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目的总结乳房Paget病的病理特点、治疗及预后情况。方法回顾性分析我院2010年1月至2015年4月期间收治的16例乳房Paget病的临床病例资料。结果本组病例中单纯Paget病2例,合并导管内癌7例,合并浸润性导管癌5例,同时合并导管内癌及浸润性导管癌2例。雌激素受体阳性表达2例,孕激素受体阳性表达2例。HER-2(+++)者7例,Ki-67≥14%者14例。乳腺癌改良根治术10例,乳房切除加前哨淋巴结活检术5例,乳房切除加低位淋巴结清扫术1例。本组术后化疗12例,其中有4例行曲妥珠单抗靶向治疗、5例行术后放疗,均未行内分泌治疗,无新辅助化疗;2例病变局限于乳头乳晕区且ER和(或)PR阳性患者术后仅行内分泌治疗;2例单纯乳头Paget且ER、PR均阴性的病患者术后未予其他治疗。术后随访时间2个月~5年,其中3例于胸肌处复发,1例于腋窝淋巴结转移,1例患者因乳腺癌转移于术后2年内去世,其他患者均生存至今,平均生存期为36.5个月。结论乳房Paget病作为特殊的一类乳腺癌,多数合并导管内癌及浸润性导管癌,其治疗及预后与该病的肿瘤分期和免疫组织化学指标相关。
Objective To summarize the pathological features, treatment and prognosis of Paget’s disease in breast. Methods The clinical data of 16 cases of Paget’s disease of breast in our hospital from January 2010 to April 2015 were retrospectively analyzed. Results The cases of simple Paget disease in 2 cases, combined with ductal carcinoma in 7 cases, with invasive ductal carcinoma in 5 cases, combined with intraductal carcinoma and invasive ductal carcinoma in 2 cases. Estrogen receptor positive expression in 2 cases, progesterone receptor positive expression in 2 cases. 7 cases of HER-2 (+++) and 14 cases of Ki-67≥14%. Modified radical mastectomy in 10 cases, mastectomy plus sentinel lymph node biopsy in 5 cases, mastectomy plus low lymph node dissection in 1 case. The group of postoperative chemotherapy in 12 cases, of which 4 cases of trastuzumab targeted therapy, 5 cases of postoperative radiotherapy, no endocrine therapy, no neoadjuvant chemotherapy; 2 lesions confined to the nipple areola area and ER And / or PR-positive patients were treated with endocrine therapy only. Two patients with Paget who had no papilloma and no PR or PR were treated with no other treatment. The patients were followed up for 2 months to 5 years. Among them, 3 cases relapsed in the pectoralis muscle, 1 case had axillary lymph node metastasis and 1 patient died of breast cancer metastasis within 2 years after operation. Other patients have survived so far and the average survival time was 36.5 months. Conclusion Breast Paget’s disease is a special type of breast cancer, and most of them are associated with intraductal carcinoma and invasive ductal carcinoma. The treatment and prognosis are related to the tumor stage and immunohistochemical index.