乳腔镜辅助乳腺癌保乳和完全腔镜腋窝淋巴结清扫手术

目的　了解乳腔镜辅助保乳和完全腔镜腋窝淋巴结清扫治疗乳腺癌的临床总体效果。方法　 92例乳腺癌采用乳腔镜辅助、经乳晕入路的隐蔽小切口完成保乳 ,并完全腔镜腋窝淋巴结清扫。结果　术中冰冻切片病理检查提示 7例切缘不净 ,靠阳性边缘扩大切除 1 0cm宽的乳腺组织 ,再次送冰冻切片提示阴性。平均每例取出淋巴结 15 7个 ,3 9例病理显示腋窝淋巴结受累 ,平均受累 3 8个。平均手术时间 112 6min ,前期手术时间较长 ,后期手术时间明显缩短。保乳术后保留的乳房形态良好 ,乳腺切除创面 4例出现皮下积液 ,经抽吸加压包扎愈合。乳腔镜腋窝清扫术中出血很少 ,未出现手术并发症。乳晕切口和腋窝部位 3个trocar孔伤口小而隐蔽。术后平均随访 11 9个月 ,未见任何乳腺和腋窝复发迹象或trocar处种植 ,患者肩关节活动均良好。结论　借助乳腔镜器械 ,能通过乳晕处微小隐蔽切口及腋窝部 3个trocar孔 ,能比较顺利地完成乳腺癌肿的切除以及腋窝淋巴结微创清扫。     

老年女性乳腺癌的临床特征及超声诊断价值

目的探讨老年女性乳腺癌的临床特征及超声诊断价值。 方法回顾性选取2015年6月至2019年12月就诊于北京协和医院乳腺外科行乳腺病灶手术获得明确病理诊断的≥70岁的老年女性288例，共计298个病灶，获取完整的临床、病理及超声影像资料。分析纳入对象的临床表现、病理特征，应用诊断试验四格表计算超声对老年女性乳腺良、恶性病灶及不同就诊原因患者良、恶性病灶的诊断效能，以及对腋窝淋巴结转移的诊断效能。 结果288例患者中，自行触及肿块189例（65.63%）、乳头溢液23例（7.99%）、体检（临床查体、影像学检查）发现肿块76例（26.39%）。298个病灶中，恶性病灶272个（91.28%），良性病灶26个（8.72%）。263例乳腺癌患者中，160例（60.84%）行乳腺肿块局部扩大切除术，71例（27.00%）行乳腺癌改良根治术，31例（11.79%）行乳腺肿块局部扩大切除术及前哨淋巴结活检或腋窝淋巴结清扫术，1例（0.38%）行全乳切除术。其中237例初诊患者术后病理T分期为T1 127例（53.59%），T2 79例（33.33%）。超声对老年女性乳腺癌的诊断敏感度、特异度和准确性分别为95.59%、50.00%和91.61%，其中超声对以肿块为主诉（包括自行触及和体检筛查发现）患者乳腺癌的诊断准确性（94.53%）高于主诉为乳头溢液患者的诊断准确性（58.33%）。102例乳腺癌患者接受了腋窝淋巴结处理，其中45例病理证实为腋窝淋巴结转移。术前超声对于腋窝转移性淋巴结诊断的敏感度、特异度和准确性分别为93.33%、73.68%、82.35%。 结论老年乳腺癌患者大多数因临床症状就诊，肿瘤分期晚。超声对以肿块为主诉的老年乳腺癌患者的诊断准确性较高，但对乳头溢液患者的诊断准确性仍有待提高。超声术前评估对老年乳腺癌患者腋窝淋巴结临床治疗方式的选择有重要价值。     

女性原发性乳腺恶性外周神经鞘瘤1例分析

对女性原发性乳腺恶性外周神经鞘瘤1例分析如下.1病历摘要女,43岁.无意中发现左乳肿物1个月余,约核桃样大小,不伴疼痛.触诊:左乳内上象限(10C处)一肿物,约3.4 cm×3.0 cm,囊性感,边界清,活动好,轻压痛,患侧腋窝未触及异常淋巴结;辅助检查:乳腺钼靶X线提示:左侧乳腺内上9C见一肿块影,部分显影,大小约3.5 cm×2.0 cm,边界较清,考虑囊肿可能?乳腺B超提示:左侧乳腺单发囊肿.初步诊断:左乳腺囊肿.术中探查:约3 cm×2.8 cm×1.5 cm,囊性感,欠光滑,剖开标本:鱼肉样.术中病理诊断:乳腺恶性肿瘤,间质肉瘤.即时行乳腺改良根治术.经齐鲁医院、千佛山医院联合会诊,术后病理诊断:(左侧)乳腺恶性外周神经鞘瘤,乳头及切缘未见肿瘤,腋窝淋巴结未见肿瘤转移(0/15).免疫组化:S100(+),CK7(-),2-AT(-),CD31(-),SMA(-).术后未行化、放疗.     

甲状腺占位性病变46例临床分析

目的探讨甲状腺占位性病变的诊断及治疗方法。方法对46例行手术治疗的甲状腺占位性病变患者的临床资料进行回顾性分析。结果影像学的检查及穿刺细胞学检查与病理检查的结果相符。病理结果及手术方式：38例良性甲状腺占位性病变,其中32例甲状腺腺瘤均行甲状腺腺瘤切除,6例良性甲状腺结节均行甲状腺结节切除;8例恶性甲状腺占位性病变,其中7例甲状腺癌行甲状腺根治术,术中行同侧甲状腺、狭部切除及周围淋巴结清扫,术后辅以放疗;1例恶性甲状腺结节行同侧甲状腺及狭部切除,未行周围淋巴结清扫,术后辅以放疗。38例手术患者术后切口均为甲级愈合,无喉上神经及喉返神经的损伤,亦无术后并发症的发生。随访6个月-2年,均未见复发。结论影像学检查及穿刺细胞学检查的结果对临床诊断有价值,能指导临床医师对甲状腺占位性病变手术方式的选择。     

印片代替冰冻切片解决乳癌快速诊断方法介绍

乳腺良性肿块与乳腺癌的手术方式完全不同,良性肿块常为采取肿物局部区段切除,或乳腺单纯切除术,如为乳腺癌则行广泛根治术,后者术式对患者的创伤很大,不但要清扫腋窝、锁骨下等组织的淋巴结而且还要切除大小胸肌,这不但影响患者体形美观,甚至还会引起同侧上肢淋巴循环障碍及运动功能不便等     

超声在乳腺癌淋巴结检测中的应用进展

传统的乳腺癌根治术包括对腋窝淋巴结的清扫（axillary lymph noded issection,ALND）,但在临床上,对Ⅰ、Ⅱ期乳腺癌患者行腋窝淋巴结清扫术后发现,约75％腋窝淋巴结无转移。近年来,越来越多的作者认为对术后病理证实腋窝淋巴结无转移的乳腺癌患者,行腋窝淋巴结清扫术并无任何治疗作用。同时,腋窝淋巴结清扫术后常会引起患侧上肢水肿,肩关节活动障碍等并发症。随着超声检测技术的进步,在预测腋窝淋巴结有无转移及避免对腋窝淋巴结无转移患者行腋窝淋巴结清扫术方面具有重要意义,现综述如下。     

隐匿性乳腺癌超声误诊探析

目的探讨隐匿性乳腺癌(occult breast cancer, OBC)的临床特点、诊治措施及超声误诊原因、防范措施。方法对超声误诊OBC 3例的临床资料进行回顾性分析,并复习相关文献。结果 3例OBC中1例因食管高分化腺鳞癌术后2年常规超声检查发现左腋窝2枚增大淋巴结,超声误诊为食管癌相关转移性淋巴结;1例因右腋窝胀痛6个月来诊,超声检查发现右腋窝副乳腺并副乳腺边缘实性肿块,误诊为右腋窝副乳腺并副乳腺纤维腺瘤;1例因无意中触及左腋窝多个肿块1个月就诊,超声检查误诊为双乳纤维腺瘤,左腋窝淋巴结增大。1例经超声引导下细针穿刺细胞学检查及左腋窝淋巴结清扫病理检查,1例经超声引导下空芯针穿刺活组织病理检查,1例经腋窝肿块部分切除活组织病理检查诊断为OBC。3例均行单侧乳腺切除加腋窝淋巴结清扫术,术后病理检查证实诊断,予规范化学治疗等,恢复良好。结论 OBC起病隐匿,易误诊。临床及超声医师要加强对OBC认识,掌握其诊断及鉴别诊断要点,建立科学诊断路径,并联合多种影像学检查手段相互验证,以降低误诊率,改善患者预后。     

乳腺叶状囊肉瘤多次复发超声表现一例

患者女,28岁,于2001年5月偶然发现右乳肿物,如“小枣”大小,无疼痛不适,无发热,皮肤无红肿,无乳头溢液。在当地医院行乳腺肿物切除术,病理诊断:右乳腺纤维腺瘤。术后2年内2次复发均行肿块切除,病理诊断均为:右乳腺纤维腺瘤。2004年患者右乳肿物再次复发,因肿瘤生长缓慢,未予治疗。2005年6月患者怀孕后右乳腺肿物生长较快,并有胀痛,因妊娠未行手术切除。2006年3月患者生产后短期内自觉右乳腺肿块有所缩小。2006年9月患者就诊时右乳肿物明显增大,大小约为20cm×20cm,遂行第4次手术,将右侧乳房单纯切除,手术病理诊断:乳腺分叶状肿瘤恶性变。术…     

乳腺黏液腺癌超声误诊原因分析

目的分析乳腺黏液腺癌(mucinous breast carcinoma,MBC)的超声表现特点、误诊原因及防范措施,以降低MBC误诊率。方法对超声检查曾误诊的MBC 11例的临床资料进行回顾性分析。结果 11例均为女性,7例因乳房肿块就诊,2例因乳头溢液就诊,2例因单位体检X线钼靶可见乳房组织有钙化病灶就诊。入院后经超声检查误诊为乳腺纤维腺瘤5例,良性叶状肿瘤2例,浸润性导管癌4例。11例均行手术治疗,术后病理检查确诊为单纯型MBC 7例,混合型MBC 4例。7例单纯型MBC于超声引导下行微创立体旋切术,术后6个月随访,超声检查均示乳腺局部结构未见明显异常,且无复发。4例混合型MBC均行改良根治术,术中常规清扫腋窝淋巴结,1例术后8个月时复查超声见胸壁局部复发伴骨转移,转至外院接受125I粒子放射性治疗;3例分别于术后6、9和7个月时复查超声示单纯局部复发,均再次行淋巴结清扫术,并接受中医辅助治疗,治疗2个月后复查超声未出现复发病灶。结论超声检查作为物理诊断方法,在MBC临床诊断及病理分型中具有一定局限性。临床医师应结合疾病本身特征对MBC进行综合评价,以与易混淆乳腺良恶性病变进行鉴别,减少误诊误治。     

高频彩色能量图在乳腺肿块良恶性鉴别诊断中的价值

本文对82例乳腺肿块术后患者进行回顾性分析,并结合其病理诊断结果进行分析研究,旨在探讨高频彩色能量图对乳腺肿块的良恶性的鉴别诊断价值。1资料与方法研究对象:2000年12月～2002年4月在我院行超声检查诊断为乳腺肿块,并于2周内进行手术切除治疗的门诊及住院患者82例,均为女性,年龄18～72岁,平均45岁。按病理检查结果分3组:乳腺良性肿瘤组44例,其中3例为单侧多发,2例为双侧肿块,病灶共51个。乳腺恶性肿瘤均为单侧单发,无腋窝淋巴结转移组25例,有腋窝淋巴结转移组13例。仪器:美国GELQGIQ400MD彩色超声诊断仪,探头频率7.5MHz,患者仰卧…     

早期乳腺癌保乳手术48例临床分析

目的探讨乳腺癌保乳治疗的方法与疗效。方法回顾性分析合肥市第一人民医院2006年11月至2011年2月间48例行保乳治疗的乳腺癌患者的相关资料。结果术后标本病理切片检查,切缘无癌细胞浸润。经6～57个月随访,无局部复发、远处转移和死亡病例。患侧乳房外形满意。结论早期乳腺癌患者的保乳治疗是安全可行的,可以获得术后良好的乳房外形。     

Adenomyoepithelioma of the breast with malignant transformation and repeated local recurrence: A case report

BACKGROUNDAdenomyoepithelioma (AME) of the breast is a rare type of benign breast tumor. Many AMEs show benign behavior, but reports of the malignant type are rare. We present the case of a patient with AME with repeated local recurrences and further malignant transformation.CASE SUMMARYA 53-year-old woman visited our hospital with a 16-mm palpable mass in the right breast. A core needle biopsy was performed. The pathological diagnosis was AME. Lumpectomy with a safety margin was performed without axillary lymph node dissection (ALND). Two years later, local recurrence developed, and the patient again underwent lumpectomy with a safety margin. The pathology showed malignant AME, and the margin was negative. Eight months later, local recurrence developed again in the same location, and a total mastectomy was performed without ALND. The pathological diagnosis was malignant AME. The patient was disease-free for three years posttreatment.CONCLUSIONThe treatment of AME requires caution, as it may exhibit repeated recurrences after local excision as well as malignant transformation.     

腋窝恶性肿瘤临床病理分析(附29例报告)

目的　探讨腋窝恶性肿瘤的临床病理诊断及其处理方法。方法　回顾性分析 2 9例腋窝部恶性肿瘤患者的临床资料。结果　 2 9例腋窝恶性肿瘤中原发性 8例 ,继发性 2 1例 ,在上皮及间叶来源均可见到 ,后者女性以乳腺来源为主。针吸细胞学检查诊断符合率 10 0 %。结论　病史与查体对诊断有相当重要的作用 ,针吸细胞学检查为一线检查方法 ,术中冰冻切片病理检查对诊断帮助甚大 ,但最后确诊有赖于常规病理和免疫组化的具体结果。     

Primary breast cancer of the vulva: a case report and review of the literature

Since 1872, 40 cases of ectopic mammary gland tissue in the vulva have been reported in the literature. Out of these, 12 had a primary cancer in the ectopic breast tissue. Seven metastases of an orthotopic breast cancer have been found in this location. We are presenting the 20th case of cancerous breast tissue in the vulva whom we classified as the 13th case of primary cancer based on clinical and histopathological criteria of primary and metastatic malignant disease. Because of the advanced age of the patient, wide local excision followed by adjuvant hormonal therapy was opted for. Nineteen months after surgery, there is no evidence of recurrent disease. Due to the rarity of this entity, its management presents therapeutic dilemmas, and variable treatment strategies are being found in the literature. In our opinion, the same basic principles used for treatment of cancers of the orthotopic breast should be applied in ectopic breast carcinoma.     

Application of neoadjuvant chemotherapy combined with anlotinib in occult breast cancer: A case report and review of literature

BACKGROUNDOccult breast cancer (OBC) is a special type of breast cancer presenting as axillary lymph node metastasis with undetectable primary lesions in the breast. Due to its low incidence and unique clinical manifestations, there is a lack of consensus on the diagnosis and treatment of OBC. We report a case of OBC treated with neoadjuvant chemotherapy combined with anlotinib. The treatment was well tolerated, and the patient achieved a pathologic complete response.CASE SUMMARYA 53-year-old woman presented with a lump in her right axillary area with no primary lesions in the breast. Pathological biopsy confirmed right axillary metastatic carcinoma. Immunohistochemical staining results were positive for progesterone receptor, cytokeratin 7, specific breast markers GATA3 and gross cystic disease fluid protein-15. Tumor cells were negative for estrogen receptor, human epidermal growth factor receptor-2, cytokeratin 5/6, cytokeratin 20, and villin. The patient was diagnosed with OBC, and she underwent neoadjuvant chemotherapy combined with anlotinib. Mastectomy plus axillary lymph node dissection was performed. The patient achieved pathologic complete response with no residual invasive tumor cells in the breast or axillary lymph nodes. Postoperatively, she received adjuvant radiotherapy and endocrine therapy.CONCLUSIONNeoadjuvant chemotherapy and anlotinib had good efficacy and safety in the treatment of OBC and may be a new therapeutic option.     

Malignant solitary fibrous tumor of the pancreas with systemic metastasis: A case report and review of the literature

BACKGROUND Pancreatic solitary fibrous tumor(SFT) is a rare neoplasm of intermediate biological potential. So far, only 22 cases have been reported since 1999. All the cases, except one, exhibited benign features. Here, we report the first case of malignant pancreatic SFT with typical Doege-Potter syndrome, along with the clinical and pathologic evidence of its systemic metastasis.CASE SUMMARY The patient was a 48-year-old man with a 1-year history of pancreatic and liver masses and refractory hypoglycemia. Increased uptake of the tracer fluorodeoxyglucose(FDG) was found in the liver and bones by fluorine-18 FDG positron emission tomography/computed tomography. After multidisciplinary discussion, a distal pancreatectomy procedure was performed, and histological examination showed a lesion composed of abundant heterogeneous spindle cells with localized necrosis. On immunohistochemistry evaluation, STAT6 was found to be diffusely expressed in the tumor. Based on the overall evidence, the patient was diagnosed with malignant pancreatic SFT with liver and bone metastases.CONCLUSION The diagnosis of malignant SFT requires comprehensive evidence including clinical, immunohistochemistry, and histological features. This case may be presented as a reference for diagnoses and management of malignant pancreatic SFTs with systemic metastasis.     

纤维肉瘤的诊断与治疗(附13例报告并文献复习)

目的∶探讨纤维肉瘤的诊断与治疗。方法：分析我院１９９４年～１９９７年收治的纤维肉瘤病人１３例并复习有关文献。结果：院外行局部切除６例次（首次４例,复发后２例）,均在术后１３天～１年复发,平均６７月,有１例复发５次;在我院首次广泛切除９例,除１例失访外,８例术后３年～１０年复发,平均６年;复发后再次行广泛切除术１２例１７例次,于术后７月～４年复发,平均２２年;复发后行广泛切除术加放疗３例,于３年～５年复发,平均４１年;１３例无远处转移,１例左大腿纤维肉瘤腹股沟淋巴结转移;误诊４例,误诊率高达３０％。结论：广泛性切除术是减少纤维肉瘤复法的重要方法;辅助放疗可能延长病人复发的时间;纤维肉瘤的诊断无特殊方法,术后病检仍是目前确认的主要手段。     

肾原发性孤立性纤维性肿瘤临床病理观察

目的 探讨原发于肾的孤立性纤维性肿瘤的临床病理特点及鉴别诊断要点.方法 复习2例肾孤立性纤维性肿瘤患者的临床资料,并对其进行组织学观察和免疫组化标记.结果 2例肾原发性孤立性纤维性肿瘤患者均为女性,年龄分别为33岁和63岁.临床主要表现为肾区钝痛,无尿频、尿急、尿痛,无血尿.CT检查示肾占位.组织学特征为瘤组织呈束状、波纹状排列,瘤细胞呈梭形,局部富于瘤细胞,间质血管丰富,部分呈血管瘤样或血管外皮瘤样结构,有明显的束状胶原.免疫表型：瘤细胞CD34、CD99和bcl-2（＋）,SMA局灶性（＋）;而HMB45和CD10（-）.结论 孤立性纤维性肿瘤具有低度恶性潜能,发生在肾极少见,以手术治疗为主,预后较好.确诊主要依靠组织病理学,并辅以免疫组化标记.     

67例早期乳腺癌保乳术疗效研究

目的探讨乳腺癌保乳治疗的方法与疗效。方法67例早期原发性乳腺癌，施行局部扩大切除并腋窝淋巴结清扫，手术后患侧乳房接受放化疗。结果手术后随访3～55个月，中位随访26个月，外形优良率为88％，其中3年1例同侧乳腺局部复发，3年局部复发率2．5％，1例死亡，总生存率98％。结论早期乳腺癌实施保乳治疗，近期疗效满意，远期效果有待长期随访观察。     

Physicians' reasons for failing to deliver effective breast cancer care: a framework for underuse

OBJECTIVE: Despite numerous randomized trials showing the health benefits of systemic and local therapies for early-stage breast cancer, underuse of these therapies remains a significant quality problem. Little is known about causes of underuse of effective cancer treatments. We sought to understand these causes to design effective interventions to improve care. RESEARCH DESIGN: To identify categories of causes of underuse, semistructured interviews were performed with physicians of breast cancer patients who did not receive effective adjuvant care in the 4 years following surgery. Underuse was defined by expert consensus based on evidence-based guidelines. SUBJECTS: Surgeons (n = 13) of all early-stage breast cancer cases who underwent surgical treatment at a tertiary care hospital and had underuse of local or systemic adjuvant therapies. RESULTS: Of all the 275 women with early-stage breast cancer, there were 44 episodes of underuse of effective therapies (16%). In 48% of cases, physicians thought treatment should occur but the treatment failed to take place (32%) or the patient refused (16%). For the other 52% of cases, physicians thought treatment should not occur because evidence did not support treatment in clinical circumstances such as older age (32%), a good prognosis based on tumor size or histology (11%), a second primary breast cancer (5%), or because of comorbidities (5%). All surgeons were aware of the benefits of adjuvant treatments. CONCLUSIONS: Causes of underuse can be identified and categorized. Using these categories, a framework of causes of underuse was constructed and interventions targeting the specific causes to improve the quality of care are suggested.