乳腺黏液癌的临床、影像学及其组织病理学特征分析  

Analysis of Clinical, Image Features and Histopathology in Breast Mucinous Carcinoma

作　　者：陈琮瑛[1] 傅建民[2] 袁鹰[1] 余容[1] 赵弘[3] 黄犁[4] 李胜利[1] 

机构地区：[1]南方医科大学附属深圳妇幼保健院超声科,深圳518028 [2]南方医科大学附属深圳妇幼保健院乳腺外科,深圳518028 [3]南方医科大学附属深圳妇幼保健院放射科,深圳518028 [4]南方医科大学附属深圳妇幼保健院病理科,深圳518028

出　　处：《中华妇幼临床医学杂志（电子版）》2012年第6期605-609,共5页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：深圳市医学科研基金项目(201102093)~~

摘　　要：目的探讨乳腺黏液癌的临床、影像学特征及其组织病理学的相关性分析,旨在提高乳腺黏液癌的早期诊断率。方法选择2008年1月至2011年12月于南方医科大学附属深圳妇幼保健院接受右侧乳房全切除术+右腋窝淋巴结切除术,或右侧保留乳头乳晕全乳切除术+右腋窝淋巴结切除术,及经病理学检查证实为乳腺黏液癌的21例患者,共计22个乳腺癌病灶(1例为双侧乳腺黏液癌)为研究对象。回顾性分析术后22个乳腺黏液癌病灶的临床、超声、影像学特征及与组织病理类型间的关系(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,并征得受试对象的知情同意)。结果 22个乳腺黏液癌病灶中,单纯型为14个(富细胞型为6个,少细胞型为8个),混合型为8个。主要临床表现为,81.8%(18/22)病灶以发现乳腺肿块1～12个月就诊,仅14.2%(3/21)患者为体检时X射线摄片提示钙化而就诊。超声检查提示,所有患者均存在无假包膜的实性肿块,85.7%(12/14)的单纯型肿块为边界清楚,回声等于或略低于皮下脂肪回声,其中92.9%(13/14)的单纯型病灶后方回声增强。75.0%(6/8)的混合型和14.3%(2/14)的单纯型乳腺黏液癌显示为肿块边界较模糊并细小毛刺,内部回声较脂肪回声低,两者比较,差异有统计学意义(P=0.008)。超声和X射线摄片检查提示术前疑恶性比例均为63.6%(14/22)。X射线摄片表现为,肿块为10个,局限性不对称致密影为2个,结构扭曲并恶性钙化和单纯不定性钙化各为1个。肿块主要为高密度,单纯型者边界清楚或呈浅分叶,混合型者边界不规则和毛刺改变。81.8%(18/22)的病灶被超声或X射线其中之一疑似为恶性。45.5%(10/22)的病灶术前超声和X射线摄片均疑似为恶性。结论乳腺黏液癌以肿块为主要临床表现。乳腺黏液癌,尤其是单纯型不具备典型乳腺癌恶性肿块的影像特征,超声和X射线摄Objective To investigate dinical, image features and histopathology of breast mucinous carcinoma in order to improve the early diagnosis of breast mucinous carcinoma. Methods From January 2008 to December 2011, twenty-one patients with 22 focuses mucinous carcinomas of the breast who were confirmed by pathology were included in this study. Mammogram and sonographic features were retrospectively evaluated according to the American College of Radiology （ACR） Breast Imaging Reporting and Data System （BI-RADS） Lexicon, all cases were classified by BI-RADS. Histological types of breast mucinous carcinoma included two forms, mixed and pure type. The latter was classified into cellular variants and hypocellular variants. The correlation between the mammogram and ultrasonographic findings of mucinous carcinoma and histologic features in different types were analyzed. Results Histological types of breast mucinous carcinoma included 8 mixed type and 14 pure type （6 cellular variants and 8 hypocellular variants）. The clinical manifestation were as follow, 81.8%（18/22） of cases presented mass as main complains, only 3 cases complained of calcification by mammogram during routine breast carcinoma screening. About ultrasonography examination, all 21 cases presented as solid mass. In pure form, they showed well-defined margins with no pseudocapsule and isoechogenic or hypoechoic internal echo pattern relative to that of subcutaneous fat in 85.7% （12/14） focuses which histological type were pure type. Ninetytwo point nine percent of pure type focuses had posterior enhancement. Seventyfive percent （6/8）of mixed type focuses and 14.3%（2/14） of pure type focuses, however, demonstrated illdefined and or spiculated margins with hypoechogenic structure. Sixtythree point six （14/22） percent of cases being classified as BIRADS 4 or 5 were suspected as malignancy by ultrasonography and Mammograms respectively. These mammograms features contained 10 masses, 2 focal asymmetrys, one architectur

关 键 词：乳腺 黏液癌 超声 X射线 

分 类 号：R737.9[医药卫生—肿瘤]