乳腺浸润性导管癌分子分型与临床特征的关系

目的探讨乳腺浸润性导管癌不同分子亚型的分布,并分析各分子亚型与临床特征的关系。方法收集2006年1月-2011年6月明确诊断为乳腺浸润性导管癌病例100例,根据雌激素受体（ER）、孕激素受体（PR）、表皮生长因子受体-2（HER-2）的表达情况划分为四型,进一步分析不同分子亚型与浸润性导管癌临床特征的关系。结果100例中Luminal A型所占比例最大为65%,7%为Luminal B型, Triple Negative型占17%,Her-2(+)型占11%。各分子亚型乳腺浸润性导管癌患者发病年龄主要集中在40~59岁之间,占73%,Luminal A型发病年龄主要集中在40~49岁,而其他三型主要分布于50~59岁,四型在不同年龄组的分布上差异有统计学意义（P＜0.05）;Luminal A型淋巴转移发生率仅为30.1%,而Luminal B型与Her-2(+)型淋巴转移发生率较高,分别为71.4%及63.6%,各分子亚型的腋窝淋巴结转移率有显著差异（P＜0.05）;病理组织学分级Ⅰ级中Luminal A型所占比例最高,而Triple Negative型主要以Ⅲ级为主,差异具有统计学意义（P＜0.05）。结论乳腺浸润性导管癌各分子亚型分布差异具有统计学意义,各分子亚型与其临床特征关系密切。     

Adenoid Cystic Carcinoma/Basal Cell Carcinoma of the Prostate: Overview and Update on Rare Prostate Cancer Subtypes

Adenoid cystic carcinoma/basaloid cell carcinoma of the prostate (ACC/BCC) is a very rare variant of prostate cancer with uncertain behavior. Few cases are reported in the literature. Data on treatment options are scarce. The aim of our work was to retrospectively review the published reports. Thirty-three case reports or case series were analyzed (106 patients in total). Pathological features, management, and follow-up information were evaluated. Despite the relatively low level of evidence given the unavoidable lack of prospective trials for such a rare prostate tumor, the following considerations were made: prostate ACC/BCC is an aggressive tumor often presenting with locally advanced disease and incidental diagnosis occurs during transurethral resection of the prostate for urinary obstructive symptoms. Prostate-specific antigen was not a reliable marker for diagnosis nor follow-up. Adequate staging with Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) should be performed before treatment and during follow-up, while there is no evidence for the use of Positron Emission Tomography (PET). Radical surgery with negative margins and possibly adjuvant radiotherapy appear to be the treatments of choice. The response to androgen deprivation therapy was poor. Currently, there is no evidence of the use of truly effective systemic therapies.     

Role of radiotherapy in ductal (endometrioid) carcinoma of the prostate

BACKGROUND: Ductal carcinoma of the prostate is a rare variant of prostate cancer that presents most commonly with obstructive urinary symptoms or hematuria. This case series of 6 patients is the first to report the outcome of ductal carcinoma treated with external beam radiotherapy. METHODS: A retrospective review was performed of patients treated between 1980 and 2006 at Fox Chase Cancer Center, Philadelphia, Penn. Six patients were identified with ductal carcinoma. RESULTS: Five of the 6 patients were treated definitively and the sixth patient was treated at recurrence 3 years after a radical prostatectomy. Patient ages ranged from 66-80 years and the initial prostate-specific antigen (iPSA) ranged from 1.69-100.3 ng/mL. Three patients had a mixed acinar and ductal carcinoma, 2 with a Gleason score (GS) of 8 and 1 with a GS of 7. Of the patients treated definitively, 4 had clinical stage T2A-T2C and 1 had clinical stage T1B. Definitive radiotherapy was delivered to the prostate with doses between 72 Gy and 78 Gy. Pelvic lymph nodes were treated in all patients. One patient was treated postradical prostatectomy to the prostate bed to a dose of 60 Gy. Adjuvant androgen deprivation was given in 5 of the patients. Two of the patients died from metastatic disease at 1.4 and 7.1 years after treatment. The remaining 4 patients remain alive between 3.2 and 4.8 years from treatment, with 3 patients biochemically without evidence of disease. No patients have developed a local recurrence. CONCLUSIONS: Ductal carcinoma of the prostate may be treated effectively with external beam radiotherapy. Aggressive management is indicated, even with low-volume metastatic disease.     

Grade of Ductal Carcinoma In Situ Accompanying Infiltrating Ductal Carcinoma As an Independent Prognostic Factor

BackgroundSeveral studies about the relationship between IDC and DCIS have been reported, but no consensus has been reached regarding clinical characteristics and prognostic value.Patients and MethodsWe reviewed the medical records of patients who underwent surgery for IDC between 2006 and 2008. DCIS adjacent to IDC was pathologically classified as either high-grade DCIS or non–high-grade DCIS.ResultsAmong 1751 IDC patients within the study period, 1384 patients (79.0%) had concomitant DCIS. There was no survival difference between patients with pure IDC and those with IDC and concomitant DCIS. However, patients with high-grade DCIS had worse survival than did patients with non–high-grade DCIS or pure IDC (5-year recurrence-free survival rates for IDC with non–high-grade DCIS, pure IDC without DCIS, and IDC with high-grade DCIS were 97%, 93%, and 86%, respectively; P = .001). This tendency was maintained regardless of estrogen receptor status or histologic grade of IDC. In a Cox regression model, patients with IDC and accompanying high-grade DCIS had a 2.5-fold higher probability of local or distant relapse than did those with IDC and low-grade DCIS (hazard ratio, 2.51; 95% confidence interval, 1.12–5.64).ConclusionsThe prognosis of patients with invasive breast cancer differed according to the grade of concomitant adjacent DCIS. Accordingly, the grade of adjacent DCIS should be considered as a prognostic factor in the clinical management of patients with breast cancer. However, in our study, the follow-up periods were short to confirm prognostic effect. Further studies are needed.     

Detection of High-Risk Human Papillomavirus DNA in Invasive Ductal Carcinoma Specimens

Background: According to several studies, there is an association between human papillomavirus (HPV) and breast cancer. Therefore, detection and genotyping of HPV seem important. The present study aimed to investigate the presence of HPV DNA in breast tissues  by analyzing the L1 gene. Materials and Methods: This case-control study was conducted on 63 formalin-fixed paraffin-embedded (FFPE) tissues of invasive ductal carcinoma (IDC) as the case group and 32 FFPE tissues of fibroadenoma as the control group. HPV DNA was detected using the polymerase chain reaction assay. Positive samples were then subjected to genotyping. All statistical analyses were performed in SPSS version 22.0. Results: The patients’ age ranged from 15 to 92 years, with a mean age of 43.54±16.36 years. HPV DNA was detected in 17/95 (17.89%) samples, including 9/32 (28.12%) fibroadenoma samples and 8/63 (12.69%) IDC samples. No significant difference was observed regarding the presence of HPV DNA between the IDC and fibroadenoma tissues (P=0.08). However, a significant difference was found in the detection of high-risk HPV (HR-HPV) between the case and control groups (P=0.03). In the case group, 87.5% of the detected viruses (7/8 samples) were HR-HPV, while in the control group, 22.22% of positive samples (2/9 samples) were HR-HPV (P=0.03). Based on the results, HR-HPV and low-risk HPV genotypes were detected in 53% (9/17) and 47% (8/17) of positive samples, respectively. Conclusion: In this study, 12.69% of IDC samples were positive for HPV genomes, and HR-HPV was detected in 87.5% of these samples. The present results suggest the important role of HR-HPV in the development of breast cancer.     

Fibrotic Focus in Invasive Ductal Carcinoma: An Indicator of High Tumor Aggressiveness

Histological examination of invasive ductal carcinoma of the breast often demonstrates the presence of an extensive central fibrotic focus (FF). The clinicopathological significance of the FF, or scar, in primary invasive ductal carcinoma is still ambiguous. One hundred and fifty-three cases of invasive ductal carcinoma (IDC) were classified into two groups, those with and those without FF. The differences in frequency of immunohistochemically detected overexpression of c- erb B-2 protein and nuclear accumulation of p53 protein, and the labeling index of proliferating cell nuclear antigen (PCNA), as well as histopathological parameters were compared between these two groups. IDCs smaller than 50 mm with FF showed a higher frequency of high-grade tumors, a higher frequency of lymph node metastasis, and a significantly higher frequency of c- erb B-2 protein overexpression than those without FF. In tumors of 20 mm or less, the incidence of nuclear accumulation of p53 protein was significantly higher in tumors with than those without FF. Tumors with FF showed a significantly higher PCNA labeling index than those without FF, regardless of tumor size. The present results indicate that the presence of FF is an important clinicopathological parameter associated with a higher degree of malignancy in IDCs, especially those smaller than 50 mm. Therefore, dividing IDCs into those with and those without FF appears to be meaningful clinicopathologically.     

Salvage Radical Prostatectomy for Radio-Recurrent Prostate Cancer: An Updated Systematic Review of Oncologic,Histopathologic and Functional Outcomes and Predictors of Good Response

A valid treatment option for recurrence after definite radiotherapy (RT) for localized prostate cancer (PC) is salvage radical prostatectomy (SRP). However, data on SRP are scarce, possibly resulting in an underutilization. A systematic review was performed using MEDLINE (Pubmed), Embase, and Web of Science databases including studies published between January 1980 and April 2020. Overall, 23 English language articles including a total number of 2323 patients were selected according to PRISMA criteria. The overall median follow-up was 37.5 months (IQR 35.5–52.5). Biochemical-recurrence (BCR)-free probability ranged from 34% to 83% at five years, respectively, and from 31% to 37% at 10 years. Cancer specific survival (CSS) and overall survival (OS) ranged from 88.7% to 98% and 64% to 95% at five years and from 72% to 83% and 65% to 72% at 10 years, respectively. Positive surgical margins ranged from 14% to 45.8% and pathologic organ-confined disease was reported from 20% to 57%. The rate of pathologic > T2-disease ranged from 37% to 80% and pN1 disease differed between 0% to 78.4%. Pre-SRP PSA, pre-SRP Gleason Score (GS), pathologic stage after SRP, and pathologic lymph node involvement seemed to be the strongest prognostic factors for good outcomes. SRP provides accurate histopathological and functional outcomes, as well as durable cancer control. Careful patient counseling in a shared decision-making process is recommended.     

t—PSA,f—PSA／t—PSA诊断前列腺癌的临床意义

为了探讨游离前列腺特异抗原（ｆＰＳＡ）与总前列腺特异抗原（ｔＰＳＡ）比率对前列腺癌的诊断价值,采用酶联免疫方法分别测定４１例前列腺癌病人,３６例前列腺增生（ＢＰＨ）病人血清ｔＰＳＡ、ｆＰＳＡ,并计算出ｆＰＳＡ／ｔＰＳＡ比率。ｔＰＳＡ界限值为４μｇ／Ｌ时,敏感度,特异度,准确度分别为８２．９％,６０．０％,７２．４％;ｆＰＳＡ／ｔＰＳＡ界限值定为１７．０％时,敏感度,特异度,准确度分别为８７．８％,９３．０％,８４．２％。结果表明：ｆＰＳＡ／ｔＰＳＡ在保持敏感度的同时,可显著地提高特异度,能更有效地诊断前列腺癌     

Ductal adenocarcinoma of the prostate

BACKGROUND:

Ductal or endometrioid adenocarcinoma of the prostate may be a subtype of prostate cancer that is amenable to aggressive local therapeutic strategies. The authors of this report investigated the clinical outcome of patients who had prostate ductal adenocarcinoma after primary radical prostatectomy or radiotherapy.

METHODS:

The clinical features of 108 patients with locally confined or advanced prostate ductal adenocarcinoma who had undergone primary radical prostatectomy (surgical group, n = 76 men) or no surgery (nonsurgical group, n = 32 men) were evaluated retrospectively. Clinical records were reviewed, and Gleason scores, clinical/pathologic stages, and preoperative prostate‐specific antigen levels were examined. The clinical features that were assessed included local recurrence, distant metastasis, and progression‐free and overall survival after primary therapy.

RESULTS:

In the surgical group, patients who had pure ductal prostate cancer survived longer (median, 13.8 years; 95% confidence interval [CI], from 13.8 years to not attained) than patients who had mixed ductal prostate cancer (median, 8.9 years; 95% CI, from 7.1 years to not attained; P = .05). In addition, the median time to local progression was shorter (2.8 years vs 4.9 years) and the median time to distant metastasis was longer (3.9 years vs 2.0 years) for patients who had pure ductal adenocarcinoma than for patients who had mixed ductal adenocarcinoma of the prostate after surgery, respectively.

CONCLUSIONS:

The results of this preliminary study suggested that pure ductal prostate adenocarcinoma tends to pursue an indolent clinical course and poses an increased risk for local recurrence. Local control (particularly prostatectomy) may improve the clinical outcome of patients with pure prostate ductal adenocarcinoma. These results need to be confirmed in prospective studies. Cancer 2009. © 2009 American Cancer Society.     

Concurrent Invasive Ductal Carcinoma of the Breast and Malignant Follicular Lymphoma,Initially Suspected to Be Metastatic Breast Cancer: A Case Report

This report describes a case of a 40-year-old female patient with concurrent invasive ductal carcinoma of the breast and malignant follicular lymphoma, initially suspected to be metastatic breast cancer. During the initial evaluation of invasive ductal carcinoma of right breast, multiple lymphadenopathies were noted throughout the body on ultrasonography and positron emission tomography/computed tomography images. Clinically, metastatic breast cancer was suggested, and the patient was administered chemotherapy, including hormonal therapy. The breast cancer improved slightly, but the lymphadenopathies progressed and excisional biopsy of a cervical lymph node revealed malignant follicular lymphoma.     

乳腺钼靶片对术前预测浸润性乳腺癌局部复发的价值

乳腺浸润性导管癌有扩散性导管内成份的存在是保留乳腺的局部切除手术后，局部复发的一个重要因素。对187例乳腺浸润性导管癌钼靶片及病理切片进行对照研究发现，钼靶片上的某些特征与扩散性导管内成分有密切关系，即：浸润性导管癌在乳腺片上表现为钙化，特别是钙化范围较大，极可能存在扩散性导管内成份：没有钙化表现的浸润性导管癌，很少合并扩散性导管内成份。所以乳腺片特征可以作为筛选实施保留乳腺手术病人的客观指标。     

Histological Factors Associated with Initial Bone Metastasis of Invasive Ductal Carcinoma of the Breast

Bone is one of the most common sites of recurrence of breast cancer. Therefore, it would be clinically very useful if breast cancers with a high probability of bone metastasis (BM) could be identified by histopathological examination of the primary lesions. To elucidate histological characteristics associated with predisposition to initial BM, we examined nine histopathological parameters in the primary lesions of 110 invasive ductal carcinomas (IDCs) of the breast with 0 to 3 regional node metastases. These cases had recurrence between 4 months and 10.1 years after the initial radical surgery. The first metastatic site was bone in 24 cases, whereas other sites were involved in 86 cases. IDCs growing in a strand growth pattern or with fibrotic focus (FF) had a significantly higher frequency of initial BM than those growing in a non-strand growth pattern or without FF, respectively. Strand growth pattern was a significant predictor of the initial BM in multivariate analysis. In all 54 IDCs that developed BM during the follow-up period, osteolytic metastasis was significantly more frequent in the group with FF than in that without FF. This study demonstrated that strand growth pattern and the presence of FF are significant histopathological factors associated with initial BM. The combination of those predictive factors along with prognostic factors may provide a useful approach to identify patients at high risk for initial BM, enabling early treatment for the recurrent cancer.     

乳腺浸润性导管癌潜在核心基因的生物信息学分析

目的 从分子层面分析乳腺浸润性导管癌(IDC)的差异表达基因(DEGs),识别潜在致病基因和分子机制.方法 分析来自美国国立生物技术信息中心(NCBI)的公共基因芯片数据库(GEO)的微阵列数据集(GSE29044).GEO2R工具筛选出IDC与正常乳腺组织间DEGs.利用DAVID在线数据库对DEGs进行相关基因功能...     

彩超与钼靶对乳腺导管内癌诊断的对比研究

目的 探讨彩超（CDUS）与数字化钼靶摄影（钼靶）对乳腺导管内癌（DCIS）的诊断价值。方法 回顾性分析73例患者79个病灶经病理确诊的DCIS术前CDUS及钼靶的影像资料,比较两者单独及联合诊断DCIS的价值。结果 经病理证实79个病灶中48个为DCIS。CDUS及钼靶诊断DCIS的敏感度分别为66.67%（32/48）和70.83%（34/48）,两者间差异无统计学意义（P>0.05）,特异性分别为90.32%和80.65%,阳性预测值分别为91.43%和85.00%,阴性预测值分别为63.64%和64.10%;两者联合诊断的敏感度为95.83%（46/48）,分别与其中一种诊断方法比较,差异有统计学意义(P<0.05)。结论 CDUS对DCIS病灶内部结构及周边导管结构紊乱检出优于钼靶,而钼靶能够较敏感地显示DCIS病灶内的微小钙化。两者联合可提高诊断DCIS的准确率。     

Contemporary Comparison of Clinicopathologic Characteristics and Survival Outcomes of Prostate Ductal Carcinoma and Acinar Adenocarcinoma: A Population-Based Study

PurposeTo investigate clinicopathologic characteristics and cancer-specific mortality (CSM) rates of ductal carcinoma (DC) versus the common acinar adenocarcinoma in nonmetastatic and metastatic (M1) prostate cancer patients.Patients and MethodsWithin the Surveillance, Epidemiology, and End Results database (2004-2015), we identified patients with histologically confirmed prostate adenocarcinoma who harbored either DC (n = 581) or acinar adenocarcinoma (n = 489,296). Kaplan-Meier and 4:1 propensity score–matched multivariable Cox regression models adjusted for clinical and pathologic parameters were used to test for CSM differences. Three separate analyses were performed on all patients with nonmetastatic disease, patients with nonmetastatic patients treated with radical prostatectomy only, and patients with metastatic disease.ResultsDC was identified in 502 (0.10%) of 469,946 patients with nonmetastatic disease and 79 (0.39%) of 19,931 patients with metastatic disease. In patients with nonmetastatic disease, 253 (50.4%) DC patients underwent radical prostatectomy, 61 (12.2%) DC patients received external-beam radiotherapy, and 188 (37.4%) received other treatment modalities. In multivariable analyses, DC was associated with higher CSM in the overall nonmetastatic patient population (hazard ratio [HR] = 1.8; 95% confidence interval [CI], 1.3-2.6; P = .001), in the nonmetastatic radical prostatectomy population (HR = 2.8; 95% CI, 1.3-6.0; P < .01), and in the M1 population (HR = 1.6; 95% CI, 1.1-2.2; P < .01).ConclusionProstate cancers of ductal origin represent a rare entity among patients with nonmetastatic disease as well as among patients with metastatic disease, and regardless of stage, DC behaves more aggressively.     

mTOR和4EBPS在乳腺浸润性导管癌中的表达及意义

[目的]探讨mTOR和4EBPS在乳腺浸润性导管癌中的表达及意义。[方法]采用免疫组化SP法检测45例乳腺癌及癌旁正常组织中mTOR和4EBPS的表达。[结果]mTOR在乳腺癌中的阳性率为75.56%（34/45）,在正常乳腺组织中的阳性率为20.00%（9/45）,差异有显著性（P〈0.05）。mTOR表达与乳腺癌淋巴结转移明显相关（P〈0.05）。4EBPS在乳腺癌中的阳性率为31.11%（14/45）,在正常乳腺组织中的阳性率为95.56%（43/45）,差异有显著性（P〈0.05）。4EBPS表达与乳腺癌淋巴结转移无关（P〉0.05）。mTOR与4EBPS表达呈负相关（r=-0.614,P〈0.05）。[结论]mTOR和4EBPS在乳腺癌组织中的异常表达可能与乳腺癌的发生有关,且mTOR的异常表达可能与乳腺癌的转移有关。     

乳腺浸润性导管癌伴神经内分泌分化预后因素的分析

目的通过分析C—erbB-2、ER、PR在乳腺浸润性导管癌伴神经内分泌分化（NED）中的表达,探讨乳腺浸润性导管癌伴NED患者的预后。方法选取根据CgA和Syn免疫组织化学染色结果确诊的乳腺浸润性导管癌伴NED的病例35例（NED阳性组）和乳腺浸润性导管癌病例100例（NED阴性组）,分析比较2组C—erbB-2、ER、PR的表达及淋巴结转移情况。结果c—erbB-2、ER、PR的阳性表达率：NED阳性组分别为62．86％（22／35）、88．57％（31／35）、82．86％（29／35）;NED阴性组分别为92．00％（92／100）、71．00％（71／100）、65．00％（65／100）,2组C—erbB-2、ER、PR的阳性表达率比较差异均有统计学意义（P均〈0．05）。淋巴结转移：NED阳性组和NED阴性组分别为16例（45．71％）和40例（40．00％）,差异无统计学意义（P〉0．05）。结论乳腺浸润性导管癌伴NED与乳腺浸润性导管癌不伴NED相比,恶性程度低,预后较好。