307例女性乳腺髓样癌报告

本文总结了３０７例经治的中国女性乳腺髓样癌。根据Ｒｉｄｏｌｆｉ等制定的诊断标准（ｃａｎｃｅｒ，１９７７，４０：１３６５～１３８６），分为９２例（２９．９％）典型髓样癌和２１５例（７０．０％）非典型髓样癌。结果表明９２例典型髓样癌和２１５例非典型髓样癌的１０年生存率分别为８４．８％（７８／９２）和７３．０％（１５７／２１５）。腋窝淋巴结的转移情况被认为是影响预后的重要因素，在腋窝淋巴结无转移组５６例典型髓样癌和１１４例非典型髓样癌的１０年生存率分别为９２．９％（５２／５６）和８６．０％（９８／１１４），而在腋窝淋巴结有转移时分别为７２．２％（２６／３６）和４９．５％（５０／１０１）。乳腺髓样癌具有良好的组织学特征和预后效果，特别是腋窝淋巴结阴性的典型髓样癌的预后效果最佳。     

乳腺典型髓样癌临床分析

目的:研究乳腺典型髓样癌的临床特征和预后。方法:分析发病年龄、肿块大小、部位、淋巴结转移与生存率关系。结果:本文58例典型髓样癌占同组女性乳腺癌的3.1%。平均发病年龄52.6岁,腋淋巴结转移率30.9%,五年和十年生存率分别为87.9%、85.2%。结论:典型髓样癌属较低度恶性肿瘤,预后较好。但也有个别病例死于脑转移。     

乳腺髓样癌的治疗

目的探讨乳腺髓样癌临床特征、治疗和预后。方法回顾性分析1995年1月至1999年12月收治的乳腺髓样癌的临床资料。结果26例乳腺髓样癌占同期治疗女性乳腺癌616例的4.2%,年龄31~66(45.8±10.6)岁,肿瘤大小1~5 CM,腋淋巴结阳性率23.1%,腋淋巴结转移的发生与乳腺肿瘤的大小无关,免疫组化检测雌激素(ER)、孕激素(PR)和HER-2/NEU的阳性率分别为26.3%、21.1%和5.3%。全组进行手术和辅助化疗(环磷酰胺、甲氨蝶呤和氟尿嘧啶)。5例服用三苯氧胺,3例进行放射性治疗。随访时间5~9年,平均7.5年,总的5年生存率为88.4%。结论乳腺髓样癌的预后较好,手术加辅助性化疗是治疗的重要手段,分子生物学指标在乳腺髓样癌预后中的作用应该受到足够的重视。     

乳腺髓样癌90例临床分析

目的探讨乳腺髓样癌的临床特点、治疗及预后。方法回顾性分析90例乳腺髓样癌的临床资料:肿瘤直径(4.1±2.2)cm,左侧49例,右侧41例,21例有腋淋巴结肿大,其中19例术前误诊为良性肿瘤而行局部切除,术中冰冻切片确诊53例,术前细针穿刺确诊18例。行乳癌根治术(Hal-sted法)49例,改良根治术41例,其中保留胸大肌的改良根治术Ⅰ式(Patey手术)29例,保留胸大小肌的改良根治术Ⅱ式(Auchinc loss手术)12例。21例腋淋巴结肿大者行术前辅助化疗,术后均行化疗。结果确诊典型和不典型髓样癌各45例,其腋淋巴结转移率无区别。均获随访,时间5.8(1.5~11)年,3年、5年生存率分别为95.6%和88.9%。结论乳腺髓样癌预后较好,术前应行细针穿刺细胞学检查和术中冰冻切片检查,手术加辅助化疗是治疗的重要手段。     

乳腺髓样癌的临床病理特点及治疗

目的 探讨乳腺髓样癌的临床病理特点、诊治和预后.方法 回顾性分析7年间收治的28例乳腺髓样癌的临床资料.全组进行手术和辅助化疗(环磷酰胺+阿霉素、紫杉醇+阿霉素).5例内分泌治疗,8例进行放射性治疗.结果 28例乳腺髓样癌占同期治疗956例女性乳腺癌的2.9%;年龄28～96(50.68 4±12.63)岁;肿瘤大小1～5 cm;腋淋巴结阳性率47.6%;肿瘤淋巴细胞浸润率100%.免疫组化检测雌激素受体(ER),孕激素受体(PR),HER-2/neu,p53的阳性率分别为35.7%,32%,32%,67.9%.术后中位随访时间为42个月(1个月至6年),总生存率为100%.结论 乳腺髓样癌的预后较好.选择合理的外科手术及辅助化疗可取得较满意的效果.分子生物学指标在乳腺髓样癌治疗和预后的作用应该受到足够重视.     

乳腺髓样癌的超声造影特征与病理对照

目的分析乳腺髓样癌的超声造影特征,并与病理学对照。方法回顾性分析13例乳腺髓样癌患者的超声造影形态学特征,比较造影前后肿块横径、肿块与周围乳腺正常组织的时间-强度曲线定量参数,并进行统计学分析。将超声造影表现与病理表现相对照。结果乳腺髓样癌超声造影显示肿块形态不规则、边界清晰、内部均匀增强分别为10、11、11例,与病理形态学特征相符合。造影前后肿块横径差异无统计学意义(P=0.61),与病理学膨胀性生长方式相符合。与周围乳腺正常组织相比,髓样癌造影剂到达时间和达峰时间显著提前(P=0.034、0.021),峰值强度显著提高(P=0.005),与病理学上病灶内血管密度增高且分布均匀、病灶周边有较大管径血管的特征相符合。结论乳腺髓样癌特征性的超声造影表现有其病理学依据,可作为临床超声诊断和鉴别诊断的依据。     

乳腺髓样癌23例临床与预后分析

乳腺癌是女性最常见的恶性肿瘤之一,其发病率呈逐年增高的趋势^[1]。其中乳腺髓样癌（medullarybreast cancer,MBC）比较少见,而且通常被认为是乳腺浸润性导管癌的一个亚型,其临床表现、病理形态和预后都有其特殊性^[2-3]。目前关于MBC的预后存在一定争议^[4-5],我们回顾性分析2000年7月至2006年7月间本院收治23例MBC患者的临床资料,报告如下。     

甲状腺髓样癌临床研究现状

195 9年Ｈａｚａｒｄ首次描述了甲状腺髓样癌 (ｍｅｄｕｌｌａｒｙｔｈｙｒｏｉｄｃａｒｃｉｎｏｍａ ,ＭＴＣ) ,自此 ,这种过去常常被误诊为甲状腺未分化癌的少见恶性肿瘤才作为一个独立的病理类型被确立下来。ＭＴＣ在甲状腺癌中所占的比例 ,一般认为在3 %～ 12 % ,国外文献报道为 5 %～ 10 %。本文从ＭＴＣ的病理学特征、生物学行为、临床表现、生物化学检查、分子生物学检查以及诊断、治疗和预后等几个方面 ,对它进行较全面的综述。1　病理学特征及生物学行为[1 ,2 ,3]ＭＴＣ起源于甲状腺Ｃ细胞。Ｃ细胞位于甲状腺叶的上半部 ,是神经内…     

支气管典型与非典型类癌49例

我们对 1970～ 2 0 0 1年经手术及病理诊断的 4 9例支气管类癌标本依典型与非典型类癌的诊断标准 (表 1)进行复诊 ,其中典型类癌 2 7例 (5 5 1% ) ,非典型类癌 2 2例 (44 9% )。现总结报道如下。表 1　支气管典型、非典型类癌的组织学诊断标准内容典　　型　　类　　癌非　　典　　型　　类　　癌生长方式实体“器官样”小梁结构或索、巢状排列癌细胞密集 ,常见菊团结构癌细胞　 较小 ,形态大小一致 ,圆或多角形 ,隔以间质或毛细血管 ,核规则 ,位于中央 ,染色质疏松 ,核仁明显 ,胞浆丰富呈微细颗粒状细胞小 ,多角形或棱形 ,核深染 ,核仁显著…     

Medullary Thyroid Carcinoma Metastasis to the Breast and Axillary Lymph Nodes

Breast metastases of medullary thyroid carcinoma (MTC) are extremely rare, and only a few cases have been reported in the literature so far. Here, we report a case of metastatic MTC to the breast and axillary lymph nodes (LN). The case illustrates that (1) metastatic MTC of the breast could be clinically and pathologically misdiagnosed as primary breast cancer, such as invasive lobular carcinoma with axillary LN involvement; (2) unlike other metastatic breast cancer patients, who have very poor prognoses, our patient survived for more than 5 years after the breast and axillary surgery; and (3) metastasis of MTC to the breast is accompanied by axillary LN metastasis, which requires thorough axillary LN dissection, as in most primary breast cancers.     

The Significance of Lobular Carcinoma In Situ and Atypical Lobular Hyperplasia of the Breast

Background

The significance of lobular neoplasia (LN), lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH)) found at core needle biopsy (CNB) of the breast remains uncertain. There is a consistent risk of underestimating malignancy after the diagnosis of LN on CNB. The aim of this study was to determine if patients with a CNB result of LN need surgical excision.

Methods

Patients were identified by searching the institutions pathology database for the terms ??lobular carcinoma in situ?? and ??atypical lobular hyperplasia?? over 20?years. Excluded from this study were those with core needle biopsy (CNB) results of ductal carcinoma in situ, atypical ductal hyperplasia, radial scar, or papilloma. Upgrade was defined as final surgical pathology of invasive carcinoma and/or ductal carcinoma in situ that was directly correlated to the site of the initial biopsy containing LN.

Results

LN was found at CNB in 285 patients, and 71?% (n?=?201) had subsequent surgical excisions. All patients with pleomorphic LCIS (pLCIS) underwent surgical excision. Following patients with pLCIS, patients with the diagnosis of LCIS were most likely to undergo surgical excision (80?%). Final pathology of the surgically excised specimens confirmed LN in 72?% (n?=?144). Also, 13?% (n?=?26) of the operated patients were upgraded to malignancy, including 8?% of ALH and 19?% of LCIS cases.

Conclusion

This is the largest series of surgical excisional pathology following LN on CNB ever reported. The likelihood of finding malignancy at surgical excision after CNB showing LN was 13?%. Patients with the diagnosis of LN on CNB should be considered for surgical excision.     

Medullary Carcinoma of the Thyroid Gland

Medullary thyroid carcinoma (MTC) is an uncommon thyroid tumor that has attracted a great deal of interest because of its frequent presentation as a familial tumor and its primary involvement in the type II multiple endocrine neoplasia (MEN) syndromes MEN-IIA and MEN-IIB and familial medullary thyroid carcinoma (FMTC). The MTC tumor cells secrete the polypeptide hormone calcitonin, which serves as an excellent tumor marker, useful for defining the presence of disease, preoperatively or following thyroidectomy. The discovery that mutations in the RET proto-oncogene are associated with MEN-II syndromes was highly significant in that it demonstrated a clear correlation between genotype and phenotype; and most importantly it provided a mechanism whereby family members at risk could be identified by direct DNA analysis. Virtually all patients with MEN-IIA, MEN-IIB, and FMTC develop MTC; therefore there is a clear rationale for performing thyroidectomy as soon as a RET mutation has been identified. Because MTC appears to be much more aggressive in patients with MEN-IIB, thyroidectomy is performed during the first year of life in this setting, whereas in patients with MEN-IIA, where the tumor appears to be more indolent, the procedure can be safety delayed until age 5 years. Reoperative neck exploration in patients with evidence of persistent or recurrent MTC has been effective in a significant number of patients, although the success of the operation requires careful patient selection and preoperative assessment. MTC, as expressed in the MEN-II syndromes, is an excellent model to evaluate the usefulness of interventional therapy in patients demonstrated to have a genetic predisposition for cancer.     

Post-radiation Atypical Vascular Proliferation Mimicking Angiosarcoma Eight Months Following Breast-conserving Therapy for Breast Carcinoma

Angiosarcoma is an aggressive tumor that most commonly presents on the scalp or face of elderly patients; however, it can develop in pateints with breast cancer following radiation and breast-conserving therapy, complicating 0.1 to 0.2 percent of such cases. Mammography and fine-needle aspiration, though often very useful in evaluating for breast carcinomas and cytological features, are often negative in early stages of angiosarcoma and difficult to interpret. We present the case of a 49-year-old Caucasian woman with a history of stage II invasive ductal carcinoma of the left breast who presented with a two-month history of increased firmness and tenderness in her left breast. On exam, her left breast had significant firmness and hardening of breast tissue with slight erythema of skin. Punch biopsy initially suggested angiosarcoma, but subsequent biopsies instead diagnosed an atypical vascular proliferation. This case represents a patient who presented with an atypical lesion concerning for angiosarcoma. Repeated biopsies were necessary to obtain the correct diagnosis. One biopsy may not be sufficient for distinguishing atypical vascular proliferation from angiosarcoma. We present this case to increase awareness of the difficulty in making this distinction.