T_(1-2)期乳腺癌患者腋窝淋巴结生发中心和窦组织细胞增生与淋巴结转移的关系

Relationship between sinus histiocytosis and germinal center hyperplasia in axillary lymph nodes and lymph node metastases of breast cancer of T_(1-2) stage

目的探讨T1-2期乳腺癌患者腋窝淋巴结生发中心增生(GH)和窦组织细胞增生(SH)与淋巴结转移的关系。方法选取104例T1-2期乳腺导管癌患者,HE染色法检测腋窝淋巴结GH和SH情况以及腋窝淋巴结转移、癌细胞分化、癌周浸润和淋巴管浸润情况,免疫组织化学染色法检测乳腺癌组织雌激素受体、孕激素受体、p53、C-erb-B2和增殖细胞核抗原的表达,分析GH、SH及其他临床病理特征的关系以及GH和SH与淋巴结转移的关系。结果 32例(31%)患者有腋窝淋巴结转移,GH和SH均阳性者、GH和SH仅1个阳性者以及GH和SH均阴性者的淋巴结转移率分别为21%、73%和81%。GH和SH均阳性者与GH和SH均阴性者以及GH和SH仅1个阳性者淋巴结转移阳性的比例差异有统计学意义(P=0.017,P=0.041)。SH表现与p53表达相关(P=0.037),GH表现与SH表现相关(P=0.000)。结论 T1-2期乳腺癌SH的发生与乳腺癌组织p53表达相关,而GH的发生与SH的发生相关。SH和GH同时发生可抑制乳腺癌淋巴结的转移,提示预后较好;而SH或(和)GH阴性提示较高的术后复发可能,需加强术后辅助化疗。

Objective To explore the relationship between sinus histiocytosis（SH） and germinal center hyperplasia（GH） in axillary lymph nodes and lymph node metastases of breast cancer of T1-2 stage. Methods One hundred and four cases of breast ductal cancer of T1-2 stage were selected,SH and GH in axillary lymph nodes,axillary lymph node metastases,cancer cell differentiation,peri-tumor invasion,and lymphatic duct invasion were examined by HE staining.Expressions of estrogen receptor,progesterone receptor,p53,C-erb-B2,and proliferating cell nuclear antigen were detected by immunohistochemical staining.The relationship among GH,SH and the other clinicopathological characteristics and between GH and SH and lymph node metastases was analysed. Results Thirty-two cases（31%） had axillary lymph node metastases.The rates of lymph node metastases in cases with positive GH and SH,positive GH or SH and negative GH and SH were 21%,73% and 81%,respectively.There were significant differences in the percents of cases with lymph node metastases between those with positive GH and SH and those with positive GH or SH（P=0.041） and between those with positive GH and SH and those with negative GH and SH（P=0.017）.SH was related to the expression of p53（P=0.037）,and GH was related to SH（P=0.000）. Conclusion SH is related to the expression of p53,and GH is related to SH in breast ductal cancer of T1-2 stage.The combination of positive GH and positive SH may suppress metastases of breast ductal cancer to lymph nodes,and may predict a better prognosis,while those with negative GH and（or） negative SH may have a high risk of relapse and need enhanced chemotherapy after mastectomy.