|
Pathology |
病理學(xué) | |
|
Most breast cancers are epithelial tumors that develop from cells lining ducts or lobules; less common are nonepithelial cancers of the supporting stroma (angiosarcoma, primary stromal sarcomas, phyllodes tumor). Cancers are divided into carcinoma in situ and invasive cancer. |
多數(shù)乳腺癌屬上皮細(xì)胞瘤，由乳腺管或小葉內(nèi)膜細(xì)胞發(fā)展而來，少數(shù)是支撐間質(zhì)的非上皮癌（血管肉瘤、原發(fā)性間質(zhì)肉瘤、葉狀腫瘤)。乳腺癌分原位癌和浸潤性癌。 | |
|
Carcinoma in situ is proliferation of cancer cells within ducts or lobules and without invasion of stromal tissue. Usually, ductal carcinoma in situ (DCIS) is detected only by mammography and is localized to one area; it may become invasive. Lobular carcinoma in situ (LCIS) is a nonpalpable lesion usually discovered via biopsy; it is rarely visualized with mammography. LCIS is not malignant, but its presence indicates increased risk of subsequent invasive carcinoma in either breast; about 1 to 2% of patients with LCIS develop cancer annually.醫(yī)學(xué).全在線www.med126.com |
原位癌為乳腺管或小葉內(nèi)的癌細(xì)胞增生，無間質(zhì)組織的浸潤。通常，原位管癌（DCIS)只有通過乳房X線照相才能發(fā)現(xiàn)，并局限于某個部位，可以發(fā)展為浸潤性。原位小葉癌（LCIS)為一觸摸不到的病變，通常經(jīng)由組織活檢發(fā)現(xiàn)，鮮少被乳房X線照相發(fā)現(xiàn)。LCIS不屬惡性，但它的出現(xiàn)表明一側(cè)乳房發(fā)生浸潤性癌的危險增加了。每年約有1－2%的LCIS病人發(fā)展為乳腺癌。 | |
|
Invasive carcinoma is primarily adenocarcinoma. About 80% is the infiltrating ductal type; most of the remainder is infiltrating lobular. Rare forms include medullary, mucinous, and tubular carcinomas. |
浸潤性癌主要是腺瘤，80%左右為浸潤性導(dǎo)管型，剩下的大多為浸潤性小葉癌。罕見類型包括髓樣、粘蛋白樣與管狀癌。 | |
|
Paget's disease of the nipple (not to be confused with the metabolic bone disease also called Paget's disease) is a form of ductal carcinoma in situ that extends into the overlying skin of the nipple and areola, manifesting with an inflammatory skin lesion. Characteristic malignant cells called Paget cells are present in the epidermis. The cancer may be in situ or invasive. |
乳頭偑吉特病（不要與同名的“偑吉特病”變形性骨炎混淆)是一種原位管癌，它擴展到乳頭上面的皮膚和乳暈，呈現(xiàn)炎癥性皮膚病變癥狀。它特有的惡性細(xì)胞稱為偑吉特細(xì)胞，存在于上皮中。乳頭偑吉特病可能是原位性，也可能是浸潤性。 | |
|
Breast cancer invades locally and spreads initially through the regional lymph nodes, bloodstream, or both. Metastatic breast cancer may affect almost any organ in the body—most commonly, lungs, liver, bone, brain, and skin. Most skin metastases occur in the region of the breast surgery; scalp metastases also are common. Metastatic breast cancer frequently appears years or decades after initial diagnosis and treatment. |
乳腺癌局部浸潤，最初經(jīng)由局部淋巴結(jié)、血流或兩者擴散。轉(zhuǎn)移性乳腺癌幾乎可以影響肌體的任何器官，并以肺、肝、骨、大腦和皮膚為最常見。多數(shù)皮膚轉(zhuǎn)移發(fā)生在乳房手術(shù)部位，頭皮轉(zhuǎn)移也較常見。乳腺癌轉(zhuǎn)移經(jīng)常在初始診斷治療幾年或幾十年之后出現(xiàn)。 | |
|
Estrogen and progesterone receptors, present in some breast cancers, are nuclear hormone receptors that promote DNA replication and cell division when they are bound to the appropriate hormones. Thus, drugs that block these receptors may be useful in treating tumors with the receptors. About 2⁄3 of postmenopausal patients have an estrogen-receptor positive (ER+) tumor. Incidence of ER+ tumors is lower among premenopausal patients. Another cellular receptor is human epidermal growth factor receptor 2 (HER2) protein; its presence correlates with a poorer prognosis at any given stage of cancer. |
有些乳腺癌帶有雌激素和孕酮受體，他們都是細(xì)胞核激素受體，與適當(dāng)激素結(jié)合時就會促進(jìn)DNA復(fù)制和細(xì)胞分裂，因此，用受體阻斷藥物治療含有這些受體的腫瘤是有用的。約2/3的絕經(jīng)后病人帶有雌激素受體陽性（ER＋)腫瘤。絕經(jīng)前病人的ER＋腫瘤發(fā)病率較低。另一個細(xì)胞受體是人表皮生長因子受體2（HER2)蛋白，它的存在與已知癌癥期預(yù)后不良有關(guān)。 | |
|
Symptoms and Signs |
|
癥狀體征 |
|
Most breast cancers are discovered as a lump by the patient or during routine physical examination or mammography. Less commonly, the presenting symptom is breast pain or enlargement or a nondescript thickening in the breast. Paget's disease of the nipple presents with skin changes, including erythema, crusting, scaling, and discharge; these usually appear so benign that the patient ignores them, delaying diagnosis for a year or more. About 50% of patients with Paget's disease of the nipple have a palpable mass at presentation. A few patients with breast cancer present with signs of metastatic disease (eg, pathologic fracture, pulmonary dysfunction). |
多數(shù)乳腺癌是在病人自檢、常規(guī)體檢或乳房X線照相時發(fā)現(xiàn)的，它只是一個腫塊。出現(xiàn)乳房疼痛或增大、或乳房莫名增厚等情況較少見。乳頭偑吉特病的特征是皮膚改變，包括紅斑、結(jié)皮、結(jié)鱗和出現(xiàn)分泌物等。表面上為良性，以至常被病人忽略，使診斷延誤一年或更久。約50%的乳頭偑吉特病患者在就診時有可觸摸到的腫塊。有些乳腺癌患者呈現(xiàn)轉(zhuǎn)移性疾病（如病理性骨折、肺功能障礙)。 | |
|
A common finding during physical examination is a dominant mass—a lump distinctly different from the surrounding breast tissue. Diffuse fibrotic changes in a quadrant of the breast, usually the upper outer quadrant, are more characteristic of benign disorders; a slightly firmer thickening in one breast but not the other may be a sign of cancer. More advanced breast cancers are characterized by fixation of the lump to the chest wall or to overlying skin, by satellite nodules or ulcers in the skin, or by exaggeration of the usual skin markings resulting from lymphedema (so-called peau d'orange). Matted or fixed axillary lymph nodes suggest tumor spread, as does supraclavicular or infraclavicular lymphadenopathy. Inflammatory breast cancer is characterized by diffuse inflammation and enlargement of the breast, often without a lump, and has a particularly aggressive course. |
體檢時通常發(fā)現(xiàn)的是一明顯腫塊，明顯不同于周圍乳房組織。乳房某一象限的彌散性纖維性變化，通常在上外側(cè)，其良性特征更明顯。一側(cè)乳房出現(xiàn)稍硬的增厚，另一側(cè)沒有，這種情況就有可能是癌的癥狀。較晚期乳腺癌的特點是腫塊固定在胸壁或上皮、皮膚出現(xiàn)衛(wèi)星結(jié)節(jié)或潰瘍，或通常的皮膚紋理因淋巴水腫出現(xiàn)擴大（所謂的桔皮狀皮膚)。表面粗糙或固定腋淋巴結(jié)提示腫瘤擴散，如鎖骨上或鎖骨下淋巴結(jié)病變。炎性乳腺癌的特點是乳房的彌漫性炎癥和增大，常常沒有腫塊，具有特殊的侵略性過程。 |
