副乳腺癌38例临床与病理分析

目的：探讨副乳腺癌（accessory breast cancer）的临床病理特征、诊断、综合治疗和预后。方法：对我院本组1985年10月～2007年11月收治的38例副乳腺癌患者的临床病理特点、诊断、治疗方法和预后做了回顾性分析总结。结果：38例副乳腺癌占同期全部乳腺癌26078 例的0.15% 。本组病例中，6 例I 期患者和3 例Ⅱ期患者行保留乳房的肿物局部广泛切除加腋窝淋巴结清扫术，切缘病理阴性；余9 例Ⅱ期患者行改良根治术，Ⅲ～Ⅳ期患者行改良根治术或根治术。组织学类型中最常见的为浸润性导管癌18例（47.4%），其中3 例伴同侧乳头管腺瘤；单纯癌6 例，导管内癌6 例，腺癌伴灶性鳞癌分化3 例，髓样癌3 例，黏液腺癌2例。病理分期（根据AJCC乳腺癌分期，2002年第6 版）中最常见的为Ⅱ、Ⅲ期，各12例（31.6％）；Ⅰ期6 例，Ⅳ期8 例。全部患者随访1～23年，中位随访时间为6 年7 个月，随访率100% 。随访至2008年11月，12例发生远处转移并死于该病，余26例健在。本组5 年总生存率为35.3%（低于乳腺癌术后5 年生存率66.8% ，P<0.05），3 年为77.8% ；5 年无瘤生存率为28.6% ，3 年为63.6% 。结论：副乳腺癌是一种罕见且预后较差的恶性肿瘤。诊断主要依靠临床表现、影像学检查和术后病理诊断。应遵循以手术为主的综合治疗原则，术后辅助治疗有可能改善患者的生存期。

Clinicopathological Analysis of 38 Cases of Accessory Breast Cancer

Objective: To study the clinicopathological characteristics，diagnosis，multiple modality therapy and prognosis of accessory breast cancer. Methods: Clinical data of 38 patients with accessory breast cancer seen in our hospital between October 1985 and November 2007. Results: The 38 cases of accessory breast cancer accounted for 0.15% of all 26,078 breast cancer cases during the same period.Six patients of stage Ⅰ and 3 patients of stage Ⅱ underwent breast-conserving local wide excision of the tumor plus axillary lymph node dissection,with the resection margins pathologically negative.The other 9 cases of stage Ⅱ patients were treated with Auchincloss mastectomy.Stage Ⅲ and stage Ⅳ patients were treated with Auchincloss or Halsted mastectomy.The most common histological type of accessory breast cancer was infiltrating ductal Carcinoma for 18 patients(47.4%)，of which 3 cases were associated with adenoma of the nipple tube.There were 6 cases of carcinoma simplex，6 cases of intraductal Carcinoma，3 cases of adenocarcinoma with focal squamous cancer cells differentiation，3 cases of medullary carcinoma，and 2 cases of mucinous adenocarcinoma.The most common pathological stages(according to AJCC staging of breast cancer,2002.6th edition)were stage Ⅱ and Ⅲ in 12 cases(31.6%)，stage Ⅰ in 6 cases，and stage Ⅳ in 8 cases.All patients were followed-up for 1 to 23 years.The median follow-up time was 6 years and 7 months，and the follow-up rate was 100%.Until November 2008，12 patients died of metastasis and the other 26 patients were still alive.The 5-year overall survival rate was 35.3%.significantly lower than that of breast cancer patients(66.8%).The 3-year survival rate was 77.8%.The 5-year disease free survivaI rate was 28.6%and the 3-year disease free survival rate was 63.6%. Conclusion: Accessory breast cancer is rarely seen but is aggressive.The diagnosis mainly depends on clinical characteristics，postoperative pathology and imaging examinations.Early diagnosis is essential.Surgery combined with other adjuvant therapies can improve patient survival.