乳腺癌术后常见并发症的临床分析

目的探讨乳腺癌术后常见并发症的原因、预防和处理方法。方法对82例乳腺癌患者的临床资料进行回顾性分析。结果皮下积液35例（42.68%）,皮瓣坏死32例（39.02%）,患侧上肢不同程度淋巴水肿及功能障碍28例（34.15%）,切口愈合困难27例（32.93%）,局部复发9例（10.98%）。经治疗73例痊愈,9例局部复发予以放疗化疗延长生存时间。结论乳腺癌术后皮下积液、皮瓣坏死、患侧上肢淋巴水肿及功能障碍、切口愈合困难、局部复发等并发症发生率较高。术前、术中及术后及时正确的处理能有效防治并发症。     

718例浸润性乳腺癌分子分型中CK5/6和EGFR的表达及临床病理分析

目的 探讨CK5/6和EGFR在浸润性乳腺癌(invasive breast carcinoma,IBC)分子分型中的表达及相关性.方法 采用免疫组化法检测718例IBC中CK5/6、EGFR、ER、PR、HER-2及Ki-67蛋白的表达,分析CK5/6、EGFR与IBC组织学类型、分子分型及其他相关标志物之间的关系....     

Primary breast lymphoma – a review of the literature and report of three cases

Primary breast lymphoma (PBL) is a rare disease accounting for 0.4-0.5% of all breast malignancies. Diffuse large B-cell lymphoma (DLBCL) is the most common histological diagnosis. The clinical presentation of PBLs is usually no different from that of carcinoma. In this paper we review the literature on the clinical presentation, diagnosis, prognostic factors and treatment options of PBL. In the light of the information gained we discuss three patients with primary breast lymphoma (one with a central nervous system relapse) who were treated in our department in the years 2002-2007. In conclusion: there is no consensus on the question of how to best treat PBL: chemotherapy, radiotherapy or combined therapy. However, the last approach to be the most successful one. Due to high incidence of central nervous system (CNS) involvement in PBL patients, many authors strongly believe that patients with aggressive forms of PBL should receive CNS infiltration prophylaxis, even in the early stages, as this may improve the outcome and significantly reduce the risk of a CNS disease relapse.     

Genetic polymorphisms in AURKA and BRCA1 are associated with breast cancer susceptibility in a Chinese Han population

Centrosome defects can result in aneuploidy and genomic instability, and have important implications for breast cancer development. The Aurora-A and BRCA1 proteins interact and both are strongly involved in centrosome regulation. Genetic variants in these two genes may have an effect on breast cancer development. Here, we report a comprehensive single nucleotide polymorphism (SNP) and haplotype-tagging association study on these two genes in 1334 breast cancer cases and 1568 unaffected controls among the Chinese Han population. Apart from a missense SNP, rs2273535 (Phe31Ile), and a probable risk SNP, rs2064863, six htSNPs were analysed in three high-LD blocks of AURKA spanning from 10 kb upstream to 2 kb downstream of AURKA. For BRCA1, six htSNPs were analysed in a large high-LD region covering 98 kb (10 kb was extended to each end of BRCA1). The results showed that four SNPs in AURKA (data in recessive model, rs2273535: OR = 2.19, 95% CI = 1.03-4.66, p = 0.0422; rs2298016: OR = 0.38, 95% CI = 0.18-0.82, p = 0.0141; rs6024836: OR = 1.54, 95% CI = 1.18-2.00, p = 0.0014; rs10485805: OR = 0.68, 95% CI = 0.47-0.98, p = 0.0380) and one SNP in BRCA1 (rs3737559, dominant model OR = 1.35, 95% CI = 1.11-1.64, p = 0.0030) were associated with breast cancer susceptibility. After correction for multiple comparisons (FDR = 0.05), only rs6024836 and rs3737559 remained significant. Two haplotypes (CC of block 2, OR = 20.74, 95% CI = 4.35-98.88, p = 0.0001; GG of block 3, OR = 1.32, 95% CI = 1.12-1.56, p = 0.0010) and one diplotype (AG-GG of block 3, OR = 1.63, 95% CI = 1.18-2.26, p = 0.0031) within AURKA showed strong associations with breast cancer risk. One haplotype of BRCA1 (CTGTTG, OR = 1.30, 95% CI = 1.06-1.59, p = 0.0118) was also associated with breast cancer risk. However, women harbouring both at-risk genotypes of Aurora-A and BRCA1 were at a slightly increased risk compared with those harbouring either at-risk variant alone. Common genetic variants in the AURKA and BRCA1 genes may contribute to breast cancer development.     

13C high-resolution-magic angle spinning MRS reveals differences in glucose metabolism between two breast cancer xenograft models with different gene expression patterns

Tumor cells have increased glycolytic activity, and glucose is mainly used to form lactate and alanine, even when high concentrations of oxygen are present (Warburg effect). The purpose of the present study was to investigate glucose metabolism in two xenograft models representing basal-like and luminal-like breast cancer using (13) C high-resolution-magic angle spinning (HR-MAS) MRS and gene expression analysis. Tumor tissue was collected from two groups for each model: untreated mice (n=19) and a group of mice (n=16) that received an injection of [1-(13) C]-glucose 10 or 15 min before harvesting the tissue. (13) C HR-MAS MRS was performed on the tumor samples and differences in the glucose/alanine (Glc/Ala), glucose/lactate (Glc/Lac) and alanine/lactate (Ala/Lac) ratios between the models were studied. The expression of glycolytic genes was studied using tumor tissue from the same models. In the natural abundance MR spectra, a significantly lower Glc/Ala and Glc/Lac ratio (p<0.001) was observed in the luminal-like model compared with the basal-like model. In the labeled samples, the predominant glucose metabolites were lactate and alanine. Significantly lower Glc/Ala and Glc/Lac ratios were observed in the luminal-like model (p<0.05). Most genes contributing to glycolysis were expressed at higher levels in the luminal-like model (fdr<0.001). The lower Glc/Ala and Glc/Lac ratios and higher glycolytic gene expression observed in the luminal-like model indicates that the transformation of glucose to lactate and alanine occurred faster in this model than in the basal-like model, which has a growth rate several times faster than that of the luminal-like model. The results from the present study suggest that the tumor growth rate is not necessarily a determinant of glycolytic activity.     

Topographical, morphological and immunohistochemical characteristics of carcinoma in situ of the breast involving sclerosing adenosis. Two distinct topographical patterns and histological types of carcinoma in situ

Moritani S, Ichihara S, Hasegawa M, Endo T, Oiwa M, Shiraiwa M, Nishida C, Morita T, Sato Y, Hayashi T, Kato A, Aoyama H & Yoshikawa K
(2011) Histopathology  58 , 835–846
Topographical, morphological and immunohistochemical characteristics of carcinoma in situ of the breast involving sclerosing adenosis. Two distinct topographical patterns and histological types of carcinoma in situ Aim: To examine the histopathological features of 24 surgically resected carcinoma in situ (CIS) involving sclerosing adenosis (SA), with special reference to the topographical relationship between CIS and SA. Methods and results: In 13 (54%) lesions, CIS was entirely surrounded by SA (type A) and in 11 (46%), CIS involved SA at least focally but was not confined to the SA area (type B). The mean size of CIS in type B (30.45 mm) was significantly larger than in type A (18.00 mm). The mean size of SA in type A (39.46 mm) was significantly larger than in type B (19.54 mm). Most type A CIS were non‐high‐grade, and the oestrogen receptor (ER)(+)/progesterone receptor (PgR)(+)/HER2(?) immunophenotype predominated. Most type B CIS were high‐grade and six (54%) were ER(?)/PgR(?). Most type A were bcl‐2(+)/p53(?) in both SA and CIS areas, but two (18%) apocrine ductal CIS of type B were bcl‐2(?)/p53(+) in both SA and CIS areas. Expression of ER and cyclin D1 in SA was not different from that of SA unassociated with cancer. Conclusions: Most CIS involving SA arises within SA and high‐grade DCIS tends to grow beyond SA. Occasional CIS may arise outside SA and secondarily involve SA.     

Clinical characteristics and biomarkers of breast cancer associated with choline concentration measured by 1H MRS

This study investigated the association between the total choline (tCho) concentration and the clinical characteristics and biomarker status of breast cancer. Sixty‐two patients with breast cancer, 1.5 cm or larger in size on MR images, were studied. The tCho concentration was correlated with the MRI features, contrast enhancement kinetics, clinical variables and biomarkers. Pairwise two‐tailed Spearman's nonparametric test was used for statistical analysis. The tCho concentration was higher in high‐grade than moderate‐/low‐grade tumors (p = 0.04) and in tumors with higher K_trans and k_ep (p < 0.001 for both). The association of tCho concentration with age (p = 0.05) and triple negative biomarker (p = 0.09) approached significance. tCho was not detected in 17 patients, including 15 with invasive ductal cancer and two with infiltrating lobular cancer. Fifteen of the 17 patients had moderate‐ to low‐grade cancers, and 11 had human epidermal growth factor‐2‐negative cancer, suggesting that these two factors might lead to false‐negative choline. Higher tCho concentration in high‐grade tumors and tumors with higher K_trans and k_ep indicates that choline is associated with cell proliferation and tumor angiogenesis. The higher choline level in younger women may be caused by their more aggressive tumor type. The results presented here may aid in the better interpretation of ¹H MRS for the diagnosis of breast lesions. Copyright © 2010 John Wiley & Sons, Ltd.     

乳腺癌保乳术后常规、三维适形和直接子野优化调强放疗技术剂量学评估

目的:比较乳腺癌保乳术后常规放疗(CR)、三维适形(3D-CRT)放疗、直接子野优化调强适形(DMPO-IMRT)放疗靶区剂量分布及危及器官受照体积等方面的差异。方法:随机选择10位乳腺癌患者,为每位患者设计上述三种照射技术的治疗计划。处方剂量为50 Gy/2 Gy/25次。所有计划都使95%靶区体积达到处方剂量要求。根据积分剂量体积直方图(DVH)比较靶区受量和相关正常器官受量的差异和剂量分布。结果:三种技术靶区均匀性指数(HI)和适形度指数(CI)差异均有显著性意义(P=0.049,P=0.001),其中尤以DMPO-IMRT的指标最佳。与CR相比,3DCRT降低了患侧肺、对侧乳腺和心脏在各个剂量区的受照体积,而DMPO-IMRT增大了患侧肺(V20、V30除外)、对侧乳腺和心脏的受照体积。与3DCRT相比,DMPO-IMRT增大了患侧肺(V30除外)、对侧乳腺和心脏的受照体积。结论:与CR相比,3D-CRT和DMPO-IMRT改善了靶区的均匀性和适形度。与此同时,3DCRT降低了本研究中各个剂量区危及器官的受照体积,DMPO-IMRT在降低患侧肺高剂量受照体积的同时,增大了患侧肺、对侧乳腺、心脏的低剂量受照体积。     

骨形态发生蛋白9抑制人乳腺癌MDA-MB-231细胞体外侵袭和迁移

目的 探讨骨形态发生蛋白9(BMP9)对乳腺癌MDA-MB-231细胞侵袭、迁移能力的影响.方法 RT-PCR法检测MDA-MB-231细胞系中BMP9的表达;扩增高滴度的BMP9表达腺病毒,感染MDA-MB-231细胞,制备高表达BMP9的重组MDA-MB-231/BMP9细胞,以此作为实验组;同时以含GFP的窄载腺病毒感染该细胞为MDA-MB-231/GFP,联合空白MDA-MB-231共同作为对照组;通过平板集落形成实验、细胞划痕实验、Transwell侵袭实验检测重组MDA-MB-231/BMP9细胞侵袭及迁移能力.结果 与对照组细胞相比,实验组细胞中BMP9 mRNA表达水平明显增高;实验组细胞集落形成率由对照的90.6%±2.5%与85.6%±3.5%显著下降至57.3%±4.5%(P＜0.05);实验组划痕愈合率由对照的95.4%±3.1%与92.5%±2.4%下降至74.0%±3.6%(P＜0.05);实验组穿膜细胞数由对照的(255.3±16.1)个与(267.3±14.9)个下降至(150.3±14.6)个(P＜0.05).结论 BMP9可以在体外抑制乳腺癌MDA-MB-231细胞的侵袭与迁移.