乳腺鳞状细胞癌影像学及临床特征探讨

Analysis imageology appearance and clinical characteristics of primary squamous cell carcinoma of the breast

目的探讨乳腺鳞状细胞癌的影像学特征及临床特点。方法回顾分析经病理证实的5例乳腺鳞状细胞癌患者的磁共振成像（MRI）和B型超声特点，其中4例行MRI扫描，5例经B型超声（US）检查。对照术后病理表现，探讨其临床表现、病理学特征与影像学的联系。结果影像学表现，MRI：肿瘤径较大，50mm左右；均发生在乳头周围；伴有皮肤肥厚2例；肿瘤边缘不整，肿瘤壁的构造鲜明，呈不均一的肥厚，无向内腔突入的乳头状阴影；T1WI等信号，EWI部分高信号；增强扫描显示肿瘤充实性部分被强化，中心坏死部分强化不明显。US所见：肿瘤平均直径40mm，5例中4例乳头距肿瘤距离为0mm，1例为19mm；肿瘤呈块状或分叶状，边缘不整，后方高回声，2例伴有侧方回声，4例显示肿瘤内部血流丰富，2例显示内部伴有液化和坏死的囊性低回声。乳腺钼靶检查（MMG）：怀疑为恶性2例，良性1例；肿瘤呈均一的高密度，无明显的毛刺征和微细钙化。均采用乳房全切术进行治疗。术后病理分期：ⅢB期3例、ⅡB期1例、ⅡA期1例。雌激素受体（ER）、孕激素受体（PR）检查均为阴性。术后施行辅助化疗者3例，术后跟踪随访其他脏器转移（肺、脑）2例。结论乳腺鳞状细胞癌患者术前MMG检查不具典型性影像学特征。MRI检查有较为突出的特征性表现，结合B型超声US及穿刺细胞、组织学检查手段，能够推测组织类型及浸润范围，对手术方式的选择及指导治疗具有重要的作用。

Objective To analyze the imageology appearance and clinical characteristics of primary squamous cell carcinoma of the breast. Methods Features of MRI （4 patients） and B-type ultrasonic inspection （5 patients） of nine patients with primary squamous cell carcinoma of the breast pathologically confirmed were retrospectively reviewed. Compared with postoperative pathological appearance, the correlation between imageology appearance and clinical, pathological characteristics was analyzed. Results Imageology appearance： In MRI： The tumor diameter was around 50 mm; The tumors were located at nearby papillae; There were two patients with pachymenia at the same time; The tumor margin was unclear, which has clear tumor wall structure and heterogeneous pachymenia, and without corpora mammillaria shadow which was toward interior; The tumors were low signal on TIWI and partially high signal on T2WI; The image with enhancement scanning showed that parenchymatous part of tumor were enhanced, while enhancements were not obviously at the centre of tumor with necrosis. In B-type ultrasonic inspection： The average diameter of tumors was around 40 mm, there were NT=0 mm in 4 cases. NT=19 mm in 1 case. The tumors presented as shape of clump or sublobe, which had unclear margin and high echoic region behind the tumor. There were also normal echo at the tumor lateral in 2 cases at the same ＇time, and 4 cases showed blood supply was abundant, and 2 cases showed that there were eolliquation and necrosis which had cystic hypoechoic signal at the tumor interior. MMG： There were class-4 in 2 cases, and Class-3 in 1 case. The tumor with little calcification which had no obvious veining showed uniformly high densities. All patients were treated with entire masteetomy. The patho-staging showed 3 cases were in Ⅲ B, 1 case was Ⅱ B, and 1 case was in Ⅱa. The results of ER and PR with all patients were negative by using immunohistochemistry. 3 cases were also treated with chemotherapy after surgery; other organs （brain and lung） were found metabasis by follow-up visit of postoperation. Conclusion For patients with primary squamous cell carcinoma of the breast, MMG inspection before surgery did not have specific imageology characteristics, while MRI has. The combination of MRI, Btype ultrasonic inspection and CNB can detect pathologic types and invasive circumscription, so it may have great applications for choose of surgery style and directions of therapy in the future.