论文部分内容阅读
目的总结新辅助化疗后乳腺癌组织、癌旁乳腺组织及淋巴结的形态学改变,并提出相关鉴别诊断注意点。方法收集入组新辅助化疗病例119例,治疗前均行核芯针穿刺活检(CNB)。复习新辅助化疗后手术切除标本的病理切片,分别记录癌组织、癌旁乳腺组织及淋巴结的治疗后改变,并根据上述改变提出鉴别诊断的注意点。结果癌组织可出现不同程度的退变及间质纤维化等多种反应,癌细胞的空泡变性、合体癌细胞等需与泡沫细胞、多核巨细胞等鉴别,免疫组化染色(AE1/AE3、CD68等)有助益。癌组织的间质反应可作为新辅助化疗后肿瘤完全消失的组织学线索。淋巴结存在与原发灶相似的治疗后改变,但出现比例较低。癌旁乳腺组织可出现导管上皮增生等改变,需与残存的导管内癌鉴别。结论乳腺癌新辅助化疗后的形态学改变会造成诊断困难,复习治疗前CNB切片、充分及必要的取材、免疫组化染色(AE1/AE3、CD68等)有助于诊断及疗效评价。
Objective To summarize the morphological changes of breast cancer tissues, paracancer breast tissues and lymph nodes after neoadjuvant chemotherapy, and to put forward the points of differential diagnosis. Methods A total of 119 neoadjuvant chemotherapy cases were enrolled in this study. All patients underwent core needle biopsy (CNB) before treatment. Review the neoadjuvant chemotherapy after surgical removal of the biopsy specimens were recorded in cancer tissue, paracancer breast tissue and lymph node changes after treatment, and according to the above changes made the differential diagnosis points. Results The cancerous tissues showed various degrees of degeneration and interstitial fibrosis and other reactions. The degeneration of the cancer cells, the desensitization of the cancerous cells, the identification of the foam cells and the multinucleated giant cells, and the immunohistochemical staining (AE1 / AE3 , CD68, etc.) helpful. The interstitial reaction of cancer tissue can be used as a histological clue for the complete disappearance of tumor after neoadjuvant chemotherapy. Lymph nodes exist similar to the primary tumor after treatment change, but the emergence of a lower proportion. Adjacent breast tissue may appear ductal hyperplasia and other changes, the need to identify with the remaining ductal carcinoma. Conclusion The morphological changes of neoadjuvant chemotherapy in breast cancer will be difficult to diagnose. Reviewing CNB sections, adequate and necessary materials, immunohistochemical staining (AE1 / AE3, CD68, etc.) will help to diagnose and evaluate the therapeutic effect.