乳腺癌广泛导管内癌成分与组织蛋白酶D Ki-67及单链DNA表达的关系及临床意义

目的 探讨乳腺癌广泛导管内癌成分（extensive intraductal component，EIC）、粉刺状坏死（comedo necrosls）、组织学分级与组织蛋白酶D（eathepsin D）、Kiab7、单链DNA（ssDNA）及c-erbB-2表达的关系。方法检测日本德岛乳腺门诊与东德岛医院1996年1月至1997年4月连续手术切除的59例乳腺浸润性导管癌标本。用免疫组化方法，检测59例乳腺浸润性导管癌中组织蛋白酶D（eathepsin D）、Ki-67、单链DNA及c-erbB-2的表达。结果EIC阳性组，肿瘤上皮细胞中的组织蛋白酶D为高表达（P=0．021），肿瘤间质细胞中的组织蛋白酶D表达差异无显著性意义。粉刺状坏死的出现，与c-erbB-2癌基因、肿瘤上皮细胞中的组织蛋白酶D和细胞增殖指数相关（P分别为0．042，0．006及0．013）。结论肿瘤上皮细胞中的组织蛋白酶D可能参与了EIC与粉刺状坏死的形成。EIC与粉刺状坏死的检测有临床应用价值。     

Cytochrome c1 in ductal carcinoma in situ of breast associated with proliferation and comedo necrosis

It is well known that comedo necrosis is closely associated with an aggressive phenotype of ductal carcinoma in situ (DCIS) of human breast, but its molecular mechanisms remain largely unclear. Therefore, in this study, we first examined the gene expression profile of comedo DCIS based on microarray data and identified CYC1 as a gene associated with comedo necrosis. Cytochrome c1 (CYC1) is a subunit of complex III in the mitochondrial oxidative phosphorylation that is involved in energy production. However, the significance of CYC1 has not yet been examined in DCIS. We therefore immunolocalized CYC1 in 47 DCIS cases. CYC1 immunoreactivity was detected in 40% of DCIS cases, and the immunohistochemical CYC1 status was significantly associated with tumor size, nuclear grade, comedo necrosis, van Nuys classification, and Ki‐67 labeling index. Subsequent in vitro studies indicated that CYC1 was significantly associated with mitochondrial membrane potential in MCF10DCIS.com DCIS cells. Moreover, CYC1 significantly promoted proliferation activity of MCF10DCIS.com cells and the cells transfected with CYC1 siRNA decreased pro‐apoptotic caspase 3 activity under hypoxic or anoxic conditions. Considering that the center of DCIS is poorly oxygenated, these results indicate that CYC1 plays important roles in cell proliferation and comedo necrosis through the elevated oxidative phosphorylation activity in human DCIS.     

Histological subtypes of ductal carcinoma<Emphasis Type="Italic">in situ</Emphasis> of the breast

BACKGROUND: It has become common to divide ductal carcinoma in situ (DCIS) of the breast into two main groups, comedo or noncomedo by tumor morphology. But noncomedo DCIS can be further stratified into several morphological patterns that exhibit several different growth patterns and most DCIS lesions have more than one pattern. In this study, DCIS elements were classified by morphological pattern and the association between predominant or recessive elements of DCIS lesions and clinicopathological findings was evaluated. METHODS: DCIS lesions from 46 patients were studied regarding the histological architectural patterns: comedo, cribriform, papillary, solid and micropapillary. The predominant architectural pattern which comprised more than 50% of the cells of the cancerous lesion was defined as the major element of the tumor and minor elements consisted of less than 50% but more than 25% of cells comprising the tumor. RESULTS: Of 24 tumors containing a comedo pattern as the major or minor element, 9 (38%) had microscopic intraductal spread over 2 cm and 11 (46%) had involvement of lobules, which was significantly higher than that observed in other types. Of 20 tumors containing a cribriform pattern as the major or minor element, 8 (40%) had microscopic intraductal spread over 2 cm and 9 (45%) had involvement of lobules, which was significantly higher than that seen in other types. Of 10 tumors containing a papillary type as the major or minor element, 5 (50%) had discrete multicentric lesions in the ipsilateral or contralateral breast, which was significantly higher than that seen in other types. CONCLUSIONS: DCIS lesions containing a comedo or cribriform element are more likely to have microscopic spread and involvement of lobules and DCIS lesions containing a papillary element are likely to be multicentric, whether the pattern are predominant in the tumor or not.     

Pathological and mammographic prognostic factors for screen detected cancers in a multi-centre randomised, controlled trial of mammographic screening in women from age 40 to 48 years

Aim

To assess pathological and radiological prognostic factors for cancers detected by screening within a multi-centre RCT trial of mammographic screening of younger women.

Method

The survival of 232 women with screen detected invasive cancer was ascertained. Data on invasive cancer size, histological grade, nodal status, vascular invasion, mammographic spiculation, comedo calcification and mammographic background were assessed. Kaplan–Meier and Cox proportional hazards methods were used to examine survival.

Results

Univariate analysis indicated that women with cancers with the following features had poorer survival; ≥30 mm, histologically grade 3, heavily node positive (4 or more positive nodes), vascular invasion positive and displaying mammographic comedo calcification.In a multivariate model survival remained poorer in women with four or more nodes positive (HR 8.36, 95% CI 2.31, 30.17) and in those with comedo calcification (HR 3.00,95% CI 1.13, 7.99).

Conclusion

Nodal status and the presence of mammographic comedo calcification have independent prognostic significance in young women with screen detected cancer.     

MIB1-determined Proliferative Activity in Intraductal Components and Prognosis of Invasive Ductal Breast Carcinoma

Intraductal components of breast carcinoma may have prognostic significance. In this study, we divided 181 invasive ductal breast carcinomas into comedo and non-comedo groups based on intraductal component morphology, and differences between the two groups in clinicopathological variables, including proliferative activity and survival, were assessed. Proliferative activity was evaluated by using MIB1 antibody, which reacts with the cell-proliferation-associated Ki-67 antigen, and was expressed as the number of MIBl-positive nuclei per 1000 cancer cells in intraductal components (MIB1 labeling index). We also investigated which variables had an impact on survival. The comedo group showed a significantly higher MIB1 labeling index than the non-comedo group ( P < 0.0001). The differences in disease-free and overall survival between the two groups were not significant ( P =0.2477, P =0.2069). Multivariate analysis of the entire series showed the MIB1 labeling index to be an independent prognostic factor predicting both disease-free survival and overall survival ( P =0.0160, P =0.0035). When multivariate analysis was repeated separately for the non-comedo and comedo groups, the MIB1 labeling index remained the most important variable predicting disease-free and overall survival in the non-comedo group ( P =0.0122, P =0.0040). Moreover, non-comedo patients with a high MIB1 labeling index had significantly shorter disease-free and overall survival than those with a low MIB1 labeling index ( P =0.0040, P =0.0402). These findings imply that MIB1-determined proliferative activity of intraductal components is an independent predictor of survival, and is the most important predictor in non-comedo cases.     

中医对粉刺的辨证分型及治疗

本文通过对临床上常见粉刺的临床表现进行分型辨治，且结合四季的自我调养，使粉刺得以消退的经验体会。     

黑头粉刺痣1例

患儿男,1岁5个月。右臀部及大腿黑头粉刺样丘疹1年余,反复红肿、溃烂半年,予抗感染治疗好转。皮损组织病理检查示表皮凹陷似扩张的毛囊,中央充满角质蛋白栓。符合黑头粉刺痣诊断     

乳腺导管内癌伴微浸润和粉刺样坏死的临床病理研究

目的：探讨乳腺导管内癌伴微浸润（ductal carcinoma in situ with microinvasion,DCIS-M）i和粉刺样坏死（comedo-necrosis）病例临床病理特点及治疗。方法：整理分析112例DCIS的临床病理资料。结果：（1）本组DCIS病例中,DCIS-Mi占25%,DCIS伴粉刺样坏死占31%。（2）病灶越大,发生微浸润的危险越高（P=0.025）,病灶〉2 cm时,DCIS-Mi的发生率为37.8%。微浸润的发生与粉刺样坏死、腋窝淋巴结的转移有显著相关性（P=0.038;P〈0.001）,与ER、PR的表达无关。（3）DCIS-Mi患者腋窝淋巴结的受累率为17.9%,不伴微浸润的DCIS患者腋窝受累率为0。（4）粉刺样坏死与ER、PR的表达强度呈负相关（P〈0.001）,与腋窝淋巴结转移无相关性（P=0.168）。结论：伴有微浸润的乳腺导管内癌患者应行腋窝淋巴结清扫;含有粉刺样坏死的DCIS易发生微浸润,手术方式的选择应倾向于全乳腺切除。     

中药内服配合西药外用治疗痤疮50例

[目的]探讨中西医结合治疗痤疮的临床疗效。[方法]将50例符合纳入标准的痤疮患者采用中医辨证内服(肺经风热型方用枇杷清肺饮,肠胃湿热型方用黄连汤,气血瘀滞型方用凉血清肺饮)治疗、局部自配痤疮液外敷药,自配中药面膜治疗。[结果]治疗3个疗程之后,50例中,治愈41例,好转7例,无效2例,总有效率为96%。[结论]中西医结合治疗痤疮有较好的临床疗效,值得推广应用。