44例隐匿性乳腺癌临床分析

Diagnosis and treatment of occult breast cancer in 44 cases

目的分析隐匿性乳腺癌的诊断、治疗及预后情况，总结其诊断和治疗经验。方法回顾性分析44例隐匿性乳腺癌患者的临床资料，44例隐匿性乳腺癌患者中，16例行乳腺癌根治术，19例行乳腺癌改良根治术，1例行保留乳腺的腋下淋巴结清扫，8例仅行腋下肿物切除。结果在接受乳腺癌根治术的35例患者中，有4例（11．4％）在术后病理切片中发现原发灶，原发灶的最大直径为0．6～2．5cm，其中3例为浸润性导管癌，1例为黏液腺癌；另有3例可在标本中见不典型增生。全组有38例患者获得随访，随访时间为12—132个月。32例行手术治疗且获得随访的患者中，2例死亡，3例术后局部复发并带瘤生存；未接受进一步手术治疗患者中，有2例分别于确诊后16和41个月后因浸润性导管癌行乳腺根治术；其余患者均无病生存。结论对以腋下淋巴结肿大为惟一临床表现、经肿物活检确认为转移性腺癌的女性患者，应高度怀疑隐匿性乳腺癌的可能性。隐匿性乳腺癌的治疗方式可采用腋窝淋巴结清扫后全乳放疗或乳腺癌根治术。

Objective To summarize the experience of diagnosis and treatment of occult breast cancer in 44 cases. Methods Clinicopathological data of 44 cases of occult breast cancer initially presenting axillary mass alone treated in our department during Jan 1997 to Dec 2008 were retrospectively analyzed. Results The 44 patients with occult breast cancer accounted for 0.42% of all breast cancer patients admitted to our hospital and institute in the same period. The surgery included radical mastectomy in 16 cases, modified radical mastectomy in 19 cases, axillary clearance in 1 case, and simple axillary node excision in 8 cases. Follow-up, ranging from 12-132 months, was available in 38 cases. Among 32 cases who underwent mastectomy or axillary clearance, 2 cases died of distant metastases and 3 cases were still alive with local recurrence at the time of analysis. In two out of six cases who refused further surgical treatment received mastectomy 16 months and 41 months after the primary diagnosis of occult breast cancer, respectively. Others were alive without evidence of recurrence or metastases at the time of analysis. Conclusions Occult breast cancer should be taken into consideration in cases presenting with axillary metastasis of unknown primary origin. The treatment of occult breast cancer should include modified radical mastectomy/radical mastectomy or breast conserving surgery combined with breast irradiation.