乳腺腺纤维瘤癌变11例临床病理分析

目的：探讨乳腺腺纤维瘤癌变的临床病理特点。方法：对1963—2001年经病理证实的乳腺腺纤维瘤癌变11例进行分析，重点分析诊断方法、病理特点、治疗方式及预后因素。结果：11例均为手术检出，其中8例为管内癌，1例小叶原位癌，2例浸润性导管癌。保守性手术8例，根治术或仿根治术3例，随访3个月-25年，均健在。结论：乳腺良性肿瘤均应手术切除并做病理检查，本病属乳腺癌的早期病变，保守性手术治疗效果良好。     

乳腺腺纤维瘤癌变

1954~1990年,36年间共收治乳腺腺纤维瘤10316例,其中腺纤维瘤癌变4例,约占同期我院收治腺纤维瘤总数的0.038%.病理组织学观察4例腺纤维瘤癌变为导管内癌,镜下均见正常的腺纤维瘤上皮发展为癌的过度性病理改变,此癌预后良好,治疗应按癌变的程度而采用适宜的治疗方法.     

乳腺腺纤维瘤10316例临床病理分析

 自1954～1990年36例间共收治乳腺腺纤维瘤10316例，均接受手术治疗并经病理证实，其中管型腺纤维瘤3436例占33．3％，围管型腺癌2795例占27．1％，混合型腺纤维瘤3156例占30．6％，分叶型腺纤维瘤526例占5．1％，囊性增生型腺纤维瘤403例占3．9％。患病年龄从9岁～68岁，中位年龄28岁。2／3在发病后2年内就诊。肿瘤最小0．3cm，最大24cm（仅1例，为分叶型腺纤维瘤），大多数≤3cm，占66．5％。病变绝大多数为单发，9228例，占89．5％，多发或双发的1088例，占10．5％。绝大多数经局部切除后治愈，少数病例433例（4．2％）切除后又复发，经再次切除治愈。在收治10316例乳腺腺纤维瘤的同期内有4例腺纤维瘤癌变为管内癌，经手术切除后，预后良好。     

乳头Paget病临床病理特征分析

目的 :探讨乳头Paget病临床特点、组织发生伴发病理亚型、性激素受体表达状况等临床病理特征。方法 :回顾分析了 2 1例乳头Paget病患者临床病理资料 ,光镜下重阅分析其病理学特征 ,并采用免疫组化SP法检测ER、PR水平。结果 :2 1例乳头Paget病中 17例临床触及肿块 ,4例未触及肿块 ,全部伴乳腺导管癌 ,前者伴发浸润性导管癌 14例、早期浸润性导管癌 3例 ,后者全部为导管内癌。腋窝淋巴结转移率47 6% ( 10 /2 1)。组织学亚型与淋巴结状态关系密切 ,P <0 0 5。ER阳性率2 3 8% ( 5 /2 1) ,PR阳性率 2 8 6%( 6/2 1) ,ER、PR同时阳性 2 3 8% ( 5 /2 1)。性激素受体水平与淋巴结状态关系密切 ,P <0 0 5 ,而与伴发组织学类型无关 ,P >0 0 5。结论 :本组乳头Paget病均伴发乳腺导管癌 ,伴乳腺肿块者均为浸润性导管癌 ,淋巴结转移率高 ,ER、PR低水平表达。     

192例乳腺肿块活检术后分析

192例乳腺肿块均经B超检查 ,手术治疗病理检查 ,对高度怀疑乳腺癌行快速病理检查以决定术式。乳腺癌2 3 90 % (4 6 192 ) ,叶状囊肉瘤 1 1% (2 192 ) ,增生性腺病 3 7 5 % (72 192 ) ,乳腺纤维瘤 2 6 1% (5 0 192 )。本组资料分析提示 ,不同年龄常提示不同的乳腺疾病 ,放宽手术治疗及病理检查的指征是早期发现乳腺癌的重要手段之一     

乳腺腺纤维瘤癌变及肉瘤变

乳腺腺纤维瘤癌变及肉瘤变天津市肿瘤研究所乳腺病理研究室（３０００６０）田艳涛，牛昀本院自１９９１年１月至１９９５年６月共收治乳腺腺纤维瘤３０１９例，均经手术切除及病理证实。其中４例为腺纤维瘤癌变，２例为灶性肉瘤变，分别占同期腺纤维瘤总数的０．１３％和...     

乳腺癌癌旁组织病理形态研究

目的 :探讨乳腺癌癌旁组织病理变化与乳腺癌的发生关系。方法 :将162例乳腺癌病理组织及乳腺癌癌旁组织连续切片制作成标本 ,HE染色 ,所有病理切片均由病理教研室教授专人阅片 ,得出病理诊断。结果 :乳腺癌最多见的癌旁病变是乳腺腺病 ( 78 40 % ) ,其次为乳腺导管扩张症 ( 3 0 86% ) ,乳腺囊肿病 ( 14 81% ) ,乳腺组织增生 ( 6 17% )。本组病例中乳腺非典型增生 41例 ,占2 5 3 1% ( 4 1/162 )。结论 :乳腺癌并非孤立的局部病变 ,而是在乳腺致癌因素作用下逐渐发展而成。对各种乳腺疾病要定期复查 ,积极治疗 ,尤其对乳腺非典性增生患者要进行追踪或防癌治疗     

从外科角度探讨乳腺导管内乳头状瘤癌变的治疗方法

目的:初步探讨乳腺导管内乳头状瘤癌变的术式。方法:对2000年1月～2004年12月本院收治的63例乳腺导管内乳头状瘤癌变病例的临床病理资料进行收集、整理、分析。结果:63例患者均接受手术治疗,其中1/4乳腺切除2例,1/4乳腺切除 腋淋巴结清扫12例,全乳切除 腋淋巴结清扫20例,仿根治术Ⅰ式(Auchincloss)23例,仿根治术Ⅱ式(Patey)5例,根治术1例。术后病理报告乳头状瘤癌变局限于导管内43例,乳头状瘤癌变伴早期浸润20例,切缘均为阴性,均未见淋巴结转移。结论:对于乳腺导管内乳头状瘤癌变可采用包括病变导管和(或)肿物的局部扩大切除术,不必常规清扫腋淋巴结。     

青年人肺癌的诊断与治疗

目的 :研究青年人肺癌的致病因素、临床特点及治疗方法。方法 :回顾性分析 1985年 1月 -2 0 0 0年 1月 ,手术治疗并经病理诊断的≤ 4 0岁青年人肺癌 67例。对其临床特点、误诊原因、手术及预后进行总结。结果 :按TNM分期 :Ⅱ期 17例、Ⅲ期 4 1例、Ⅳ期 9例。病理类型 :腺癌和小细胞癌达67 2 % (45 67)。术前 4 1例曾误诊误治。全部经手术治疗 ,34例行根治手术 ,2 0例行姑息手术 ,13例行剖胸探查。 1年、3年、5年存活率分别为 73 1%、4 6 3%、2 5 4 %。结论 :青年人肺癌就诊时多为晚期 ,生物学行为较差 ,早期诊治是提高生存的根本措施。综合治疗可提高疗效     

Ⅲ期以上肺癌外科治疗45例临床分析

近年来 ,随着外科技术的提高 ,基层医院也大量开展了晚期肺癌的外科治疗 ,分析我院 45例Ⅲ期以上肺癌手术切除的临床资料 ,就有关问题作初步探讨。1　临床资料1 1　一般资料1995年 2月 -2 0 0 1年 12月 ,我们对 45例Ⅲ期以上肺癌患者施行外科手术 ,其中男 2 7例 ,女 18例 ;年龄 2 4～ 72岁 ,平均5 2 4岁 ;中央型肺癌 17例 ,周围型肺癌 2 8例。病理类型 :鳞癌2 2例 ,腺癌 17例 ,小细胞癌 4例 ,腺鳞癌 2例。按pTNM分期 :ⅢA期 2 5例 (T2 N2 M0 9例、T3N0 M0 10例、T3N1 M0 4例、T3N2 M0 2例 ) ,ⅢB期 18例 (T4 N1 M0 11例、T4 N2 M…     

乳腺癌的保留乳房治疗体会

为了探讨乳腺癌保留乳房综合治疗的原则和近期疗效,回顾分析实施保留乳房手术+术后化疗+术后放疗+雌激素受体试验阳性的32例Ⅰ、Ⅱ期乳腺癌患者的内分泌治疗随访。32例全部生存,1例同侧复发,所有病例乳房外形正常。初步研究结果提示,乳腺癌的保留乳房治疗是一种需多科密切配合的综合性治疗手段,可成为早期乳腺癌的主要治疗方法。     

三阴乳腺癌保乳治疗的疗效分析

目的 探讨三阴乳腺癌行保乳治疗后的疗效观察.方法 行保乳手术治疗的乳腺癌患者593例,所有病例的ER、PR、HER2/neu状态均经病理证实,根据ER、PR、HER2/neu的状态分为三阴乳腺癌(ER、PR、HER2/neu 均为阴性)及非三阴乳腺癌(ER、PR、HEE2/neu其中任何一项为阳性)两组.其中三阴乳腺癌92例,非三阴乳腺癌501例.结果 截止2009年11月,共随访593例,中位随访时间为52月,出现局部复发病例11例,远处转移28例,死亡16例.三阴乳腺癌组比非三阴乳腺癌组有较高的远处转移率,预后较差.但三阴乳腺癌和非三阴乳腺癌患者在术后的局部复发率上无明显差异.结论 三阴乳腺癌相较非三阴乳腺癌总体预后差,但没有证据说明三阴乳腺癌行保乳手术后局部复发率更高.患者不必因为三阴乳腺癌而缩小其保乳治疗的指征,三阴乳腺癌患者仍是保乳治疗的合适人选.     

隐匿性乳腺癌36例诊治分析

回顾分析临沂市肿瘤医院乳腺外科收治的36例隐匿性乳腺癌(OBC)患者的临床资料,并结合文献进行讨论。所有病例腋下肿物均经切检病理确诊。乳腺钼靶检查2例诊断为乳腺癌,3例患者为可疑乳腺癌;乳房彩超检查1例诊为乳腺癌,3例患者为可疑乳腺癌。行改良根治术28例,乳腺癌根治术4例,保留乳房手术2例,腋窝淋巴结清除加全乳放疗2例。30例患者获得随访,15例生存时间>5年。回顾分析结果提示,对腋下肿块应行切除活检以明确诊断;乳腺钼靶、彩超及腋下肿物激素受体检测有一定价值;乳腺核磁共振扫描能够提高OBC的检出率。手术方式宜采用改良根治术或保留乳房后全乳照射,并辅以化疗及内分泌治疗等以提高长期生存率。     

Correlation of radiological and clinical features of metanephric neoplasms in adults

The main objective was to determine the clinical and radiological features of metanephric neoplasms. The tumors were diagnosed on histopathological examination. The clinical data and imaging features were retrospectively analyzed. Between 1998 and 2003, 3 patients underwent radical nephrectomy for renal masses turning out as metanephric neoplasms on histopathology. Two of these tumors were metanephric adenoma (MA) and one was metanephric adenofibroma (MAF). Clinical and radiological features were reviewed. All patients were adult females who presented with flank pain. Tumor was detected on screening ultrasound as a hyperechoic lesion. In all cases CT showed a hyper-attenuating exophytic lesion with cystic areas that enhanced with IV contrast. Based on combination of clinical and imaging features it may be possible to prospectively identify metanephric neoplasms and thus avoid unnecessary radical nephrectomy in favor of conservative surgery.     

MR对乳头溢液的诊断价值

目的:对比乳腺MR、钼靶和超声检查对乳头溢液的诊断价值。方法:对11例因乳头溢液在中山大学附属肿瘤医院就诊的患者进行前瞻性的研究。所有患者均行平扫及动态增强MR扫描、钼靶及超声检查,都做了导管造影,其中4例因各种原因导管造影失败,其余7例均行导管造影检查;11例患者均行手术,恶性者行改良根治术,良性者行乳腺区段切除术。结果:在11例患者的24个病灶中,MR的图象与最后的组织病理学结果均有关联性。MR图象正确诊断出纤维腺瘤3个,乳腺癌3个,导管内乳头状瘤11个,纤维囊性乳腺病5个,小叶增生1个,误诊硬化性腺病为乳腺癌1个,诊断准确率为95.8%(22/24)。而钼靶、导管造影和超声的诊断准确率均低于50%(5/24,12/24及8/24)。结论:乳腺MR检查能鉴别良恶性乳头溢液,提供了一种非侵入性的乳腺导管造影的方法。     

早期乳腺癌患者行改良根治手术与保乳术的疗效观察

目的分析早期乳腺癌患者分别进行改良根治手术和保乳手术的临床效果。方法 105例早期乳腺癌患者,在知情同意下,按患者及其家属意愿分为保乳组(53例)和改良根治组(52例)。保乳组采用保乳手术治疗,改良根治组采用改良根治手术。结果两组患者2年生存率和复发率比较,差异无统计学意义(P>0.05);保乳组生存质量评分均明显高于改良根治组,差异有统计学意义(均为P<0.05)。结论保乳手术与改良根治手术对患者的生存率、复发率差异无统计学意义,但是保乳手术大大提高了患者的生存质量。     

Breast cancer in women thirty years old or less]

PURPOSE: Breast cancer rarely occurs in very young women, its diagnosis and management could sometimes be difficult. Our aim is to analyse the epidemiological and clinicopathological features of a group of very young women and especially to evaluate the results of therapeutic strategy. METHODS: We report a retrospective study conducted at the department of radiotherapy in Alexis-Vautrin Centre, concerning 30 patients aged < or = 30 years in whom a diagnosis of invasive breast carcinoma was made between 1986 and 2001. RESULTS: Six patients had familial history of breast cancer. Palpable tumor was found in 90% of cases, the average size was 3.5 cm. Eleven patients presented with stage I, 11 presented with stage II, 6 presented with stage III and 2 presented with stage IV. Five cancers were diagnosed after pregnancy (average tumor size = 5.8 cm). Eleven patients received neoadjuvant chemotherapy and 23 (82%) of 28 operable cases of invasive malignancy underwent breast conservative surgery (BCS). We found an invasive ductal carcinoma with grade III in 13/27 cases and a nodal involvement in a half of cases, 11 patients of 26 had no expression of oestrogen receptor. The average follow-up was 5 years: six patients (20%) recurred locally (all of them were initially treated by BCS), four patients developed a contralateral breast cancer and three developed a second malignancy. Ten patients died of their metastatic disease. The 5-year overall survival rate was 78%. CONCLUSION: Our results are consistent with those of the published reports and suggest that very young women with breast cancer have a poorer prognosis compared with the older ones. They should receive, according to their prognostic factors, an appropriate regional, systemic and hormonal therapy.     

Nine breast angiosarcomas after conservative treatment for breast carcinoma: a survey from French comprehensive Cancer Centers

OBJECTIVES: To conduct a survey of the angiosarcomas developing after breast conservation for carcinoma in the French Cancer Centers, to study the evolution of these cases in detail, and to review literature in an attempt to propose an optimal treatment scheme. MATERIAL AND METHODS: Eleven of the 20 French Cancer Centers agreed to research and retrospectively analyze all angiosarcomas discovered in patients previously treated by conservative treatment. The majority of the patients were node negative, T1N0M0. The mean age of the patients at the time of primary breast cancer treatment was 62.5 years, and 69 years at the diagnosis of the angiosarcoma. RESULTS: During the last two decades, nearly 20,000 patients have been treated conservatively in these 11 centers, and only 9 cases of angiosarcoma were found. The median latency period between the treatment of the breast carcinoma and the diagnosis of the breast angiosarcoma was approximately 74 months, with a range of 57-108 months. Mastectomy was performed as the main treatment of this angiosarcoma. All recurrences after mastectomy for the angiosarcoma appeared within 16 months after the mastectomy. A median time of recurrence was found to be 7.5 months, regardless of the treatment. The angiosarcomas appeared to be very aggressive, and chemotherapy, radiotherapy, and sometimes hyperthermia could only palliate the condition for a short time. After the diagnosis of angiosarcoma, the median survival was 15.5 months, showing a particularly poor prognosis. Only 1 patient of 9 is alive without progressive disease at 32 months after salvage mastectomy for the recurrence of the angiosarcoma. Precise data obtained from 11 centers show that, of 18115 breast carcinomas treated conservatively, only 9 breast angiosarcomas are reported, which represents a prevalence of 5 cases of angiosarcoma per 10,000, which is the same prevalence for primary breast angiosarcomas occurring in healthy breasts. CONCLUSION: Angiosarcoma developing after breast conserving therapy for carcinoma is a rare event, and induction of it by treatment is controversial. However, early diagnosis is essential and it appears that radical mastectomy gives the highest chance of cure and the best long-term survival.     

乳腺癌改良根治术与保乳综合治疗的效果比较（197例病例分析）

目的比较乳腺癌改良根治术与保留乳房综合治疗的疗效、不良反应。方法 98例改良根治术患者与99例保乳手术加放疗的患者进行比较。改良根治术患者中有49例接受术后放疗,其中8例行常规患侧锁骨上野及内乳野照射,另41例行患侧胸壁及锁骨上野照射;保乳术后皆全乳切线照射50 Gy,瘤床追加电子束照射10Gy。患侧锁骨上X线30 Gy＋电子束20 Gy。结果改良根治术组有3例因多发骨转移而死亡,另有6例出现胸壁复发,2例出现锁骨上淋巴结转移,1例出现腋下淋巴结转移,胸骨和肺转移各1例;保乳组有1例随访14月时因多发骨转移死亡,余患者均无复发。两组的总生存时间差异无统计学意义（P=0.234）,但无瘤生存时间保乳组要优于改良根治术组（P〈0.001）。保乳组患者的放疗不良反应中,84.6%为Ⅰ级反应,14.5%为Ⅱ级反应,仅1例出现Ⅲ级迟发性毒性反应。无皮肤、软组织坏死、乳房及上肢水肿等并发症。美容效果达到优83例（83.8%）,良4例（4.0%）,一般12例（12.1%）。满意率（优＋良）87.9%。结论与改良根治术比较,保乳综合疗法安全、可靠,美容效果满意,并发症发生率低,可保全患者的生理功能和社会心理状态,提高其生活质量。