乳腺导管内乳头状瘤及其癌变组织CD44v6蛋白表达的研究

背景与目的：CD44v6是乳腺上皮恶性转化中的一个重要成分,在乳腺良恶性病变中有不同的表达,但其在良恶性病变的鉴别诊断中的价值并没有得到很好和研究,本研究目的是检测CD44v6在乳腺导管内乳头状瘤及导管内乳头状瘤癌变组织中的表达,探讨CD44v6在乳腺导管内乳头状瘤诊断及鉴别诊断中的作用。方法：对49例导管内乳头状瘤,12例导管内乳头状瘤癌变,15例导管内癌,15例浸润性导管癌及20例正常乳腺组织的石蜡切片进行免疫组织化学染色。结果：在正常组织,导管内乳头状瘤,乳头状瘤癌变,导管内癌,浸润性导管癌中,肌上皮细胞（basal epithelial cell)的CD44v6蛋白表达阳性（＋＋／＋＋＋）率分别为95．00％,85。72％,66。66％,66。66％,0％,导管内乳头状瘤与乳头状瘤癌变之间无统计学差异（P＞0．05）,而上此细胞（luminal epithelial cell)的CD44v6蛋白表达阳性（＋＋／＋＋＋）率分别为5．00％,83．34％,93．33％,100％,导管内乳头状瘤与乳头状瘤癌变之间有统计学差异（P＜0．01）,结论：通过免疫组化检测CD44v6蛋白表达对诊断导管内乳头状瘤是否癌变具有重要参考价值。     

乳腺乳头状瘤病及其癌变临床病理分析

[目的]探讨乳腺乳头状瘤病及癌变病例的临床病理特征。[方法]回顾分析18例乳腺乳头状瘤病(包括癌变病例)的临床资料、光镜组织学检查和免疫组化染色结果,以及随访资料。[结果]临床主要表现为乳房肿块和乳头溢液。镜下见乳腺中小导管扩张,上皮呈不同程度的增生。癌变灶可局限或弥散分布于乳头状瘤病组织中,两者存在明显的过渡性改变。免疫组化:Ki-67在中度、中-重度乳头状瘤病及其伴癌变3组患者中阳性表达呈递增趋势。[结论]乳腺乳头状瘤病及其癌变的诊断目前仍靠病理组织学形态,Ki-67可反映乳头状瘤病及其癌变的不同程度的增殖分化状态。     

细胞学诊断乳腺导管内乳头状瘤的临床病理分析

目的：探讨细胞学诊断乳腺导管内乳头状瘤的可靠性及对临床的指导意义。方法：选择有病理对照的细胞学诊断为乳腺导管内乳头状瘤病例56例．镜下观察其乳头溢液涂片和细针穿刺细胞学涂片（FNAC）的细胞形态特点．并与组织切片进行对照分析结果：56例中诊断准确率为87．5％（49／56），误诊率为12．5％（7／56），其中4例诊断为导管上皮细胞增生．2例误诊为纤维腺瘤．1例误诊为乳腺癌一结论：通过乳头溢液及细针穿刺细胞学联合诊断乳腺导管内乳头状瘤较为可靠．对术前诊断有一定指导意义．但对病变多发及较复杂的病例诊断宜慎重，尤其是乳腺肿块伴溢液诊断乳腺癌应谨慎．最好行切检病理检查。     

HPV16/18E6蛋白及HPV18DNA在乳腺导管内乳头状瘤组织中的表达

目的：探讨人乳头状瘤病毒（HPV）18型感染与人乳腺导管内乳头状瘤病因学之间的关系。方法：对柳州地区女性28例乳腺导管内乳头状瘤和5例导管内乳头状瘤恶变材料采用SP法免疫组化染色和原位杂交技术进行HPV16／18E6蛋白及HPV18DNA的检测。结果：乳腺导管内乳头状瘤组中HPV16／18E6蛋白和HPV18DNA的阳性率分别为21．4％和28．6％，多发性组中HPV18 DNA阳性显著高于单发性组（P＜0．04），而导管内乳头状瘤恶变组中HPV18 DNA的阳性率为80．0％，显著高于导管内乳头状瘤组（P＜0．05）。结论：柳州地区女性乳腺导管内乳头状瘤组织中有HPV18DNA感染的存在。HPV18型感染可能涉及乳腺导管内乳头状瘤的发生、发展过程。     

纤维乳管镜对乳腺导管内肿瘤的诊断价值

目的：探讨纤维乳管内窥镜（简称“纤维乳管镜”）对乳腺导管内肿瘤的诊断价值。方法：66例单侧单孔血性乳头溢液的患者入院行手术治疗,术前均同时行纤维乳管镜检查及超声检查,回顾性分析其术前检查诊断与病理符合情况。结果：66例血性乳头溢液患者,病理证实乳腺导管内肿瘤59例（其中导管内乳头状瘤47例,导管内乳头状瘤伴上皮非典型增生4例,导管内癌8例）,导管内肿瘤发生率89．39％（59／66）,导管内肿瘤伴非典型增生（癌前病变）及导管内癌发生率18．18％（12／66）;单纯导管扩张症7例,发生率10．61％（7／66）。59例病理所示导管内肿瘤的患者乳管镜检查阳性57例（包括导管内乳头状瘤伴上皮非典型增生4例,导管内癌8例）,阴性2例,导管内肿瘤诊断率96．61％（57／59）。超声检查阳性30例（包括导管内乳头状瘤伴上皮非典型增生1例,导管内癌3例）,阴性29例,导管内肿瘤诊断率50．85％（30／59）,二者比较有统计学意义（P〈0．01）。结论：血性乳头溢液患者乳腺导管内肿瘤发生率较高,纤维乳管镜检查显著提高乳腺导管内肿瘤（包括导管内癌）的诊断率,对乳腺导管内肿瘤的诊断具有重要价值。     

乳腺乳头状瘤病及其癌变

乳腺乳头状瘤病及其癌变田艳涛／／,综述,李树玲,傅西林,审校天津市肿瘤研究所乳腺癌研究室（天津市　３０００６０）乳腺乳头状瘤病是发生于乳腺中小腺管的多发病变,常为囊性增生病的重要组成部分。亦是一种常见的乳腺病理变化。其与乳腺癌的关系如何？是否癌前病变...     

乳腺导管内乳头状瘤癌变5例报告

乳腺导管内乳头状瘤少见，是发生于乳腺导管上皮细胞的良性肿瘤，常发生于近乳晕的大乳管，是乳头溢液的最常见原因。乳腺导管内乳头状瘤有癌变可能，目前对乳腺导管内乳头状瘤癌变研究较少，治疗方法尚无定论。我院自1980年1月～2002年1月间收治乳腺导管内乳头状瘤癌变5例，现结合文献对该病的临床表现、诊断治疗及预后进行探讨。     

乳腺导管内乳头状瘤的诊断与外科治疗（附51例报告）

目的：总结分析乳腺导管内乳头状瘤的诊断与外科治疗经验与方法，提高对本病合理的处理水平。方法。回顾性分析我院51例经手术病理证实的导管内乳头状瘤的临床资料。结果：导管造影检查的敏感性为74．5％（38／51）；定位准确率为98％（50／51）。通过美蓝法手术切除病灶、安全、准确，彻底。切口应用简易细引流管后，无一皮下积液与血肿，愈合良好。结论：导管造影仍是目前导管内乳头状瘤诊断较可靠的方法，确诊患者均应手术治疗，应用简易细引流管可减少术后并发症的发生，对血性溢液患者均应警惕癌变的可能。     

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。所有惠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。     

乳腺大导管乳头状瘤和乳头状癌

1.天津市人民医院瘤科九年间住院治疗大导管上皮增生症5例,大导管乳头状病20例和乳头状癌9例。大导管上皮增生和乳头状瘤占乳腺肿瘤的2.9%,乳头状癌占乳癌的2.3%。2.乳头状瘤是一种少见的良性肿瘤,癌变者甚少见,故不宜视为癌前瘤变。惟大形乳头状瘤的临床表现与乳头状癌颇相似,宜慎重鉴别。3.乳头状癌是有特殊表现的乳癌,临床多可初步辨认。此种癌瘤的恶性度较低,生长较慢,发生腋转移者较一般乳癌为少。但治疗原则仍以乳癌根治术为宜。     

Papillary duct hyperplasia of the breast in children and young adults

Papillary duct hyperplasia (papilloma and/or papillomatosis) are relatively common breast lesions in adult women. However, they are rarely seen in women younger than 30 years of age or in children. This report presents the findings in 38 children and young adult women aged 10 to 26 years (average, 17 years). Six (16%) were younger than 14 years of age and 31 (82%) were 20 years or younger. Three types of papillary duct hyperplasia were described as papilloma (9 cases), papillomatosis (9 cases), and sclerosing papillomatosis (20 cases). None of these lesions exhibited the prominent cystic component of juvenile papillomatosis (JP) and most lacked other features of JP such as apocrine metaplasia and stasis. Other than a slightly older average age at diagnosis for sclerosing papillomatosis, no significant clinical differences were found related to the patterns of papillary duct hyperplasia. Thirteen percent reported a positive family history for breast carcinoma. No carcinomas have been detected in the 38 patients (follow-up, 14-307 months) and only one subsequent carcinoma was described after an interval of 22 years among 36 other cases reported in the literature. A family history of breast carcinoma is reported in 28% of JP cases and 5% have associated carcinoma. Further follow-up will be necessary to fully define the natural history of papillary duct hyperplasia in these young patients. There appear to be sufficient morphologic and clinical differences from JP to warrant a separate diagnostic term for this group of lesions. Treatment should be local excision.     

Study of Benign and Malignant Intraductal Lesions of the Breast by Fiberoptic Ductoscopy

OBJECTIVE To observe and subtype the appearance of intraductal papilloma (lesions) and of infiltrating ductal carcinoma or early infiltrating ductal carcinoma using a fiberoptic ductoscope (FDS) examination, and to discuss the differentiation and diagnosis of benign and malignant tumors by FDS.METHODS The characteristics of FDS images and diagnostic data for 229patients with intraductal papilloma (lesions) and 50 patients with ductal carcinoma, who were confirmed by surgical pathology from October 1998 to December 2003, were analyzed retrospectively.RESULTS The appearance of the lesions observed by FDS were grouped into 4 types: a monothelia (type Ⅰ), polythelia (type Ⅱ), superficies (type Ⅲ)and a mixture (type Ⅳ). Intraductal papillomas (lesions) were more commonly seen in type Ⅰ and Ⅱ, and intraductal carcinomas or early infiltrating ductal carcinomas were more commonly seen in type Ⅲ and Ⅳ;there was a statistically significant difference in the distribution of the ductoscopic types, except in type Ⅱ, between the two types of lesions, P＜0.001. The focal detection rate by FDS for intraductal papilloma and papillomatosis was 99.6% (228/229) and for breast cancer was 96.0% (48/50). The diagnostic accuracy was 97.8% (224/229) and 82.0% (41/50),respectively.CONCLUSION FDS can be a guide for the treament of benign and malignant intraductal tumors, with early discovery and accurate diagnosis.     

乳腺癌前病变与乳腺癌相关的多指标病理学研究

目的：探讨各种乳腺癌前病变与乳腺癌发生的关系。方法：应用全乳腺大切片技术结合ＣＥＡ、ｃ－ｅｒｂＢ－２癌基因产物免疫组化检测及流式细胞术（ＦＣＭ）测定ＤＮＡ含量、Ｓ期细胞比率（ＳＰＦ）和细胞增殖指数（ＰＩ）,对３９３例乳腺癌标本进行癌旁和癌前病变与乳腺癌相关性的多指标综合研究。结果：乳腺癌最多见的癌旁病变是导管上皮增生（５５．２％）,其次为囊性增生病（５３．４％）和乳头状瘤病（２２．２％）。其中与乳     

乳腺导管内增生性病变的分类及其临床病理特点

乳腺导管内增生性病变不仅是病理诊断的难点,也是乳腺外科治疗方案选择不统一的问题所在。2003年WHO乳腺肿瘤组织学分类将其分为普通型导管增生(usual ductalhyperplasia,UDH)、平坦型上皮不典型增生(flat epithelial atypia,FEA)、不典型导管增生(atypical ductal hyperplasia,ADH)和导管原位癌(ductal carcinoma in situ,DCIS)4类。UDH的细胞学及组织学构型均无不典型性,ADH仅有细胞学不典型性而无组织构型不典型性,DCIS则具有细胞学和组织构型的双重不典型性,而FEA中的少数应视为癌前病变。微小钙化是导管内增生性病变常见的X线表现形式。乳腺摄影能早期发现临床触及不到的微小癌及早期癌,尤其是DCIS,有助于临床手术范围或手术方式的选择。     

Nipple discharge as a sign of preneoplastic lesions and occult carcinoma of the breast: clinical and galactographic study in 103 consecutive patients.

A clinical and galactographic investigation was carried out on 103 patients with hematic, serous-hematic, and serous nipple discharge. The age of the patients ranged from 18 to 72 years. A single papilloma was found in 20 cases, diffuse papillomatosis in 2 cases, atypical ductal hyperplasia in 8 cases, and ductal carcinoma in 4 cases (3 of these were infiltrating and 1 was noninfiltrating associated with a diffuse papillomatosis). Mammography gave no indications of carcinoma in any of the 4 cases. In the remaining 49 patients, pictures of ductal hyperplasia, periductal mastitis or sclerosis, sclerosing adenosis, or ductal ectasia were observed. The various types of lesions were often associated. Lacunae, stenosis, or occlusion of the ducts, evidenced by galactography, correlated well with the histologic findings of proliferative lesions of the ductal epithelium. Nevertheless, in practice, it should be the type of discharge that indicates surgery rather than galactographic or cytologic data, which appeared to have little diagnostic value. The frequency with which preneoplastic (or limit) lesions, and also nonsuspect carcinomas were found in patients with a significant nipple discharge confirm the importance of this symptom for a secondary prevention of early diagnosis of mammary neoplastic lesions originating from galactophorous ducts. Finally, complete resection of the galactophorous ducts must be considered as the best treatment in all patients with a suspicious nipple discharge that requires surgery.     

Galectin-3及p-AKT在乳腺浸润性导管癌的表达及意义

目的研究Galectin-3和p-AKT在乳腺浸润性导管癌（IDC）中的表达及意义。方法应用免疫组织化学Envision二步法检测97例乳腺IDC和20例乳腺腺病组织中Galectin-3和p-AKT蛋白的表达情况。结果 Galectin-3和p-AKT表达在乳腺IDC（阳性率分别为84.5%、77.3%）和良性病变中（阳性率分别为25.0%、30.0%）差异具有统计学意义（P〈0.05）;在乳腺IDC中,死亡组Galectin-3和p-AKT表达（97.1%、91.4%）明显高于生存组（77.4%、69.4%）（P〈0.01）,p-AKT表达与淋巴结转移相关（P〈0.01）,Galectin-3和p-AKT表达与乳腺IDCTNM分期、组织学分级无关,与年龄相关;Galectin-3表达和p-AKT表达呈正相关（r=0.606,P〈0.05）。结论乳腺IDC中Galectin-3和p-AKT表达可能促进肿瘤演进,高表达Galectin-3和p-AKT的乳腺IDC具有更高侵袭性和淋巴结转移能力,并提示预后不佳。对Galectin-3和p-AKT作用机制的深入研究有可能使其成为乳腺IDC患者个体化治疗的新靶标。     

Preoperative localization and surgical approach in 344 cases of non-palpable breast lesions

From June 1985 to August 1989, 344 cases of mammographic non-palpable breast lesions were operated on at the National Cancer Institute in Milan. The mammographic findings consisted of clusters of microcalcifications in 162 cases (42.1%), suspicious opacities with irregular borders in 116 cases (37.7%) and opacities containing microcalcifications in 66 cases (19.2%). The mean age of the patients was 51 years (range 31-77 years). In all patients localization was performed 1 day before the operation, introducing a self-retaining anchor wire into the mammary parenchyma. The histological findings showed benign breast disease in 184 cases (53.4%); proliferative dysplasia without atypia in 150 cases (81.5%); proliferative dysplasia with atypia in 22 cases (12%); fibroadenoma in nine and papilloma in three cases. Of 160 patients with carcinoma, 37 had non-infiltrating carcinoma: 28 of these cases (17.5%) had non-infiltrating ductal carcinoma and nine cases (5.6%) had lobular carcinoma in situ. In the 123 cases with infiltrating breast cancer the histological types were ductal infiltrating carcinoma (32.5%), lobular infiltrating carcinoma (9.8%), and 34.1% of the cases an associated or prevalent intraductal carcinoma was found. In 138 cases (85.6%) a conservative surgical procedure (quadrantectomy or more limited excision) was done, and in 22 (14.4%) cases a total mastectomy was necessary because of the extent of the disease. Axillary dissection was performed in 116 of the 123 patients with histological invasive carcinoma. Nodal metastases were found in 24 cases (20.7%), and only one node was involved in nine of the cases (37.5%), two to three nodes in nine cases (37.5%) and four to ten nodes in six cases (25%).     

乳管内视镜检查1 337例乳头溢液患者误诊原因分析

回顾分析1998年10月~2005年8月1337例乳管内视镜检查(fiberoptic ductoscopy,FDS)临床病理资料,其中478例经手术得到病理结果。分析结果显示,不同导管内病变在乳管镜下各有特征,但图象特征有重叠区域,易导致误诊;乳管内视镜对导管内乳头状瘤、乳头状瘤病和乳腺癌的病理诊断符合率分别为94·5%、88%和93·6%。回顾性研究结果提示,乳管内视镜对乳头溢液有较高的诊断符合率,但还须结合其他方法进一步提高其诊断价值。     

不伴肿物乳头溢液124例分析

 目的　深讨不伴肿物乳头溢液对检出早期乳腺癌及癌前病变的临床价值。方法　对124例不伴肿物乳头溢液患者(其中浆液性溢液47例,血性溢液74例,脓性3例),行手术治疗,先行病变导管切除,如为恶性,则行乳腺癌改良根治术。结果　本组病例良性者115例,占92.7%,其中乳腺导管内乳头状瘤和乳腺囊性增生病占79%;乳头状瘤(病)伴瘤细胞或导管上皮增生活跃(癌前病变)14例,占11.3%;乳腺癌9例,占7.3%,9例患者均为血性乳头溢液,占血性溢液之12.2%,均为临床早期癌(T0期乳腺癌)。结论　不伴肿物乳头溢液对检出早期乳腺癌及癌前病变有重要的临床价值。     

The distribution of carcinoembryonic antigen in breast carcinoma. Diagnostic and prognostic implications

Carcinoembryonic antigen (CEA) has been shown to be a useful tumor marker in patients with breast carcinoma. The unlabeled antibody immunoperoxidase technique was used to localize CEA in 93 cases of primary breast carcinoma, 15 cases of atypical duct papillomatosis, and 4 cases of duct papilloma. Normal breast epithelium and breast epithelium in fibrocystic disease did not stain positively for CEA. Twenty-four of 27 (88%) intraductal carcinomas, and 47 of 69 (68%) infiltrating duct carcinomas were CEA positive. In contrast, only 5 of 21 (23%) in situ lobular carcinomas and 8 of 24 (33%) infiltrating lobular carcinomas were positive for CEA. All 15 cases of atypical epithelial papillomatosis were negative, whereas 1 of the 4 cases of duct papilloma exhibited microscopic foci of weak CEA positivity. There was a trend for infiltrating duct carcinomas, 3 cm in diameter or smaller, staining strongly positive for CEA, to be associated with synchronous axillary lymph node metastases (P = 0.09). Tumor heterogeneity was a constant feature of CEA staining with positivity varying from region to region and even from cell to cell. Positive immunohistochemical staining for CEA may play an adjunctive role in discriminating intraductal carcinoma from atypical papillary ductal proliferations.