Hartveit F, Lilleng P K
Department of Pathology, Gade Institute, University of Bergen, Norway.
Histopathology. 1996 Mar;28(3):241-6. doi: 10.1046/j.1365-2559.1996.d01-415.x.
Measurement of the area of the tumour deposits present in routine sections from the axillary nodes from a series of 1069 breast cancer patients showed that 138 cases had a single micrometastasis (0.2 cm2 or less), while in 29 a similar load was spread over two or more nodes. These 167 cases represent 15% of the patients in the series. Twentyfive of them had died of breast cancer within a mean follow-up of 6 years. They had smaller micrometastases than those surviving (P < 0.0025). Histological examination in the 138 with single micrometastases showed that two variants were present. In one, tumour growth was confined to the capsular lymphatics and/or the subcapsular sinus. In the other, tumour growth was present in the nodal lymphoid tissue, and, on occasion, at the other sites as well. Those with growth in the lymphoid tissue had a better prognosis than those without (P < 0.0035). Prognosis in the former was comparable to that in the node-negative cases, while in those lacking such growth it was similar to that in the node-positive. The presence of these two variants could explain divergent reports in the literature on prognosis in cases with micrometastases. While the mechanisms behind this apparent paradox remain speculative, the observation can be of diagnostic interest in routine surgical pathology.
对1069例乳腺癌患者腋窝淋巴结常规切片中肿瘤沉积物面积的测量显示，138例有单个微转移灶（面积0.2平方厘米或更小），而29例中相同负荷分布在两个或更多淋巴结中。这167例占该系列患者的15%。其中25例在平均6年的随访期内死于乳腺癌。他们的微转移灶比存活患者的更小（P<0.0025）。对138例有单个微转移灶的患者进行组织学检查发现存在两种类型。一种类型中，肿瘤生长局限于包膜淋巴管和/或包膜下窦。另一种类型中，肿瘤生长存在于淋巴结淋巴组织中，有时也存在于其他部位。淋巴组织中有肿瘤生长的患者预后比没有的患者更好（P<0.0035）。前者的预后与淋巴结阴性病例相当，而缺乏这种生长的患者预后与淋巴结阳性病例相似。这两种类型的存在可以解释文献中关于微转移病例预后的不同报道。虽然这种明显矛盾背后的机制仍属推测，但这一观察结果在常规外科病理学中可能具有诊断意义。
