Please use this identifier to cite or link to this item: http://hdl.handle.net/11455/13971
標題: 犬惡性乳腺腫瘤:預後與組織病理學之研究
Canine malignant mammary tumors: Prognostic and histopathologic studies
作者: 張仕杰
Chang, Shih-Chieh
關鍵字: dog

malignant mammary tumor
mammary tumor
prognosis
surgery
惡性乳腺腫瘤
乳腺腫瘤
預後
外科
出版社: 獸醫學系暨研究所
摘要: 本研究犬惡性乳腺腫瘤包括四個部分,第一個是惡性乳腺腫瘤患犬術後2年存活相關連之預後因子,第二個是卵巢子宮摘除術(ovariohysterectomy, OHE)在患犬複合型乳癌切除後的預後角色,第三個是不同腫瘤分期和組織學類別乳腺腫瘤患犬之壽命觀察,第四個是證實一新乳癌組織學類別即乳癌皮脂腺分化。 第一部分,由79隻惡性乳腺腫瘤母犬的醫療記錄中來證實手術切除腫瘤後2年存活相關連之預後因子。結果顯示,由單變項分析得知與術後2年存活有顯著相關的預後因子包括臨床分期、腫瘤大小、有無OHE、區域淋巴結或遠端轉移和腫瘤組織學類別。當腫瘤大於5公分且後前已存在6個月以上之患犬比較容易出現淋巴結轉移。相對於單一型乳癌患犬,OHE較有利於複合型乳癌患犬術後2年存活。經由多變項分析得知臨床分期、腫瘤大小和OHE顯著與惡性腫瘤患犬術後2年存活相關連。 第二部分的研究是證明OHE對患犬複合型乳癌切除後2年存活之影響。在本研究中包括50頭複合型乳癌患犬,其中21頭犬在乳腺腫瘤切除之前、同時或之後有執行過OHE的病史。再者,複合型乳癌臨床分期第I、II和III期患犬中有60%,而第IV或V期患犬中有30%經歷OHE。由結果顯示出複合型乳癌患犬當切除腫瘤同時進行OHE者,可顯著降低術後2年內死亡的危險。另外,若是在乳腺腫瘤切除之前施行過OHE亦可減少術後2年內死亡的危險,但不具統計學上的顯著性。 第三部分的研究是針對不同腫瘤分期和組織學類別患犬壽命的觀察。本研究收集腫腺乳瘤患犬病例時間是從西元1998至2005年,總共有74頭患犬經歷腫瘤切除並且同時追踪患犬至其死亡為止。由結果發現將近有50%的乳腺腫瘤患犬的死因是復發或轉移。本研究中所有患犬術後的平均存活時間為16.62 months,而平均壽命為12.07年。由結果顯示,雖然不同腫瘤分期和組織學類別與患犬術後存活時間長短相關,但平均患犬壽命卻相類似。再者,OHE不僅有利於延長患犬術後存活時間,亦可增加腫瘤腫瘤患犬的壽命。 第四部分的研究是證實一新的乳癌類別乳癌皮脂腺分化。這是一種特別少見具有皮脂腺分化的侵襲型乳癌,發生在一10歲齡混種母犬。患犬的左側第5乳腺出現二個團塊。該腫瘤觸感堅實且出現淺表潰瘍灶,剖面呈現白色至淡棕色外觀並有分葉樣與壞死灶。顯微鏡檢查發現該腫瘤是由二種明顯不同形態的腫瘤細胞所組成,即導管內乳突狀腺癌和皮脂腺癌。在皮脂腺癌區域可見腫瘤細胞堆積成個別的團塊區,每個團塊區包含有被少量至多層基底樣細胞包團之分化良好的皮脂腺細胞和角化上皮細胞。這些腫瘤細胞含有豐富且泡沫樣的細胞質,類似皮脂腺細胞,可以在導管內乳突樣癌細胞群中被發現到,由此作為該癌細胞呈現皮脂腺化生的證據。由這兩型腫瘤細胞的同時存在顯示出皮膚附屬器細胞與乳腺導管細胞應是共同來自於胚胎時期的外胚層。而此類乳癌呈現出廣泛的淋巴管與淋巴結轉移特色,造成預後不良。
The study conducted for canine malignant mammary tumors consists of four parts including first, prognostic factors associated with survival two years after surgery in dogs with malignant mammary tumors; second, role of ovariohysterectomy (OHE) on dogs after surgical removal of mammary complex carcinomas; third, complete lifetime observation in dogs with various stages and types of mammary tumors; forth, identification of a mammary carcinoma with sebaceous differentiation. First, medical records of 79 female dogs with malignant mammary tumors were reviewed to identify prognostic factors associated with survival 2 years after surgery. Results of univariate analyses indicated that clinical stage, tumor size, ovariohysterectomy status, metastasis to adjacent lymph nodes or distant sites, and histologic classification of the tumor were significantly associated with survival 2 years after surgery. Tumors >= 5 cm in diameter and tumors that had been identified > 6 months before surgery were more likely to metastasize to adjacent lymph nodes. Ovariohysterectomy was more beneficial in dogs with complex carcinomas than in dogs with simple carcinomas. In multivariate analyses, clinical stage, tumor size, and ovariohysterectomy status were significantly associated with outcome 2 years after surgery. Second, to determine the effect of OHE on survival 2 years of female dogs with mammary complex carcinomas after surgical removal, 50 female dogs with mammary complex carcinomas were eligible for this study. Twenty-one dogs out of 50 dogs were with history of OHE performed prior to, after, or simultaneously with mammary tumor removal. OHE was conducted in 60% of dogs with stage I, II, or III tumors, and in 30% of dogs with stage IV or V tumors, respectively. Results showed dogs with mammary complex carcinomas undergoing OHE simultaneous with mammary tumor surgery have a reduced risk of death in 2 years. Although not statistically significant, a reduced risk of death in 2 years was found if OHE was done prior to mammary tumor surgery. Third, the study was conducted for complete lifetime observation in female dogs with various stages and types of mammary tumors. During the study period from 1998 to 2005, a total of 74 dogs diagnosed with mammary tumor after surgical treatment were followed up until death. It was found that approximately 50% of the dogs with mammary tumors died because of metastasis or local recurrence. They had an average survival time of 16.62 months after surgical removal, and an average life-span of 12.07 years. The results showed that although different stages or different types of the tumors were associated with the length of survival time after surgical removal, the length of total life span was similar among dogs with different tumor stages/types. Moreover, ovariohysterectomy (OHE) not only offered longer survival time after surgery, but also increased total life span in dogs with mammary tumors. Forth, this study identifies on an invasive mammary carcinoma with a rare distinctive feature characterized by sebaceous differentiation of tumor cells. This tumor occurred in a 10-year-old female mixed breed dog. The patient had two masses in the left 5th mammary gland. Grossly the masses were firm, whitish to light brown and superficially ulcerated. On cut surface, they were multilobulated with foci of necrosis. Microscopically, the tumors were composed of two distinctive neoplastic components, intraductal papillary adenocarcinoma and sebaceous carcinoma. The regions of sebaceous tumor were clumped separately, contained well-developed sebaceous cells and keratinized epithelial cells, and were surrounded by few to several layers of basaloid cells. The cells with abundant foamy cytoplasm that resembled sebaceous cells were also found within the intraductal papillary-like nests of mammary carcinoma providing evidence of sebaceous metaplasia. Sebaceous differentiation in a mammary gland tumor is possible because skin appendages and ductal apparatus of the mammary gland share a common anlagen. This tumor had an aggressive behavior with lymphatic metastasis. Consequentially, the dog had a poor prognosis.
URI: http://hdl.handle.net/11455/13971
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