Clinical Research of 106 Cases of Intraductal Papillomary Tumor
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摘要: 目的:探讨乳腺导管内乳头状肿瘤的临床表现、病理类型与治疗方法。方法:回顾分析106例女性乳腺导管内乳头状肿瘤病例,探讨其临床表现、病理类型及治疗方法。病理诊断依据2003年WHO《乳腺和女性生殖系统肿瘤的病理学和遗传学》有关乳腺导管内乳头状肿瘤分类标准。结果:106例乳腺导管内乳头状肿瘤临床表现:乳头溢血最常见,占56.6%(60/106);其次为乳房肿块,占30.2%(32/106);同时有乳头溢血和乳房肿块者,占13.2%(14/106)。病理结果:中央型导管内乳头状瘤38例(35.8%),周围型导管内乳头状瘤42例(39.6%),非典型乳头状瘤7例(6.6%),导管内乳头状癌、囊内型乳头状癌及浸润性乳头状癌19例(17.9%)。年龄>50岁的导管瘤病例,恶性占54.3%(19/35);病变位于二级以下导管,恶性占40.4%(23/57);钼靶片提示伴有钙化的,恶性占46.5%(20/43);既往有导管瘤病史者,恶性占55.2%(16/29);均有统计学意义。治疗方法:1)导管及周围腺体区段切除;2)大区段、象限或全乳切除;3)乳癌改良根治术。结论:术前精确定位是手术成功的关键。对于年龄>50岁,钼靶显示有钙化,病灶位于二级以下导管和既往有导管瘤病史的乳腺导管乳头状肿瘤,恶变机率高,以手术切除病变组织为治疗原则,手术后应严密观察,定期随访。Abstract: Objective: To study the pathological type and therapy of intraductal papillomary tu-mor. Methods: To review 106 cases female intraductal papillomary tumor in our department and inves-tigate their clinic symptom 、 pathological type and therapy way. Pathological type criteria are followedas the criteria which were made by WHO in 2003. Results: Nipple bloody discharge is most common,56.6%(60/106), secondly breast lump, 30.2%(32/106) and thirdly both, 13.2%(14/106) among 106 casesfemale intraductal papillomary tumor clinic symptoms. There are 38 cases central intraductal papilloma(35.8%), 42 cases intraductal papilloma(39.6%), 7 cases intraductal papilloma with atypical hyperplasia(6.6%), 19 cases invisive papillomary carcinoma (17.9%) among pathological types. The rate of malig-nant disease in breast is 54.3% among intraductal papilloma over 50 years, 40.4% in secondary ductabove, 46.5% with microcalcification, 55.2% with the past papilloma,all having statistical significance.Therapy ways include: 1) Duct lesion and surrounding tissue excision; 2) Big section 、 dimension or totalbreast excision; 3) Modified radical mastectomy. Conclusion: The key to success of operation is preciselocation preoperation. The carcinogenesis rate is high in papilloma which lesions lie above secondary duct or accompanying with calcification or having past papilloma. The treatment principle is surgical excision, and all patients should be given closely observation and regular follow-up visits.
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Keywords:
- intraductal papilloma tumor /
- pathological type /
- threapy
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[1] 1 李树玲, 主编 . 乳腺肿瘤学 [M]. 北京 : 科学技术文献出版社,2000.63-83.
2 张式暖, 王艳华, 戚文明, 等 . 乳腺乳头状瘤病及其癌变的病理组织学研究 [J]. 潍坊医学院学报,1998,20(2):107-108.
3 Page DL, Salhany KE, Jensen RA, et al. Subsequent breast carci-noma risk after biopsy with atypia in a breast papilloma [J]. Can-cer, 1996, 78(2): 258-266.
4 田艳涛, 李树玲, 傅西林 . 乳腺乳头状瘤病及其癌变的全乳腺切片病理组织学研究 [J]. 中华肿瘤杂志,1997,19(4):290-292.
5 刘 红, 范 宇, 惠 锐, 等 . 乳腺乳头状瘤病癌变的临床诊治 [J]. 中国肿瘤临床,2001,28(6):425-427.
6 张传山, 程 虹, 译 .WHO 肿瘤病理学及遗传学分类乳腺肿瘤(2003)[M]. 北京 : 诊断病理学杂志社,2005.52-55.
7 Sakorafas GH, Tsiotou AG. Ductal carcinoma in situ (DCIS) ofthe breast: evolving perspectives [J]. Cancer Treat Rev, 2000, 26(2): 103-125.
8 Hungermann D, Decker T, Burger H, et al. Papillary tumors of the breast[J]. Pathologe, 2006, 27(5): 350-357.
9 Rabban JT, Koerner FC, Lerwill MF. Solid papillary ductal carci-noma in situ versus usual ductal hyperplasia in the breast: a po-tentially difficult distinction resolved by cytokeratin 5/6 [J]. HumPathol, 2006, 37(7): 787-793.
10 Douglas-Jones A, Shah V, Morgan J, et al. Observer variability inthe histopathological reporting of core biopsies of papillary breast lesions is reduced by the use of immunohistochemistry for CK5/6,calponin and p63[J]. Histopathology, 2005, 47(2): 202-208.
11 Tse GM, Tan PH, Lui PC, et al. The role of immunohistochem-istry for smooth-muscle actin, p63, CD10 and cytokeratin 14 inthe differential diagnosis of papillary lesions of the breast [J]. ClinPathol, 2007, 60(3): 315-320.
12 牛 昀, 李 妤, 牛瑞芳, 等 .E2F-1 和 Rb 基因表达与乳腺乳头状瘤病及导管内癌的相关性 [J]. 中华肿瘤杂志,2004,26(5):290-293.
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