乳腺神经内分泌癌诊治分析

Neuroendocrine carcinoma of the breast,diagnosis and therapy analysis

关键词:  乳腺  神经内分泌癌  诊断

Key words:  breast  neuroendocrine carcinoma  diagnosis

摘要:

［目的］探讨乳腺神经内分泌癌的临床诊断和治疗。［方法］回顾性分析中国航空工业中心医院1990年1月~2009年3月收治的3例乳腺神经内分泌癌的临床特征、病理、治疗及预后。［结果］3例乳腺神经内分泌癌均以无痛性乳腺肿物就诊。钼靶示病灶内无钙化和毛刺。超声示低回声结节，内部回声不均匀，边界清楚，血流丰富。病理检查具有神经内分泌癌的形态学特点，免疫组织化学染色结果突触素（Syn）（++）1例，Syn （+++）2例；嗜铬颗粒蛋白A（CgA）（++）3例；神经元特异性烯醇化酶（NSE）（+）1例，NSE（++）2例；3例患者人表皮生长因子受体2 （HER－2）均为阴性。随访时间15～96个月，无淋巴结转移1例，术后无病存活至今；淋巴结转移2例，其中1例术后12个月全身多发转移，存活15个月后死亡，另1例术后36个月出现骨转移，至今存活60个月。［结论］乳腺神经内分泌癌十分罕见。钼靶示病灶内无钙化和毛刺，超声示低回声结节，内部回声不均匀，边界清楚，血流丰富，免疫组织化学染色HER-2表达阴性可能是该病的临床特点。病理形态学及免疫组织化学染色是确诊该病的唯一可靠依据。该病预后可能与一般乳腺癌类型无明显差异，均与病理类型及临床分期有关。

Abstract:

［Objective］To study the features of the clinical diagnosis and treatment of neuroendocrine carcinoma of the breast.［Methods］Three patients with breast neuroendocrine carcinoma were admitted from January 1990 to March 2009 in Aviation Central Hospital of China.Their clinical and pathological data,treatment and prognosis were analyzed retrospectively.［Results］All the three lesions were palpable,painless and were found by the patients themselves.Molybdenum target film showed no calcification and sentus in any of the three lesions.Ultrasound image presented circumscribed masses with heterogeneously hypoecho,distinct boundary and abundant vascularity.All the patients were diagnosed neuroendocrine carcinoma pathologically.Immunohistoche mical results showed Syn(++) in 1 case,Syn(+++) in 2 cases,CgA(++) in 3 cases and NSE(+) in 1 case,NSE(++) in 2 cases;Her-2 was negative in the 3 patients.The 3 patients were followed up for 15 to 96 months.One patient with no lymph node metastasis was still alive without relapse and metastasis 96 months after the treatment.There were two patients with lymph node metastasis.Multiple metastasis were revealed in 1 patients with lymph node metastasis in 12 months after operation and died in 15 months after excision.Bone metastasis was seen in another patient with lymph node metastasis in 36 months after operation and had survived for 60 months after excision.［Conclusion］Neuroendocrine carcinoma is a rare malignant tumor of the breast.No calcification and sentus,heterogeneously hypoecho,distinct boundary,abundant vascularity and negative expression of Her-2 might be the characteristics of the disease.Diagnosis of this disease should only depend on pathological and immunohistochemical results.neuroendocrine carcinoma of the breast may have no difference from other clinical well-informed breast cancers.Prognosis of the disease is correlated with its pathological types and clinical TNM-Staging.