乳腺黏液腺癌的细针吸取细胞学诊断价值及标准

目的 探讨细针吸取细胞学(FNAC)在诊断乳腺黏液腺癌中的价值及标准。方法 对14例乳腺黏液腺癌FNAC涂片的基本形态学要素进行回顾性比较研究,并对细胞学诊断为Ⅰ～Ⅲ级的病例进行原因分析。结果 乳腺黏液腺癌核级主为1—2级,属轻～中度异型性,诊断敏感性为71．4％,假阴性率为28．6％。14例均出现多少不等的黏液,12例出现三维结构为主以及弥散为主的细胞排列方式,11例出现中度异型的游离肿瘤细胞。乳腺纯黏液腺癌组4例出现砂粒体。结论 只要掌握乳腺黏液腺癌FNAC涂片基本形态特征,FNAC诊断乳腺黏液腺癌是可行的。     

乳腺原发性黏液性囊腺癌临床病理分析和文献复习

目的 探讨乳腺原发性黏液性囊腺癌(mucinous cystadenocarcinoma,MCA)的临床病理特征及鉴别诊断.方法 分析1例MCA的组织病理学、免疫表型资料并复习文献.结果 乳腺肿物切面呈囊实性.镜下见大小不等、分布不均的囊性区,囊壁衬覆富含黏液的肿瘤细胞,或呈单层柱状、或复层化增生或形成乳头状结构.肿瘤细胞胞质内黏液呈PAS、AB染色阳性.肿瘤细胞CK7阳性,CK20阴性,ER、PR、HER2均阴性.囊壁肿瘤细胞外侧肌上皮细胞呈p63、SMA阴性.结论 (1)MCA是主要发生于绝经后妇女的罕见肿瘤,预后较好.(2)与卵巢和(或)胰腺黏液性囊腺癌类似,诊断原发肿瘤需先排除转移可能.     

原发性乳腺黏液性囊腺癌1例

<正>患者女性,56岁。因发现右侧乳腺包块4年余入院。体检:右侧乳腺外侧9点钟方向可触及质地较硬包块,境界不甚清楚,活动度较差,无压痛,无乳头溢液,无橘皮征,双侧腋窝可扪及质软样组织。余无异常发现。乳腺超声示:右侧     

超声引导下导丝定位切除术治疗触诊阴性乳腺病灶的价值

目的探讨超声引导下导丝定位切除术治疗触诊阴性乳腺病灶的临床应用价值。方法选择133例超声探及但临床触诊阴性的乳腺病灶,在超声引导下将定位导丝置入乳腺病灶内,根据定位导丝的位置切除病变及其周围部分正常组织,并送检病理检查。结果133例患者共136个结节,导管内乳头状瘤9例,乳腺增生症伴纤维腺瘤样结构形成25例,非典型增生4例,乳腺增生症35例,纤维腺瘤53例,乳腺浸润性癌8例,导管原位癌2例。结论超声引导下导丝定位切除术治疗触诊阴性乳腺病灶具有定位准确、操作简单、微创等优点,该技术的应用对于乳腺癌的早期诊断及早期治疗具有重要价值。     

高频超声诊断乳腺疾病的价值

乳腺疾病的发病率逐年上升,乳腺增生尤为常见.乳腺癌的发病率居我国女性恶性肿瘤中的第二位,已有报道为首位[1].发病年龄也趋于年轻化.因超声检查具有简便、易行且无损伤,已成为检查乳腺的常规方法之一.     

乳腺不典型炎性病变超声特征分析

目的探讨3种乳腺不典型炎性病变的声像学特征。方法选择经病理检查证实的48例乳腺导管扩张症(年龄16~60岁)、28例肉芽肿性乳腺炎(年龄36~78岁)及20例乳腺慢性炎症(年龄26~64岁)患者,均为女性。回顾性分析声像学表现,总结其超声特征。结果 96例乳腺炎性病变患者多无典型的乳腺红肿热痛炎症反应或明确的乳腺炎既往史,3种病变的声像学特征较相似,多呈形态不规则、边缘不清晰、回声不均匀的低回声病灶,纵横比小于0.7,病灶伴囊性成分及后方回声增强较常见,而点状强回声、高回声晕及腋窝淋巴结肿大少见。结论不典型乳腺炎性病变的超声表现具有一定特征性,检查者应提高对该类疾病的认识,提高术前超声诊断准确率。     

高频超声对乳腺肿块的声像图分析

目的 探讨乳腺肿块的各种声像学特征,评价高频超声在乳腺癌诊断中的重要价值.方法 观察120例乳腺肿块,对比分析了乳腺癌与良性结节的声像图差异.结果 120例乳腺肿块均行手术或活检,病理证实结果为,恶性23例,良性97例;其中无明显肿块以片状低回声区伴微钙化为主要表现者1例.乳腺癌与良性结节在肿块的形态、边界、纵横比值是否>1、微钙化点、恶性环、血流信号、阻力指数>0.7、峰值流速PSV>20cm/s,两者比较有显著性差异(P<0.05),其准确性为89.2%.结论 高频超声诊断乳腺肿块良恶性符合率高,对乳腺肿块良恶性的诊断及鉴别诊断具有重要的临床应用价值.     

超声弹性成像技术在乳腺病变诊断中的进展

超声弹性成像作为对传统超声的补充,它能够评估组织的固有弹性属性并提供有关组织相对硬度方面的信息,是一种全新的、可靠的非侵袭性技术。文章综述了超声弹性成像的原理、相关技术及评分标准。着重介绍了压迫式超声弹性成像技术在乳腺疾病中的应用、存在的局限性、影响因素及超声弹性成像技术发展前景。     

超声检查对乳头区域乳腺病变的诊断价值

目的评价超声检查在诊断乳头区域乳腺疾病中的价值。方法对159例经超声检查并经临床或病理明确诊断的乳头区域病灶进行回顾性分析,计算其超声诊断符合率,并对其声像图特点包括二维、彩色多普勒、弹性成像特点进行归纳分析。结果所有病例包括乳腺导管扩张症73例;导管内乳头状瘤10例;导管内乳头状增生8例;纤维腺瘤16例;乳腺囊肿29例;软纤维瘤3例;腺病10例;炎性病灶5例;乳头湿疹样癌(Paget病)1例;浸润性导管癌4例。超声检出率100%,诊断符合率94.97%。结论乳头后方乳腺病变声像图有特异性表现,超声检查可作为其首选检查方法。     

Different extent of hypoxic-ischemic brain damage in newborn rats: histopathology,hemodynamic, virtual touch tissue quantification and neurobehavioral observation

Objective: To explore the correlation between pathological and ultrasound changes applying conventional ultrasound, Color Doppler ultrasound andVirtual Touch Tissue Quantification (VTQ) technique in newborn hypoxic-ischemic brain damage (HIBD) rat models. To provide theoretical basis for early diagnosis and treatment of HIBD neonatal. Methods: A total of 90 newborn Wistar rats were divided into ischemia, asphyxia and control group according to different HIBD molding methods. Conventional ultrasound, Color Doppler ultrasound and VTQ were applied on 3 h, 12 h, 24 h, 48 h and 72 h postoperative. After the observation of 72 h, 10 rats in each group were randomly selected for pathological specimens production. The rest rats were raised for 30 days for neuroethology detection. Results: In ischemia group and asphyxia group, there were 4 deaths and 6 deaths in the modeling process; the mortality rate was 13.33% (4/30) and 20.00% (6/30) respectively. For ischemia group, the systoli velocity (Vs), diastolic velocity (Vd) and resistance index (RI) of right middle cerebral artery (MCA) were significantly decreased after operation (P<0.05). For asphyxia group, the Vs and RI of right MCA were significantly decreased after operation (P<0.05), while the Vd of right MCA was significantly increased after operation (P<0.05), which lead to the postoperative RI value in each time point was all significantly lower than that in ischemia group (P<0.05). For ischemia group and asphyxia group, the VTQ results increased significantly postoperative (P<0.05), and compared with ischemia group and control group, the postoperative VTQ value in each time point was all significantly higher in asphyxia group (P<0.05). The neuroethology results were significantly lower in the ischemia group and asphyxia group (P<0.05), and the results in ischemia group were significantly higher than those of asphyxia group (P<0.05). And the results are consistent with the pathological findings. Conclusion: There is a consistent correlation among histopathological changes, hemodynamic changes, VTQ values and neuroethology results in HIBD animal models. As noninvasive quantitative ultrasound elastography methods, Color Doppler ultrasound and VTQ can assess the extent of HIBD damages in newborn rats with specific values. This study provides basic research and theory to early diagnosis and early treatment of neonatal hypoxic-ischemic brain damage.     

An interesting case of a mucinous tumour of the breast

We report the case of a mucinous cystadenocarcinoma of the breast in an elderly patient who presented with a large breast mass. Mucinous cystadenocarcinoma is a rare subtype of breast carcinoma. It classically occurs in post-menopausal women and is usually negative for ER, PR and HER2. This tumour may be difficult to differentiate from other similar variants of breast carcinoma and particularly from metastatic mucinous cystadenocarcinomas originating from other organs, such as the ovary and pancreas.     

31例乳腺粘液腺癌临床病理与预后的关系

目的：探讨乳腺粘液腺癌的临床病理特征及其与预后的关系。方法：收集我院乳腺粘液腺癌存档标本３１例，其中单纯型２６例，混合型５例。对其组织学类型、粘液量、淋巴结状态、雌激素受体水平以及生存率进行回顾性分析。结果：（１）单纯型给型的淋巴结转移率及５年生存率，差异均有显著性；（２）癌实质中粘液含量与预后无明显关系；（３）１０例单纯型雌激素受体检测阳性率为８０．０％。结论：单纯型和混合型有不同的生物学行为；     

24例乳腺黏液癌临床病理分析

目的：探讨乳腺黏液癌的临床病理特点,临床进展及预后。方法：对24例乳腺黏液癌进行病理学形态观察,并采用Max Vision法进行免疫组织化学雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、Her-2、Ki-67染色,对其进行随访和分析并回顾相关文献。结果：18例单纯型乳腺黏液癌,其中1例伴有微乳头结构的乳腺黏液癌,6例混合型。免疫组织化学肿瘤细胞22例ER阳性,19例PR阳性,1例混合型黏液癌HER-2阳性,单纯型黏液癌HER-2均阴性,单纯型乳腺黏液癌和混合型乳腺黏液癌两者具有统计学意义(P<0.05)。结论：乳腺单纯型黏液癌特征是细胞巢漂浮在黏液湖中,并由富含毛细血管的纤维分割。细胞团大小和形态各异,核异型性不明显,ER、PR阳性,HER-2阴性。单纯型乳腺黏液癌(pure mucinous carcinoma,PMCs)生长缓慢,转移率低,可以行保乳手术。伴有微小乳头结构的乳腺黏液癌(mucinous micropapillary carcinoma,MUMPC)与混合型乳腺黏液癌易发生转移,建议行乳腺改良根治手术,术后辅助放化疗。     

Surface topography and ultrastructural changes of mucinous carcinoma breast cells

Mucinous carcinoma of the breast (MCB) is histologically classified into 2 groups: (1) pure MCB and (2) mixed MCB. Pure MCB carries a better diagnosis than mixed MCB. This research relates to the cell surface topography and ultrastructure of the cells in the above cases and aims to find the differences between them, by means of two methods: scanning electron microscopy (SEM) and transmission electron microscopy (TEM). For the SEM examination, it was necessary to initially culture the MCB tissues and then proceed with the usual SEM method. In contrast, for the TEM technique, MCB tissues were initially fixed followed by the classic TEM method. The authors found the topography of pure MCB cases to be without nodes. The cell membrane was smooth, with numerous pores and small ruffles that covered the entire cell. The ultrastructural appearance of the same cases was with a normal cell membrane containing abundant collagen fibers. They also had many small vesicles containing mucin as well as secretory droplets. In contrast the mixed MCB had a number of lymph nodes and their cell surface topography showed stronger changes such as microvilli, numerous blebs, ruffles and many long projections. Their ultrastructure showed very long microvilli with large cytoplasmic inclusions and extracellular mucin collections, electron-dense material vacuoles, and many important cytoplasmic organelles. An important fact is that mixed MCB also contains areas of infiltrating ductal carcinoma. These cells of the cytoplasmic organelles are clearly responsible for the synthesis, storage, and secretion of the characteristic mucin of this tumor type. Evidently, this abnormal mucin production and the abundance of secretory granules along with the long projections observed in the topographical structure might be responsible for transferring tumor cells to neighboring organs, thus being responsible for metastatic disease.     

Mucinous cystadenocarcinoma of the breast coexisting with infiltrating ductal carcinoma

A recently described and rare variant of breast carcinoma, mucinous cystadenocarcinoma (MCA), is reported in a 65-year-old post-menopausal woman. She presented with a gradually enlarged breast tumor. A well-circumscribed tumor measuring about 3 cm in diameter was noted in the mammographic and ultrasonographic examinations. The mammographic and ultrasonographic findings were indistinguishable from more common mucinous carcinoma (colloid carcinoma) of the breast. The gross appearance of the tumor was well-defined and cystic, consisting of abundant transparent to bloody mucin, as well as whitish solid parts. Microscopically, the tumor was characterized by abundant extracellular and intracellular mucin. It looked like a mucinous cystic neoplasm of the ovary and pancreas. Particularly, few microscopic foci of ordinary intermediate-grade infiltrating ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS) were observed around the main lesion in this case. A transition from ordinary DCIS to MCA in situ was found. It might indicate MCA derives from a metaplasia process of ordinary DCIS. MCA can be easily differentiated from mucinous carcinoma by quite different histologic and immunohistochemical findings. According to the previously reported and present cases, MCA of the breast more commonly affects elderly women and has a relatively favorable prognosis.     

Mucinous metaplasia of breast carcinoma with macrocystic transformation resembling ovarian mucinous cystadenocarcinoma in a case of synchronous bilateral infiltrating ductal carcinoma

Mammary mucinous cystadenocarcinoma (MCA) is a rare, invasive ductal carcinoma (IDC) of the breast that is virtually identical morphologically to MCA of the ovary, pancreas or appendix. Synchronous bilateral breast tumors, not uncommonly encountered in fibroadenoma and lobular carcinoma, are unusual in IDC. Reported herein is a primary MCA of the right breast coexisting with a bilateral ordinary IDC in a 55-year-old Taiwanese woman who underwent modified radical mastectomy of both breasts with bilateral axillary level I and II lymph node dissection. In the right breast a 2.5 cm unilocular mucus-filled cyst was found. It had complex papillae, some of which were supported by delicate fibrovascular stroma, lined by simple to slightly stratified columnar neoplastic epithelial cells with intracellular mucin and an abundance of intracystic extracellular mucin, coexisting with a low-grade ordinary IDC. In the left breast a high-grade ordinary IDC was discovered. The patient had undergone simple abdominal total hysterectomy for myoma uteri along with bilateral salpingo-oophorectomy 10 years previously. Based on pathological studies and a literature review, it is suggested that mammary MCA arises from mucinous metaplasia and macrocystic transformation of ordinary breast carcinoma. A brief discussion of bilateral breast cancers is also given.