Paget’s disease of the breast: the experience of the European institute of oncology and review of the literature

Background Paget’s disease of the breast is an uncommon presentation of breast malignancy, accounting for 1–3% of all the breast tumors and presents in different histopathologic patterns: in association with an underlying invasive or non invasive carcinoma, or without any underlying neoplasia. In the literature, different methods are used for the treatment. Mastectomy with or without axillary dissection has been considered as the standard treatment procedure for many years. Several studies have already shown that breast conservation with radiation therapy is an oncologically safe option. Regarding the axillary approach, several studies have documented the presence of positive sentinel lymph node even in Paget’s disease alone. The objective of this study was to retrospectively analyze outcome of patients affected by Paget’s breast disease and to define our institutional experience. Patients and methods Between May 1996 and February 2003, 114 patients with confirmed Paget’s disease of the breast were retrieved and underwent surgery at the European Institute of Oncology of Milan, Italy. The median age of the patients was 54 years at the time of the diagnosis. In our study, the histopathological examination of the operated specimen revealed one hundred seven patients with Paget’s disease associated with an underlying invasive or non invasive carcinoma, and seven patients without underlying carcinoma. Patients underwent either conservative breast surgery or mastectomy, with or without sentinel lymph node biopsy and/or axillary surgery. Each patient was evaluated after surgery at a multidisciplinary meeting to selecting systemic therapy. Results Seven patients had “pure” Paget’s disease of the breast and one hundred seven had the disease associated with an underlying carcinoma. As surgical techniques 71 mastectomies and 43 breast conserving surgeries have been performed. Complete axillary dissection was done in patients with clinically positive lymph node and/or sentinel lymph node biopsy positive. Sentinel lymph node biopsy was performed in nineteen patients with invasive component and five were positive and underwent axillary dissection. Eleven sentinel lymph node biopsies were done in patients with non invasive component and none of them was positive. Adjuvant systemic therapies were based on the final tumor, node and metastasis stage: thirty patients received adjuvant chemotherapy alone, fourteen received endocrine treatment alone, twenty-six patients were evaluated to receive both chemo and endocrine therapy. The median duration of follow up was 73 months and was updated in the last 6 months. Five patients developed local recurrence, one had regional recurrence, another two had loco-regional recurrences and fourteen had distant metastasis as a first event. Malignancy-related deaths were censored in the statistical analyses cancer for and due to another tumor in eleven patients. Additionally, deaths were not related to malignancy totally in thirteen patients. Conclusions Screening examination and imaging techniques are fundamental. Breast conserving surgery combined with breast irradiation for patients with invasive and non invasive breast carcinoma has become the treatment of first choice. All surgical conservative approaches should include the complete nipple–areolar complex and margins of resected specimen free of tumor. Thanks to the evolution of the conservative approach, good cosmetic result can be obtained. To be informed about the axillary lymph node status and to avoid the patient to have a second surgical approach, sentinel lymph node biopsy should be performed.     

Analysis of 6 cases of stromal sarcoma of the breast

OBJECTIVE To investigate the clinical and pathological characteristics, diagnosis and treatment of stromal sarcoma of the breast （SSB）. Methods： The clinical and pathological data of 6 patients with SSB treated between 1954 and 2007 were retrospectively analyzed.
METHODS The clinical and pathological data of 6 patients with SSB treated between 1954 and 2007 were retrospectively analyzed.
RESULTS All patients were female and one was menopausal. The median age of the patients was 39 years old （range, 20-55）. All cases had a history of a palpable mass. The tumor rapidly augmented in a short time period in 3 patients. One patient had discontinuous pain and 3 patients had masses located in the upper outer quadrant of the breast. The median tumor radius was 6.0 cm （range, 3-15 cm）. According to the AJCC breast cancer staging standard （6th edition）, 1 case was of stage ⅡA, 2 cases were of stage ⅡB, 2 cases were of stage ⅢB and one case couldn＇t be staged. Four patients were initially treated by excising the tumor and then undergoing mastectomy or modified radical mastectomy after recurrence. Radical mastectomy was suitable for those with pectoralis major muscle involvement. Two patients received simple mastectom）~ 2 patients underwent radical mastectomy and another 2 patients received modified radical mastectomy. After surgery, all patients were identified as SSB through pathology, with focal ossification in one case and mucinous degeneration in another one case. Four patients who underwent axillary lymph node dissection did not have lymph node metastases. Three patients received chemotherapy after surgery. After a median follow-up time of 36.5 months （8-204 months）, 4 patients had recurrence after local excision and 3 patients had recurrence more than 2 times with a median time to recurrence of 2.5 months （1 to 4 months） after surgery. One patient had lung metastases at 7 months after the initial surgery and the other 5 patients were alive without disease at the end of the follow-up period.
CONCLUSION SSB is difficult to diagnose preoperatively and is characterized by its tendency to .recur locally. To obtain negative margins, wide local excision or mastectomy must be performed. Axillary lymph node dissection is not mandatory. The roles of adjuvant chemotherapy and radiotherapy have still been controversial.     

Microinvasive ductal carcinoma of the breast treated with breast-conserving surgery and definitive irradiation.

An analysis was performed of 39 consecutive women with microinvasive ductal carcinoma of the breast treated with breast-conserving surgery and definitive irradiation during the period 1977 to 1988. Microinvasive ductal carcinoma was defined as predominantly intraductal carcinoma with microscopic or early invasion. Surgical treatment of the primary tumor included excisional biopsy or wide resection. Axillary lymph node staging showed that 37 patients were pathologically node negative and two patients were pathologically node positive, each with only one positive lymph node. The median follow-up was 55 months (mean = 65 months; range = 25-135 months). The 5-year actuarial rate of overall and cause-specific survival were both 97%. The 5-year actuarial rate of freedom from distant metastases was 93%. Nine patients developed a recurrence in the breast; eight of the nine patients had isolated local only first failures, and one of the nine patients had a local recurrence simultaneously with distant metastases. The median time to local failure was 42 months (mean = 53 months; range = 20-116 months). Of the eight patients with local only first failure, seven patients have been salvaged with further treatment and remain free of disease at the time of last follow-up, and one patient has died of subsequent distant metastatic disease. Median follow-up after salvage treatment was 29 months (mean = 27 months; range = 0-54 months). Comparison of the patients with microinvasive ductal carcinoma with two control groups of intraductal carcinoma and invasive ductal carcinoma was performed. Although the rate of local failure was significantly higher for patients with microinvasive ductal carcinoma as compared to the two control groups, the rates of survival and freedom from distant metastases for patients with microinvasive ductal carcinoma were intermediate to the two control groups. Because of the high rates of survival and freedom from distant metastases and because of the ability to salvage patients with local recurrence, breast-conserving surgery and definitive irradiation should continue to be considered as an alternative to mastectomy for appropriately selected and staged patients with microinvasive ductal carcinoma of the breast.     

125例乳腺浸润性小叶癌的临床特征及预后分析

 目的　分析乳腺浸润性小叶癌的临床特征及预后情况。方法　回顾性分析1990年1月至2008年12月中山大学肿瘤防治中心收治的125例乳腺浸润性小叶癌患者的临床资料,总结其临床特征、复发及生存情况。结果　125例浸润性小叶癌患者的中位年龄45岁（27～76岁）,诊断时肿块超过3 cm者占61.6 %（77／125）,51.2 %（64／125）患者区域淋巴结阳性,80.8 %（101／125）患者为Ⅱ期以上,89.6 %（112／125）患者的激素受体阳性。中位随访58个月（11～222个月）,此时有32例出现复发及转移,18例死亡。生存分析显示,浸润性小叶癌患者的5年无病生存率和总生存率分别为82.2 %和87.3 %。多因素分析显示,是否进行内分泌治疗是影响浸润性小叶癌的唯一预后因素。结论　乳腺浸润性小叶癌患者在发病中位年龄上与其他病理类型乳腺癌无明显差异,诊断时呈现肿瘤较大和淋巴结侵犯较多是该病的一个特点,激素受体阳性率高是该病的另一个特点。临床病理特征的差异没有显著影响患者预后。     

Merkel cell carcinoma

Opinion statement Merkel cell carcinoma is a rare cutaneous neoplasm most commonly affecting the head and neck of elderly white patients. Even with treatment, Merkel cell carcinoma has a strong propensity toward local recurrence, lymphatic spread, and distant metastasis. Because of its rarity and the subsequent lack of well-controlled clinical trials, no single standard of care exists for the treatment of this aggressive tumor. In our institution, primary lesions are excised with wide margins or by Mohs’ micrographic surgery. After local removal, the excision site is treated locally with external radiation therapy. Sentinel lymph node mapping and biopsy are performed. Patients with tumor within a sentinel lymph node undergo lymph node dissection and radiation to the lymphatic basin. Adjuvant chemotherapy is offered to high-risk patients with local disease and to patients with metastases. Patients with distant metastases are treated with a combination of salvage chemotherapy and radiation therapy.     

53例早期乳腺癌保乳治疗临床分析

目的探讨早期乳腺癌保乳治疗的手术处理方法及近期疗效。方法 2005年6月至2009年10月共收治女性乳腺癌患者276例,对其中Ⅰ~Ⅱ期原发乳腺癌施行保乳手术治疗,手术方式采用乳腺局部肿物扩大切除加同侧腋窝淋巴结清扫术或同侧前哨腋窝淋巴结活检术,术中对肿物进行切缘冰冻快速病理检查,术后患侧乳房接受放射治疗。结果 53例患者成功实施了保乳手术,手术后随访6个月,对保留乳房治疗的满意率达99%,十分满意占90%,与腋窝前哨淋巴结活检术结合进一步降低了患侧上肢淋巴水肿等并发症的发生,提高了患者的生活质量。经随访2~52个月,中位随访17个月,无乳腺局部复发病例,无远处转移及死亡病例。结论Ⅰ~Ⅱ期乳腺癌保乳治疗近期疗效满意,相关手术的处理方法可行,远期疗效有待长期随访观察。     

Conservative surgery in patients with multifocal/multicentric breast cancer

Purpose Many physicians recommend mastectomy in case of multifocal (MF) or multicentric (MC) breast cancer due to a theoretical risk of poor local control with less extensive surgery. We retrospectively evaluate outcome of patients with MF/MC cancers who had breast conservation with specific attention on local control and predictive factors of recurrence. Patients and methods Four hundred and seventy six patients with either MF (n = 421) or MC (n = 55) breast cancer, underwent breast-conserving surgery between 1997 and 2002 in a single institution. Median follow up was 73 months (range 11–118). Results Median age was 53 years (range 23–86). Invasive lobular carcinoma was found in 88 patients (18.5%) and mixed ductal-lobular cancer in 27 (5.7%) patients. Two hundred and sixty-seven patients (76.7%) had two identified tumor foci, 55 patients (15.3%) had three and 29 patients (8.0%) had four or more. Two hundred and sixty-one patients (55.3%) had nodal involvement. The 5-year cumulative incidence of local relapse was 5.1%. At the multivariate analysis, over-expression of HER2/neu and lack of both estrogen and progesterone receptors (HR: 3.2, 95% C.I. 1.01–10.0, and HR: 2.7, 95% C.I. 1.06–7.7, respectively) were associated with a higher ipsilateral breast cancer reappearance rate. Involvement of four or more lymph nodes and lack of estrogen and progesterone receptors (HR: 2.7, 95% C.I. 1.06–6.7, and HR: 4.7, 95% C.I. 2.1–10.4, respectively) were associated with poorer overall survival. Conclusions In selected patients with MF/MC breast cancer, wide conservative surgery is not associated with poor local disease control and can be considered whenever acceptable cosmetic results can be achieved.     

Prognostic value of biologic subtype and the 21-gene recurrence score relative to local recurrence after breast conservation treatment with radiation for early stage breast carcinoma: results from the Eastern Cooperative Oncology Group E2197 study

The present study was performed to evaluate the significance of biologic subtype and 21-gene recurrence score relative to local recurrence and local-regional recurrence after breast conservation treatment with radiation. Eastern Cooperative Oncology Group E2197 was a prospective randomized clinical trial that compared two adjuvant systemic chemotherapy regimens for patients with operable breast carcinoma with 1-3 positive lymph nodes or negative lymph nodes with tumor size >1.0 cm. The study population was a subset of 388 patients with known 21-gene recurrence score and treated with breast conservation surgery, systemic chemotherapy, and definitive radiation treatment. Median follow-up was 9.7 years (range = 3.7-11.6 years). The 10-year rates of local recurrence and local-regional recurrence were 5.4 % and 6.6 %, respectively. Neither biologic subtype nor 21-gene Recurrence Score was associated with local recurrence or local-regional recurrence on univariate or multivariate analyses (all P ≥ 0.12). The 10-year rates of local recurrence were 4.9 % for hormone receptor positive, HER2-negative tumors, 6.0 % for triple negative tumors, and 6.4 % for HER2-positive tumors (P = 0.76), and the 10-year rates of local-regional recurrence were 6.3, 6.9, and 7.2 %, respectively (P = 0.79). For hormone receptor-positive tumors, the 10-year rates of local recurrence were 3.2, 2.9, and 10.1 % for low, intermediate, and high 21-gene recurrence score, respectively (P = 0.17), and the 10-year rates of local-regional recurrence were 3.8, 5.1, and 12.0 %, respectively (P = 0.12). For hormone receptor-positive tumors, the 21-gene recurrence score evaluated as a continuous variable was significant for local-regional recurrence (hazard ratio 2.66; P = 0.03). The 10-year rates of local recurrence and local-regional recurrence were reasonably low in all subsets of patients. Neither biologic subtype nor 21-gene recurrence score should preclude breast conservation treatment with radiation.     

乳腺纯上皮化生性癌9例观察及文献复习

背景与目的:乳腺化生性癌十分少见。对此,本文旨在探讨乳腺纯上皮化生性癌的病理和临床特征以及治疗。方法:回顾性分析1997-2007年9例在我院治疗的女性乳腺纯上皮化生性癌病例。结果:患者中位年龄50岁(37～78岁),9例均行根治术或改良根治术,病理诊断为梭形细胞化生性癌6例,鳞癌3例。雌激素受体(ER)和/或孕激素受体(PR)阳性者2例。2例淋巴结转移。中位随访时间为25(3～112)个月,术后局部复发1例,远处转移3例,肺转移2例,2例患者死亡,1例带瘤生存。结论:本病以梭形细胞化生性癌多见,可同时表达上皮和间叶组织抗原,但较少表达ER和PR。患者多以无痛性肿块就诊,肿块局切复发率高。腋窝淋巴结转移少见,肺转移多见。手术治疗宜选择单纯乳房切除加前哨淋巴结活检。     

The value of intraoperative frozen section examination of sentinel lymph nodes in breast cancer

Background

Sentinel node biopsy is a standard diagnostic component for the treatment of patients with a primary mammary carcinoma. By concomitantly performing intraoperative lymph node biopsy and primary tumor resection, patients with a positive sentinel node (SN) are not subjected to the inconvenience and risks of second surgical intervention. The aim of this retrospective study was to determine the sensitivity, accuracy and long-term consequences of the frozen section (FS) examination of the SN in breast cancer patients.

Methods

Sentinel lymph node biopsy was performed in 615 patients with an invasive tumor of the breast. Frozen sections of the SN were taken from the optimal cross-sectional surface. Serial sections were made from the remaining SN and stained using hematoxylin–eosin and immunohistochemistry.

Results

Sentinel node frozen biopsy accurately predicted the state of the axilla in 559 (90.7%) patients. There were 50 false-negative findings in patients with sentinel node metastases. The sensitivity and specificity of the intraoperative frozen section examination were 71.6% and 100%, respectively. Follow-up (mean 36.3 months) of all false-negative cases showed no development of local axillary recurrence. The results demonstrated no significant relation between tumor size and frozen section sensitivity. Frozen section investigation was less sensitive in ascertaining micrometastases (sensitivity 61.1%) than macrometastases (sensitivity 84.0%, p < 0.001).

Conclusion

Intraoperative frozen section examination of the sentinel node is a useful predictor of axillary lymph node status in breast cancer patients. Seventy-two percent of the patients with metastatic disease were correctly diagnosed and spared a second surgical procedure.     

乳腺癌骨转移相关的临床病理因素的研究

目的：研究与乳腺癌骨转移有关的临床、病理因素，探讨有助于预测乳腺癌骨转移的危险因素。方法：对本院1981年1月～2000年12月手术的3796例乳腺癌患者的随访资料进行回顾分析，根据首发转移部位分组，研究116例骨转移的临床、病理资料，并与内脏转移、淋巴结或软组织转移患者的情况作比较。结果：本组病例首次复发为骨转移者116例，占3．1％；骨转移与患者年龄轻、肿块直径大、临床体检腋淋巴结肿大、腋淋巴结转移数多、病期为Ⅱ／Ⅲ期、组织学类型为非特殊型浸润性癌相关；多因素逐步回归分析术前资料显示，肿块大小、体检腋淋巴结状况与骨转移相关；术后资料中，肿块大小、腋淋巴结转移数、病理类型与骨转移相关。本组骨转移患者均曾接受正规的局部治疗和辅助化疗；首次复发在局部、淋巴结、软组织或局部复发伴远处转移组中，特殊型浸润性癌所占比例明显高于骨转移的患者；骨转移和内脏转移的时间分布无差别，而局部复发和／或淋巴结、软组织转移组，复发时间较骨转移组早。结论：年轻的、肿块分级为T2／T3，临床体检腋淋巴结肿大者，术前有必要进行同位素骨扫描检查；非特殊型浸润性乳腺癌，肿块分级为T2／T3，腋淋巴结转移数≥4枚，为骨转移的高危因素，可在此类病例中开展双磷酸盐的辅助治疗研究。     

Primary non-Hodgkin’s lymphoma of the breast treated nonsurgically: report of three cases

Extranodal non-Hodgkin’s lymphoma (NHL) is a rare breast disease. Here we report three cases of primary NHL of the breast. The first patient was a 29-year-old woman with a firm mass in her right breast with ipsilateral axillary lymphadenopathy. An excisional biopsy revealed NHLs. Clinical stage was IIAE. The tumor and enlarged lymph nodes had successfully been treated following the combination therapy. The second patient was a 70-year-old women with an elastic hard mass in her left breast. An excisional biopsy revealed NHLs and clinical stage was 1AE. The tumor disappeared following the combination therapy. The third patient was a 67-year-old women with a hard mass in her left breast. Core needle biopsy revealed NHLs and clinical stage was 1AE. The tumor disappeared following chemotherapy. All patients are alive with no evidence of recurrence 4–8 years after the initial treatment. Although a standard treatment has yet to be established, an initial treatment with combination therapy without surgical intervention including axillary dissection appears to be appropriate for this rare disease.     

Multimodality management for 145 cases of Merkel cell carcinoma

The results of the multimodality management of 145 cases of cutaneous Merkel cell carcinoma (MCC) are reported herein. Patient information was obtained from medical records of four Canadian institutions and one French institution. These data included ages, pathological stages, disease sites, histological and treatment details. Cause-specific survival (CSS), overall survival (OS) and disease-free survival (DFS) rates were analyzed by the log-rank and Kaplan-Meier methods. From 1988 to 2007, 145 cases were analyzed. There were 74 men and 71 women. Median age was 78 years (range 47–95.2). Median follow-up was 21.5 months (range 0.5–169.1). During the follow-up period, 37 local, 37 regional nodal and 15 distant recurrences were determined to be either solitary or multifocal sites of treatment failure. Relapsing patients were treated with multimodal treatments provided that their general state of health did not preclude this approach. Either initially and/or at relapse, 30 patients were treated with either multiagent (mostly etoposide with cisplatin or carboplatin) or single-agent chemotherapy, including irinotecan, taxotere and topotecan. In conclusion, recurrence should be treated with multimodalities. Our experience of long-term survivors after treatment of recurrence is encouraging.     

Ductal carcinoma in situ of the breast

Ductal carcinoma in situ (DCIS) of the breast is a noninvasive form of breast cancer that has increased in incidence over the past several decades secondary to screening mammography. DCIS now represents 20–30% of all newly diagnosed cases of breast cancer. Patients with DCIS typically present with an abnormal mammogram, and diagnosis is most commonly obtained with an image-guided biopsy. Historically, mastectomy was considered the primary curative option for patients with DCIS. However, treatment of DCIS continues to evolve, and now treatment strategies also include breast-conserving therapy, which consists of local excision followed by radiation therapy or local excision alone. Multiple randomized trials have confirmed a decrease in ipsilateral breast tumor recurrence in patients treated with local excision followed by radiation therapy compared with local excision alone. Ongoing clinical trials attempt to identify a subgroup of DCIS patients at low risk for recurrence who may not benefit from radiation therapy. In addition, because the majority of ipsilateral breast tumor recurrences occur near the original primary tumor site, partial breast irradiation is currently under investigation as a treatment option for DCIS patients. Randomized trials have shown tamoxifen can reduce the risk of ipsilateral and contralateral breast tumor recurrences while the role of aromatase inhibitors is the subject of current clinical trials. DCIS represents a complex pathologic entity, and treatment optimization requires a multidisciplinary approach.     

Optimal management of ductal carcinoma in situ of the breast

Ductal carcinoma in situ (DCIS) represents a breast lesion that is diagnosed with increasing frequency, mainly due to the wide use of screening mammography. Today, DCIS comprises 15–25% of all breast cancers detected at population screening programs. Consequently, the concepts of properly managing such patients assume a greater importance in everyday practice. Mammographically detected microcalcifications are the most common presentation of DCIS. Despite recent technological advances (including Stereotactic-guided directional vacuum-assisted biopsy), mammographically guided wire biopsy remains the “gold-standard” for obtaining a histological diagnosis in patients with non-palpable, mammographically detected DCIS. Management options include mastectomy, local excision combined with radiation therapy, and local excision alone. Given that DCIS is a heterogeneous group of lesions rather than a single entity, and because patients have a wide variety of personal needs that must be addressed during treatment selection, it is obvious that no single approach will be appropriate for all forms of DCIS or for all patients. Careful patient selection is of key importance in order to achieve the best results in the management of the individual patient with DCIS. Axillary lymph node dissection is unnecessary in the treatment of pure DCIS, but it is indicated when microinvasion is present. In these cases, sentinel lymph node biopsy may be an excellent alternative. In the NSABP B-24 trial, tamoxifen reduced both the invasive and non-invasive breast cancer events in either breast by 37%. Nearly all patients who develop a non-invasive recurrence following breast-sparing surgery are cured with mastectomy, and approximately 75% of those with an invasive recurrence are salvaged. Selected patients initially treated by lumpectomy alone may also undergo breast-conservation therapy at the time of relapse according to the same strict guidelines of tumor margin clearance required for the primary lesion; radiation therapy should be given following local excision. The use of systemic therapy in patients with invasive recurrence should be based on standard criteria for invasive breast cancer.     

Primary axillary radiotherapy as axillary treatment in breast-conserving therapy for patients with breast carcinoma and clinically negative axillary lymph nodes

BACKGROUND: The objective of the current study was to evaluate the effectiveness and morbidity of primary axillary radiotherapy in breast-conserving therapy for postmenopausal, clinically axillary lymph node negative patients with early stage breast carcinoma. METHODS: Between 1983-1997, 105 patients with clinically negative axillary lymph nodes and breast carcinoma were treated with wide local excision followed by radiotherapy to the breast, and axillary and supraclavicular lymph node areas. Adjuvant treatment with tamoxifen was given to 75 patients. The median follow-up of patients still alive was 41 months (range, 8-137 months). Fifty-five patients with no evidence of disease at last follow-up were examined prospectively with respect to late functional damage. RESULTS: The mean age of the patients was 64 years. Three patients developed a local recurrence. No isolated axillary lymph node recurrence was observed. In two patients, axillary recurrence was accompanied by distant metastases. The 5-year disease free interval and the overall survival were 82% (standard error [SE], 6%) and 83% (SE, 6%), respectively. In five patients, arm edema was reported and impaired shoulder function was reported in seven patients. Prospectively scored, arm edema was reported subjectively by the patient in 4% and objectively measured in 11% of cases. Impaired shoulder function was reported subjectively in 35% and objectively measured in 17% of cases. No brachial plexus neuropathy was noted. CONCLUSIONS: Primary axillary radiotherapy for postmenopausal women with clinically lymph node negative, early stage breast carcinoma was found to result in low axillary lymph node recurrence rates with only limited late complications. Therefore, primary axillary radiotherapy should be considered as axillary treatment in selected patients as an alternative to axillary lymph node dissection.     

Axillary recurrence after negative sentinel lymph node biopsy

Background Sentinel lymph node biopsy (SLNB) has almost totally replaced axillary lymph node dissection as the first-line axillary procedure for node-negative breast cancer. SLNB has a false-negative rate of 0–22%, and regional nodal recurrence is a major concern after SLNB. In this study, we assessed axillary recurrence and risk factors in breast cancer patients 40 months after negative SLNB. Methods Of 940 patients with node-negative breast cancer who underwent SLNB between December 2003 and January 2006 at Asan Medical Center, 720 were negative on SLNB, as determined using 99-m TC radiocolloid and subareolar injection technique. Of the 720 patients negative on SLNB, 174 underwent further axillary dissection, 253 underwent node sampling, and 293 received SLNB only. Results A mean of 2.1 SLNs was removed per patient. At a median follow-up of 40 months (range 24–49 months), recurrence in the axilla was observed in three patients, all of whom had undergone SLNB only; two of these patients also had recurrences in internal mammary lymph nodes. Tumors in all three patients were hormone-receptor negative, and two were c-erbb2 negative. Conclusion The axillary recurrence rate was low in patients negative on SLNB. Negative hormone-receptor status and high nuclear grade may be risk factors for regional nodal failure after SLNB.     

68例乳腺小管癌回顾性分析

目的研究乳腺小管癌生物学特点、腋窝淋巴结转移与相关指标的关系及治疗方式的选择进行回顾性分析。研究乳腺小管癌生物学特点、腋窝淋巴结转移与相关指标的关系,对上述因素影响治疗方式的选择进行回顾性分析。方法收集1987年6月到2014年3月来哈尔滨医科大学附属第一医院诊治的乳腺小管癌病人,进行病理蜡块的重新核对,并进行电话随访,了解小管癌病人的预后情况。结果68例乳腺小管癌病人中,腋窝淋巴结转移与肿瘤直径大小、组织学分级密切相关。所有病人中,仅一例病人复发,24例病人死于其他疾病,无远处转移或死于乳腺癌病人。结论小管癌预后良好,复发率低。同时,目前乳腺小管癌的治疗方式的选择不够合理,术前肿物空心针穿刺比例不够,外科腋窝分期没有给予充分重视,保乳率仍有提高的空间。     

A case of ectopic breast cancer with a literature review

A 63-year-old woman was referred to our hospital because of a right axillary nodule in 2004. Physical examination showed a spherical nodule measuring 0.5 cm in diameter in the right axilla. No mass was palpable in either breast. Mammograms were normal. Ultrasonography revealed a subcutaneous hypoechoic mass 0.7 mm in maximum diameter in the right axilla. The patient underwent an excisional biopsy. Histological examination revealed an invasive ductal carcinoma (scirrhous carcinoma) in ectopic breast tissue. The patient subsequently underwent a wide local excision of the tissue surrounding the biopsy scar, with axillary lymph node dissection. Histologically, no residual tumor or nodal metastasis was found. Postoperatively, she received endocrine therapy and remains well, without any evidence of recurrence 4 years 10 months after operation. Cancer of the ectopic breast tissue is rare, and most cases present as a solitary axillary mass. Long-term outcomes remain unclear. We present a case of breast carcinoma in the axillary ectopic mammary gland and summarize the clinical features of 94 cases, including ours, in Japan. We also compare long-term survival between ectopic breast cancer and usual breast cancer according to TNM T stage and lymph node metastasis.     

巴氏腺腺样囊性癌临床病理分析

目的 探讨巴氏腺腺样囊性癌的临床病理特征和治疗方法.方法 回顾性分析6例巴氏腺腺样囊性癌患者的临床及病理资料.6例患者的中位年龄为40.5岁(30～54岁).主要治疗方式为手术切除,其中单纯外阴肿物剥除术1例,外阴根治性切除术加双侧腹股沟淋巴结清扫或活检术4例,外阴局部扩大切除术加双侧腹股沟淋巴结活检术1例.有2例患者术后补充放疗.6例患者均随访至2009年4月1日,中位随访时间124.5个月(8～241个月).结果 6例巴氏腺腺样囊性癌均经病理确诊,肿瘤细胞呈筛状排列及侵犯神经是其典型的病理特点.术后病理显示,切缘阳性2例,阴性1例,邻近肿瘤1例,不详2例.腹股沟淋巴结阴性5例,不详1例.有4例患者复发,其中3例局部复发,后出现肺转移;1例仅出现肺转移.在复发患者中,死亡1例,生存时间为135个月;另3例患者分别带瘤生存120、30和36个月,总生存时间分别为241、128和103个月.2例无复发患者无瘤生存8个月和121个月.结论 巴氏腺腺样囊性癌生长缓慢,患者长期预后较好,但容易局部复发和肺转移.首选治疗方法为手术切除,对于术后切缘阳性、局部浸润较深或侵犯神经者以及复发无法手术者可行辅助放疗或姑息性放疗.