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- 乳腺癌术后两年，做过化疗，不典型腺细胞？补传图片
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本帖最后由 于 2009-09-10 19:13:00 编辑
1. We should know the women's LMP, breast cancer type and diagnosed time, detailed treatment history (radiation?).
2. If this patient is not in LMP or within 12 days, At most I may consider to call AGC based on the first photo. The AGC may represent neoplastic lesions or reactive change, especially for this women with history of chemotherapy, 带环 (the patient has or not???).
3. Remember that most women (70-80%) with AGC Pap would have no neoplastic lesions. Again Pap test is a screening test. You must be 100% sure, otherwise please do not call malignant for your pap test, especially for this 35 young lady.
4. if the women is in LMP or within 12 days, we need to think over the meaning of these cells.
5. Breast cancer cells can occour in the Pap smear, but it is very rare.
6. Also we should consider the patient's age. If the young women has both breast and gynecologic tumor, the patient may have BRCA gene mutation.
just for your reference.
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- Comment in:
- Gynecol Oncol. 2009 Sep;114(3):381-2.
Histologic follow-up results in 662 patients with Pap test findings of atypical glandular cells: results from a large academic womens hospital laboratory employing sensitive screening methods.
Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-3180, USA. zhaoc@upmc.edu
OBJECTIVE: Atypical glandular cell (AGC) Pap interpretations and screening for glandular neoplasias remain major challenges. We document the largest reported AGC histopathologic follow-up experience and include verification bias-adjusted data on laboratory screening sensitivity. METHODS: AGC Pap tests of endocervical origin (AGC-EC), endometrial origin (AGC-EM), and not otherwise specified (AGC-NOS) were documented at a center serving an older low risk population. 98% of Pap tests were liquid-based cytology (LBC) specimens screened using computer-assisted screening. Follow-up diagnoses were correlated with cytology and stratified into age groups. Screening sensitivity was assessed by examining Pap results during 1 year preceding neoplastic diagnoses. Verification bias was adjusted with findings in over 2000 patients with hysterectomies. RESULTS: Of 247,131 Pap tests, 1021 (0.41%) reported AGC results and 662 cases had tissue follow-up. Precancerous or malignant neoplastic histologic outcomes were documented in 101 patients (15.3%), including 8.3% cervical, 6.3% endometrial, and 0.6% ovarian. AGC results were most often associated with neoplastic cervical outcomes in women younger than 40 and with neoplastic endometrial outcomes in women 50 or older. AGC-NOS with a squamous cell abnormality and AGC-EC results suggested cervical neoplasia, while AGC-EM results suggested endometrial neoplasia. CONCLUSIONS: AGC Pap results detected significant numbers of cervical and non-cervical neoplasias. Since 38 of 44 (86%) of AGC-detected carcinomas were endometrial or ovarian, HPV co-testing would not have aided screening in detecting the majority of malignancies diagnosed after AGC Pap results. Verification bias-adjusted Pap screening sensitivity in the laboratory for detection of significant neoplastic cervical disease was 93%.
I have a AGC-follow up paper published recently. This is the largest study in this area till now.
Gynecol Oncol. 2009 Sep;114(3):383-9. Epub 2009 Jun 7.
Second malignancies after breast cancer: the impact of different treatment modalities.
Kirova YM, De Rycke Y, Gambotti L, Pierga JY, Asselain B, Fourquet A; Institut Curie Breast Cancer Study Group.
Department of Radiation Oncology, Institut Curie, Paris, France. youlia.kirova@curie.net
Treatment for non-metastatic breast cancer (BC) may be the cause of second malignancies in long-term survivors. Our aim was to investigate whether survivors present a higher risk of malignancy than the general population according to treatment received. We analysed data for 16 705 BC survivors treated at the Curie Institute (1981-1997) by either chemotherapy (various regimens), radiotherapy (high-energy photons from a 60Co unit or linear accelerator) and/or hormone therapy (2-5 years of tamoxifen). We calculated age-standardized incidence ratios (SIRs) for each malignancy, using data for the general French population from five regional registries. At a median follow-up 10.5 years, 709 patients had developed a second malignancy. The greatest increases in risk were for leukaemia (SIR: 2.07 (1.52-2.75)), ovarian cancer (SIR: 1.6 (1.27-2.04)) and gynaecological (cervical/endometrial) cancer (SIR: 1.6 (1.34-1.89); P<0.0001). The SIR for gastrointestinal cancer, the most common malignancy, was 0.82 (0.70-0.95; P<0.007). The increase in leukaemia was most strongly related to chemotherapy and that in gynaecological cancers to hormone therapy. Radiotherapy alone also had a significant, although lesser, effect on leukaemia and gynaecological cancer incidence. The increased risk of sarcomas and lung cancer was attributed to radiotherapy. No increased risk was observed for malignant melanoma, lymphoma, genitourinary, thyroid or head and neck cancer. There is a significantly increased risk of several kinds of second malignancy in women treated for BC, compared with the general population. This increase may be related to adjuvant treatment in some cases. However, the absolute risk is small.
PMID: 18268495 [PubMed - indexed for MEDLINE]-
2: Asian Pac J Cancer Prev. 2009 Jan-Mar;10(1):163-6.
Uterine malignancy following tamoxifen use in breast cancer patients in Iran: case series and literature review.
Behtash N, Hashemi R, Karimi Zarchi M.
Gynecology Oncology Department, Vali-Asr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran. nadbehtash@yahoo.com.
BACKGROUND: This study evaluated tumor characteristics and survival in women with breast cancer who subsequently developed uterine cancer. METHODS: Information about endometrial cancer in tamoxifen users following breast cancer refered to the gynecologic oncology clinic of Vali-Asr hospital between 1997-2007 was evaluated. RESULTS: Among 330 patients with endometrial cancer, 5 were in women previously diagnosed with breast cancer. Two cancers were malignant mixed Mullerian tumors of the uterus (MMMT), 2 were endometrioid adenocarcinomas, and one was a papillary clear cell carcinoma. Patients received tamoxifen for 4-8 years. The endometrial cancers occurred 2-11 years after initial treatment for the breast cancers. Four of the endometrial cancers featured abnormal uterine bleeding and one of them had increased vaginal discharge and all were diagnosed on endometrial curetting. All patients received standard surgical staging for endometrial cancer and all except one were stage I. At laparotomy of one patient, an advanced stage MMMT was found with diffused peritoneal spread and ascites. In spite of the surgery, she died of disease, 3 months later. The other patients remain recurrence-free for breast cancer and uterine cancer after 6-120 months. CONCLUSION: Breast cancer patients who use tamoxifen and have early stage endometrial cancers demonstrate a good prognosis. Abnormal uterine bleeding or vaginal discharge are the most important symptoms.
PMID: 19469647 [PubMed - indexed for MEDLINE]-
3: Breast Cancer Res Treat. 2008 Nov;112(1):99-108. Epub 2007 Dec 7.
Prognosis of uterine corpus cancer after tamoxifen treatment for breast cancer.
Hoogendoorn WE, Hollema H, van Boven HH, Bergman E, de Leeuw-Mantel G, Platteel I, Fles R, Nederlof PM, Mourits MJ, van Leeuwen FE; Comprehensive Cancer Centers TAMARISK-group. Department of Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Tamoxifen increases the risk of uterine corpus cancer. Since only few, mostly small, studies have examined prognosis of uterine corpus cancer following tamoxifen, we conducted a large retrospective cohort study to further investigate this. We examined histopathologic and immunohistochemical characteristics of 332 patients with uterine corpus cancer following breast cancer, according to tamoxifen use. Survival was examined in the same patients combined with 309 patients from a previous study with updated follow-up. Histological review of all cancers was performed. Long-term tamoxifen users showed a higher proportion of non-endometrioid tumors than non-users (32.7% vs. 17.4%, P=0.004), especially serous adenocarcinomas and carcinosarcomas. An increased proportion of FIGO stage III and IV tumors was also observed (20.0% vs. 11.3%, P=0.049). Within FIGO stage I, both short-term and long-term tamoxifen users showed a higher proportion of tumors limited to the endometrium than non-users (35.7% vs. 22.9%, P=0.049 and 0.004 respectively). Uterine corpus cancers in long-term tamoxifen users were more often steroid receptor-negative (ERalpha, PRA and PRB, P<0.05) and P53-positive (P=0.015). Three-year uterine corpus cancer-specific survival was worse for long-term tamoxifen users than for non-users (82% vs. 93% P=0.0001). The survival difference remained after adjustment for histopathologic and immunohistochemical characteristics (hazard ratio (HR) for >or=2 years tamoxifen=2.4; 95% CI=1.2-4.6). In conclusion, this large study clearly shows that tamoxifen-associated tumors have less favorable histological features and a worse survival. Our results can be applied when weighing risks and benefits of tamoxifen versus other hormonal agents used in the prevention and treatment of breast cancer.
乳腺癌术后经Tamoxifen治疗后，极有可能发生子宫癌。请见文献报道。
1: Br J Cancer. 2008 Mar 11;98(5):870-4. Epub 2008 Feb 12.
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