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    彩色多普勒超聲診斷乳腺佩吉特病1例
    關鍵字:乳腺,診斷,彩色,AB,CD,EF,yz,wx,qr,st, 發布時間:2011-08-21

    ?574? 與胎體相連。羊膜帶綜合征為偶發病例,再發風險極低…。 參考文獻 [1]嚴英榴.楊秀雄.沈理.產前超聲診斷學.北京:人民衛生出版社。 2003:435. [2]BustamantesJ,GalindoMartinezDF.Caudalappendix insequential defectsofanmiotierupture.C,ineeloOhstetMex,1997,65(2):114一 117. [3]吳青青,陳焰.羊膜帶綜合征的研究進展.中華婦產科雜志, 2002.37(3):187—188. (收稿日期:2009—12-05) -病例報道? 彩色多普勒超聲診斷乳腺佩吉特病1例 許益 [中圖法分類號】R737.9[文獻標識碼】B 患者女,57歲。因左乳溢液3個月來我院就診。患者近 3個月發現左乳不規則溢液伴脫屑,呈淡黃色,無血性溢液,雙 乳無脹痛、瘙癢,無胸悶胸痛、畏寒發熱等明顯不適。查體:左 乳乳頭皮膚表面可見黃豆大小局限性潰爛,其內可見多個肉紅 色乳頭狀凸起(圖1),雙乳及腋窩來捫及確切包塊,乳腺皮膚 無凹陷。左乳分泌物涂片檢查,見高度可疑癌細胞。 超聲檢查使用PhilipsHDll彩色多普勒超聲診斷儀,探頭 頻率9.5—18.0MHz。超聲所見:左側乳頭大小約14mm x 9.0mmX10mm,右側乳頭大小約12nlni×5.0mm×7.0mm, 左乳頭內實質回聲不均勻,邊界欠清,近基底部可見錐形稍高 回聲團(圖2),邊界不清,范圍約9mm×4mill,其內可見多個 大小約1.0min散在沙粒狀強回聲。將血流頻譜量程調至 5em/s左右時,動態觀察團塊內可見少許星點狀低速血流信號 (圖3)。右側乳頭及雙側乳腺、腋窩未見異常團塊聲像。超聲 診斷:左側乳頭實質內不均質稍強回聲團伴鈣化灶(結合病史, 乳腺佩吉特病?)。 行左側單純乳房切除術。術中所見:左乳頭少許淡血漿樣 滲液,左乳頭內隱約町捫及結節,左乳其余位置未見包塊。左 乳乳頭皮膚鏡下所見:Paget細胞成簇狀浸潤表皮(圖4)。病 理診斷:左乳乳頭Paget病,腫瘤累及乳頭部導管并形成導管內 癌。乳頭下方乳腺實質內未見腫瘤累及。 圖1左側乳頭皮膚潰爛圖2雙側乳頭對比聲像I冬j圖3左側乳頭見星點狀血流信號圖4鏡卜.見Paget細胞成簇狀浸 潤表皮(X100) 討論乳腺佩吉特病又稱濕疹樣乳腺癌,是一種特殊類型 的乳腺癌,以乳頭、乳暈皮疹開始,呈顆粒狀、深紅色、類似濕疹 樣變化,多在一年后發現為乳腺癌。本病I臨床上較少見,極易 誤診為皮膚濕疹,且該病早期,腺體內多無明確病灶或無局限 性腫塊,臨床根據組織涂片查及Paget細胞確診。故該病早期 的彩色超聲影像學資料不多。此病早期主要需與不典型乳腺 導管內乳頭狀瘤相鑒別,兩者均有乳頭溢液等癥狀,但后者多 有導管擴張的超聲影像學改變,結合臨床,多無乳頭皮膚浸潤 的表現。此患者雙側乳腺內并未捫及包塊,若行彩色超聲檢查 時,遺漏對乳頭、乳暈的檢查,不易發現病灶的存在。且由于乳 作者單位.:614000四川省樂山市人民醫院超聲影像科 頭內病灶小,位置表淺,檢查時應用分辨力高的高頻超聲探頭, 其次,為更確切的顯示乳頭導管及其內的占位影像,排除導管 病變,檢查前不應擠空乳頭。 乳腺佩吉特病行病理檢查具確診意義。對于有乳頭、乳暈 皮膚濕疹、潰爛、溢液等臨床表現的患者,行乳房超聲檢查時, 更應重視對乳頭、乳暈的檢查。且此類病種,在行超聲診斷時, 要注意結合臨床表現及病史,盡可能為臨床手術方式與術后治 療提供詳細、全面的超聲影像學資料。 (收稿日期:20lO一05一11) 萬方數據 換頁

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