Mai K T, Yazdi H M, Perkins D G
Department of Laboratory Medicine, The Ottawa Hospital, Civic Campus, University of Ottawa, Ontario, Canada.
Pathol Int. 1999 Nov;49(11):956-61. doi: 10.1046/j.1440-1827.1999.00976.x.
The pattern of spread of intraductal carcinoma associated with mammary Paget's disease has not been well studied. The purpose of this study was to examine the site of origin and the pattern of tumor spread with a three-dimensional view by serial sectioning of the tissue blocks from 19 cases of Paget's disease. Intraductal carcinoma in the superficial portion of the lactiferous ducts was seen in continuity with the overlying epidermis with Paget's disease in all 19 cases. In seven cases that had adequate tissue sampling, five showed a continuous pattern of the intraductal carcinoma within the superficial as well as the deep breast tissue. In the remaining two cases, a portion of benign duct was identified between the intraductal carcinoma in the superficial lactiferous duct and the deep breast tissue. This discontinuous pattern of spread of the intraductal carcinoma was also identified in the foci of carcinoma in deep tissue. In the five cases in which the tumor involved the skin and only the superficial portions of the lactiferous duct, the leading edge of the intraductal carcinoma was seen orientated in the direction of the nipple towards the deep breast tissue. Our study of Paget's disease demonstrated that in addition to tumor spread along the lactiferous ducts from intraductal carcinoma in the deep tissue towards the nipple, there was a group of Paget's disease arising from the nipple. These lesions included: (i) lesions limited to the areolar tissue; and (ii) lesions with intraductal carcinoma involving the duct system in both superficial and deep breast tissue with and, possibly, without skip areas pattern of spread. Although certain cases of Paget's disease may appear superficial, an independent associated carcinoma in deep breast tissue has to be ruled out.
乳腺佩吉特病相关导管内癌的扩散模式尚未得到充分研究。本研究的目的是通过对19例佩吉特病组织块进行连续切片，从三维视角检查肿瘤的起源部位和扩散模式。在所有19例病例中，均可见输乳管浅表部分的导管内癌与上方伴有佩吉特病的表皮相连续。在7例有足够组织样本的病例中，5例显示导管内癌在乳腺浅表及深部组织中呈连续模式。在其余2例中，在浅表输乳管内的导管内癌与乳腺深部组织之间发现了一部分良性导管。导管内癌的这种不连续扩散模式在深部组织的癌灶中也有发现。在5例肿瘤累及皮肤及仅输乳管浅表部分的病例中，可见导管内癌的前沿朝向乳头并指向乳腺深部组织。我们对佩吉特病的研究表明，除了深部组织的导管内癌沿输乳管向乳头扩散外，还有一组佩吉特病起源于乳头。这些病变包括：（i）局限于乳晕组织的病变；（ii）伴有或可能不伴有跳跃区域扩散模式的导管内癌累及乳腺浅表和深部组织导管系统的病变。尽管某些佩吉特病病例可能看似表浅，但必须排除乳腺深部组织中独立的相关癌。
