發問日期
2011年10月26日
問題內容
現在33歲，2011/9/26做粗針穿刺，2011/10/5做乳房保留手術，二份報告如下:
2011/9/26 粗針穿刺病理檢查報告:
breast,right, core needle biopsy, --- fibroadenoma with focal pattern of fibrocystic disease and adenosis
breast, left, core needle biopsy, --- invasive ductal carcinoma
gross description
The specimen #1 (right) submitted consists of four tissue fragments measuring up to 1.5*0.1*0.1 CM in size fixed in formalin.
grossly, they are gray and cord like.
all for section and labeled as A.

The specimen #2 (left) submitted consists of four tissue fragments measuring up to 1.6*.0.1*0.1 CM in size fixed in formalin.
grossly, they are gray and cord like.
All for section and labeled as B.

MICROSCOPIC DESCRIPTION:
right breast, specimen #1
Histologic type:
Fibroadenoma
Focal pattern of fibrocystic disease and adenosis
Histologic pattern:
1. Proliferated ramifying, slitlike and and small-round mammary ducts in a hyperplastic fibromyxoid stroma
2. Focal ductal dilation and intraductal epithelial hyperplasia

Left breast, specimen #2
Tumor type : invasive ductal carcinoma
Tumor grade (provisional SBR grade): Ⅱ (Moderately differentiated) (score 7)
Tubule formation: 10-75%(score 2)
Nnclear pleomorphism : Moderate (score 2)
Mitotic count : >11/10 HPF (score 3)
Tumor size : Not assessable due to biopsy
Ductal carcinoma in situ (DCIS) : Present; cribriform type, intermediate grade Extensive intraductal carcinoma status (DCIS>25%): Not assessable due to biopsy Peritumoral lymphovascular invasion: Suspicious
Perineural invasion : Absent

Tumor necrosis :Mild to moderate
Margin: Not assessable due to biopsy

ADDENDUM
Results of immunohistochemical study:
Estrogen receptor (ER): Positive (>90%, moderately to strongly)
Progesterone receptor (PR): Positive(15%, moderately to strongly)
Assessment of HER-2/neu protein: Positive (score : 3+)

2011/10/5 乳房保留手術病理檢查報告:
DIAGNOSIS:
Breast, left, breast conserving therapy,---invasive ductal carcinoma,
poorly differentiated(grade III)
Skin, breast, left, breast conserving therapy,---free of cancer
Lymph node, axillary, left, frozen section and dissection,---free of
metastasis(0/13)
Soft tissue, axillary, left, frozen section,---free of cancer

GROSS DESCRIPTION:
Specimen for frozen section:
The specimen #1 submitted consists of one tissue fragment measuring 0.9*0.5
*0.3 cm in size in fresh state.
Grossly, it is fleshy, yellow and fatty.
All for section and labeled as follows:
Fs1:frozen section
Fc1:frozen control
The specimen #2 submitted consists of two tissue fragments measuring up to 0.9*0.7*0.5 cm in size in fresh state.
Grossly, they are fleshy to yellow and firm to fatty.
All for section and labeled as follows:
Fs2:frozen section
Fc2:frozen control

FROZEN SECTION:
Specimen #1: Absence of lymphoid tissue
Specimen #2:Presence of a lymph node with no evidence of malignancy

Left breast cancer


Subsequent specimen:
Breast:Left
Specimen:Breast conserving therapy with the axillary content in fresh state
Size of the breast removed:11.6*8.3*2.1cm
Dimension of the covering skin:4.5*1.2 cm
Size of the axillary soft tissue:7.4*4.4*1.7 cm
Tumor location: Single tumor, lateral to the nipple
Gross tumor:YES
Size of the tumor:1.9*1.8*1.7 cm
Tumor growth pattern: Circumscribed margin
Texture of the tumor:Gray and solid
Gross margin:
Basal:Free(3 mm)
Superior:Free(35 mm)
Lateral:Free(24mm)
Inferior(stitch marked):Free(42 mm)
Medial:Free(21mm)
Lymph nodes:Totally thirteen,up to 1.1 cm in greatest diameter
Separate fragment:
Two, up to 10.3*5.8*1.5 cm in size: gray to yellow and firm
Representative sections are taken and labeled as follows:
A1-4:breast(A1:with the basal margin; A1 and A4: with skin)
B1-4:superior, lateral, inferior and medial margins, sequentially
C1-2:lymph nodes
D:separate fragment
MICROSCOPIC DESCRIPTION:
Histologic type:Invasive ductal carcinoma
Histologic grade (SBR grade):III(Poorly differentiated)(score 8)
Tubule formation:10-75%(score 2)
Nuclear pleomorphism:Marked(score 2)
Mitotic count:>11/10HPF(score 3)
Tumor size:1.9cm, measured on the histologic slides(pT1c)
Ductal carcinoma in situ (DCIS):Positive; cribriform type, intermediate grade
Extensive intraductal carcinoma status (DCIS>25%):Negative
Peritumoral invasion:Absent
Tumor necrosis:Moderate
Microcalcification:Present
Margin:
Basal:Free(3 mm, measured on the histologic slide)
Superior:Free(35 mm, as measured grossly)
Lateral:Free(24 mm, as measured grossly)
Inferior:Free(42mm, as measured grossly)
Medial:Free(21 mm, as measured grossly)
Skin:Free of cancer
Lymph nodes(Positive/Total):(pNO)
Axillary:0/13
Soft tissue, axillary:Free of cancer
Associated findings:
Adenosis, columnar cell change and atypical ductal hyperplasia
pTNM:pT1cNo

REFERENCE:
M11-06343

Breast,right, core needle biopsy,---fibroadenoma with focal pattern of
fibrocystic disease and adenosis
Breast, left, core needle biopsy,---invasive ductal carcinoma


目前33歲未婚，已知乳癌一期，淋巴13顆未感染
請問:
1.開刀後的組織並沒有再做ER、PR、HER-2檢驗，醫生只依據粗針穿針的檢查結果來當治療指標，依據粗針穿針做的ER、PR、HER-2檢驗三者都是陽性，偽陽性的機率有多高?是否需要再拿開刀後的組織重新化驗一次?
2.『6次小紅莓 + 1年賀癌平』 跟『4次小紅莓 + 4次紫杉醇+ 4次賀癌平』，那一個化療適合我?二者五年跟十年復發率與死亡率是多少?
3.若只單做6次小紅莓成效如何?
4.HER-2是偽陽性，賀癌平是否就不用做了?
5.目前未婚，紫杉醇是否會造成卵巢嚴重退化而不孕?

謝謝～
回答醫師
謝瑞坤
回答日期
2011年10月26日
回答內容
你好, 你罹患乳癌第一期pT1cN0 (0/13), 雖屬第一期但大小稍大1.9*1.8*1.7 cm，細胞分化不良poorly differentiated (grade III), 荷爾蒙接受體 Estrogen receptor (ER): 強陽性 (>90%), Progesterone receptor (PR): 陽性 (15%), 第二型上皮生長因子接受體HER-2/neu: 強陽性 (3+), 應追加輔助性治療以降低復發

1. 乳房保留手術, 術後應追加局部放射線治療

2. 建議『6次小紅莓 + 追加局部放射線治療 + 1年賀癌平 (HER-2/neu 陽性3+) + 5年 抗荷爾蒙Tamoxifen治療』是合理的選項治療, 許多其他選項與利弊應多與你的主治醫師深入討論

3. 無論是小紅莓, 紫杉醇, Tamoxifen 均有可能影響月經甚至生育能力, 建議可先冰凍保存卵子