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目的探讨乳腺癌术后Stewart-Treves综合征的临床病理学特征,提高对该病的诊治水平。方法报道3例乳腺癌术后Stewart-Treves综合征,采用CD34,D2-40,CD31,FⅧ,CK,EMA,vimentin和Ki-67等抗体进行免疫组化染色,并复习文献。结果 3例乳腺癌术后Stewart-Treves综合征患者均以患侧肢体水肿为首发症状,病变皮肤出现红斑或破溃,均有放疗史。镜下表现为浸润性生长的不规则脉管,内衬细胞异型性明显,局部增生成片。免疫组化示肿瘤细胞CD34、CD31、D2-40和vimentin弥漫(+),FⅧ灶性(+);Ki-67约30%(+)。结论乳腺癌术后出现淋巴管肉瘤很少见,与淋巴水肿相关,肿瘤细胞表达淋巴管内皮标记物和出现异型性是诊断关键,患者预后差。
Objective To investigate the clinicopathological features of Stewart-Treves syndrome after breast cancer surgery and to improve the diagnosis and treatment of the disease. Methods Three cases of postoperative Stewart-Treves syndrome of breast cancer were reported. Immunohistochemical staining was performed using antibodies such as CD34, D2-40, CD31, FⅧ, CK, EMA, vimentin and Ki-67. Results All the 3 patients with Stewart-Treves syndrome after breast cancer were characterized by edema of the diseased limbs as the first symptom, erythema or rupture of the diseased skin with history of radiotherapy. Microscopic appearance of infiltrative growth of irregular vessels, lining cells obvious atypia, local hyperplasia into pieces. Immunohistochemistry showed tumor cells CD34, CD31, D2-40 and vimentin diffuse (+), FⅧ focal (+); Ki-67 about 30% (+). Conclusions Lymphangiosarcoma is rare in postoperative breast cancer patients. Lymphatic sarcoma is associated with lymphedema. The expression of lymphatic endothelial markers and atypia in tumor cells is the key point of diagnosis. The prognosis is poor.