乳腺癌与乳腺增生病某些内分泌激素的差异及其临床意义

目的通过比较乳腺癌与乳腺增生病患者内分泌激素变化,对内分泌激素与免疫系统的关系进行初步分析. 方法随机选取绝经前和绝经后的乳腺癌患者各28例、乳腺增生病患者各22例,在治疗前采血样,对垂体激素6项（PRL、GH、TSH、ACTH、FSH、LH）和性类固醇激素3项（E2、P、T）进行检测,采用秩和检验,正态近似法（Wilcoxon法）对结果行统计学分析. 结果绝经前乳腺癌患者FSH 水平高于乳腺增生患者,其它垂体激素（PRL,GH,TSH,ACTH,LH ）和性类固醇激素（E2,T,P）水平无显著性差异（P〉0.05）.绝经后乳腺癌患者ACTH水平高于乳腺增生病患者,其它垂体激素（PRL,GH,TSH,FSH, LH）和性类固醇激素（E2,T, P） 比较含量无显著差异（P〉0.05）.结论绝经前乳腺癌患者血浆中的FSH和绝经后乳腺癌患者ACTH水平高于乳腺增生病患者,说明乳腺癌患者内分泌激素与免疫系统之间正常规律被打破.下丘脑-垂体-肾上腺轴（HPA）短、长反馈失调,使免疫功能受抑制;雌激素诱导癌细胞基因突变,雄激素刺激细胞的敏感性增加,加速乳腺癌的发展.     

绝经后乳腺癌雌、孕激素受体状态与血清性激素水平的关系

目的探讨绝经后乳腺癌雌激素受体(ER)、孕激素受体(PR)状态与患者血清性激素水平的关系及意义。方法使用全自动免疫分析仪化学发光分析法检测41例乳腺癌患者血清性激素六项(LH、FSH、PRL、E2、P、T)水平,免疫组化EnVision二步法检测乳腺癌ER、PR表达状态。结果绝经后乳腺癌PR阴性组与PR阳性组比较,患者血清LH、FSH水平显著增高(P值分别为0.005和0.031),PRL、E2、P、T水平在二组间差异无统计学意义;在ER阴性组与ER阳性组之间所测性激素水平差异无统计学意义。结论绝经后乳腺癌PR表达状态可能与垂体激素LH、FSH水平有关。     

绝经前乳腺癌组织雌激素受体与血清雌激素水平相关性的初步探讨

目的:探讨绝经前乳腺癌雌激素受体(ER)表达与患者血清雌激素(E2)水平的关系。方法:使用全自动免疫分析仪化学发光分析法检测84例乳腺癌患者血清性激素6项(LH、FSH、PRL、E2、P和T)水平,免疫组化EnVi-sion二步法检测乳腺癌ER表达状态。据ER检测的结果,分为阳性及阴性两组,对其对应的雌激素数值进行统计学分析。结果:在P临界值设定为0.05水平下,进行t检验,t=-1.59912,P=0.11364,两组样本中显现的E2水平差异无统计学意义。结论:绝经期前乳腺癌患者ER表达可能与雌激素水平无关。     

胃癌、大肠癌患者血清性激素水平测定的临床意义

目的：探讨胃肠癌患者血清性激素水平及其临床意义。方法：采用放射免疫法，测定116例胃肠癌患者血清黄体生成素（LH），卵泡刺激素（FSH），催乳素（PRL），睾酮（T）及雌二醇（E2）水平。结果：胃癌患者LH，FSH，PRL水平均高于对照组（P＞0．05），T，E2水平均低于对照组，男性胃癌患者T水平显著低于对照组（P＜0．05），年龄小于60岁的男性胃癌患者血清T水平随肿瘤恶性程度的增加而明显下降（P＜0．01），结直肠癌患者TH，FSH，PRL，T水平与正常人比较，无显著性差异（P＞0．05），男性患者血清E2水平在正常值范围，女性患者E2水平显著低于正常人（P＜0．05），并在绝经期前随肿瘤恶性程度的增加而明显下降（P＜0．01），结论：男性胃癌患者血清T水平和女性结直肠癌患者血清E2水平，可作为判断患者病情的指标之一。     

GnRh对乳腺癌根治术后口服他莫昔芬患者子宫内膜的保护研究

目的探讨促性腺激素释放激素激动剂(GnRh)对乳腺癌根治术后口服他莫昔芬(TAM)患者子宫内膜的保护作用。方法选取2016年3月至2017年6月间复旦大学附属华山北院收治的89例乳腺癌根治术后患者,采用随机数字表法分为试验组44例和对照组45例。试验组患者采用术后口服TAM+肌肉注射达菲林治疗,对照组患者采用单纯口服TAM治疗。比较两组患者治疗前后促卵泡生成素(FSH)、雌二醇(E2)和黄体生成素(LH)水平及组织病理改变,采用阴道B超于治疗后3、6和12个月记录两组患者子宫内膜变化情况。结果对照组患者治疗后3、6和12个月,子宫内膜厚于治疗前,差异均有统计学意义(均P <0. 01),试验组患者子宫内膜薄于治疗前及对照组,差异均有统计学意义(均P <0. 05)。治疗后,对照组患者FSH和LH水平均高于治疗前,E2水平低于治疗前试验组患者FSH、E2和LH水平均低于治疗前及对照组,差异均有统计学意义(均P <0. 05)。治疗后,试验组患者子宫内膜增生率为9. 1%,子宫内膜息肉发生率为0. 0%,均低于对照组的35. 6%和11. 1%,差异均有统计学意义(均P <0. 05)。随访12个月,试验组患者未见阴道不规则出血,对照组出现3例(6. 7%)少量阴道不规则出血患者,差异无统计学意义(P> 0. 05)。结论乳腺癌根治术后,患者口服TAM化疗并应用GnRHa不仅能减少子宫内膜病理改变,还可阻止卵巢功能受损,有临床应用价值。     

国内乳腺癌患者性激素三项指标测定现状及应注意的问题

性激素三项指标包括雌二醇（estradiol,E2）、促卵泡刺激素（follicle—stimulatinghormone,FSH）和促黄体生成素（1uteinizinghormone,LH）。对于激素反应性乳腺癌患者,内分泌治疗是重要治疗措施之一。第三代芳香化酶抑制剂（aromataseinhibitors,AIs）作为初始治疗、辅助治疗均可显著降低乳癌复发率、远处转移,提高无病生存期及总生存期。因此,AIs已经成为绝经后、激素反应性乳腺癌患者的重要治疗选择。     

血清性激素水平及癌基因c-erbB-2在胃癌中的表达及临床意义

目的 :探讨胃癌患者血清性激素水平及癌组织中c erbB 2基因表达的临床意义。方法 :采用放射免疫法 ,测定 67例胃癌患者血清黄体生成素 (LH ) ,卵泡刺激素 (FSH) ,催乳素 (PRL) ,睾酮 (T )及雌二醇 (E )水平 ,同时检测癌组织中c erbB 2基因表达。结果 :胃癌患者LH、FSH、PRL水平均高于对照组 ,P >0 0 5 ,T、E2 水平低于对照组。其中 ,男性胃癌患者血清T水平显著低于对照组 ,P <0 0 5 ,与胃癌浸润深度 (P <0 0 5 )、肿瘤大小 (P <0 0 5 )、淋巴结转移 (P <0 0 5 )密切相关 ;胃癌组织中 ,c erbB 2基因表达阳性率为 3 7 3 1% (2 5 /67) ,与胃癌浸润深度(P <0 0 5 )、淋巴结转移 (P <0 0 5 )密切相关 ,与肿瘤大小无关。结论 :男性血清T水平及c erbB 2基因与胃癌生长、浸润、转移有密切关系 ,可作为判断预后的独立指标。     

化疗对乳腺癌患者性激素及月经的影响

目的:研究术后辅助化疗对乳腺癌患者性激素的影响及与月经的关系.方法:对60例乳腺癌患者术后行6个周期的CAF方案辅助化疗,观察化疗期间患者月经和血浆雌二醇( E2) 、孕酮( P) 、黄体生成素(LH)、促卵泡素(FSH)的变化及其影响因素.结果:40 例患者化疗期间发生闭经(闭经组) ,20 例化疗结束时仍有月经(未闭经组) .其中闭经组8例化疗后可恢复,32例不可恢复.闭经组患者血浆E2 、P 水平下降( P＜0.05) .闭经发生率与年龄、化疗药物强度和化疗进程呈正相关( P＜0.05) ,其中黄体生成素(LH)、促卵泡素(FSH)下降组月经不可再恢复.结论:化疗可抑制乳腺癌患者性激素的分泌,导致闭经的发生.     

男性乳腺发育和乳腺癌与血清E2和ER及PR关系的临床研究

目的:研究男性乳腺发育、乳腺癌与雌激素水平、雌激素受体(ER)及孕激素受体(PR)之间的关系,探讨男性乳腺发育、乳腺癌患者病因及其临床治疗。方法:用放射免疫检测法测定了35例男性乳腺发育和20例正常献血员血清雌二醇(E2)、睾酮(T);用免疫组织化学SP法测定了35例男性乳腺发育、8例乳腺癌患者乳腺切除标本的ER和PR。结果:男性乳腺发育患者血清E2明显高于正常对照组(P=0·023),而T值两组差异无统计学意义;男性乳腺发育(77·1%、71·4%)、乳腺癌患者(87·5%、75·0%)病理标本ER、PR阳性率均较高。结论:男性乳腺发育、乳腺癌与体内E2水平及乳腺ER、PR相关,可能是机体环境中较高的雌激素及其相关激素一起与局部乳腺ER、PR相互作用,诱发男性乳腺发育,进而可能发展为乳腺癌;ER阻滞剂及降低雌激素水平的芳香化酶抑制剂可用于临床治疗男性乳腺发育和乳腺癌。     

乳腺癌和部分乳腺良性疾患与性激素的关系

本文采用放射免疫分析法,对164例乳腺癌、35例乳腺增生、16例导管内乳头状瘤和403例正常妇女对照,进行外周血雌酮(E_1)、雌二醇(E_2)、孕酮(P)和睾酮(T)水平测定。按行经情况及年龄组进行分析研究。结果表明;乳腺癌妇女未绝经组E_1、T水平明显升高;绝经后E_1;P和T水平明显下降;E_1、P和T水平的改变在更年期最为显著。60岁后乳腺癌的发病与性激素关系不大。乳腺增生妇女的性激素水平变化与乳腺癌妇女十分相似,不同之处在于乳腺增生妇女未绝经组P水平明显升高。     

Carcinoma of the axillary breast

A review of the world literature regarding carcinoma of ectopic breast tissue along with the addition of one cases is reported. A total of 90 cases of carcinoma of ectopic breast tissue were found, 64 of which occurred in the axilla. The combined survival beyond the 4-year post-treatment period was 9.4%. No survival advantage was found for radical or modified radical mastectomy over that of local excision combined with axillary dissection or radiation. The addition of radiation therapy to either type of mastectomy provided no additional benefit. The correct preoperative diagnosis was rarely made. Outcome was reported in 42 cases; 28 survived longer than 1 year, with 12 recurrences at the time of reporting, and 6 were alive with no evidence of disease at 4 years or longer. Improved prognosis requires diagnostic suspicion and early biopsy of unidentified lesions of the axilla or embryonic milk line.     

Breast implant‐associated anaplastic large cell lymphoma,an under‐recognised entity

Breast implant‐associated anaplastic large cell lymphoma (BIA‐ALCL) is a rare form of T‐cell lymphoma, recently linked to the use of certain types of breast implants. Although rare, BIA‐ALCL is being increasingly recognised and radiologists can play an important role in its early diagnosis. BIA‐ALCL is thought to be related to chronic inflammation from indolent infection of the biofilm surrounding implants leading to malignant transformation of activated T cells in genetically susceptible individuals. Clinical features include breast enlargement or asymmetry, discomfort, heaviness and/or a palpable mass in the context of long‐standing implant(s). Ultrasound is the primary imaging modality, and the presence of more than a trace of peri‐implant fluid should prompt consideration of aspiration for cytology, flow cytometry and microbiological analysis. This article reviews the clinical, imaging and pathology features of BIA‐ALCL. In addition, the current recommended management guidelines for suspected cases are discussed.     

Prospective analysis of the long-term effect of teaching breast self-examination and breast awareness

Breast cancer is the most common cancer in women in the industrialized world and a leading cause of death. Breast self-examination (BSE) is one of the methods for an early detection of breast cancer. In the present study the effectiveness of a campaign promoting BSE and breast awareness was analysed. Seminars were conducted in 2003 in Lower Saxony, Germany by a female gynaecologist and a social pedagogue and included a lecture, an individual training in BSE in a separate room and a talk about the importance of regular BSEs. Questionnaires were handed out immediately after the seminar and were sent by post 1 year later. Attendance of the seminar resulted in a significantly higher percentage of monthly BSEs (21.4% before vs. 61.9% after the teaching). Furthermore, 92.1% of the women who did not perform a monthly BSE stated that at least they examined their breasts more frequently after attending the seminar. The data demonstrate that the seminars in BSE had profound effects on the compliance of women in carrying out BSE regularly and correctly, without influence of age or education.     

Trends in the management of breast cancer

Responses of general surgeons to a questionnaire on breast cancer were analyzed to determine the current trends in the management of this disease. A 21-item questionnaire was mailed to members of the New Jersey Chapter of the American College of Surgeons in 1982 and the responses, received on noncoded, anonymous answer sheets, were analyzed for frequency distribution. These responses were compared to previously recorded responses to the same questions for 1971 and 1977. Seventy-six percent of the respondents in 1982 performed needle aspirations often or always, compared to 36% in 1971 and 80% in 1977. The use of routine mammography has increased from 16% in 1971 and 20% in 1977 to 38% in 1982. Modified radical mastectomy is now the most common type of procedure employed in the management of stage I breast cancer, with 89% of respondents in favor of this approach compared to 15% in 1971 and 60% in 1977. Fifty-nine percent of the respondents are not opposed to breast reconstruction following mastectomy versus 14% in 1971 and 49% in 1977. For patients with axillary nodes, chemotherapy with multiple agents was recommended by 76% of general surgeons in 1982, compared to 58% in 1977. These results indicate a continuing trend towards increasing use of needle aspiration and routine mammography for diagnosis and for employment of chemotherapy with multiple agents in the adjuvant treatment of patients with positive axillary nodes. Furthermore, modified radical mastectomy is the operation of choice for stage I cancer of the breast for increasing numbers of surgeons.     

保乳手术在乳腺癌治疗中的应用

目的 :研究保乳手术在Ⅰ、Ⅱ期乳腺癌中的治疗效果。方法 :从 1990年 3月到 2 0 0 4年 3月 ,对直径≤3cm ,肿瘤边缘距乳晕≥ 2cm的部分患者施行保乳手术 ,部分肿瘤直径 >3cm的患者先行术前化疗 ,肿瘤缩小后再做保乳手术。手术切除肿瘤周围约 2cm的正常组织 ,达到切缘阴性 ,腋窝清扫范围为Ⅰ、Ⅱ水平淋巴结。开始时应用 1切口设计 ,后来改为 2切口。术后先进行放疗 ,再进行化疗和 (或 )内分泌治疗。结果 :2 6 5例保乳手术腋窝淋巴结清扫数目为 5～ 2 9个 ,平均 16个。本组患者局部复发部位均为乳腺 ,无腋窝复发者 ,三年、五年、十年生存率分别为 99%、94 %、80 % ,局部复发率为 5 .4 %、7%、7.7% ,乳房保留率为 97.8%、93%、88% ,保留乳房的美容效果满意率为 83.2 %。结论 :保乳手术适用于Ⅰ、Ⅱ期乳腺癌患者 ,可以取得良好的生存率、局部控制率和美容效果 ,是乳腺癌治疗的首选术式。     

The anatomy of the arteries and veins of the breast

Textbook accounts of this subject are inadequate. This review considers the work of Cooper and Salmon and reproduces some of their figures. Applications in the diagnosis and treatment of cancer are discussed. The largest mammary arteries are the lateral (from the axillary) and the anterior medial and posterior medial (from the internal thoracic). The branches of these arteries do not follow the duct system, but instead form a plexus in the anterior fat layer. Normally there are no hypervascular or hypovascular areas. The contribution of the mammary branches of the posterior (aortic) intercostal arteries is minor. There are superficial and deep sets of veins, the latter associated with arteries. Mammary vessels of living women are demonstrated by infrared photography, thermography, and mammography. In the diagnostic use of these methods there is a tendency to rely upon the concept of normal vascular symmetry, but this is a fallacy.     

Breast reduction and cancer in the gland remnant: a review

Aims The main aims of this paper are: (1) to evaluate the impact of partial breast gland removal, for cosmetic or functional reasons on cancer incidence in the long-term post-surgical follow-up; (2) to define the incidental cancer finding during breast reduction; (3) to examine the oncological perspective of contralateral breast reduction in women with post-mastectomy breast reconstruction, (4) to consider the impact of breast reduction techniques as first choice procedure in the treatment of cancers in megalomastia. Methods. We reviewed the clinical articles published in the last 20 years addressed to the relationship between the amount of tissue removed and cancerogenesis of the remnant gland. The review has been also extended to published papers outlining the future trends of breast reduction procedures from an oncological perspective, potentially as specific choice of selected cancer treatment in megalomastia. Results. Assessment of the literature data reveals that breast reduction does decrease the risk of breast and other types of cancers. The actual risk lowering for patients older than 40 is related to the amount of tissue removed. Conclusion. This study illustrates that breast reduction surgery should be encouraged, besides the known aims, as a preventive operation in those patients presenting degrees of breast hypertrophy and a family history of breast cancer.     

Decreased rates of advanced breast cancer due to mammography screening in The Netherlands

The effect of the implementation of the Dutch breast cancer screening programme during 1990-1997 on the incidence rates of breast cancer, particularly advanced breast cancer, was analysed according to stage at diagnosis in seven regions, where no screening took place before 1990. The Netherlands Cancer Registry provided detailed data on breast cancer incidence in 1989-1997 by tumour stage, age and region. Annual age-adjusted incidence rates of all breast cancers and advanced cancers, defined as large tumours T2+ with lymph node and/or distant metastases, were compared with rates in 1989. In general, breast cancer incidence rose strongly in the early 1990s, especially in the age category 50-69 years (estimated annual percentage change (EAPC) 4.25; 95% CI 1.70, 6.86). The increase was mainly due to the increase in small T1 cancers and ductal carcinoma in situ. However, in women aged 50-69, advanced cancer incidence rates showed a significant decline by 12.1% in 1997 compared with 1989 (EAPC -2.14, 95% CI -3.47, -0.80), followed by a breast cancer mortality reduction of similar size after approximately 2 years. We confirm that breast cancer screening initially leads to a temporary strong increase in the breast cancer incidence, which is followed by a significant decrease in advanced diseases in the women invited for screening. It is evident that breast cancer screening contributes to a reduction in advanced breast cancers and breast cancer mortality.