目的 探讨雄激素受体(androgen receptor,AR)在ER阳性和阴性乳腺癌中的表达及其与临床病理特征、预后的关系.方法 收集270例浸润性乳腺癌患者的临床病理资料,将ER分成阳性组与阴性组.分析两组AR表达与乳腺癌临床病理特征及多种蛋白标志物的关系,并复习相关文献.使用Kaplan-Meier Plotter数据库对AR在乳腺癌患者的预后价值进行分析.结果 270例浸润性乳腺癌患者AR阳性率为78.5％.AR与ER、PR、HER-2、CK5/6、组织学分级、Ki-67增殖指数、神经侵犯及脉管侵犯有关(P<0.05).ER阳性组中AR阳性率(88.1％)高于ER阴性组(60.2％).进一步分析发现ER阳性组中AR与组织学分级及CK5/6阳性有关(P<0.05);ER阴性组中AR与HER-2、CK5/6、组织学分级、神经侵犯、脉管侵犯、淋巴结转移及pTNM分期有关(P<0.05).Kaplan-Meier Plotter预后分析发现,ER阳性组中AR高表达者总生存期显著高于低表达者,而ER阴性组中AR高表达者总生存期低于低表达者(P<0.05).结论 AR在ER阳性和阴性乳腺癌患者中的阳性率及临床意义不同,检测AR表达可为不同ER表达状态患者预后提供参考.

目的 探讨激素受体阳性的乳腺癌患者新辅助化疗(NACT)效果影响因素及临床病理特征变化.方法 选取安徽医科大学第一附属医院自2016年1月至2019年12月收治的接受新辅助化疗激素受体阳性的163例乳腺癌患者为研究对象.对新辅助疗效进行评估、分析NACT前后标本激素受体(HR)、人类表皮生长因子受体2(HR-2)、细胞增殖抗原(Ki-67)蛋白染色情况.采用单因素分析与多因素Logistic回归分析确定激素受体阳性的乳腺癌患者NACT效果影响因素.结果 雌激素受体(ER)、孕激素受体(PR)激素受体的染色比率与染色强度均呈正相关性(r=0.448、0.488,P<0.05).NACT后,ER、PR、Ki-67的表达率均低于NACT前,差异均有统计学意义(P<0.05).结论 未绝经、腋窝淋巴结阳性、组织学分级高、Ki-67高表达均可作为激素受体阳性乳腺癌患者NACT有效预测因素.

目的 探讨microRNA (miR)-100对乳腺细胞和乳腺癌细胞增殖能力的直接负调控作用.方法 免疫组化和q-PCR检测临床乳腺癌组织标本、正常人乳腺上皮细胞MCF-10A、人乳腺癌细胞MCF-7中miR-100的表达水平差异.利用慢病毒载体筛选建立稳定低表达miR-100的细胞株MCF-10A和高表达miR-100的MCF-7细胞株.检测比较上述细胞中miR-100对正常乳腺上皮细胞和乳腺癌细胞活力、平板克隆形成能力的影响.结果 在正常乳腺组织和细胞系中miR-100表达水平明显比乳腺癌组织和乳腺癌细胞中高;成功构建稳定下调miR-100表达的正常乳腺上皮细胞MCF-10A和上调miR-100表达的乳腺癌细胞MCF-7,显示抑制其表达后乳腺细胞的增殖能力上调;相反,上调其表达后对乳腺癌细胞的增殖行为有抑制作用,表现为增殖水平的减弱.结论 miR-100的表达和乳腺细胞的增殖水平负相关,并且直接负调控人乳腺上皮细胞和乳腺癌细胞的增殖能力,提示其可能成为预防和治疗乳腺癌的潜在有效靶点.

目的:研究单核细胞趋化蛋白1(MCP-1)及其受体CC趋化因子受体2(CCR2)在酒精刺激乳腺癌血管生成中的作用及其机制.方法:建立小鼠饮酒乳腺癌移植瘤模型,免疫组化检测肿瘤组织中MCP-1和CCR2表达与血管标志物血小板内皮细胞黏附分子1(PECAM-1)和血管内皮生长因子(VEGF)表达的相关性.体外建立3D肿瘤-内皮细胞共培养系统观察肿瘤血管新生,检测MCP-1/CCR2信号在酒精介导血管生成中的作用.通过细胞迁移实验检测MCP-1/CCR2是否增加细胞移动而促进脉管形成.结果:饮酒的荷瘤小鼠肿瘤组织中MCP-1和CCR2均高表达,且表达水平和血管新生标志物PECAM-1和VEGF相一致.通过3D肿瘤-内皮细胞共培养系统观察到小鼠乳腺癌E0771细胞和内皮细胞相互作用可促进血管的形成,酒精可以增强此种肿瘤血管新生效应.外源性MCP-1可以促进此种肿瘤血管生成,其受体CCR2抑制剂处理则可以有效抑制酒精刺激的肿瘤血管生成.进一步研究发现MCP-1/CCR2可以增强内皮细胞的迁移能力.结论:MCP-1/CCR2信号途径在酒精刺激乳腺癌血管生成中发挥重要作用,其机制可能是促进了内皮细胞的迁移从而加速了肿瘤脉管新生.

目的 通过对乳头溢液患者的纤维乳管镜(fiberoptic ductoscopy,FDS)下表现与病理诊断结果作对照分析,探讨FDS在诊断乳头溢液疾病中的临床应用价值.方法 对947例病理性乳头溢液患者进行FDS检查,综合分析诊断后与病理结果 进行对照分析.结果 患者平均年龄43岁,685例占位性病变中良性病变637例(93％),恶性病变48例(7％).患者年龄35～50岁、肿瘤直径较大、红色溢液的患者中恶性肿瘤比例较高.FDS诊断乳腺导管癌的敏感性为41.7％(20/48),特异性为97.0％(618/637),阴性预测值为95.7％(618/646),阳性预测值为51.3％(20/39),准确性为93.1％(638/685),诊断价值较高.结论 FDS对乳头溢液患者的早期良恶性病变的诊断具有重要价值,并且有利于保留乳房皮肤和乳头、乳晕,是乳头溢液患者首选检查方法.

目的 大肿块乳腺癌患者往往合并有远处转移,预后差.本研究前瞻性观察紫杉醇联合卡铂周方案序贯卡培他滨一线治疗晚期大肿块乳腺癌的有效性与安全性.方法 2015-01-01-2018-04-30就诊安徽医科大学第一附属医院的初诊Ⅳ期大肿块乳腺癌患者16例,乳腺原发肿块分期T3～T4,且合并远处器官转移,给予紫杉醇75 mg/m2联合卡铂AUC=2方案,每7d重复,用药≤12周,客观疗效评价达到完全缓解(complete remission,CR)、部分缓解(partial response,PR)患者序贯卡培他滨单药2 000mg/m2,口服,2次/d,d1～d14,21d为1个周期.近期客观疗效评价采用RECIST 1.1标准,不良反应评价采用NCI-CTCAE 4.0标准.结果 可评价疗效16例患者,使用紫杉醇卡铂周方案化疗达CR 1例(6.3％),PR 13例(81.3％),稳定(stable disease,SD)2例(12.5％),CR+PR患者共14例进入卡培他滨序贯治疗,1例患者达到CR,中位无进展生存时间(progression free survival time,PFS)达到9.8个月,中位总生存时间尚未达到,1年生存率93.7％.Ⅲ～Ⅳ度不良反应为白细胞下降11例(78.6％),血小板下降2例(14.3％),恶心2例(14.3％),转氨酶升高1例(7.1％).结论 紫杉醇联合卡铂周方案序贯卡培他滨一线治疗晚期大肿块乳腺癌起效快,疗效好,不良反应可控.

Objective To promote the development and application of the portable surgical navigation system and provide a more effective and feasible diagnostic and treatment method for breast cancer sentinel lymph nodes (SLNs) through comparing the wearable surgical navigation system with the Ming De system.Methods Forty patients with early clinical diagnnose of breast cancer sentinel lymph nodes received ICG as a lymphatic tracer were randomly divided into Google group and Ming De group,which were tested by using the wearable surgical navigation system and the Ming De system,respectively.Two groups of patients underwent conventional SLNB.Results The average time to complete a biopsy was shorter in the Google group than in the Ming De group.The difference was statistically significant (P ＜ 0.05).The detection,accuracy and sensitivity rate of sentinel lymph node in Google group were similar to those in Ming De group,the difference was not statistically significant (P ＞ 0.05).The number of SLNs detected in the Google group was significantly smaller than that in the Ming De group,the difference was statistically significant (P＜ 0.05).Conclusions Wearable surgical navigation system based on Google glasses is portable,real-time and accurate.Its detection,accuracy and sensitivity rate is not inferior to the Ming De system currently being used.In addition,it has a higher potential in improving the efficiency of surgery to reduce the operation time.

曲线美是女性得天独厚的宝贵资源.然而,乳腺疾病一直是影响女性健与美的问题之一.如何防患于未然,让乳房保持健康、美丽?坚持定期自我检查乳房健康状况,不失为一种很好的保健方法.长期自我检查,便于早期发现乳房异常.月经正常的女性,自我检查乳房的最佳时间可以选在月经来潮后的第9-11天.

目的 研究环耙明在巨噬细胞极化过程中的作用.方法 用100 ng/ml脂多糖(LPS)和20 ng/ml干扰素γ(IFN-γ)处理RAW264.7 24 h刺激成M1型巨噬细胞,用20ng/ml白介素-4(IL-4)处理RAW264.7 24 h刺激成M2型巨噬细胞,用荧光定量PCR(QPCR)法检测各分型中一氧化氮合成酶(iNOS)、CD86、精氨酸酶-1(Arg-1)、CD206、GLi1、ptch1 mRNA水平的表达;用QPCR法、Western blot法、免疫荧光法检测加入环耙明后对M1型巨噬细胞分泌iNOS的影响.结果 M1型巨噬细胞高分泌iNOS、CD86、M2型巨噬细胞高分泌Arg-1、CD206(P＜0.01);40 nmol/L环耙明刺激后,M1型巨噬细胞中ptch1 mRNA水平的表达明显增强且在100 nmol/L时达到最大值(P＜0.01);经环耙明1 000nmol/L刺激后有效降低了iNOS的mRNA和蛋白水平,可能提示环耙明会促进巨噬细胞向M2型巨噬细胞分化.结论 环耙明能够明显地降低M1型巨噬细胞中iNOS的分泌.

目的 探讨乳腺癌和癌旁组织中核心结合因子(RunX2)基因的表达差异及其与乳腺癌患者的临床特征和预后的关系.方法 选择75例乳腺癌患者癌组织标本,所有患者术前未经放疗和化疗,采用免疫组化法检测乳腺癌组织和癌旁组织RunX2的表达情况.分析乳腺癌患者RunX2基因的表达与年龄、病理分型、术后分期、淋巴转移、肿瘤大小、雌激素受体(ER)表型、孕激素受体(PR)表型、人类表皮生长因子2(HER2)表型、ki67表达水平以及生存率的关系.结果 75例患者的癌组织中有44例乳腺癌组织高表达RunX2,31例组织低表达RunX2;而癌旁组织仅23例高表达,52例均表达较低.癌组织和癌旁组织中RunX2的表达水平差异有统计学意义(P＜0.05).RunX2基因的表达高低与患者年龄、术后分期、淋巴结转移、病理类型、PR表型、HER2表型无明显相关性,但是与患者的ER表型和ki67表达相关(P＜0.05),并且高表达RunX2患者术后3年的总体生存率较低表达患者差.结论 乳腺癌组织中RunX2基因高表达与患者的ER表型和临床预后呈正相关性,进一步证实了RunX2在乳腺癌发生发展中起到重要作用.

目的 研究内皮细胞特异性分子-1(ESM-1)作为敏感的分子标志物对乳腺癌预后的预测及复发的判断.方法 选取133例乳腺癌患者石蜡标本,进行癌组织和癌旁组织切片,采用免疫组化法研究ESM-1蛋白的表达,分析ESM-1与肿瘤生物学行为及患者预后之间的关系.结果 ESM-1的表达在乳腺癌组织中弱,而在癌旁组织中强;在分期早的肿瘤中表达高于分期晚的肿瘤.ESM-1和乳腺癌的预后有着密切的关系,在腋窝转移阳性患者中ESM-1表达低于腋窝阴性患者且差异有统计学意义(P＜0.05),人类表皮生长因子受体2(HER-2)过表达患者中ESM-1的表达低于HER-2无扩增患者,差异有统计学意义(P＜0.05),其他相关因素差异无统计学意义.结论 ESM-1可以成为判断乳腺癌患者预后的一个分子标志物,ESM-1在组织中的高表达往往预示着该患者有较好的预后和长期的生存.

Objective To evaluate intraoperative tracing of sentinel lymph nodes ( SLNs) by fluorescence imaging combined with carbon nanoparticles .Methods 112 breast cancer patients eligible for sentinel lymph node biopsy were randomly assigned to the combination group (56 cases)receiving indocyanine green (ICG)and carbon nanoparticles as the lymphatic mapping tracers and ICG alone group (56 cases).Intraoperative frozen sec-tion was performed , followed by conventional histopathology .Results In the combination group , subcutaneous lymphatic vessels were successfully visualized in 53 patients and the detection rate was 94.6%(53/56).The flu-orescence SLNs were successfully detected in 54 patients and the detection rate was 96.4%(54/56)in ICG alone group.In the combination group , SLNs were successfully identified in 54 patients by fluorescence and 52 patients by black dyed, and the SLNs detection rate was 100%(56/56).While in the ICG alone group, the SLNs were found in 52 patients and the detection rate was 92.9%(52/56)(χ2 =2.3, P>0.050).The average number of detected SLNs was 3.7 ±1.5 ( 205/56 ) in combination group vs 2.5 ±1.4 ( 130/52 ) in ICG alone group ( t =-3.5, P=0.001).17 metastatic SLNs were found in 10 patients in the combination group vs 12 metastatic SLNs in 9 patients in ICG alone group .Conclusion Combination of ICG and carbon nanoparticles for mapping sentinel lymph nodes in breast cancer patients can increase the number of SLNs detected and the detection rate , reducing the rate of misdiagnosis and false negative rate .

Objective To evaluate the clinical value of ultrasound-guided minimally invasive treatment of breast abscess compared with conventional surgery.Methods From Jun.2010 to Dec.2011,68 patients with breast abscess were diagnosed and hospitalized,including 44 cases of lactation women and 24 cases of nonlactation women.All the patients voluntarily received ultrasound-guided breast minimally invasive treatment and catheter flushing of the abscess.Results 66 cases with breast abscess were clinically cured.The length of the incision was about 4 mm and the operation during was about 30 mins.The patients had little trauma and satisfactory appearance.The treatment time was 7-9 days.2 cases with breast abscess during lactation period recurred 1 month after operation and received incision and drainage operation.There was no recurrence during the follow-up of 6 to 12 months.Conclusions The ultrasound-guided minimally invasive treatment of breast abscess has good operation effect and can shorten operation time.The patients have satisfactory appearance,low recurrence rate and can avoid long-term dressing.The method is an ideal and effective treatment of breast abscess.

Objective To study clinical effects of lavage treatment for inflammatory breast diseases guided by color Doppler sonography.Methods The lesions of 63 patients with inflammatory breast diseases (30 of breast abscess,20 of plasma cell mastitis,13 of breast chronic sinus)were positioned by color Doppler sonography.Surgical debridement and lavage catheter treatment were performed under general anesthesia.Results 54 patients were healed by first intention,and they were satisfied with their breast shapes.4cases of mammary abscess,3cases of plasma cell mastitis and 2 cases of breast chronic sinus had relapse within half a month.Conclusions Color Doppler sonography guided lavage treatment of inflammatory breast diseases is simple with significant healing effect,fast recovery speed,less recurrence and high cure rate.The operation had little pain to patients and small hidden postoperative scar.The breast shapes are nice-looking.

<正>乳腺癌已成为危害妇女健康的恶性肿瘤之首[1]。早期发现乳腺癌,可以显著降低乳腺癌综合治疗后的复发率、转移率及死亡率,提高生存期。早期乳腺癌的表现之一就是乳腺隐匿性钙化。乳腺隐匿性钙化是乳腺隐匿性病变的一种,即常规钼靶X线检查显示乳腺内成簇钙化灶,而临床症状体征阴性的乳腺隐匿性病变[2]。如何精确定位乳腺隐匿性钙化灶并判断其性质,对于进一步治疗至关重要。现将本科2008年6月至2010年6月收治的63例乳腺隐匿性钙化患者的治疗及操作报道如下。

近年来,随着人们生活水平的改善,女性社会地位的提高,工作压力的增大以及饮食结构的改变,乳腺疾病的发生率逐年增高,乳腺癌已经成为威胁女性生命健康的"头号杀手".接受乳腺切除的女性逐渐增多,乳腺切除后,不仅会造成乳房外观上的畸形,还会影响患者的生活质量和心理健康.我们自2008年6月至2010年3月对46例接受乳房单纯切除术的患者,进行了硅橡胶假体Ⅰ期置入胸大肌后的乳房重建术,取得良好效果及社会效益.

<正>1病例资料男,69岁。右侧腹股沟不可复性肿块4月余伴疼痛入院。患者自诉有右腹股沟肿块5年余,可滑入阴囊,可还纳。近4个月肿块不可还纳,固定于腹股沟区且伴疼痛,自行口服止痛药(具体用药不详),症状可缓

我们根据肿瘤发生位置及肿瘤大小,因人而异,个体设计,采取腔镜腋窝入路,行乳腺多发/巨大纤维腺瘤腔镜辅助腋窝径路肿块切除12例.术后切口愈合良好,患者对外形满意,现报道如下.临床资料1一般资料:安徽医科大学第一附属医院乳腺甲状腺外科自2009年8月-2010年6月收治乳腺良性肿瘤患者12例,年龄12～45岁,中位年龄30岁.双乳多发纤维腺瘤8例,最多1例双乳共9个纤维腺瘤,青春期巨大纤维腺瘤4例;最大1例纤维腺瘤9 cm×10 cm,最小者仅0.6 cm ×0.6 cm.单发巨大肿块8例患者肿块均体积较大,最大者可达9 cm×10 cm,且位于外侧象限。

0bjective To explore the feasibility of immediate breast reconstruction with subpectoral implantation of silicone gel prothesis after skin-sparing modified radical mastectomy.Methods A total of 28 patients of 0,I,II stage breast cancer underwent skin-sparing modified radical mastectomy.Over the same period,breast reconstruction had been completed with inserting silicone gel prosthesis subpectoralis.Results All 28 patients' nipple-areola complex were conserved.Postoperative follow-up 2～18 months,Bilateral breast were symmetry,good appearance.Excellent and good rate was 96.5%.No local recurrence or distant metastasis.No obvious complications occurred.Conclusion Immediate breast reconstruction with subpectoral implantation of silicone gel prothesis after skin-sparing modified radical mastectomy is proven to be an effective and safe method with the advantage of good appearance,shorter recovery time in earlier breast cancer.

Objective To explore the relationship between the four different molecular subtypes of locally advanced breast cancer(LABC) and the clinical effect of neoadjuvant chemotherapy containing docetaxel and anthracyclines on breast cancer. Methods The record of 68 patients with LABC who were treated with the therapeutic scheme was reviewed. Breast cancer molecules were diagnosed by core needle biopsy through IHC and were divided into four subtypes. After 3 to 5 courses of treatment, the relationship of molecular subtype and clinical effects was analyzed. Results Univariate analysis showed that absence of estrogen receptor (ER) expression and size of tumor (≤5cm) were predictive factors for clinical complete response (cCR) (P<0.05).Over expression of HER-2 and molecular subtypes were predictive for pathologic complete response (pCR) (P<0.05). pCR rate of HER2+/ER- subtype in this therapeutic scheme was, higher than that of other subtypes and pCR rate of Luminal A subtype was the lowest. Multivariate analysis showed that molecular subtypes cant be the predictive factors for this therapeutic scheme (P>0.05) and only HER-2 (P<0.05) was the independent variable in predicting pCR for this therapeutic scheme. Conclusion Molecular subtypes can not independently predict pCR for neoadjuvant chemotherapy regimen containing docetaxel and anthracyclines.