乳腺癌新辅助化疗前后病理组织学的变化

Histopathological changes of breast cancer after neoadjuvant chemotherapy

目的观察乳腺癌新辅助化疗前后的病理组织学改变。方法选择经粗针穿刺确诊的乳腺癌患者56例,采用FEC方案行新辅助化疗,完成2-3周期后再行手术治疗。手术后通过肿瘤分级、肿瘤坏死、炎细胞浸润、间质出血、纤维化等指标对化疗前后组织学标本进行比较评价。结果新辅助化疗后肿瘤完全消失1例,肿瘤实质细胞呈不同程度的蜕变,如肿瘤细胞坏死、原位癌结构形成、瘤巨细胞形成、肿瘤细胞胞浆空泡化。间质变化包括间质水肿、坏死、出血、玻璃样变性、钙化、纤维化和炎细胞浸润等。结论新辅助化疗不仅产生肿瘤细胞的坏死,也可导致瘤巨细胞形成。新辅助化疗对肿瘤间质也有明显的影响。

Objective To evaluate histopathological changes of breast cancer after neoadjuvant chemotherapy. Methods Evaluation of histopathological changes was carried out restrospectively in 56 patients with breast cancer who undertook neoadjuvant chemotherapy. The diagnosis of breast cancer was identified by core needle biopsies before chemotherapy. All patients received neoadjuvant FEC chemotherapy for 2 to 3 cycles followed by mastectomy or conserving-breast surgery. The histopathalogical changes were compared between the pre- and post-chemotherapy specimens based on necrosis, edema, inflammatory infiltrate, bleeding, fibrosis in tumor. Results One patient got complete pathologic response that the tumor disappeared. A significant histopathologic changes including necrosis, giant epithelial tumor cells, ductal carcinoma in situ and cytoplasmic vacuolation in tumor ceils were observed after neoadjuvant chemotherapy as well as edema, necro- sis, fibrosis, hyaline degeneration, inflammatory infiltrate in interstitium. Conclusions Neoadjuvant chemotherapy resulted in not only parenchymatous changes such as necrosis, giant epithelial tumor cells, but also interstitial part changes in breast cancer.