乳腺Paget病的临床诊断与治疗  

Clinical diagnosis and treatment of Paget disease of breast

作　　者：何宇 余育俊 贾曾荣[1] 王琛 黄瀚章 黄国裕 韩少良[1] He Yu;Yu Yujun;Jia Zengrong;Wang Chen;Huang Hanzhang;Huang Guoyu;Han Shaoliang(Department of General Surgery, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang Wenzhou 325000, China)

机构地区：[1]温州医科大学附属第一医院外科,325000

出　　处：《中国医师进修杂志》2019年第8期697-700,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨乳腺Paget病的早期诊断和治疗方法。方法回顾性分析1995年1月至2018年6月温州医科大学附属第一医院收治的26例乳房Paget病患者的临床资料。结果26例患者中,主要临床表现为乳头湿疹样改变19例(73.1%)、伴乳头溢液9例(34.6%)及乳腺肿块6例(23.1%)。本病确诊分别通过刮片细胞学4例(15.4%)、活检8例(30.8%)及针吸细胞学或切除后病理检查14例(53.8%)。单纯乳头Paget病3例(11.5%),伴导管内癌18例(69.2%)及伴浸润性导管癌5例(19.2%)。病理TNM分期分别是0期19例(73.1%),Ⅰ期3例(11.5%),Ⅱ期2例(7.7%),Ⅲ期2例(7.7%)及Ⅳ期0例。实施乳腺癌根治术2例,改良根治术18例,单纯乳房切除术4例,乳房切除+低位腋窝淋巴结切除+术中快速冰冻检查2例。术后采用CEF(环磷酰胺+表柔比星+替加氟)/EC(表柔比星+环磷酰胺)+T(多西他赛)或TP(多西他赛+顺铂)方案实施辅助化疗14例,曲妥珠单抗靶向治疗2例、辅助放疗5例。除1例失访外,其他25例患者随访8~108个月,5年生存率为96.0%(24/25),10年生存率为52.0%(13/25)。结论乳房Paget病确诊依赖细胞学或病理学检查,而治疗则根据肿瘤分期、合并其他类型乳腺癌及有无腋窝淋巴结转移等,选择手术为主的综合治疗。Objective To investigate early diagnosis and treatment of Paget disease of breast. Methods The clinicopathological data of 26 cases of breast Paget disease in the First Affiliated Hospital of Wenzhou Medical University from January 1995 to June 2018 was analyzed. Results The main clinical manifestation of 26 patients was eczema like papillae in 19 cases (73.1%), and associated with nipple discharge in 9 cases (34.6%) and breast mass in 6 cases (23.1%). The diagnosis of this disease was based on curettage cytology in 4 cases (15.4%), biopsy in 8 cases (30.8%), and needle aspiration cytology or post resection pathological examination in 14 cases (53.8%). Paget disease consisted of simple papillary Paget disease in 3 cases (11.5%), ductal carcinoma in 18 cases (69.2%) and invasive ductal carcinoma in 5 cases (19.2%). Pathological TNM staging was 0 stage in 19 cases (73.1%), stage Ⅰ in 3 cases (11.5%), stage Ⅱin 2 cases (7.7%), stage Ⅲ in 2 cases (7.7%) and no stage in Ⅳ case. In this group, 2 cases underwent radical mastectomy, 18 cases underwent modified radical mastectomy, 4 cases underwent simple mastectomy, and 2 cases underwent mastectomy combined with low axillary lymph node dissection and intraoperative rapid frozen examination. Fourteen patients received adjuvant chemotherapy with CEF(cyclophosphamide+ pharmorubicin+tegafur)/EC(pharmorubicin+cyclophosphamide)+T(docetaxel) or TP(docetaxel+cis-platinum)regiment after operation, 2 cases were treated with trastuzumab targeted therapy and 5 cases with adjuvant radiotherapy. Twenty-five of 26 patients were followed up for 8-108 months except one patient lost in follow-up. The 5-year survival rate was 96.0%(24/25), and the 10-year survival rate was 52.0%(13/25). Conclusions The diagnosis of Paget disease of the breast depends on cytology or pathology, and multidisciplinary treatment based on surgery is judged of by tumor stage and coincident other types of breast cancer and axillary lymph node involvement.

关 键 词：PAGET病 乳头湿疹样乳腺癌 治疗结果 

分 类 号：R737.9[医药卫生—肿瘤]