例患者中,HER-2过表达型的局部复发率（12.3％）及远处转移率（27.4％）均高于其他分型（P＜0.05）。Luminal A型、Luminal B型、HER-2过表达型及Basal-like型6年无病生存率分别为86.8％、75.8％、58.9％、79.1％（P＜0.05）;6年生存率分别为92.1％、83.1％、67.1％、88.0％（P＜0.05）。Cox多因素回归分析显示,淋巴结转移数目、组织学分级、内分泌治疗及分子分型是影响新疆地区乳腺癌总生存时间（OS）和无病生存时间（DFS）的独立因素,民族亦是影响该地区乳腺癌患者DFS的独立因素。结论 新疆地区Luminal A型乳腺癌最常见,预后最好,HER-2过表达型比例最低,预后最差。乳腺癌预后与淋巴结转移数目、组织学分级、内分泌治疗及分子分型有关,民族是影响乳腺癌患者DFS的重要因素。     

男性乳腺癌的临床病理特征及生存分析

目的 探讨男性乳腺癌患者的临床病理特征及影响预后的因素。方法 回顾性分析1999年1月至2010年5月经病理证实的55例接受手术治疗的男性乳腺癌患者。采用Kaplan-Meier法绘制生存曲线,Log-rank检验进行生存比较,多因素分析用Cox风险比例回归模型。结果 55例患者的5年生存率为61.8％。肿瘤TNM分期Ⅰ、Ⅱ、Ⅲ和Ⅳ期患者的5年生存率分别为75.0％、69.6％、45.4％和20.0％,差异有统计学意义（P＜0.05）。组织学分级Ⅰ、Ⅱ和Ⅲ级患者的5年生存率分别为83.3％、67.5％和333％,差异有统计学意义（P＜0.05）。单因素分析显示,不同组织学分级、T分期、TNM分期、淋巴结有无转移及是否放疗均与男性乳腺癌患者的5年生存率有关（P＜0.05）。Cox回归模型分析显示,组织学分级（HR=3.690,95％CI：1.476～9.225,P＜0.05）和TNM分期（HR=3.437,95％CI：1.447～8.163,P＜0.05）是影响男性乳腺癌预后的独立因素。结论 组织学分级和TNM分期是影响男性乳腺癌预后的独立因素。男性乳腺癌的诊治有待进一步研究。     

Evaluating distant metastases in breast cancer: from biology to outcomes

There is an urgent need to understand distant metastases in breast cancer as they are the most lethal form of recurrence and a major cause of mortality in patients. Some predictors for distant metastases, including nodal status, tumor grade, and hormonal status, are useful in identifying patients at increased risk for distant metastases. Adjuvant endocrine therapy has been the treatment of choice for postmenopausal women with hormone-sensitive breast cancer, and some therapies have shown significant reductions in the risk of distant metastases. Skeletal metastases in breast cancer are treated with bisphosphonates with a certain level of success. With more new agents undergoing clinical trials, a thorough review of the specific and long-term safety of these agents is essential, as is a better understanding of the deterioration in the quality of life and cost concerns of patients who develop distant metastases. Gene-expression profiling is a new entrant in the field of distant metastases diagnosis, which is largely successful in defining gene signatures that predict the development of distant metastases. This review will discuss the biology and the impact of distant metastases on outcomes for patients with breast cancer; it also encompasses the current status, emerging focus, and future perspectives in treatment of skeletal metastases in patients with breast cancer.     

早期乳腺癌乳房保留治疗的疗效分析

目的 评价早期乳腺癌保乳术后伞乳放疗的生存率和局部.区域控制率,探讨影响局部控制的因素.方法 近10年收治的早期乳腺癌接受保乳术者335例,其中术后单纯放疗、序贯化放疗、同期放化疗、化放化疗分别为25、194、80、36例.312例接受腋窝淋巴结清扫,2例前哨淋巴结活榆.310例接受辅助化疗.256放疗范围为单纯乳房,79例包括区域淋巴结照射.全乳和区域淋巴结照射剂量为50 Gy分25次,中位瘤床剂量为60 Gy分30次.放疗和手术间隔时问<4、4～8、>8～20、>20周的比例分别为16.4%、23.6%、37.3%、22.7%.结果 中位随访期48.0个月(25.3～146.7个月).5年局部一区域控制率和同侧乳房控制率分别为94.5%和95.6%;5年无病生存率、无转移牛存牢和总生俘率分别为88.6%、93.2%和98.8%.单因素分析发现脉管受侵、神经受侵犯和Ⅱ期切除的5年局部控制率下降,手术与放疗间隔时间、化疗与放疗结合方式的局部榨制率均相似.多因素分析发现脉管侵犯和Ⅱ期切除是独立的预后因素.序贯化放疗+单纯放疗、同期放化疗、化放化疗≥3级皮肤反应(湿性脱皮)发生率分别为4.5%、80.0%、77.0%(χ2=226.00,P=0.000).结论 早期乳腺癌保乳术加术后伞乳放疗等可获得良好的局部控制率和牛存率.脉管受侵与否和Ⅱ期切除是影响局部控制率的独立预后因素.未发现手术与放疗间隔时间、放疗与化疗结合方式对局部控制率有影响,但同期放化疗或化放化疗者发生皮肤湿性脱皮的概率明显增高.     

Impact of gene-expression profiling in patients with early breast cancer when applied outside the guideline directed indication area

PurposeIn Dutch guidelines, gene expression profiles (GEP) are indicated in estrogen receptor positive early breast cancer patients in whom benefit of chemotherapy (CT) is uncertain based on traditional prognostic factors alone. Aim of the present study is to assess the use and impact of GEP on administration of adjuvant CT in breast cancer patients who have according to national guidelines a clear indication to either use or withhold adjuvant chemotherapy (clinical high or low risk).MethodsClinical low- and high-risk patients, according to Dutch breast cancer guidelines, diagnosed between 2011 and 2014 were selected from the Netherlands Cancer Registry. Influence of GEP use and GEP test result on CT administration was assessed with logistic regression.ResultsOverall, 26,425 patients were identified; 4.8% of patients with clinical low risk (444/9354), 7.5% of the patients with a clinical high risk (1281/17,071) received a GEP. GEP use was associated with significantly increased odds of CT administration in clinical low-risk patients (OR = 2.12 95% CI: 1.44–3.11). In clinical high-risk patients, GEP use was associated with a decreased frequency of CT administration (OR = 0.55, 95% CI: 0.48–0.63). Adherence to the GEP result was higher in clinical high-risk patients with a discordant GEP result as compared to clinical low-risk patients with a discordant GEP result: 71.7% vs. 52.2%, respectively.ConclusionGEP is frequently used outside the indicated area and significantly influenced the administration of adjuvant CT, although adherence to the test result was limited.