乳腺原发性印戒细胞癌的临床和病理分析 - 第三军医大学学报.docVIP

乳腺Paget病复杂临床特征分析 曾朋12，胡薇1*，盛湲1，施俊义1，苏东玮1，刘夕水1 1.第二军医大学长海医院甲乳外科 上海 200433 2武警江西省总队医院外一科，南昌 330030 摘要 目的 探讨乳腺Paget病的临床、病理特点，重视鉴别诊断，指导治疗。方法 观察2007年初到2010年初收治的16例乳腺Paget病的临床表现以及病理和免疫组化特点，并与Bowen病、黑色素瘤鉴别。结果 乳腺Paget病经常合并浸润性乳腺癌。本组合并乳腺浸润性导管癌约50%，伴导管原位癌25%，有淋巴结转移者31.25%。其免疫组化结果，ER和/或PR20%者仅12.5%，HER-2强阳性（+++）达56.25%。行改良根治术9例，行全乳单纯切除5例，行象限切除术2例。结论 乳腺Paget病并非少见，有着特征性的皮损，结合病理易于诊断，但须注意有无合并浸润性乳腺癌，同时需要与Bowen病及黑色素瘤等疾病鉴别，以免影响治疗方案的决定。 关键词 乳腺肿瘤；Paget病；病理学；诊断 Paget disease of the Breast：complex clinical study.Zeng Peng12, Hu Wei1*, Sheng Yuan1, Shi Junyi1, Su Dongwei1, Liu Xishui1. Department of thyroid and breast, Changhai Hospital, Second Military Medical University, Shanghai 200433 The First Department of Surgery, General Hospital of Armed Police Forces Jiangxi Regional Headquarters, Nanchang , 330030 [Abstract] Objective To explorer the clinical manifestation and pathological features and differential diagnosis of the breast Paget disease for an appropriate management．Methods 16 cases of Paget disease of the breast from January 2007 to January 2010 were retrospectively analyzed．Results There are 14 cases associated with a breast cancer(87.5%) and 5 cases(31.25%) had associated positive axillary node．The results of immunohistochemistry, ER and / or PR 20% was only , HER-2 +++ up to 56.25%. Definitive treatment consisted of modified radical mastectomy in 9 patients, mastectomy in 5 patients and quadrant resection in 2 cases．Conclusion Persisting eczematoid changes of the nipple-areola complex is a suspicious symptom for Paget disease of the breast. With pathological features, it was easy to differential diagnose Paget disease of the breast with Bowen disease and melanoma. [Key words] breast cancer, Paget disease, pathology, diagnosis 字典 乳腺Paget病(Paget disease of the breast)，主要表现为乳头-乳晕区的癌，呈湿疹样改变，故又称湿疹样癌，临床少见。现回顾性分析我院2007年初到2010年初收治的16例乳腺Paget病的临床资料，探讨乳腺Paget病的临床、病理特点，以及鉴别诊断要点，以提高对本病的诊断，采取恰当的治疗。 1 资料与方法 1．1 一般资料 本院2007年初到2010年初收治了16例乳腺Paget病，患者均为女性，年龄46～78岁（60.2510.92），中位57.5