Campbell A, Moazami N, Ditkoff B A, Kurtz E, Estabrook A, Schnabel F
Comprehensive Breast Center, Columbia-Presbyterian Medical Center, 622 West 168th Street, New York, New York, 10032, USA.
J Surg Res. 1998 Jul 15;78(1):27-30. doi: 10.1006/jsre.1998.5414.
The risk of development of breast lesions in patients on chronic immunosuppression is unknown. In order to assess this risk, a retrospective review was performed of the records of 87 women between the ages of 12 and 47 years who received thoracic organ transplant from 1987 to 1996 at our institution. Inclusion criteria consisted of patients who were premenopausal, had no previous history of breast disease, and survived for at least 1 year posttransplantation. All patients were on a triple immunosuppressive regimen consisting of cyclosporine, steroids, and azathioprine. Mean follow-up was 4 +/- 1.2 years with a range of 1-6 years. During this period, 21 patients (24%) with a mean age of 38 +/- 10 years had screening or diagnostic mammography. The remainder of patients with a mean age of 24 +/- 9 years were followed clinically. Overall, 10 patients (11%) developed a total of 17 palpable, solid lesions at 33 to 72 months posttransplantation. Fifteen of these lesions were surgically excised. Five of the patients had multiple lesions. Pathological examination of the specimens revealed fibroadenoma in nine, fibrocystic disease in four, low grade phylloides tumor in one, and T-cell lymphoma in one case. None of the patients have developed primary breast cancer during follow-up. In conclusion, short-term immunosuppression does not increase the risk of the development of benign breast lesions in young women after thoracic organ transplantation, but rather the distribution of benign lesions is similar in an age-matched population. There were several cases of multiple fibroadenomas in the transplant population, but mammography revealed no malignant disease in this age group and does not need to be utilized in this population beyond what is considered standard for immunocompetent patients. The long-term effect ofimmunosuppressive therapy on the developmentof breast cancer in this group remains to be defined.
长期接受免疫抑制治疗的患者发生乳腺病变的风险尚不清楚。为了评估这一风险，我们对1987年至1996年间在本机构接受胸器官移植的87名年龄在12至47岁之间的女性的记录进行了回顾性研究。纳入标准包括绝经前、既往无乳腺疾病史且移植后存活至少1年的患者。所有患者均接受由环孢素、类固醇和硫唑嘌呤组成的三联免疫抑制方案。平均随访时间为4±1.2年，范围为1至6年。在此期间，21名平均年龄为38±10岁的患者进行了筛查或诊断性乳房X线摄影。其余平均年龄为24±9岁的患者进行临床随访。总体而言，10名患者（11%）在移植后33至72个月出现了总共17个可触及的实性病变。其中15个病变接受了手术切除。5名患者有多个病变。标本的病理检查显示9例为纤维腺瘤，4例为纤维囊性疾病，1例为低级别叶状肿瘤，1例为T细胞淋巴瘤。随访期间没有患者发生原发性乳腺癌。总之，短期免疫抑制不会增加年轻女性胸器官移植后发生良性乳腺病变的风险，而且良性病变的分布在年龄匹配的人群中相似。移植人群中有几例多发性纤维腺瘤，但乳房X线摄影显示该年龄组无恶性疾病，在该人群中不需要超出免疫功能正常患者的标准进行使用。免疫抑制治疗对该组乳腺癌发生的长期影响仍有待确定。
