Wiggett W S, Louw M, Karusseit V O L
Department of Surgery, University of Pretoria, Pretoria, South Africa.
S Afr J Surg. 2012 Jul 11;50(3):75-8. doi: 10.7196/sajs.1103.
Surgery is sometimes performed on patients with peau d'orange (dermal oedema) of the breast. This may be done to achieve local control of cancer after neo-adjuvant chemotherapy or in resectable locally advanced disease. Conventional practice is not to place excision lines through areas of peau d'orange for fear of recurrence in such an area. The question can be asked whether this wisdom is still valid in modern practice. No formal cohort studies documenting the histopathology of the skin in areas of peau d'orange have been published, and available descriptions are scanty.
To describe the histopathological features of peau d'orange.
Consecutive patients undergoing mastectomy for cancer in whom peau d'orange was present were selected over a period of 2 years. Blocks of skin were excised from areas of peau d'orange and examined histologically. The presence, nature and location of malignant cells were recorded and correlated with lymph node pathology. Prior administration of neo-adjuvant chemotherapy was noted.
Twenty-six mastectomy specimens were examined. Tumour islands in lymphatics were identified in 10 of the 26 specimens. These tumour groups were found in lymph vessels of both the superficial and deep dermal plexuses. In 1 specimen the presence of malignant cells was equivocal. Metastatic tumour was present in axillary lymph nodes in 19 of 22 specimens. Fourteen patients had been treated with neo-adjuvant chemotherapy, and 5 of their specimens exhibited the presence of tumour cell groups in lymphovascular channels.
Tumour cells were present in the lymphatic vessels in areas of peau d'orange in 38% of the specimens studied. It would be expected that placing an excision line in such an area would result in an incomplete cancer operation in a high percentage of, but not all, cases.
有时会对患有乳房橘皮样改变（皮肤水肿）的患者进行手术。这可能是在新辅助化疗后实现癌症局部控制，或是针对可切除的局部晚期疾病进行的操作。传统做法是不在橘皮样改变区域设置切除线，因为担心该区域会复发。在现代实践中，这个观点是否仍然有效值得探讨。目前尚未发表过记录橘皮样改变区域皮肤组织病理学的正式队列研究，现有描述也很匮乏。
描述橘皮样改变的组织病理学特征。
选取两年内连续接受乳腺癌乳房切除术且存在橘皮样改变的患者。从橘皮样改变区域切除皮肤组织块并进行组织学检查。记录恶性细胞的存在、性质和位置，并与淋巴结病理学结果相关联。记录新辅助化疗的先前使用情况。
共检查了26个乳房切除标本。26个标本中有10个在淋巴管中发现了肿瘤岛。这些肿瘤团块在浅真皮丛和深真皮丛的淋巴管中均有发现。1个标本中恶性细胞的存在不明确。22个标本中有19个腋窝淋巴结存在转移瘤。14例患者接受了新辅助化疗，其中5个标本在淋巴管通道中出现了肿瘤细胞团。
在所研究的标本中，38%的橘皮样改变区域淋巴管中存在肿瘤细胞。可以预期，在这样的区域设置切除线，在高比例（但并非全部）的病例中会导致癌症手术不彻底。
