occult breast cancer
Introduction
Introduction to occult breast cancer Occult breast cancer (OBC) is a special type of breast cancer. Generally refers to breast cancer that is clinically the primary manifestation of no lymphatic mass in the clinic. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: pleural effusion
Cause
Concealed breast cancer
(1) Causes of the disease
As for the cause of the occultation of primary breast cancer, Owen analyzed 25 cases of OBC:
1 primary tumor is small (20/25 of tumor diameter less than 1cm, 14/25 less than 5mm);
2 fibrous mastitis caused thickening of whole milk tissue, hindering the detection of small primary tumors (7/25);
3 lesions deep (23/25) and mostly acne-like cancer is not conducive to percussion. From a clinical perspective, tumors larger than 2 cm in diameter and clinically unexploded, occur in patients with hypertrophic breasts.
(two) pathogenesis
The tissue characteristic of OBC is that the diameter of breast tumor is more than 1cm. The phenomenon that the primary tumor is small and the metastatic tumor is large may be caused by the differential growth of the two. In the initial stage of discovery of some cancer, the host immunity The ability to effectively control its growth, at the same time, the cancer is transferred out of the lymphatics and grow in the regional lymph nodes, in theory, the antigenicity of the primary tumor can cause a strong immune response, Although the immune response controls the growth of the primary tumor, it does not control the growth of the metastases. This may be related to the alteration of the antigenicity of the cancer in metastatic cancer. Therefore, the immune response evoked by the primary tumor is metastatic. Does not work, OBC pathologically early histological cancer such as lobular carcinoma in situ, intraductal cancer is more common, this cancer has metastasized and remains a phenomenon of lobular carcinoma in situ or intraductal carcinoma, suggesting that the basement membrane is degraded or The punctate cell penetrating area that has not been seen by pathological examination, Gallager et al. used histochemical methods to prove that under the light microscope, it is an intraductal cancer or a carcinoma in situ. In fact, cancer cells have penetrated the basement membrane. In addition, Check the adenovirus reason missed the stove and invasive carcinoma in situ lesions found only also possible.
Prevention
Occult breast cancer prevention
1. Improve the pathological detection rate: The pathological detection rate of breast concealed lesions is reported in the literature between 45% and 100%, more than 50%, and the measures to reduce the pathological diagnosis of microscopic primary mammary gland are:
1 preoperative mammography X-ray suspicious area fine needle X-ray positioning and postoperative gross specimen X-ray photography control;
2 application of continuous pathological biopsy or whole milk large section pathology examination technology;
3 whole milk large section electron microscopy.
2. Strengthen postoperative follow-up: It was confirmed by postoperative follow-up and autopsy experience that no lesions in the excised mammary gland could not rule out the possibility of primary tumor in the breast, but should be consciously followed in the treatment of such cases. Pay attention and find the primary mammary gland at the same time.
Complication
Occult breast cancer complications Complications pleural effusion
Pleural effusion.
Symptom
Concealed breast cancer symptoms Common symptoms Milky inflammatory lymph nodes enlargement lumps mass nipple discharge pleural effusion pleural metastasis
The patient was treated with a lumps of the ankle. The enlarged lymph nodes of the ankle were found by the patient during the shower or dressing. Occasionally, the doctor examined the health when the body was examined. The diameter of the mass was mostly about 3 cm, and the larger one was more than 5 cm. There were no distant metastasis findings in the case group. The Shandong Cancer Prevention Research Institute found 1 case of ipsilateral supraclavicular lymphadenopathy, 1 case with pleural metastasis as the first symptom, and no breast clinical mass and molybdenum target positive OBC. The former showed an enlarged supraclavicular lymph node with a diameter of 5 cm on the same side. The axillary lymph nodes were enlarged but the diameter was <1 cm. Surgery confirmed that there was a primary lesion with a diameter of 0.5 cm in the upper quadrant of the breast. The latter was treated with pleural effusion and the thoracic cavity. The effusion found adenocarcinoma cells. During the treatment of pleural effusion, nipple hemorrhagic fluid appeared in the contralateral breast. Three consecutive episodes of smear cytology were used to detect cancer cells, and mammography was performed without mammary gland mass. And calcification, confirmed by histological examination of simple mastectomy for breast invasive ductal carcinoma, breast volume is too large.
The interval between the detection of metastases and the detection of primary mammary glands, the short days, the elderly can reach more than 2 years, Kloppe reported 1 case, the primary breast cancer occurred 48 months after axillary lymph node biopsy Clinical manifestations.
In the case of axillary lymphadenopathy, most of them are benign lesions, accounting for 76.4%. In malignant cases, they can be caused by both primary cancer and metastatic cancer. For example, lymphoma, sweat gland cancer, etc. can originate in axillary lymph nodes. Breast, respiratory, digestive, genitourinary cancer, thyroid cancer, skin cancer and malignant melanoma of the limbs, soft tissue sarcoma, etc., can be transferred to the axillary lymph nodes, but in female patients, malignant lesions of the axillary lymph nodes occur in the mammary gland Cancer metastasis is more common.
Feuerman reported that axillary lymph node biopsy confirmed 21 cases of metastatic carcinoma, 14 women, 10 of which were metastasis of breast cancer, and 4 cases of non-breast metastasis, with clinical manifestations of primary breast cancer, axillary lymph node metastasis Among the female patients without any primary signs, the conclusion that most of the primary tumors are located in the breast is recognized, but the histopathological examination of the conventional method of axillary lymph node biopsy has misdiagnosis. Jachson has reported a pathological diagnosis. For right apocrine adenoma, 3 years and 4 months after the right breast appeared primary cancer, Patce reported 29 cases of OBC, of which 2 cases were diagnosed as axillary lymph node metastasis as squamous cell carcinoma and Hodgkin's disease, followed by Primary breast cancer; Iglehart diagnosed 5 cases of non-adenocarcinoma (negatively differentiated squamous cell carcinoma, lymphoma, malignant black tumor, 1 case, undifferentiated carcinoma), and found glandular ducts by electron microscopy. The characteristic structure of adenocarcinoma such as epithelium, the primary mammary gland was found after modified radical mastectomy for breast cancer, and the opposite case. Copelanel reported a case of adenoid lymph node metastasis and radical radiotherapy according to breast cancer. ,corpse It is confirmed to be Hodgkin's disease. Therefore, when performing axillary lymph node biopsy, it should be closely coordinated with pathologists. In addition to general pathological examination, electron microscopy ultrastructural analysis and histochemical special staining may be feasible if necessary. Differential diagnosis of soft tissue sarcoma and malignant pigmented tumor.
Examine
Concealed breast cancer screening
1. Axillary lymph node biopsy: routine histopathological examination of axillary lymph nodes can be found in a variety of tumor cells, such as apocrine adenocarcinoma, poorly differentiated squamous cell carcinoma, lymphoma, malignant black tumor-like cells, etc., can be found in the tumor cells by electron microscopy Tube, secrete epithelial and other characteristics of adenocarcinoma.
2. Breast aspiration cytology: In combination with the existing breast examination method in the case of axillary lymph node metastasis, it will help the detection of OBC, needle aspiration cytology and fine needle in the suspicious area of imaging examination. Positioning the biopsy can confirm the diagnosis.
3. X-ray examination of mammography: The real contribution of mammography is to find small breast cancer or recessive breast cancer in early clinical stage. When there is obvious clinical manifestation of breast cancer, it is of little significance. Calcification is often OBC. The X-ray is the only manifestation, but the calcification is not a unique sign of breast cancer. Other X-ray signs of OBC include increased unilateral angiogenesis, increased or abnormal catheterization, skin thickening, and continuous examination of focal matrix density. It is generally believed that X-ray molybdenum target tablets can be found in tumors with a diameter of several millimeters. The detection rate of molybdenum target OBC is reported to be 5% to 72.5%, but most reports are around 50%.
4. CT examination: There is a high detection rate of breast cancer. In a group of 78 cases confirmed by pathology, 73 cases (94%) were detected by CT, and the proportion of molybdenum target examination was 77%, although CT could not. It replaces the conventional X-ray molybdenum target examination, but can overcome the limitations of common X examination, especially in hypertrophic breasts. CT is superior. When the maximum diameter of the tumor is less than 1.5mm, CT is not easy to detect, for early breast. Cancer and OBC, when used in combination, can increase their detection rate.
5. ER measurement: ER lymph node metastasis ER determination 50% positive, help OBC diagnosis and guidance treatment, ER positive suggest breast cancer axillary lymph node metastasis, but its negative can not rule out breast cancer.
6. Ultrasonic tomography and mammographic images.
Diagnosis
Diagnosis and diagnosis of occult breast cancer
In the pathological diagnosis of axillary lymph node metastatic adenocarcinoma without significant primary tumor and extensive extensive examination (including chest X-ray, gastrointestinal X-ray, intravenous pyelography, endoscopy, hepatobiliary and pancreatic pelvic organs B-ultrasound, etc.) Necessity is still controversial, but it is necessary to exclude certain tests for diagnosis while focusing on breast examination.
