乳腺paget病的诊治:附33例分析

目的：通过探讨有关乳腺Paget病的临床特点、预后因素和手术处理原则,提高外科医生对乳腺Paget病的认识。方法：回顾性分析我院1975年至2002年收治的33例乳腺Paget患者的临床资料。结果：33例患者平均年龄57岁,29例行改良根治术,4例行单纯乳腺切除。23例患者（69.7％）合并有乳腺癌。26例（78.8％）主要表现为乳头乳晕区湿疹样改变,其中单纯乳腺paget病10例,导管内癌8例,浸润性导管癌8例（1例有腋窝淋巴结转移）;另外7例合并乳腺肿块（21.2％）的患者中,无1例为单纯乳腺paget病,1例为导管内癌,6例为浸润性导管癌（4例有腋窝淋巴结转移）。结论：大多数乳腺Paget病伴有导管内癌或浸润性导管癌,有乳腺肿块的患者合并浸润性导管癌的可能性更大,预后更差,治疗应更为积极。

Diagnosis and treatment of Paget's disease of the breast: report of 33 cases

To study the clinical features and histologic criteria of Paget' s disease of breast,and evaluate the potential prognostic factors for better appropriate treatment strategies.Methods Thirty-three patients treated for Paget's disease of breast were reviewed retrospectively.Results The median age of diagnosis was57years.Twenty-nine patients were treated by modified radical mastectomy,4cases by mastectomy.Twenty-three(69.7%)patients had underlying carcinoma.Twenty-six(78.8%)patients did not have a palpable breast mass,10of them was simple Paget' s disease,eight had ductal carcinoma in situ,eight had invasive ductal carcinoma.Seven patients had a palpable breast mass,and none of them was simple Paget' s disease,except one of them had ductal carcinoma in situ,six had invasive ductal carcinoma.Conclusions Most patients with Paget' s disease had associated breast carcinoma.Paget' s disease of the breast with a palpable breast mass is more likely to be accompanied by an invasive ductal carcinoma and had a poor prognosis.Patients with any nipple complaints deserve a serious investigation.