乳腺髓样癌108例临床分析

Medullary Carcinoma of the Breast:An Analysis of 108 Cases

本文收治女性乳腺髓样癌１０８例，占同期１２年间收治乳腺癌的８．５％。年龄２８～８０岁，中位年龄５３岁。Ⅰ期２０例，Ⅱ期６０例，Ⅲ期２５例，Ⅳ期３例。８８例行了传统根治术，１５例行了改良根治术，５例行了乳腺单纯切除术。腋淋巴结转移阳性为４３．５％。本组５．１０年生存率分别为８４％，７３％。其中典型髓样癌、不典型髓样癌５年、１０年生存率分别为８９．４％、７６．５％；８１％、６０％（Ｐ＞０．２５）。作者认为髓样癌是乳腺癌中较常见的一种病理类型，发病年龄较大，临床上多表现为乳腺内无痛性肿块，边界多较清楚，似有包膜，故与乳腺良性肿瘤较难鉴别，且易误诊。作者提出，对３５岁以上的女性乳腺内肿块，均应常规进行钼靶Ｘ线检查，细针穿刺细胞学涂片以明确诊断，必要时进行术中冰冻，以免延误诊断和治疗。

108 cases of medullary carcinoma of the breast were treated from May 1984 to May 1996.It accounted for 8.5% of all breast cancers during the Same Period.All Cases were diagnosed by Pathology and were females.The age ranged from 28 to 80 years with an average of 53 years.There were 20 stage Ⅰ,60 stageⅡ,25 stage Ⅲ,3 stageⅣ.88 cases underwent radical mastectomy,15 modified radical mastectomy,5 mastectomy only.43.5% of patients with positive anxielary nodes was discovered.of 81 cases All were five year follow-up,26 ten year follow-up.The five and ten year survivived rates were 84%,73%. 56.5% Of 108 cases was medullary carcinoma,atypical medullary only in 43.5 %.The five and ten years suruival rates were 89.4%,76.5% and 81.3%, 60%(P>0.25). We suggest the medullary carcinoma is a more histologic tape of breast cancer.In clinical.it usually presents a non pain palpable mass with a clear edge and is misdiagnosed for fibroadenoma.Typical medullary carcinoma is demonstrated by lymphocytic infiltration.It may be an indicator of host response.The prognosis is better.Author thinks the correct preoperative diagnosis is especially important for a tumor in the breast for patients over 35 years of age.Mammographic examination and fine needle aspiration cytology is helpful.when it was suspicious,frozen section during operation can be done.