乳腺癌患者皮肤转移8例临床分析

Clinical analysis of 8 cases of skin metastasis in patients with breast cancer

目的探讨乳腺癌患者皮肤转移的临床表现、组织病理、免疫组化和预后。方法回顾分析8例乳腺癌患者皮肤转移的临床皮损特点、组织病理、免疫组化和愈后。结果 8例乳腺癌患者皮肤转移按临床皮损表现分为3例炎症型、1例盔甲型、4例结节型。3例炎症型患者皮损镜下示表皮及真皮淋巴管被肿瘤细胞围绕,真皮水肿,毛细血管周围有淋巴细胞浸润;1例盔甲型患者镜下示皮下组织内少许腺管状排列的肿瘤细胞,胶原纤维增生;4例皮损表现为结节型患者镜下示肿瘤细胞形成巢状,位于真皮全层和皮下组织内。8例患者肿瘤细胞ER、PR、Her-2、BRCA1、P120膜、GCDFP-15均有阴性、阳性表达,Ki-67则均阳性不同程度表达。患者根据免疫组化及基因表达制定治疗方案后有不同程度的延长生命周期。结论乳腺癌患者皮肤转移临床表现不一;组织病理是乳腺癌患者皮肤转移诊断的金标准,转移灶表现不一其组织病理甚为不同;免疫组化对于肿瘤细胞的性质判断、疾病的预后判断、指导疾病的治疗有着极其重要的意义;临床证实乳腺癌患者皮肤转移预后明显好于其他内脏器官转移性肿瘤。

Objective To investigate the clinical manifestation, histopathology, immunohistochemistry and prognosis of skin metastasis in breast cancer patients. Methods To analyze the clinical lesion characters of histopathology, immunohistochemistry and prognosis of 8 patients with breast cancer retrospec- tively. Results 8 cases of breast cancer patients with skin lesions were divided into 3 kinds according to the clinical manifestations of skin lesions, 3 cases of inflammation, 1 case of armor type, 4 cases of nodular. The 3 cases of inflammation under the microscope showed epidermis and dermal lymphatic vessels surrounded by tumor cells; dermal edema; lymphocytic infiltration surrounding capillaries; 1 case of armor type under the microscope showed a few glandular tumor cells in subcutaneous tissue, collagen fibers hyperplasia; and 4 cases of nodular under the microscope showed nest-like tumor cells , located in every layer of dermis and subcutaneous tissue. The expression of ER, PR, Her-2, BRCA1, P120 and GCDFP-15 were negative or positive in 8 patients. The ex- pression of Ki-67 was positive in different degrees. Patients have different degrees of extended life cycle after the formulation of treatment protocols based on immunohistochemistry and gene expression. Conclusion The clinical manifestations of skin metastasis in patients with breast cancer are different. Histopa- thology is the gold standard for diagnosis of skin metastases in patients with breast cancer. The histopathology of metastases varies according to the metastatic lesions of breast cancer. Immunohistoehemistry is of great importance for the characterization of tumor cells, the prognosis of disease and the treatment of dis- ease. Clinical treatment confirmed prognosis of breast cancer patients with skin metastases were significantly better than that of other visceral organ metastases tumor.