肉芽肿性小叶性乳腺炎的临床病理

目的探讨肉芽肿性小叶性乳腺炎的临床病理特点。方法对20例肉芽肿性小叶性乳腺炎临床资料和病理学特征进行回顾性分析。结果患者均为经产妇,平均年龄32.5岁,单侧乳腺肿块,8例临床怀疑乳腺癌,组织学表现均以乳腺小叶为中心的肉芽肿性炎,8例可见多核巨细胞,13例形成微脓肿,所有病例均未发现病原微生物。结论肉芽肿性小叶性乳腺炎术前诊断困难,确诊依赖病理诊断,治疗以手术切除为主。     

89例肉芽肿性乳腺炎的临床病理学特征分析

目的 研究肉芽肿性乳腺炎的临床病理学特点,探讨其诊治方法.方法 回顾性分析天津医科大学附属肿瘤医院2003年1月至2011年3月期间收治的89例肉芽肿性乳腺炎的临床病理学特征和随访资料.所有病例标本经过抗酸染色及过碘酸雪夫氏(PAS)染色.结果 患者均为女性,年龄为22 ～ 57岁,平均年龄为(33.9±6.8)岁,其中85例有哺乳史,均以乳腺肿块就诊.组织病理特点为以乳腺小叶为中心的病变,呈结节状多灶性分布,小叶内可见以上皮样细胞、多核巨细胞、淋巴细胞及中性粒细胞为主的炎性细胞浸润,病变组织的切缘未见炎症细胞;所有病例抗酸染色和PAS染色未见分枝杆菌及霉菌.89例患者均选择手术治疗,手术以乳腺小叶区段切除为主,并根据患者具体情况调整术式.术后随访1～ 102个月,中位随访时间为74个月,仅1例复发.结论 肉芽肿性乳腺炎的临床表现不易与乳腺癌鉴别,组织病理学检查是唯一确诊手段.     

类固醇激素治疗后手术切除与直接扩大切除治疗肉芽肿性小叶性乳腺炎的对比分析

正近几年,肉芽肿性小叶性乳腺炎(granulomatous lobular mastitis,GLM)的发病率呈上升趋势,患者多伴有乳腺小叶上皮样组织细胞和多核巨细胞组成的肉芽肿,伴或不伴微小脓肿形成~([1]),目前,治疗GLM的方法包括手术治疗、激素治疗、免疫抑制药物等,其中,临床上常采用激素治疗和手术治疗。笔者回顾性分析了中国医科大学附属盛京医院收治的46例GLM患者的临床资料,探讨了类固醇激素治疗后手术切除     

肉芽肿性乳腺炎的临床病理特征及其综合治疗

目的 探讨肉芽肿性乳腺炎(GM)的临床病理特征及类固醇激素联合手术综合治疗的效果.方法 回顾性分析2011年6月至2012年6月本院收治的45例GM的临床病理学特征和治疗方法及效果.结果 本组GM的临床表现主要为乳腺肿块,空芯针穿刺病理检查均表现为以乳腺小叶为中心伴微小脓肿及多种炎细胞浸润的肉芽肿性炎症.21例(46.7％,21/45)伴脓肿形成者中,19例(90.5％,19/21)脓液细菌培养为阴性.本组患者均接受类固醇激素治疗,平均治疗1周(0.5 ～2周)后病变开始缩小,平均用药6.2周(2～18周)后肿块缩小至2 cm以内,遂行病灶切除术.术后中位随访5.2个月(5 ～12个月),3例患者复发,复发率为6.7％(3/45),治愈率为93.3％ (42/45).结论 肉芽肿性乳腺炎需经空芯针穿刺活检等病理学检查方法得到确诊,其诊治涉及多种学科.类固醇激素联合手术治疗GM是一种有效的方法,可避免乳房全切术,降低复发率.     

肉芽肿性小叶性乳腺炎细菌学研究进展

肉芽肿性小叶性乳腺炎(GLM),又称为特发性肉芽肿性乳腺炎,是一种病因尚不明确的慢性乳腺炎症,近几年中国发病率有上升的趋势。目前国内外有关其病因的研究尚有争议,主要以自身免疫和细菌感染占主导。笔者就GLM细菌学的研究进展予以综述,从而进一步认识细菌在GLM中的作用,为指导临床的诊疗提供依据。     

乳腺腺样囊性癌临床病理观察

目的:探讨乳腺腺样囊性癌临床病理学特点、免疫表型及鉴别诊断要点。方法:分析3例乳腺腺样囊性癌的临床特点、病理组织学形态、免疫组化特点,并复习相关文献。结果:3例乳腺腺样囊性癌均为女性,年龄58~80岁。大体上均为境界相对较清楚的肿块。镜下肿瘤形成管状-梁索状、筛状、实体型结构。肿瘤主要由腺上皮、肌上皮、基底样细胞构成,其中腺上皮表达CK7、CK5/6、CD117,肌上皮表达SMA、p63,基底样细胞表达p63、CK5/6、CD117,但均不表达ER、PR、Her-2。3例乳腺腺样囊性癌均行乳腺癌改良根治术,术后随访至今均无复发。结论:乳腺腺样囊性癌是一种少见的乳腺浸润性癌亚型,有其独特的组织形态学特点,预后较好。     

导管周围乳腺炎与肉芽肿性乳腺炎的临床鉴别与处理

目的探讨导管周围乳腺炎与肉芽肿性乳腺炎的临床特点及处理方法。方法 2006年5月至2010年1月本院收治了36例经病理证实的导管周围乳腺炎或肉芽肿性乳腺炎患者,对该36例患者的临床资料进行回顾性分析。结果 病理结果显示导管周围乳腺炎25例,肉芽肿性乳腺炎11例。两种疾病均以反复脓肿、乳房肿块及乳腺窦道或瘘管为表现。25例导管周围乳腺炎患者病变均位于乳晕2cm环内,其中14例合并乳头内陷;治疗包括,手术治愈4例（肿块型局限者）占16%,药物加手术治愈10例（肿块并乳头内陷者8例及合并窦道及乳头内陷者2例）,占40%;仅用药物治疗痊愈6例（脓肿型4例和肿块并窦道2例）,占24%,随访2～27个月未见复发,另有5例（肿块型1例和肿块并乳头内陷者4例）仍接受三联抗菌药物治疗。11例肉芽肿性乳腺炎患者中9例病变位于乳晕2cm环外,未见合并乳头内陷;治疗包括,7例三联抗菌药物治疗后肿块缩小至1～2cm后手术切除病变,其中1例合并多发窦道者术后3个月复发,予三联抗菌药物治疗2个月后范围缩小,再次行手术治疗,术后12个月未见异常,余6例随访6～24个月,未见复发;2例仍在行三联抗菌药物治疗,待病变缩小手术;2例皮质激素治疗停药后复发,再用激素治疗2周病变缩小,手术切除病变,未见复发。两组患者无一例行全乳房切除。结论 导管周围乳腺炎和肉芽肿性乳腺炎临床表现相近,需临床与病理检查结合确诊,手术是该病的主要治疗手段,病变复杂广泛者可先行三联抗菌药物治疗,待病变缩小至1～2cm、病情稳定后,手术治疗效果更好     

老年女性乳腺囊性增生病39例临床分析

乳腺囊性增生病是妇女的常见疾病 ,8年来我科对 39例老年性乳腺囊性增生病进行了诊治 ,并定期随访观察 ,对其治疗无明显疗效者进行了针吸细胞学检查 ,有 9例患者发现癌变 ,现报告如下 :1　临床资料1.1　一般资料　本组 39例为女性患者 ,年龄最大 75岁、最小 6 0岁 ,平均年龄 6 7岁。因乳房肿块伴轻度疼痛就诊 ;37例患者肿块位于乳腺外上象限 ,仅 2例位于外下象限 ;乳头均无凹陷、无溢液。乳腺局部均触及结节状或片块状增厚的组织 ,界限较清 ,质韧 ,腋下未触及肿大淋巴结。1.2　诊断与治疗　门诊均诊断为乳腺囊性增生病 ,口服他莫昔芬 10ｍｇ…     

涎腺分泌性癌临床病理特征分析并文献复习(附4例)

目的:研究并探讨涎腺分泌性癌(secretory carcinoma, SC)的临床病理特征、免疫表型、鉴别诊断、治疗及预后。方法:对4例涎腺分泌性癌进行HE染色和免疫组化染色,收集分析4例涎腺分泌性癌的临床资料并复习相关文献。结果:4例肿瘤均发生在腮腺,患者年龄为30岁～55岁,中位年龄为40岁;肿瘤直径为0.5 cm～3.0 cm;肿瘤组织均界限清楚,2例大部分切面灰白实性,质地中等;1例切面实性,灰粉灰黄相杂,质软易碎;1例呈囊实性改变,实性区质软灰粉色。镜下观察,肿瘤细胞排列成多种结构,可呈微囊、大囊及腺管内乳头状排列。肿瘤细胞界限不清,胞浆丰富,呈嗜酸性或空泡状,具有圆形或卵圆形的细胞核,核仁明显,核分裂象及坏死少见。4例肿瘤细胞CK5/6、p63均为阴性表达,肿瘤细胞均弥漫强表达S100、Mammaglobin,弥漫表达CKAE1/AE3、CK7、CK8、Vimentin,大部分肿瘤区域DOG1表达缺失,仅在少数瘤巢周或腔缘弱阳性,而Ki67增殖指数约10%。结论:发生于涎腺的分泌性癌类似于乳腺的分泌性癌,是一种少见的低度恶性肿瘤,由于其典型的形态学特征,并结合免疫组化结果...     

胰腺实性-假乳头状瘤的CT表现及手术可行性评价

探讨胰腺实性-假乳头状瘤的CT特征,以提高术前诊断准确性并为手术和预后评估提供依据。方法: 回顾性分析经手术病理证实的胰腺实性-假乳头状瘤20例,男2例,女18例,年龄12～73岁,平均年龄（30.3±16.2）岁,所有病例均行CT平扫及多期动态增强检查,分析肿瘤的CT表现,并与术中实际情况进行对照。结果:CT平扫:20例肿物均表现为较大的胰腺肿块,其中13例明显突出于胰腺轮廓外;肿块呈类圆形、椭圆形或分叶状,边缘较清楚;13例为囊实性,3例为囊性,4例为实性;其中9例肿物内可见钙化。14例肿块位于胰头,其中4例胰管轻度扩张,1例明显扩张,均未见胆管扩张。1例伴肝转移。CT增强:3例囊性肿物的囊壁及分隔可见强化;17例实性及囊实性肿物的实性部分平扫为等密度或较低密度,增强后均有强化,动脉期强化程度均较低,平均CT值（51.45±10.63）HU,静脉期和实质期强化程度较动脉期提高,平均CT值分别约（82.05±22.04）HU和（81.83±19.86）HU,并与动脉期差别均有统计学意义（t1=-7.34,P=0.000和t2=-7.36,P=0.000）,但静脉期和实质期强化CT值无差别（t3=-0.15,P=0.880）。所有20例肿瘤均已行手术切除,其中包括肝转移灶。结论:结合患者年龄、性别和临床表现特点,CT检查多能对胰腺实性-假乳头状瘤做出正确诊断,鉴于肿瘤多为低度恶性或良性,一般均可行手术切除。      

Clinicopathological features of gastric metastasis from breast cancer in three cases

The common sites for metastases from breast cancer are lymph nodes, bone, lung, liver, and brain. Gastrointestinal (GI) metastasis is rarely found or diagnosed in patients with breast cancer. This report presents three cases of gastric metastasis from breast cancer. Case 1 was a 42-year-old female diagnosed with gastric metastasis after mastectomy with axillary lymph node dissection for invasive lobular carcinoma of the left breast. Case 2 was a 54-year-old female who was diagnosed to have invasive lobular carcinoma of the left breast with systemic bone and gastric metastasis. Case 3 was a 54-year-old female who was diagnosed to have bilateral invasive ductal carcinoma of the breast with simultaneous bone and gastric metastasis. The immunohistochemical statuses for estrogen receptor, progesterone receptor, mammaglobin, and gross cystic disease fluid protein-15 (GCDFP-15) between the primary and gastric metastatic lesions were all well matched. All three cases were treated with systemic chemotherapy, hormone therapy or both, without surgical intervention for gastric lesions. Two patients with disseminated disease died 27 and 58 months after diagnosis of gastric metastasis, while one patient without organ metastasis is still alive at 56 months after diagnosis. It is important to make a correct diagnosis by distinguishing gastric metastasis from breast cancer in order to select the optimal initial treatment for systemic disease of breast cancer.     

未见明显肿块及钙化的乳腺癌X线表现分析

目的:总结分析无明显肿块及钙化的乳腺癌钼靶X线片特征。方法:回顾性分析26例经手术及病理证实为乳腺癌,而钼靶X线片未见明显肿块及钙化病例的X线片、病史资料、B超检查等。结果:26例病例临床均触及肿块或结节,乳腺分型25例为散在纤维腺体型(少量腺体型)和不均质型(多量腺体型),病灶与腺体无明显分界。24例为乳腺浸润性导管癌,2例为浸润性小叶癌。结论:乳腺钼靶X线片未见明显肿块及钙化,而临床触及肿块或结节的病例,应结合B超及体检仔细分析X线片,并与对侧比较,能明显提高乳腺癌的诊断准确率。     

Invasive Lobular Breast Cancer Presenting an Unusual Metastatic Pattern in the Form of Peritoneal and Rectal Metastases: A Case Report

Gastrointestinal metastases from invasive lobular breast cancer are uncommon with the stomach and small intestines being the most common metastatic sites. Peritoneal and rectal metastases are very rare and only rarely occur as the first manifestation of disease. We herein report the case of a 47-year-old woman who presented with abdominal carcinomatosis as a first sign of invasive lobular breast carcinoma (ILC). Identifying the most important immunohistochemical markers for ILC: gross cystic disease fluid protein 15, estrogen and progesterone receptors enabled a correct diagnosis. After a six year disease-free period, relapse occurred with severe obstruction due to rectal metastasis from lobular breast carcinoma. Since there was no widespread metastatic disease, surgery with concomitant hormonal therapy was performed.     

Breast hamartoma: fine-needle aspiration cytologic finding

BACKGROUND: Breast hamartoma is an unusual, well-circumscribed, tumor-like mass entering into the differential diagnosis of benign breast disease. To the authors' knowledge, the cytology of these lesions has not been well described. Although fine-needle aspiration is a well established procedure for the detection of breast carcinoma, its utility in classifying benign breast disease is less clear. METHODS: Fine-needle aspirates from eight patients with histologically proven hamartomas were reviewed. None of the cases had a preoperative fine-needle aspiration diagnosis of hamartoma. Cytologic characteristics were retrospectively evaluated in a semiquantitative manner and compared with the histologic findings. RESULTS: The aspirates were moderately cellular and contained sheets of both bland ductal cells and lobular units. Adipose tissue was present in varying amounts. Bipolar stromal nuclei were readily apparent, whereas intact stromal fragments were less prominent. Cytologic atypia was uniformly absent. CONCLUSIONS: The cytology of breast hamartomas shows considerable overlap with other benign breast disease and is unlikely to be interpreted as malignant. The findings of intact lobular units and a relative paucity of stroma in an aspirate from a well circumscribed breast lesion may suggest the diagnosis of hamartoma.     

Histiocytoid breast carcinoma: a case report with immunohistochemical and ultrastructural studies

This is the first documented report of a case of histiocytoid breast carcinoma in Japan. The patient was a 55-year-old woman with a right breast lump. An excisional biopsy revealed proliferation of histiocyte-like cells with slightly atypical nuclei within fibrous stroma. In places, tumor cells showed an invasive pattern similar to that in invasive lobular carcinoma including a targetoid pattern, as well as a focus of in situ lobular carcinoma with transition to the histiocytoid cells. Immunohistochemical stainings of the tumor cells demonstrated positive reactions for cytokeratins and epithelial membrane antigen. Gross cystic disease fluid protein 15, an apocrine marker, was almost uniformly positive in their cytoplasm. From these results, we supposed that histiocytoid breast carcinoma is a variant of invasive lobular carcinoma. Histiocytoid breast carcinoma is easily misdiagnosed as a benign lesion such as granular cell tumor or xanthoma. Points of differential diagnosis were described and we stressed that it is most important for pathologists to keep this variant in mind in order to avoid misdiagnosis.     

乳腺小肿块的诊断、鉴别诊断及误诊原因分析

目的探讨乳腺小肿块高频超声图像的异同点,对照病理结果,提高超声对乳腺小肿块的诊断和鉴别诊断.方法取112例乳腺小肿块患者的高频超声声像图与病理结果对照分析.结果超声诊断均为纤维化,病理诊断间质纤维化1例,间质胶原化7例,囊肿21例,乳腺导管扩张17例,瘤样病变15例,单纯性小叶增生14例,囊性增生症12例(其中1例伴大汗腺化生),硬化性乳腺病9例,纤维腺瘤形成趋势9例,脂肪瘤6例,浸润性导管癌1例.本组诊断符合8例,符合率7.14%.结论高频超声在乳腺小肿块诊断中须抓住细小的特征性表现,以提高诊断符合率.     

Lobular breast cancer: how useful is breast magnetic resonance imaging?

RATIONALE AND OBJECTIVES: To review magnetic resonance imaging (MRI) findings in lobular breast carcinoma, the in situ or infiltrating subtype, with special attention to the dynamic curves with the aim to evaluate possible differences with ductal carcinoma. METHODS: In 2 years, 27 patients with lobular and one with tubular carcinoma underwent MRI at the Istituto Nazionale Tumori of Milan. RESULTS: All lobular carcinomas demonstrated early or late enhancement (100% sensitivity), without significant differences in morphology compared with ductal carcinoma, but frequently with a different shape of the dynamic curves. CONCLUSIONS: Due to its infiltrative growth associated to only limited connective tissue reaction, lobular carcinoma often encounters difficulties in mammographic diagnosis. In contrast, MRI can be very helpful in evaluating the true extension of the disease, especially when breast conservation is considered. Due to a more consistent fibrotic stroma, these lesions sometimes show a delayed enhancement, which suggests that more than one set of subtracted images should be evaluated during MRI analysis.     

Immunohistochemical study of the ras oncogene expression in human breast lesions

An immunohistochemical study of ras oncogene expression in human breast lesions was carried out using a monoclonal antibody, Y13 259, to the ras encoded p21 protein. A total of 75 cases of breast disease examined included: 33 simple and complex cystic disease; 22 simple and hyperplastic fibroadenomas; 18 ductal, lobular and mixed carcinomas and 2 in situ carcinomas. Most of the complex cystic disease, hyperplastic fibroadenomas and all types of carcinomas showed high p21 expression as indicated by staining intensity. These results suggest that elevated ras expression may play an important role in the development of some premalignant and malignant breast lesions.     

外耳道腺样囊性癌临床病理分析及文献复习

目的:探讨外耳道腺样囊性癌的临床病理特点,提高对该病的认识。方法:观察6例外耳道腺样囊性癌的组织学特点及免疫组化特性。结果:患者男性3例,女性3例,年龄41~68岁,平均年龄55岁,6例均有耳部疼痛,2例发生肺转移。肿物最大径0.8~4 cm,实性,无包膜,镜下均以筛状结构为主,伴有不同比例的管状和实性结构,4例见神经浸润,免疫组化CK和p63均阳性。结论:外耳道腺样囊性癌较少见,易发生肺转移,诊断靠病理诊断。