乳腺Paget病14例临床病理分析

Clinical and pathological analysis of 14 cases Paget disease

目的:探讨乳腺Paget病的流行病学、临床、病理特点。方法:收集1994～2004年14例经病理诊断为乳腺Paget病的资料,从发病率、发病年龄、临床表现、病理及预后等方面加以分析与研究。结果:乳腺Paget病的发病率为0.9%,高发年龄为40～52岁,临床表现以乳头病变为首发症状,病理检查显示Paget细胞CK8表达阳性率为100%、cerbB-2表达阳性率为91.67%,而ER、PR表达阳性率为16.67%。CK-8、cerbB-2、ER及PR中每一标记物在Paget细胞和同一病例深部癌组织中阳性表达一致。总的5、10年生存率分别为81.82%和72.73%。结论:乳腺Paget病作为乳腺癌的一种特殊类型,多与乳腺癌同时存在,CK-8阳性表达率100%表明乳腺Paget病的Paget细胞来源于深部的癌组织,cerbB-2阳性表达率高于不伴有Paget病的乳腺癌,而ER、PR阳性表达率低于不伴有Paget病的乳腺癌,提示乳腺Paget病预后不良。内分泌治疗效果可能不如不伴有Paget病的乳腺癌好,并且预后可能很差。

Objective：To understand the clinical and pathological features of Paget disease.Methods：From 1994 to 2004,14 eases Paget disease were analysed in clinical and pathological features.Results：Paget＇s disease accounted for 0.9 percents of the total number of breast cancer patients treated in the same period of time. The mean age of patients was 46 years ,in the clinic behavior, the first symptom was the nipple change . Paget cells were positive for CK-8 （100%） ,Paget cells were positive for eerbB-2 （91.67%）, ER and PR were 16.67%. The rate of expression of these molecular markers was similar in both Paget cells and the underlying intraduetal and/or duetal carcinoma eells.5-year and 10-year survival rate was 81.82% and 72.73%.Conclusion：Paget disease, as a special form of breast cancer, may accompany the breast cancer. All of paget cells are positive for CK-8,which illuminate the intraepidermal Paget cells root in the underlying carcinoma. The rate of positive cells for cerbB-2 is higher in Paget disease than the breast cancer,but one of positive cells for ER and PR is lower than the breast cancer. The outcome shows that Paget disease may be of no effect for endocrine therapy and prognosis is poor.