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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 2009-09-13 18:54:00 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.
我来帮赵老师翻译一下：
1。我们应该知道病人的末次月经，乳腺癌的类型、诊断时间和具体的治疗方案（是否用过放疗）？
2。如果这个病人不是在末次月经或者12天之内，根据第一张图我最多认为是非典型腺细胞。AGC可能代表肿瘤性的或者反应性病变，特别是在这样一个化疗史或者带环(? ? ?)患者
3。应当记住的是细胞学报AGC的病人70-80%是没有病变的，除非你是100%的确定，否则在细胞学上不要报恶性，特别是这个病人仅35岁
4如果这个病人是在末次月经或者12天之内，我们需要仔细考虑这些细胞的意义
5 乳腺癌细胞可以出现在巴氏涂片中,但是非常罕见。
6 我们也应该考虑患者的年龄。如果是年轻女性既有乳腺癌又有妇科肿瘤,病人可能有BRCA基因突变。
仅供参考。
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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