乳腺癌术后食管转移情况的Meta分析

目的探讨乳腺癌术后食管转移临床特点、诊断及治疗。方法检索1989年至2011年期间文献报道的乳腺癌术后食管转移病例,分析其临床数据和生存资料。结果共检索到乳腺癌术后食管转移报道病例28例。发病中位年龄67(41～83)岁;乳腺癌术后距食管转移的中位间隔时间10.5年(3.5～24年);除1例(3.6%)表现为呕血外,其余27例(96.4%)均表现以进行性加重的吞咽困难;GI检查显示转移部位发生在食管胸中段15例(53.6%)、胸中下段2例(7.1%)、胸下段8例(28.6%)、食管胃结合部3例(10.7%);食管转移灶有免疫组化检测结果的共11例(39.3%),均显示ER(+)和(或)PR(+);发生食管转移后的治疗方法包括化疗、内分泌治疗、放疗以及食管扩张、食管支架置入、姑息性手术等。28例中有详细生存资料的共22例(78.6%),其中15例死亡,7例仍存活,22例的中位总生存时间为18(1～96)个月,1、3、5年生存率分别为54.5%、27.3%、9.0%。结论对于有乳腺癌病史,特别是病史较长或伴有高危复发因素的患者,出现吞咽困难症状时首先要考虑乳腺癌食管转移的可能。     

临床肿瘤细胞学研究的历史回顾与展望

中国临床肿瘤细胞学(China clinical oncocvtology)工作起始于20世纪50年代初,历经了半个多世纪艰难曲折的发展。在各种新技术、新方法的推动下出现了突飞猛进的局面。巴氏涂片的临床应用也始于当时。由于全国开展了宫颈癌的普查,宫颈癌的发病率和死亡率都有明显的下降。在各种宫颈癌筛查试验中,液基细胞学检查的诊断价值最高。细针穿刺细胞学的应用,目前已遍及人体各个脏器和部位,根据数万例的观察,尚未发现肿瘤沿针道扩散的证据。过去30年间,我国进行食管拉网细胞学检查36万人次,检出食管上皮细胞重度增生近万例,食管癌和贲门癌27000余例,早期癌2800多例,食管拉网法发现无症状的早期食管癌占食管癌的80％以上,食管拉网法的阳性准确率高达98．5％。核仁组成区嗜银染色的临床应用十分广泛,我国发表的有关这方面的研究论文已超过500篇,内容包括常见的各种肿瘤,如：胃、肺、肝、大肠、乳腺等各种恶性肿瘤,在良恶性肿瘤的鉴别诊断中以恶性淋巴瘤和淋巴结良性疾患的鉴别最有价值。对临床肿瘤细胞学工作的今后发展,本文提出了四点建议。     

Postradiation squamous cell cancer of the breast

Primary squamous cell carcinoma of the breast is a rare clinical entity. We diagnosed a patient who presented with a pure squamous cell cancer of the breast 12 years after local radiation for a primary adenocarcinoma of breast. Previously reported cancers related to radiation of the breast have been squamous cell of skin and esophagus and sarcomas, especially angiosarcomas, and on literature review this is the first reported case of primary squamous carcinoma of the breast related to previous radiation. Although our observation suggests a possible link, no established cause and effect relationship is known at this point.     

Peritoneal cancer arising after total abdominal hysterectomy and bilateral salpingo-oophorectomy for cervical cancer in a patient with right breast cancer and germline mutation of <Emphasis Type="Italic">BRCA1</Emphasis> gene: a case report and literature review

Primary peritoneal carcinoma is usually advanced at diagnosis and curability is low unless the patient has a small tumor burden. Peritoneal carcinoma can occur in association with hereditary breast and ovarian cancer syndrome, which is thought to account for 5–6% of all breast cancer. Mutations of two breast cancer susceptibility genes, BRCA1 and BRCA2, are responsible for hereditary breast and ovarian cancer. Women with BRCA1/2 mutations often undergo risk-reducing salpingo-oophorectomy (RRSO) to prevent both ovarian and breast cancer. However, peritoneal carcinoma has been reported to develop after RRSO in patients with BRCA1/2 mutations. We experienced a patient with peritoneal carcinoma and inguinal lymph node metastasis after surgical resection of breast cancer and subsequent RRSO. This report describes the first case of peritoneal carcinoma arising after RRSO in a Japanese patient with BRCA1 mutation, including a review of the literature on peritoneal carcinoma associated with BRCA1/2 mutation.     

Prostate cancer metastasis to thyroid gland

Metastases to the thyroid gland are rarely encountered in clinical practice. They may originate from various primary sites, mainly kidney, lung, breast, esophagus and uterus. Prostate cancer is one of the most frequent malignancies in men. It generally has a favorable course, and autopsy series have shown occult prostate cancer in many subjects, especially in aged males. However, prostate cancer sometimes exhibits an aggressive behavior and cases with a poor prognosis have been reported. Occasional reports of metastasis from prostate cancer to the thyroid gland have been documented. We describe the case of a 73-year-old patient presenting with thyroid metastasis from long-standing prostate cancer.     

The BRCA2 c.9004G>A (E2003K) variant is likely pathogenic and recurs in breast and/or ovarian cancer families of French Canadian descent

Specific BRCA1 and BRCA2 mutations recur in French Canadian breast and/or ovarian cancer families because of common ancestors, facilitating carrier detection in this population. We recently reported a BRCA2 c.9004G>A variant of unknown clinical significance in two French Canadian breast cancer families. It confers a E3002K alteration in the conserved C-terminus domain of BRCA2, and has been reported in non-French Canadian cancer families. Seven variant positive French Canadian families have since been identified by mutation screening of referrals to hereditary cancer clinics. In this article, we describe the cancer phenotypes of these families and further assess the contribution of this variant in the French Canadian population. We screened index breast cancer cases from 58 cancer families with at least three confirmed cases of breast and/or ovarian cancer and 960 breast cancer cases (48 years mean age) not selected for family history of cancer that were previously found not to carry the most common BRCA1 and BRCA2 mutations reported in this population. The index variant-positive cases from each family had breast cancer between the ages of 35-55 years (43 years mean age); and reported close relatives with breast cancer diagnoses between the ages of 28-84 years (57 years mean age). Three families had ovarian or peritoneal cancers. BRCA2-associated cancers, such as bladder, esophagus, pancreas, prostate, and thyroid cancers also occurred in these families. One c.9004G>A carrier also harbored the PALB2 c.2323C>T (Q775X) mutation found to recur in French Canadian breast cancer cases. No new BRCA2 variant carriers were identified in mutation screens. The absence of BRCA2 c.9004G>A carriers in the breast cancer cases not selected for family history contrasts with familial cases, supporting a pathogenic status for this variant and addition to the existing common BRCA1 and BRCA2 mutation-screening panel for French Canadian breast and/or ovarian cancer families.     

乳腺癌肿瘤标志物新的研究进展

目前乳腺癌已成为危害女性健康的第一大恶性肿瘤, 且发病率呈逐年递增趋势, 其早期诊断、治疗及预后成为当下研究的热点。乳腺癌肿瘤标志物对于其早期诊断、个体化治疗及预后均具有重要的临床实践指导意义。分子生物学的不断发展, 为乳腺癌肿瘤标志物的基础与临床研究奠定了良好的基础。近年来, 乳腺癌的诊断治疗手段逐渐增多, 肿瘤标志物的应用也不断受到青睐, 经典的肿瘤标志物已不足以更好的指导临床实践, 因此不断有新的肿瘤标志物出现。为了解乳腺肿瘤标志物在乳腺癌诊治中的重要作用及其相关最新研究, 本文结合国内外最新研究报道, 对乳腺肿瘤标志物新的研究进展做一简要综述。      

Breast cancer with skeletal metastases at initial diagnosis. Distinctive clinical characteristics and favorable prognosis

Fifteen patients with breast cancer who had skeletal metastases already present at the time the primary breast lesion was detected, were retrospectively identified. The majority were postmenopausal, estrogen receptor-positive, and had large (often neglected) primary lesions. Eleven patients were asymptomatic with respect to their skeletal metastases, although bone scans and bone roentgenograms revealed multiple areas of involvement in all patients. The median survival from the time of diagnosis was 33 months (range, 1-74 months); the 5-year actuarial survival was 45%. Systemic therapy with hormones or chemotherapy was effective in producing subjective responses; radiotherapy to painful bony areas was also an effective palliative treatment. Median survival in this group of patients was significantly improved when compared to our breast cancer patients who had extraskeletal metastases at initial diagnosis (33 versus 9 months, respectively), and to previously reported series of breast cancer patients with metastases at initial diagnosis. Since patients with Stage IV breast cancer and metastases limited to the skeleton often have prolonged survival, complications from bone metastases (e.g. pathologic fracture, epidural spinal cord compression) and other intercurrent illnesses should be managed aggressively.     

Case report of bilateral inflammatory breast cancer

MASANNAT Y.A., PETER M., TURTON P. & SHAABAN A.M. (2010) European Journal of Cancer Care
Case report of bilateral inflammatory breast cancer Inflammatory breast cancer (IBC) is a rare entity that makes up 1–3% of breast cancers. As the diagnosis of IBC is mainly clinical, for the inexperienced the clinical appearance can mimic mastitis leading to diagnostic delay and it is often associated with a poor prognosis. Very few cases of bilateral IBC are reported in the literature, all of which have been synchronous. We report an unusual case of bilateral metachronous IBC each with complete clinico‐pathological response after treatment with neoadjuvant chemotherapy and surgery on both occasions.     

The experiences of men with breast cancer in the United Kingdom

To investigate the experiences of men with breast cancer across the United Kingdom, a multi-phase study using: (a) focus groups (n = 4) with men and women with breast cancer and with healthcare professionals; (b) questionnaires to men with breast cancer (n = 161); (c) follow-up interviews with these men (n = 30) and (d) reconvening the focus groups (n = 2) for the men and women with breast cancer. The majority of men (84%, n = 135) reported their symptoms early, but were shocked to receive a breast cancer diagnosis. Disclosure of the diagnosis was commonly made to partners (80%, n = 129) and other close family and was influenced by perceptions of embarrassment, stigma and altered body image. Very little information was available to participants; that which was available was often inappropriate as it was intended for women. Over half the sample wanted much more information (56%, n = 90). This study also demonstrated low utilisation of formal support services and initiatives are needed to improve the information and support provided to men with breast cancer after diagnosis and treatment. Increasing the profile of breast cancer in men generally amongst healthcare professionals and the public is also needed.     

Breast cancer in Cowden's disease: a case report with review of the literature

We report a case of invasive breast cancer in a 62-year-old female patient with Cowden's disease. A left modified radical mastectomy was performed and histopathology of the tumor showed invasive ductal carcinoma, histological grade 3, without lymph node metastasis. The patient had a past history of endometrial cancer at 55 but did not have a family history of malignant disease. Goiter was palpable but aspiration cytology revealed no malignancy. There were several papillomas on the oral mucosa and multiple papillomatous lesions on the right femur. Barium X-ray and endoscopic examination revealed multiple, small, hyperplastic polypoid lesions on the esophagus, stomach and rectum. Histopathology of the biopsy specimens from the esophagus and stomach showed acanthotic squamous epithelium and foveolar hyperplastic polyps. The patient was followed up closely to monitor the thyroid lesions and polyposis of the digestive tract. A total of 12 breast cancer patients who also had Cowden's disease have been reported in Japan and these cases are reviewed in this report.      

Carcinoma of the esophagus--actual epidemiology in Germany]

Over the last years the incidence of esophageal cancer in Germany has been rising. One of the reasons of this rise is the increase of adenocarcinoma (AC) of the esophagus, a nearly unknown diagnosis 30 years ago. The incidence of squamous cell carcinoma (SCC) is rising, too. The main risk factors for the development of SCC as well as for AC are heavy smoking and alcohol. Barrett's esophagus is predominantly developing in men after a longer lasting gastroesophageal reflux. In consequence, AC of the esophagus will be observed mostly in men. Patients with AC differ from patients with SCC by a smaller number of concomitant diseases, which are often caused by obesity of patients with AC. The preoperative risk factors of patients with SCC are caused by tobacco and alcohol. Only patients with early cancer (pT1) of the esophagus have a good prognosis with a 5-year survival rate of 83% for AC and 63% for SCC.     

Disclosure of breast cancer diagnosis: patient and physician reports. GIVIO (Interdisciplinary Group for Cancer Care Evaluation, Italy)

Although there is considerable controversy about what information regarding the diagnosis of cancer is most helpful to patients in meeting their psychological and medical needs, little research exists on what patients who are treated in non-specialized institutions are told about their diagnosis and treatment. We assessed the information that breast cancer patients received about their diagnosis from the perspective of both the patient and the physician, in order to determine whether they agree in their perceptions of communication, and whether the nature of patient-physician communication is associated with patient satisfaction. Questionnaires were completed by 1171 Italian breast cancer patients (representing a 81.5% response rate) and their physicians at the time of surgery for breast cancer. Only a minority of patients (47%) reported having been told that they had cancer. Satisfaction with information was highest among women who had been told the diagnosis. Patient and physician reports of what information was conveyed about the diagnosis differed for over half of patients, with highest satisfaction levels reported when both patient and physician stated that the diagnosis had been conveyed. While comparison of patient and physician reports should not be used to validate either source of information, the degree of patient-physician disagreement found in this research may alert physicians to potential difficulties that can arise in communicating with cancer patients.     

Familial male breast carcinoma

Breast cancer in men is a rare disease, accounting for approximately 1% of all breast cancers. In a recent review of the literature, only 12 reports of breast cancer in related men have been recorded. A case of familial breast cancer is reported involving two men and two women. The role of hereditary factors and associated etiologic factors in male breast cancer are reviewed. The overall prognosis of male patients with breast cancer is poor compared with female patients with breast cancer, possibly related to a delay in diagnosis and difference in regional spread of the tumor. Increased surveillance of families with a history of male breast cancer and the presence of associated etiologic factors appears advisable.     

Pathologic aspects of inflammatory breast carcinoma: part 1. Histomorphology and differential diagnosis

Inflammatory breast carcinoma (IBC) is rare, but it is the most aggressive variant of breast cancer. Because a diagnosis of IBC is usually based on the presence of typical clinical symptoms that are not always associated with certain pathologic characteristics, the diagnosis often presents a great challenge even to the most experienced clinicians. Even more, IBC has not been associated with a specific histologic tumor type. With recent epidemiologic and molecular evidence now suggesting that IBC is a distinct disease entity rather than a subtype of locally advanced breast cancer, the accurate differentiation of this disease has never been more crucial to ensuring appropriate treatment. The focus of this chapter is on the histomorphologic characteristics of IBC and its broad differential diagnosis.     

The changing face of breast cancer--past,present and future perspectives

Breast cancer used to be perceived as a stigmatized disease and rates of early diagnosis were poor because women were often reluctant to present to their physician. Once a diagnosis had been made, there was no adjuvant therapy and little in the way of palliative treatment for advanced disease. Fortunately, the situation today is much improved and although breast cancer remains the most common form of cancer in women, changing attitudes have helped to ensure improved awareness and earlier presentation of patients, leading to earlier diagnosis and better prognosis. Improved detection and treatment regimes have begun to impact on breast cancer mortality; important long-term treatment goals include the prevention of both disease recurrence and the development of advanced disease. This will necessitate improvements in systemic therapies based on the biological properties of the tumor rather than relying on early diagnosis and chemo-prevention. Significant progress has been made over the last 30 years, and the future of breast cancer treatment should be faced with optimism.     

Increased risk of esophageal cancer after breast cancer.

BACKGROUND: Adjuvant radiation therapy for breast cancer has been related to excess esophageal cancer risk, but population-based data are scanty. PATIENTS AND METHODS: We considered esophageal cancer risk among 11 130 breast cancer patients diagnosed between 1974 and 2002 in the Swiss cantons of Vaud and Neuchatel, and followed-up to the end of 2002, for a total of 75 900 women-years at risk. RESULTS: Overall, 18 cases were observed compared with 8.9 expected, corresponding to a standardised incidence ratio (SIR) of 2.0 [95% confidence interval (CI) 1.2-3.2]. The SIR was 1.6 in the first 10 years after diagnosis and 3.3 for >/=10 years after diagnosis, 2.3 for cases diagnosed between 1974 and 1988 and 1.5 for those diagnosed after 1988, 2.3 (based on 15 cases) for squamous cell cancer and 1.3 (based on three cases) for adenocarcinomas, and 2.9 for the upper third, 2.3 for the middle third and 1.9 for the lower third of the esophagus. CONCLUSIONS: These data confirm an excess esophageal cancer risk following treatment for breast cancer which could not be explained by confounding of tobacco or alcohol alone. The excess risk tended to decrease for cases diagnosed after 1988, leaving open the issue of the risk of modern radiotherapy for breast cancer on esophageal cancer.     

肿瘤患者血清中鸟氨酸脱羧酶的研究

用高效液相色谱法测定了正常人及乳腺癌、宫颈癌、食管癌、肺癌患者血清中鸟氨酸脱羧酶活性。结果表明,肿瘤患者血清中鸟氨酸脱羧酶的活性升高,P＜0.05。其乳腺癌、宫颈癌、食管癌及肺癌的阳性率分别为:75.0%、63.6%、50.0%和42.9%。说明测定血清中鸟氨酸脱羧酶的活性对肿瘤的诊断有一定临床意义。     

Familial breast cancer and genes involved in breast carcinogenesis

Breast cancer has often been reported to run in families, and the most important risk factor for the disease is a family history of breast cancer. Numerous pedigrees and segregation analyses have suggested an autosomal dominant transmitted susceptibility to breast cancer. Familial breast cancer occurs alone or associated with other cancers in clinically distinguishable syndromes. Such cases may be characterized by early onset, bilateral disease, prolonged survival, and anticipation, mainly seen as a higher penetrance or earlier onset in subsequent generations. Studies of patients and tumors from these families as well as sporadic cases have led to localization and/or identification of a number of genes implicated in breast carcinogenesis of familial and sporadic breast cancer.     

Fertility and menopausal outcomes in young breast cancer survivors

BACKGROUND: Following treatment for breast cancer, many young women are interested in having a child. There are few data available regarding actual fertility and menopausal outcomes in young breast cancer survivors. We evaluated these outcomes among young breast cancer survivors in collaboration with the Young Survival Coalition, an international advocacy group for young women with breast cancer. PATIENTS AND METHODS: All registered Young Survival Coalition survivor members were sent a link to the survey about fertility issues for women with early-stage breast cancer via e-mail; 440 women who completed the survey were eligible for this analysis. Survey respondents were a median of 2.8 years from diagnosis. Mean age at breast cancer diagnosis was 32.6 years. RESULTS: Of the 440 women in this cohort, 247 women (56%) recalled that they had desired a future pregnancy at diagnosis, and 43 women (10%) took steps to preserve fertility. A total of 384 women (87%) received chemotherapy. A total of 295 women (67%) reported that they remained premenopausal, and an additional 33 women (8%) were receiving ovarian suppression therapy at the time of the survey. Since diagnosis, 70 women (16%) had been pregnant > or = 1 time; 40 women (9%) had > or = 1 live birth. Out of the 247 women who reported wanting a future pregnancy at diagnosis, 59 (24%) had become pregnant. Of the 60 women who reported having tried to become pregnant since diagnosis, 34 (57%) were successful. CONCLUSION: Most young women remain premenopausal after breast cancer treatment, including chemotherapy. A relatively small percentage of women in this series had become pregnant; however, the median time since diagnosis was relatively short.