乳腺化生性癌的病理特征、复发和生存情况分析

目的:探讨乳腺化生性癌的病理特征、复发和生存情况。方法:选取我院于2002年1月至2015年12月期间收治的7例乳腺化生性癌患者临床病历资料进行回顾性分析,讨论乳腺化生性癌的病理特点和鉴别诊断、组织起源以及治疗预后等。结果:7例乳腺化生性癌PR、ER和HER-2均显示为阴性,广谱CK则显示为阳性;所有入选患者均显示EGFR阳性,其中有3例患者显示p53阳性,4例患者显示CK5/6阳性。此外,3例患者经腋窝淋巴结清扫后显示有2例患者出现腋窝淋巴结转移,4例患者经前哨淋巴结活检后结果:显示无癌转移。结论:乳腺化生性癌在临床上属于乳腺癌中较为罕见的亚型,其生物学行为和生存预后均不佳,HER-2和PR、ER等多显示为阴性,容易复发,目前主要治疗方法:为在手术治疗的基础上加以放射治疗。     

Colloid carcinoma of the breast with concomitant metastasis and a tuberculous lesion in the axillary lymph nodes. A case report.

A 30-year-old woman presented with a lump in the left breast and left axillary lymphadenopathy that, on fine needle aspiration cytology (FNAC), proved to be duct cell carcinoma with metastasis. Histology of the radical mastectomy specimen showed a mixed colloid carcinoma. Axillary lymph nodes revealed a variety of pathologic changes consisting of reactive hyperplasia, tuberculosis and metastasis. A combination of a tuberculous lesion and metastasis in the same lymph nodes was also found. During follow-up, after radiotherapy, the patient developed left supraclavicular and right cervical lymphadenopathy that, on FNAC, revealed a tuberculous lesion and metastasis, respectively. The rarity of this condition with double pathology is highlighted, and the reason behind the limitations of FNA in subtyping the primary malignancy and its failure to detect the tuberculous lesion in the axillary lymph node are discussed.     

Diagnostic value of fine needle aspirates processed by ThinPrep® for the assessment of axillary lymph node status in patients with invasive carcinoma of the breast

X. Jing, E. Wey and C. W. Michael Diagnostic value of fine needle aspirates processed by ThinPrep® for the assessment of axillary lymph node status in patients with invasive carcinoma of the breast Objective: To evaluate the utility of ThinPrep® as an optional specimen processing method for the detection of axillary lymph node metastasis of invasive breast carcinoma. Methods: A computer SNOMED search from the file at our institution between January 2003 and August 2011 retrieved a total of 209 fine needle aspiration (FNA) specimens of axillary lymph nodes prepared by ThinPrep and followed by axillary lymph node biopsy and/or dissection. Original cytological diagnoses and corresponding histological diagnoses were documented. Using the histological diagnoses as the gold standard, the diagnostic parameters including sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and diagnostic accuracy were calculated. Both cytology and histology slides from cyto‐histologically discrepant cases were reviewed. Results: Out of a total of 209 specimens, 193 (92%) had adequate diagnostic material while the remaining 16 specimens (8%) were inadequate for cytological assessment. The diagnostic specimens included 168 invasive ductal carcinomas (IDC), 15 invasive lobular carcinomas (ILC) and 10 mixed carcinomas (IDC and ILC). Excluding 19 cases with malignant cells on FNA in which no residual tumour was found in fibrotic lymph nodes after neoadjuvant therapy (cytology and histology confirmed on review) ThinPrep detected nodal metastasis with an overall sensitivity of 77.5%, specificity of 100%, PPV of 100% and NPV of 53.7%. Diagnostic accuracy was 82.2%. There was no difference in Bloom–Richardson grade or the number or size of metastases between tumours with true‐positive and false‐negative cytology. Sampling error was the sole factor contributing to cyto‐histological discrepancy. Conclusions: ThinPrep is a good alternative to the conventional smear for cytological assessment of axillary lymph node status in patients with invasive breast carcinoma, particularly when specimens are collected at remote sites or when cytologists are not available for assistance during FNA.     

乳腺癌腋窝淋巴结转移患者应用多普勒超声与CT的诊断价值比较

摘要 目的：探讨乳腺癌腋窝淋巴结转移患者应用多普勒超声与CT的诊断价值比较。方法：回顾性分析2017年3月至2019年3月我院接诊的60例经过手术病理证实的乳腺癌患者。比较多普勒超声与128排螺旋CT在乳腺癌腋窝淋巴结转移中的检出率、声像特征比较及两组灵敏度、特异度、准确度。结果：在术后经过病理证实的60例乳腺癌手术患者中,有38例为腋窝淋巴结转移,有22例未腋窝淋巴结转移,在多普勒超声诊断结果对乳腺癌腋窝淋巴结转移诊断中,36例得到确诊,在128排螺旋CT诊断中,30例得到确诊;多普勒超声皮质向心性生长、淋巴结内钙化灶、淋巴结横直径比值及淋巴结边界模糊检出率均显著高于128排螺旋CT检出率,差异显著（P＜0.05）;将病理结果作为金标准。多普勒超声灵敏度、特异度、准确度均比128排螺旋CT结果高,两组方式比较具有显著差异（P＜0.05）。结论：多普勒超声在乳腺癌腋窝淋巴结转移中诊断价值高,可帮助临床提供正确诊断,以选择合适的治疗方案。     

超声弹性成像技术对腋窝淋巴结性质的诊断价值

目的:研究超声成像技术对腋窝淋巴结性质的诊断价值。方法:从2013年5月至2014年2月,选择我院50例乳腺癌患者,对所有患者进行弹性成像技术检测出74个腋窝淋巴结。对所有腋窝淋巴结使用四分法进行评分,将其与手术病理结果进行比较。结果:74个腋窝淋巴结中,反应性淋巴结有42个,纵径为(0.9-2.4)cm,平均纵径为(1.31±0.33)cm;乳腺癌腋窝淋巴结转移个数为25个,纵径为(1.2±3.8)cm,平均纵径为(2.04±0.72)cm。良性淋巴结弹性评分大多为1分(54.55%)以及2分(27.27%),恶性淋巴结评分多为3分(63.33%)以及4分(20.00%)。恶性淋巴结评分为(3.12±0.61)分,良性淋巴结评分为(1.68±0.74)分,结果显示,两组淋巴结弹性评分具有较大差异(即P<0.05),具有可比性。结论:综上所述,超声弹性成像技术操作较为简便,效果较为直观,评分法能够提供组织的硬度信息,在临床工作中,与常规超声联合应用有利于提高评价腋窝淋巴结良恶性性质的准确度。值得临床推荐使用。     

Inclusions of benign nevus cells in the capsule of axillary lymph nodes in three cases of breast cancer

Three cases of breast carcinoma are reported in which the capsule of an axillary lymph node contained inclusions of benign-appearing nevus cells. The lesions were exclusively limited to the lymph node capsule without involvement of peripheric sinus or parenchyma. In one case, another lymph node presented a metastasis histologically identical to the primary neoplasm. The differential diagnosis with the carcinomatous metastasis and the possible origin of these inclusions are discussed.     

Metaplastic breast carcinoma. A diagnostic problem in fine needle aspiration biopsy.

Fine needle aspiration (FNA) was used to evaluate a breast lump and enlarged lymph nodes in a woman with a prior history of lumpectomy on the contralateral breast and a recent negative mammogram. The FNA cytologic findings included markedly atypical fibroblast-like cells lying singly and in groups in a myxoid background, highly atypical multinucleated cells and numerous mitoses, features that were interpreted as a high-grade malignant mesenchymal tumor. The carcinomatous cells in the aspirates were only fully appreciated after histologic examination of the mastectomy specimen and the axillary lymph node metastases showed a dual differentiation consisting of both epithelial and mesenchymal components, leading to a final diagnosis of metaplastic carcinoma. Electron microscopic study of histologic samples confirmed the dual differentiation, and both keratin and vimentin intermediate filaments were recognized by immunohistochemical staining. The regional lymph node metastases were predominantly sarcomatous, which apparently is a rare event. The entity of metaplastic carcinoma is discussed in relation to other mixed epithelial-mesenchymal lesions of the breast, and the previous literature on this entity is briefly reviewed.     

初诊腋窝淋巴结阳性乳腺癌新辅助化疗后对腋窝淋巴结转阴性前哨活检的影响分析

摘要 目的：探究对初诊腋窝淋巴结阳性乳腺癌行新辅助化疗患者开展腋窝前哨淋巴结活检的临床意义。方法：选择2017年1月至2020年10月于我院接受改良根治术或保乳术治疗的100例初诊腋窝淋巴结阳性乳腺癌患者,将其中50例病理检测II B、III期行4~8个疗程新辅助化疗后实施前哨淋巴结活检患者设为研究组,将50例I、II A期直接行前哨淋巴结活检患者设为对照组,对比两组患者前哨淋巴结检出率、准确率、假阴性率和灵敏度,同时就患者病理特征与前哨淋巴结检出率的相关性开展分析。结果：（1）比较显示研究组患者与对照组患者在前哨淋巴结检出数、前哨淋巴结检出率以及前哨淋巴结假阴性率方面组间差异不大（P>0.05）;（2）病理学特征分析显示肿瘤直径以及临床N分期同新辅助化疗后患者前哨淋巴结检出阳性率密切相关（P<0.05）。结论：对初诊腋窝淋巴结阳性行新辅助化疗乳腺癌患者实施前哨淋巴结活检具有较显示的临床意义,能够较好的预测患者腋窝淋巴结状况,同时化疗前肿瘤直径、临床N分期是影响前哨淋巴结检出率的重要影响因素。     

Fine needle aspiration cytology in lymphadenopathy of HIV-positive cases

OBJECTIVE: To evaluate the role of fine needle aspiration biopsy (FNAB) material in 25 HIV-positive cases with lymphadenopathy. STUDY DESIGN: We selected 25 cases for the present study who were enzyme-linked immunosorbent assay positive for HIV (HIV-1). FNAB was performed as a routine, outdoor procedure with informed consent of the patient. For each case, along with routine May-Grünwald-Giemsa and hematoxylin and eosin staining, Ziehl-Neelsen staining for acid-fast bacilli and periodic acid-Schiff staining for fungi were performed wherever necessary. RESULTS: A total of 28 sites were aspirated from 25 HIV patients. All these patients were heterosexual, and none had a history of drug abuse. FNAB was performed under ultrasound guidance in all four cases of a retroperitoneal group of lymph nodes. The most common FNAB diagnosis was reactive lymphoid hyperplasia (10), followed by tuberculosis (8). There were three cases diagnosed as fungal infection (two, Cryptococcus; one, histoplasmosis). FNAB of a case of lymph node was suggestive of tuberculosis. There was one case each diagnosed as non-Hodgkin's lymphoma and squamous cell carcinoma (metastatic). One case of a small axillary lymph node did not yield representative material. CONCLUSION: FNAB is a relatively inexpensive initial investigative technique in the diagnosis and management of HIV-positive patients. It can obviate the need for surgical excision and enable immediate treatment of specific infections.     

Clinical and pathological characteristics of occult breast cancer and review of the literature

Purpose: Occult breast cancer is defined as axillary metastasis without clinically and/or radiologically evident primary tumor. In female patients presenting with isolated axillary nodes with adenocarcinoma, the most likely primary cancer is an invasive breast carcinoma. Herein we present our experience over this issue, together with a brief review of the literature about this clinically challenging condition. Methods: We retrospectively analyzed 1215 consecutive breast cancer patients treated at our clinic between 2004- 2010. Four of these patients presented with axillary nodal metastasis without clinical and radiological evidence of a primary breast tumor. Results: The incidence of occult breast cancer in our clinic was 0.32%. Median follow-up was 8 months. All patients were alive and remained free of disease at the end of the follow-up period. Conclusion: The prognostic factors for occult breast carcinoma are similar to that of its overt counterpart. The number of axillary lymph node involved and the hormone receptor status are considered significant prognostic predictors. Further studies with randomization and longer followup are needed for the establishment of a safe management plan.     

Robinson cytologic grading of invasive ductal breast carcinoma: correlation with histologic grading and regional lymph node metastasis

OBJECTIVE: To evaluate the importance of cytologic grading of breast carcinoma and its association with histologic grading and the existence of axillary lymph node metastasis. STUDY DESIGN: Aspirates and surgical samples from 100 patients with invasive ductal breast carcinoma not otherwise specified were studied. In 50 patients, > or = 1 metastatic nodes were identified. The cytologic grade was evaluated using the Robinson method and the histologic grade using the Elston modification of the Bloom-Richardson method. A study was undertaken to establish the association between histologic and cytologic grades and to compare the various parameters used to evaluate cytologic grade with the presence of axillary node metastasis. RESULTS: A statistically significant association was observed between cytologic and histologic grades (p < 0.0005) and between cytologic grade and presence of axillary metastasis (p < 0.0005). Similarly, cell dissociation (p < 0.0005), cell uniformity (p = 0.0010) and the appearance of nuclear margins (p < 0.0005) all displayed a positive correlation with regional metastasis. CONCLUSION: Cytologic grade may provide relevant information on the aggressiveness of invasive ductal breast carcinoma and could be a useful parameter to take into consideration when selecting neoadjuvant therapy.     

Initial axillary staging of breast cancer using ultrasound‐guided fine needle aspiration: a liquid‐based cytology study

A. Schiettecatte, C. Bourgain, C. Breucq, N. Buls, V. De Wilde and J. de Mey
Initial axillary staging of breast cancer using ultrasound‐guided fine needle aspiration: a liquid‐based cytology study Objective: To evaluate the preoperative detection of axillary metastasis combining ultrasound (US)‐guided fine needle aspiration cytology (FNAC) and liquid‐based cytology (Surepath^®) to reduce sentinel node procedures. Methods: In total, 148 patients with clinically negative lymph nodes and no preoperative therapy were included. All patients underwent preoperative ultrasound of the axilla with FNAC if suspicious lymph nodes were found. Complete axillary lymph node dissection was performed at primary surgery when FNAC was positive. All other patients underwent a sentinel node procedure. Results: US‐guided FNAC of the axilla revealed metastasis in 34 (23.0%) of the 148 patients. These 34 patients were 53.1% of all patients (n = 64) with proven axillary lymph node involvement. In 66 patients (44.6%), both ultrasound and histopathology were negative. Overall sensitivity of US‐guided FNAC was 50.0%, specificity 100%, positive predictive value 100% and negative predictive value 70.2%. In T1 tumours, all patients referred for sentinel node procedure were node‐negative. The correlation between malignant FNAC and histopathology was 100%. US‐guided liquid‐based FNAC in patients with no clinically positive lymph nodes reduced the necessity for a sentinel node procedure by 23.0%. Conclusions: We advocate that US‐guided fine needle aspiration (FNA) combined with liquid‐based cytology of axillary lymph nodes should be included in the preoperative staging of breast cancer.     

P-gp、MMP-2、C-erbB-2在乳腺癌原发灶和转移淋巴结中的表达对比研究

目的：探讨乳腺癌侵袭转移和多药耐药之间的关系,为治疗方案的个体化提供依据。方法：采用免疫组化方法检测46例乳腺浸润性导管癌患者乳腺原发灶及相应腋淋巴结转移灶中P-gp、MMP-2、c-erbB-2的表达,结合临床表现、病理学指标,分析其相关性。结果：46例原发灶P-gp阳性表达35例（76.1%）,MMP-2阳性表达25例（54.3%）,c-erbB-2高表达18例（39.1%）;相应腋淋巴结转移灶P-gp阳性表达28例（60.9%）,MMP-2阳性表达16例（34.8%）,c-erbB-2高表达16例（34.8%）;P-gp、MMP-2蛋白表达水平与肿块大小、淋巴结转移数目均呈正相关（P〈0.05）,c-erbB-2蛋白表达水平与腋窝淋巴结转移数量呈正相关,与ER、PR表达呈负相关,P-gp阳性表达与MMP-2和c-erbB-2的表达呈正相关（P〈0.05）。结论：肿瘤原发灶与转移灶存在异质性,P-gp、MMP-2、c-erbB-2的表达与乳腺癌的多药耐药和侵袭转移有关,检测上述基因在原发灶与转移灶的表达,为乳腺癌选择个体化的化疗、内分泌治疗及分子靶向治疗提供了分子生物学依据。     

Predicting the response of localised oesophageal cancer to neo-adjuvant chemoradiation

Background

One of the most exciting and talked about new surgical techniques in breast cancer surgery is the sentinel lymph node biopsy. It is an alternative procedure to standard axillary lymph node dissection, which makes possible less invasive surgery and side effects for patients with early breast cancer that wouldn't benefit further from axillary lymph node clearance. Sentinel lymph node biopsy helps to accurately evaluate the status of the axilla and the extent of disease, but also determines appropriate adjuvant treatment and long-term follow-up. However, like all surgical procedures, the sentinel lymph node biopsy is not appropriate for each and every patient.

Methods

In this article we review the absolute and relative contraindications of the procedure in respect to clinically positive axilla, neoadjuvant therapy, tumor size, multicentric and multifocal disease, in situ carcinoma, pregnancy, age, body-mass index, allergies to dye and/or radio colloid and prior breast and/or axillary surgery.

Results

Certain conditions involving host factors and tumor biologic characteristics may have a negative impact on the success rate and accuracy of the procedure. The overall fraction of patients unsuitable or with multiple risk factors that may compromise the success of the sentinel lymph node biopsy, is very small. Nevertheless, these patients need to be successfully identified, appropriately advised and cautioned, and so do the surgeons that perform the procedure.

Conclusion

When performed by an experienced multi-disciplinary team, the SLNB is a highly effective and accurate alternative to standard level I and II axillary clearance in the vast majority of patients with early breast cancer.     

Breastfeeding and Immunohistochemical Expression of ki-67, p53 and BCL2 in Infiltrating Lobular Breast Carcinoma

Background/Aim

Invasive lobular breast carcinoma is the second most common type of breast cancer after invasive ductal carcinoma. According to the American Cancer Society, more than 180,000 women in the United States find out they have invasive breast cancer each year. Personal history of breast cancer and certain changes in the breast are correlated with an increased breast cancer risk. The aim of this work was to analyze breastfeeding in patients with infiltrating lobular breast carcinoma, in relation with: 1) clinicopathological parameters, 2) hormonal receptors and 3) tissue-based tumor markers

Materials and Methods

The study included 80 women with ILC, 46 of which had breastfeed their children. Analyzed parameters were: age, tumor size, axillary lymph node (N), distant metastasis (M), histological grade (HG), estrogen receptor (ER), progesterone receptor (PR), androgen receptor (AR), Ki-67, p53 and BCL2

Results

ILC of non-lactating women showed a larger (p = 0.009), lymph node involvement (p = 0.051) and distant metastasis (p = 0.060). They were also more proliferative tumors measured by Ki-67 (p = 0.053). Breastfeeding history did not influence the subsequent behavior of the tumor regardless of histological subtype

Conclusion

Lactation seems to influence the biological characteristics of ILC defining a subgroup with more tumor size, axillary lymph node involvement, distant metastasis and higher proliferation measured by ki-67 expression.     

Fine needle aspiration of follicular variant of papillary thyroid carcinoma presenting with pleural effusion: a case report

BACKGROUND: Malignant pleural effusion in association with mesothelioma, bronchogenic carcinoma and breast carcinoma is common, although less frequently reported with other malignancies. We report a follicular variant of papillary thyroid carcinoma (FVPTC), diagnosed on fine needle aspiration cytology (FNAC) of thyroid and lymph nodes and subsequently proved to have metastasized to the pleural cavity. CASE: A 46-year-old man presented with history of breathlessness, thyroid swelling, pleural effusion and bilateral cervical lymphadenopathy. FNAC of the thyroid swelling and the lymph nodes showed features of FVPTC with cervical lymph node metastasis. Pleural fluid examination led to suspicion of pleural involvement by metastatic deposit, confirmed by subsequent pleural biopsy. CONCLUSION: Thyroid malignancies presenting with pleural effusion are rare. In this case, although pleural fluid cytology suggested involvement of pleura, a definitive diagnosis could be rendered only on pleural biopsy. An ancillary aid, such as immunocytochemistry, could have helped establish pleural involvement on routine pleural fluid cytology alone. This case emphasizes the possible existence of rare cases of FVPTC that may be associated with a dismal prognosis. In our case, initial diagnosis of FVPTC could be made only on correlating FNA features of thyroid aspirate with those of lymph node aspirate.     

Sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer

The indication of neoadjuvant chemotherapy has been recently extended; it is now applied not only in locally advanced breast cancer but in primarily resecable tumours as well, in order to promote breast conservation. Based on recent clinical results, the reconsideration of traditional lymph node dissection in axillary staging is timely in patients receiving neoadjuvant chemotherapy. Precise axillary staging needs surgical removal of lymph nodes. Based on prospective randomised trials, sentinel lymph node biopsy appears to be appropriate for axillary staging even in tumours requiring neoadjuvant treatment. The extended indication of sentinel lymph node biopsy raises several questions and problems. In the present paper the authors review the results and possible limitations of sentinel lymph node biopsy in relation to neoadjuvant chemotherapy.     

The Significance of Regional Lymph Node Metastases in Breast Carcinoma

The significance traditionally attached to regional lymph node metastases has been questioned following a retrospective review of 922 patients with early breast cancer.Conservative surgical removal of axillary lymph node metastases and conservative irradiation of internal mammary lymph node metastases did not prejudice the five- and 10-year survival rates of patients so treated.Axillary lymph node recurrences had an ominous prognosis and occurred more commonly in the conservatively treated patients, yet survival rates were the same as those following radical mastectomy. Many axillary lymph node recurrences occurred more than five years after primary therapy, or with or after other evidence of reactivation of the breast cancer.It is suggested that breast cancer patients do not do poorly because they have regional lymph node metastases, but rather they have these metastases when they do poorly.     

Breast carcinoma and malignant melanoma metastasis within a single axillary lymph node

A 58 year old lady presented with a right breast cancer and a prior history of malignant melanoma excised from the right chest wall eight years previously. An abnormal axillary lymph node resected contained features of both metastatic breast carcinoma and malignant melanoma. Following oncologic breast cancer management, the patient is well with no evidence of recurrence at three years.