内容紹介
A Case of Late Recurrence of Breast Cancer Causing Multiple Organ Metastases 27 Years Postoperatively
Summary
The patient was a 77-year-old female with a history of treatment for cancer of the right breast 27 years earlier, who presented with a chief complaint of a subcutaneous mass in the left lower quadrant of her abdomen. A thorough examination revealed high breast cancer-related tumor marker values, and based on a computed tomography(CT)examination, a tentative diagnosis of multiple lung, liver, retroperitoneal, and abdominal wall metastases was made. Although there were multiple organ metastases, in view of the long interval before the recurrence, absence of any symptoms, and the patient's age, we initiated treatment by weekly administration of an aromatase inhibitor and trastuzumab. The treatment was effective; the multiple metastases regressed, and the tumor marker levels decreased. One year after the start of treatment, the patient had a rebound in the tumor marker levels, and an increase in the size of the liver metastases was observed in diagnostic images. The aromatase inhibitor was discontinued and replaced with high-dose toremifene citrate, and trastuzumab was administered every other week. This regimen achieved efficacy, and the liver metastases regressed. As of 2 years since the start of the initial treatment, no progression of the metastases has been observed, and the patient continues to be treated with the same regimen.
要旨
症例は77歳,女性。27年前に右乳癌の既往歴がある。左下腹部の皮下腫瘤を主訴に来院。精査の結果,乳癌関連の腫瘍マーカーが高値であり,CT上多発肺,肝,後腹膜,腹壁転移の疑いと診断された。多臓器転移ではあるものの再発までの期間が非常に長いこと,自覚症状もないこと,患者の年齢を考慮してアロマターゼ阻害剤およびトラスツズマブの毎週投与による治療を開始した。治療は奏効し転移巣は縮小,腫瘍マーカーも減少した。治療開始より1年後に腫瘍マーカーの再上昇および画像上肝転移巣の再増大を認めたため,内服治療を高用量クエン酸トレミフェンに,トラスツズマブは隔週投与に変更した。再度効果が得られ肝転移巣は縮小した。初回治療開始より2年経過した時点でも転移巣の増悪は認めず同治療を継続中である。
目次
Summary
The patient was a 77-year-old female with a history of treatment for cancer of the right breast 27 years earlier, who presented with a chief complaint of a subcutaneous mass in the left lower quadrant of her abdomen. A thorough examination revealed high breast cancer-related tumor marker values, and based on a computed tomography(CT)examination, a tentative diagnosis of multiple lung, liver, retroperitoneal, and abdominal wall metastases was made. Although there were multiple organ metastases, in view of the long interval before the recurrence, absence of any symptoms, and the patient's age, we initiated treatment by weekly administration of an aromatase inhibitor and trastuzumab. The treatment was effective; the multiple metastases regressed, and the tumor marker levels decreased. One year after the start of treatment, the patient had a rebound in the tumor marker levels, and an increase in the size of the liver metastases was observed in diagnostic images. The aromatase inhibitor was discontinued and replaced with high-dose toremifene citrate, and trastuzumab was administered every other week. This regimen achieved efficacy, and the liver metastases regressed. As of 2 years since the start of the initial treatment, no progression of the metastases has been observed, and the patient continues to be treated with the same regimen.
要旨
症例は77歳,女性。27年前に右乳癌の既往歴がある。左下腹部の皮下腫瘤を主訴に来院。精査の結果,乳癌関連の腫瘍マーカーが高値であり,CT上多発肺,肝,後腹膜,腹壁転移の疑いと診断された。多臓器転移ではあるものの再発までの期間が非常に長いこと,自覚症状もないこと,患者の年齢を考慮してアロマターゼ阻害剤およびトラスツズマブの毎週投与による治療を開始した。治療は奏効し転移巣は縮小,腫瘍マーカーも減少した。治療開始より1年後に腫瘍マーカーの再上昇および画像上肝転移巣の再増大を認めたため,内服治療を高用量クエン酸トレミフェンに,トラスツズマブは隔週投与に変更した。再度効果が得られ肝転移巣は縮小した。初回治療開始より2年経過した時点でも転移巣の増悪は認めず同治療を継続中である。