123例乳腺Paget病临床特点分析

Clinical analysis of 123 patients with Paget's disease of the breast

目的总结近年来乳腺Paget病特点。方法回顾性分析郑州大学第一附属医院2011年10月至2017年12月123例乳腺Paget病患者的入院情况、手术方式、病理特点。结果患者发病年龄26～86岁,平均(52.6±11.0)岁。发病时间3 d～20 a,中位发病时间为1 a。就诊原因中,以皮肤病变就诊占70.7%(87/123),肿块就诊占18.7%(23/123),合并病变占10.6%(13/123)。术前彩超发现肿块占41.5%(49/118),其他回声异常占28.8%(34/118),合并异常占13.6%(16/118),无明显异常占16.1%(19/118)。手术方式中,保乳术占3.3%(4/123),改良根治术占52.0%(64/123),单纯切除术占44.7%(55/123)。病理结果中单纯乳腺Paget病占9.8%(12/123),乳腺Paget病合并导管原位癌占29.3%(36/123),乳腺Paget病合并浸润癌占60.9%(75/123)。免疫组化表现为ER、PR低表达,Her-2高表达,Ki-67<15%占9.6%(11/115),Ki-67 15%～30%占18.5%(21/115),Ki-67≥30%占72.2%(83/115)。淋巴结转移占15.4%(19/123)。根据是否伴有浸润将病例分为非浸润癌和浸润癌两组,两组肿块、淋巴结比例比较,差异有统计学意义(P<0.05);两组ER、PR、HER-2、Ki-67的表达比较,差异无统计学意义(P>0.05)。结论乳腺Paget病有其独特的临床特征,病程进展缓慢,ER、PR呈低表达,Her-2、Ki-67呈高表达;早期乳腺彩超对乳腺Paget病的分期较为重要。

Objective To detail characteristics of mammary Paget’s disease recent years.Methods To retrospectively analyze the physical examination,operational manner and pathological characters of the 123 cases with Paget’s disease of the breast treated in the First Affiliated Hospital of Zhengzhou University between Mar.2011 and Dec.2017.Results The diagnosis age was from 26 to 86.The age of onset is normal distribution(52.6±11.0).The onset time ranged from 3 days to 20 years,and the median onset time was 1 year.Among the attendance reason,skin lesions occurred in 70.7%(87/123),palpable mass in breast occurred in 818.7%(23/123)mass in breast,both the mass and the skin lesions occurred in 10.6%(13/123).Among the color Doppler ultrasound,the masses occurred in 41.5%(49/118),abnormal in other echo occurred in 28.8%(34/118),the masses with the abnormality occurred in 13.6%(16/118),with no obvious abnormality occurred in 16.1%(19/118).Among the operative methods,breast conserving operation occurred in 3.3%(4/123),mastectomy occurred in 52.0%(64/123),mastectomy occurred in 44.7%(55/123).Paget’s disease alone accounted for 9.8%(12/123),Paget’s disease complicated with ductal carcinoma in situ accounted for 29.3%(36/123),Paget’s disease with invasive carcinoma accounted for 60.9%(75/123).In the immunohistochemistry,the cases showed with lower ER and PR expression and higher HER-2 overexpression.About the Ki-67,the low expression rate group occurred in 9.6%(11/115),the middle expression rate group occurred in 18.5%(21/115),the high expression rate group occurred in 72.2%(83/115).Four person with lymph node metastasis,the rate was 15.4%.The patients were divided into two groups according to whether they were accompanied with invasion or not.There was significant difference in the proportion of tumor and lymph node between the two groups(P<0.05).There was no significant difference in the expression of ER,PR,HER-2,Ki-67 between the two groups(P>0.05).Conclusion Paget’s disease of mammary has its unique clinical characteristics,slow progress of the course,low expression of ER and PR,and high expression of Her-2 and Ki-67,and the early stage of breast color ultrasound is of great importance to the stage of Paget’s disease.