导管内恶性肿瘤的乳管镜下表现分析

Ductoscopic Manifestations of intraductal malignant tumor

目的初步总结、分析、探讨导管内恶性肿瘤的乳管镜下表现类型,以提高认识,指导临床乳管镜检查时病变性质的判定。方法回顾性总结我院2005年12月～2007年6月内行乳管镜检查的273例乳头溢液患者临床及镜下表现资料,诊断导管内恶性肿瘤13例(乳头状瘤恶变4例),对镜下表现分析、归类。结果13例导管内恶性肿瘤镜下表现可分为三种类型:①球形、桑椹形或草莓形,与良性乳头状瘤不易鉴别,本组4例;②不规则形,伴有水泡样改变或葡萄样改变,本组5例;③管壁不规则隆起,本组4例。全组多发肿瘤7例,单发6例。结论①导管内癌镜下表现多样,部分肿瘤与良性病变镜下鉴别困难;②水泡样或葡萄样改变,以及不规则隆起增厚伴周围管壁僵硬在导管内癌诊断中有一定意义,值得进一步的探讨研究;③对乳管镜发现的导管内占位病变,应积极手术;④乳管镜发现乳管内多发占位性病变,应积极手术。

Objective To analyse and discuss the manifestations of intraductal malignant tumor showed by breast ductal scopy, and to increase the diagnosis accuracy of such diseases. Methods We retrospectively reviewed the clinical data and ductoscopic manifestations of 13 cases of intraductal malignant tumors in our hospital from December 2005 to June 2007. Results Three categories were classified to describe the 13 cases. Firstly, 4 cases appeared as bulbiform or mulberry -shaped, and difficult to be distinguished from benign tumors. The second category was irregular tumor accompanied with blisters or grape-shaped change, and 5 cases involved. Finally, another 4 cases displayed as irregular uplift and rigidity of duct wall and without typical tumors. Conclusion Intraductal malignant tumors show variable manifests with ductoscopy, some of them are difficult to distinguish from benign tumors. Blisters - or grape -shaped change and irregular uplift and rigidity of duct wall are significative in diagnosing intraductal malignant tumor and are worthy further study. Surgical excision is needed for all intraductal tumors.