乳腺Paget's病的临床病理分析  

Clinical and Pathological Analysis of Paget' s Disease

作　　者：李越[1] 王欣[1] 于治灏[1] 赵颖[1] 宁连胜[1] 曹旭晨[1] 

机构地区：[1]乳腺癌防治教育部重点实验室天津市肿瘤防治重点实验室天津医科大学附属肿瘤医院乳腺一科,天津市300060

出　　处：《中国肿瘤临床》2009年第17期980-982,共3页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨有关乳腺Paget’s病的发生机制,临床特点,治疗原则及预后情况,使该病的诊治更趋合理。方法:回顾性分析我院1998～2008年收治的48例乳腺Paget’s病患者的临床资料。结果:48例患者中位年龄56.5岁,以乳头乳晕糜烂结痂为唯一症状者24例,合并乳头溢液者11例,伴有乳头回缩或消失者5例,合并瘙痒者3例,单纯肿物者2例,乳头糜烂伴肿物者3例。38例患者合并有乳腺癌,其中合并导管内癌34例,合并浸润性导管癌4例,单纯Paget’s病10例。38例行乳腺癌根治术,7例行全乳+低腋窝淋巴结清扫术,1例行单纯乳腺切除术,2例未手术,其中ER、PR阳性7例,HER-2阳性19例。结论:大多数乳腺Paget’s病伴有导管内癌或浸润性导管癌,有乳腺肿块的患者合并浸润性导管癌的可能性更大,预后更差,且浸润性癌多伴有ER、PR阴性,HER-2阳性,预示预后较差,因而治疗应更为积极。Objective： To explore the mechanism, clinical features, treatment and prognosis of Paget＇s disease. Methods： A total of 48 Paget＇ s disease cases diagnosed and treated in our hospital between 1998 and 2008 were retrospectively reviewed. Results： The average age of these 48 patients was 56.5 years. Twenty-four cases presented with a single symptom of nipple-areola complex erosion and scab, while 11 cases had nipple-areola complex erosion and nipple discharge, 5 cases had nipple recovery or disappearance, and 3 cases had pruritus. Two cases were diagnosed based on a lump and 3 cases were diagnosed on the basis of nipple erosion and a lump. Of these 48 cases, 38 also had breast cancer, 34 of which were ductal carcinoma in situ and 4 of which were invasive ductal carcinoma. Ten cases were simple Paget＇ s disease. Thirty-eight cases underwent mastectomy, 7 cases received breast and low axillary lymph node dissection and 1 case received simple breast adenectomy. Two cases had no treatment. Of the 48 cases, 7 had positive expression of ER and PR and 19 cases had positive expression of Her-2. Conclusion：Most breast Paget＇s disease cases were combined with ductal carcinoma in situ or with invasive ductal carcinoma. Paget＇ s disease cases with breast lumps are more likely to have invasive ductal carcinoma. Invasive carcinoma tumors usually express ER and Her-2 and do not express PR, suggesting a poor prognosis and an immediate need for appropriate treatment.

关 键 词：乳腺Paget’s病 治疗 预后 

分 类 号：R737.9[医药卫生—肿瘤] R323.23[医药卫生—临床医学]