乳房Paget病16例临床分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 张君丞 , 王鑫 ,  郑新宇

中国医科大学附属第一医院乳腺外科（辽宁沈阳 110001）;

Corresponding author：

郑新宇, Email: xyzheng126@126.com

Keywords：

Paget病; 乳头湿疹样乳腺癌; 原位癌

DOI：

10.7507/1007-9424.20150392

Video：

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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。

Citation： 张君丞, 王鑫, 郑新宇. 乳房Paget病16例临床分析. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(12): 1510-1511. doi: 10.7507/1007-9424.20150392 Copy

1.	Schelfhout VR, Coene ED, Delaey B, et al. Pathogenesis of paget, s disease: epidermal heregulin-alpha, motility factor, and the HER receptor family. J Natl Cancer Inst, 2000, 92(8): 622-628.
2.	Noel JC, Fayt I, Buxant F. Proliferating activity in paget disease of the nipple. Pathol Oncol Res, 2010, 16(1): 7-10.
3.	Morandi L, Pession A, Marucci GL, et al. Intraepidermal cells of Paget, s carcinoma of the breast can be genetically different from those of the underlying carcinoma. Hum Pathol, 2003, 34(12): 1321-1330.
4.	马俊喜, 高峰, 王峰, 等.乳腺Paget病11例诊治体会.中国现代普通外科进展, 2009, 12(2): 158, 179.
5.	Lohsiriwat V, Martella S, Rietjens M, et al. Paget, s disease as a local recurrence after nipple-sparing mastectomy: clinical presentation, treatment, outcome, and risk factor analysis. Ann Surg Oncol, 2012, 19(6): 1850-1855.
6.	Fu W, Lobocki CA, Silberberg BK, et al. Molecular markers in Paget disease of the breast. J Surg Oncol, 2001, 77(3): 171-178.
7.	Fu W, Mittel VK, Young SC. Paget disease of the breast: analysis of 41 patients. Am J Clin Oncol, 2001, 24(4): 397-400.
8.	Siponen E, Hukkinen K, Heikkilä P, et al. Surgical treatment in Paget, s disease of the breast. Am J Surg, 2010, 200(2): 241-246.
9.	Chen CY, Sun LM, Anderson BO. Paget disease of the breast: chang-ing patterns of incidence, clinical presentation, and treatment in the U.S. Cancer, 2006, 107(7): 1448-1458.
10.	Marshall JK, Griffith KA, Haffty BG, et al. Conservative management of Paget disease of the breast with radiotherapy: 10-and 15-year results. Cancer, 2003, 97(9): 2142-2149.
11.	刘双格, 邢华, 续哲莉.乳腺Paget病的研究现状.现代肿瘤医学, 2011, 19(7): 1432-1435.
12.	Kothari AS, Beechey-Newman N, Hamed H, et al. Paget disease of the nipple: a multifocal manifestation of higher-risk disease. Cancer, 2002, 95(1): 1-7.
13.	Kawase K, Dimaio DJ, Tucker SL, et al. Paget's disease of the breast: there is a role for breast-conserving therapy. Ann Surg Oncol, 2005, 12(5): 391-397.
14.	Sheen-Chen SM, Chen HS, Chen WJ, et al. Paget disease of the breast an easily overlooked disease? J Surg Oncol, 2001, 76(4): 261-265.
15.	Sanders MA, Dominici L, Denison C, et al. Paget disease of the breast with invasion from nipple skin into the dermis: an unusual type of skin invasion not associated with an adverse outcome. Arch Pathol Lab Med, 2013, 137(1): 72-76.
16.	Lee HW, Kim TE, Cho SY, et al. Invasive Paget disease of the breast: 20 years of experience at a single institution. Hum Pathol, 2014, 45(12): 2480-2487.
17.	Wärnberg F, Garmo H, Emdin S, et al. Effect of radiotherapy after breast-conserving surgery for ductal carcinoma in situ: 20 years follow-up in the randomized SweDCIS Trial. J Clin Oncol, 2014, 32(32): 3613-3618.

1. Schelfhout VR, Coene ED, Delaey B, et al. Pathogenesis of paget, s disease: epidermal heregulin-alpha, motility factor, and the HER receptor family. J Natl Cancer Inst, 2000, 92(8): 622-628.
2. Noel JC, Fayt I, Buxant F. Proliferating activity in paget disease of the nipple. Pathol Oncol Res, 2010, 16(1): 7-10.
3. Morandi L, Pession A, Marucci GL, et al. Intraepidermal cells of Paget, s carcinoma of the breast can be genetically different from those of the underlying carcinoma. Hum Pathol, 2003, 34(12): 1321-1330.
4. 马俊喜, 高峰, 王峰, 等.乳腺Paget病11例诊治体会.中国现代普通外科进展, 2009, 12(2): 158, 179.
5. Lohsiriwat V, Martella S, Rietjens M, et al. Paget, s disease as a local recurrence after nipple-sparing mastectomy: clinical presentation, treatment, outcome, and risk factor analysis. Ann Surg Oncol, 2012, 19(6): 1850-1855.
6. Fu W, Lobocki CA, Silberberg BK, et al. Molecular markers in Paget disease of the breast. J Surg Oncol, 2001, 77(3): 171-178.
7. Fu W, Mittel VK, Young SC. Paget disease of the breast: analysis of 41 patients. Am J Clin Oncol, 2001, 24(4): 397-400.
8. Siponen E, Hukkinen K, Heikkilä P, et al. Surgical treatment in Paget, s disease of the breast. Am J Surg, 2010, 200(2): 241-246.
9. Chen CY, Sun LM, Anderson BO. Paget disease of the breast: chang-ing patterns of incidence, clinical presentation, and treatment in the U.S. Cancer, 2006, 107(7): 1448-1458.
10. Marshall JK, Griffith KA, Haffty BG, et al. Conservative management of Paget disease of the breast with radiotherapy: 10-and 15-year results. Cancer, 2003, 97(9): 2142-2149.
11. 刘双格, 邢华, 续哲莉.乳腺Paget病的研究现状.现代肿瘤医学, 2011, 19(7): 1432-1435.
12. Kothari AS, Beechey-Newman N, Hamed H, et al. Paget disease of the nipple: a multifocal manifestation of higher-risk disease. Cancer, 2002, 95(1): 1-7.
13. Kawase K, Dimaio DJ, Tucker SL, et al. Paget's disease of the breast: there is a role for breast-conserving therapy. Ann Surg Oncol, 2005, 12(5): 391-397.
14. Sheen-Chen SM, Chen HS, Chen WJ, et al. Paget disease of the breast an easily overlooked disease? J Surg Oncol, 2001, 76(4): 261-265.
15. Sanders MA, Dominici L, Denison C, et al. Paget disease of the breast with invasion from nipple skin into the dermis: an unusual type of skin invasion not associated with an adverse outcome. Arch Pathol Lab Med, 2013, 137(1): 72-76.
16. Lee HW, Kim TE, Cho SY, et al. Invasive Paget disease of the breast: 20 years of experience at a single institution. Hum Pathol, 2014, 45(12): 2480-2487.
17. Wärnberg F, Garmo H, Emdin S, et al. Effect of radiotherapy after breast-conserving surgery for ductal carcinoma in situ: 20 years follow-up in the randomized SweDCIS Trial. J Clin Oncol, 2014, 32(32): 3613-3618.

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乳房Paget病16例临床分析

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