Department of Pathology, Henry Ford Hospital, Detroit, Michigan, USA.
Arch Pathol Lab Med. 2013 Jul;137(7):955-60. doi: 10.5858/arpa.2012-0137-OA.
Breast cancer treatment has greatly evolved from radical mastectomy to more cosmetically acceptable and less-debilitating surgeries. Nipple-sparing mastectomy is increasingly done for both cancer treatment and risk reduction. The frequency of terminal duct lobular units (TDLUs) and occult neoplastic epithelial proliferation in grossly/clinically unremarkable nipples (GUNs) is not well investigated.
To describe frequency of TDLUs and occult and overt neoplastic nipple involvement.
Nipples from 105 consecutive specimens (90 therapeutic, 15 prophylactic) were studied. Sixty-five nipples were entirely submitted to evaluate frequency of TDLUs; the rest had 1 vertical section submitted.
Terminal duct lobular unit was seen in 17 GUNs (26%). Six had TDLU in the base, 6 had it in the papilla, and 5 in both. Four GUNs showed lobular carcinoma in situ (1), Paget disease (1), and pagetoid extension of underlying malignancy (2). Grossly/clinically abnormal nipples had Paget disease (2), lymphovascular invasion (2), invasive carcinoma (4), and pagetoid extension (5). Involved nipples were closer to tumor (mean, 1.1 versus 3.2 cm, P < .001), had larger underlying tumors (mean, 4.3 versus 2.6 cm, P = .03) and of higher grade (P = .04), and more often had lymph node metastases (91% versus 44%, P = .007). No pathologic abnormalities were found in prophylactic mastectomy nipples.
Terminal duct lobular units were seen in 26% of nipples. They were frequently seen in the nipple papilla. Occult neoplastic epithelial proliferation was seen in 5% of grossly/clinically unremarkable therapeutic mastectomy nipples. Pagetoid extension was the dominant spread of underlying malignancy. Overall, the nipple was more often involved by larger and higher-grade tumors located closer to the nipple. All prophylactic mastectomies had unremarkable nipples. These findings should be considered while selecting patients for nipple-sparing mastectomy.
乳腺癌的治疗已经从根治性乳房切除术发展为更美观、对身体影响更小的手术。保乳手术不仅用于治疗癌症，还用于降低风险。目前对大体/临床无异常乳头（GUN）中终末导管小叶单位（TDLU）和隐匿性肿瘤上皮增殖的频率尚不清楚。
描述 TDLU 以及隐匿性和显性乳头受累的频率。
研究了 105 例连续标本（90 例治疗性，15 例预防性）的乳头。65 个乳头全部送检，以评估 TDLU 的频率；其余标本送检 1 个垂直切片。
17 个 GUN（26%）中发现 TDLU。6 个 GUN 的 TDLU 位于基底，6 个位于乳头，5 个位于基底和乳头均有。4 个 GUN 显示小叶原位癌（1 个）、派杰病（1 个）和潜在恶性肿瘤的派杰样延伸（2 个）。大体/临床异常乳头有派杰病（2 个）、脉管侵犯（2 个）、浸润性癌（4 个）和派杰样延伸（5 个）。受累乳头距肿瘤更近（平均 1.1cm 与 3.2cm，P<.001），肿瘤更大（平均 4.3cm 与 2.6cm，P=.03），分级更高（P=.04），且淋巴结转移更常见（91%与 44%，P=.007）。预防性乳房切除术的乳头未发现病理异常。
26%的乳头可见 TDLU，常位于乳头乳头。治疗性乳房切除术的大体/临床无异常的 5%乳头可见隐匿性肿瘤上皮增殖。派杰样延伸是潜在恶性肿瘤的主要扩散方式。总体而言，更大、更高分级、更靠近乳头的肿瘤更常累及乳头。所有预防性乳房切除术的乳头均无异常。在选择保乳术患者时，应考虑这些发现。
