内容紹介
Summary
Occult breast cancer, which develops as a metastatic lesion with no primary tumor detected in the breast, is a rare breast cancer. A 68-year-old female patient particularly complained of the presence of a right axillary mass. The mass in the right axilla was palpable, but no tumor was found in both the breasts on palpation, ultrasound examination, or MRI. Partial breast resection and axillary lymph node dissection were performed following a diagnosis of invasive ductal carcinoma by core needle biopsy. There was no mammary gland tissue present around the tumor due to the pathology of the disease, and the tumor was diagnosed as occult breast cancer. As the cancer was ER negative and HER2 positive, treatment with a combination of FEC, docetaxel, and trastuzumab was initiated. Radiotherapy, which irradiated the right supraclavicular fossa and the right mammary gland, was administered. No disease recurrence and mammary tumor has been reported in the patient till date. Treatment of occult breast cancer generally includes local therapy such as radiation and surgery. However, in the present case, we did not operate upon the breast; instead we treated the right breast and the right supraclavicular fossa with radiation therapy. As the tumor was HER2 positive, we reasoned that local control of disease would be likely if treatment with chemotherapy and trastuzumab was performed effectively.
要旨
潜在性乳癌は転移巣で発症し,乳房内に原発巣を認めないまれな乳癌である。症例は68歳,女性。右腋窩腫瘤を主訴に当院を初診した。右腋窩に腫瘤を触知するも,触診・エコー・MRIで乳腺に所見を認めなかった。針生検で浸潤性乳管癌の診断で,腫瘤に対して乳房温存円状部分切除および腋窩リンパ節郭清を行った。病理学的検討で腫瘤の周囲に乳腺組織はなく,潜在性乳癌の診断であった。ER陰性,HER2陽性のため,FEC・ドセタキセル・トラスツズマブを行い,右鎖骨上窩と右全乳房に放射線治療を行った。現在まで再発や乳腺の腫瘤は指摘されていない。潜在性乳癌における乳腺に対する治療は,一般的に放射線や手術などの局所療法を行うべきとの見解が多い。本症例においては右全乳房と右鎖骨上窩に放射線照射を行い,非切除として経過観察している。HER2陽性であったため抗癌剤とトラスツズマブの治療を十分に行えば,局所のコントロールは可能と考えられた。
目次
Occult breast cancer, which develops as a metastatic lesion with no primary tumor detected in the breast, is a rare breast cancer. A 68-year-old female patient particularly complained of the presence of a right axillary mass. The mass in the right axilla was palpable, but no tumor was found in both the breasts on palpation, ultrasound examination, or MRI. Partial breast resection and axillary lymph node dissection were performed following a diagnosis of invasive ductal carcinoma by core needle biopsy. There was no mammary gland tissue present around the tumor due to the pathology of the disease, and the tumor was diagnosed as occult breast cancer. As the cancer was ER negative and HER2 positive, treatment with a combination of FEC, docetaxel, and trastuzumab was initiated. Radiotherapy, which irradiated the right supraclavicular fossa and the right mammary gland, was administered. No disease recurrence and mammary tumor has been reported in the patient till date. Treatment of occult breast cancer generally includes local therapy such as radiation and surgery. However, in the present case, we did not operate upon the breast; instead we treated the right breast and the right supraclavicular fossa with radiation therapy. As the tumor was HER2 positive, we reasoned that local control of disease would be likely if treatment with chemotherapy and trastuzumab was performed effectively.
要旨
潜在性乳癌は転移巣で発症し,乳房内に原発巣を認めないまれな乳癌である。症例は68歳,女性。右腋窩腫瘤を主訴に当院を初診した。右腋窩に腫瘤を触知するも,触診・エコー・MRIで乳腺に所見を認めなかった。針生検で浸潤性乳管癌の診断で,腫瘤に対して乳房温存円状部分切除および腋窩リンパ節郭清を行った。病理学的検討で腫瘤の周囲に乳腺組織はなく,潜在性乳癌の診断であった。ER陰性,HER2陽性のため,FEC・ドセタキセル・トラスツズマブを行い,右鎖骨上窩と右全乳房に放射線治療を行った。現在まで再発や乳腺の腫瘤は指摘されていない。潜在性乳癌における乳腺に対する治療は,一般的に放射線や手術などの局所療法を行うべきとの見解が多い。本症例においては右全乳房と右鎖骨上窩に放射線照射を行い,非切除として経過観察している。HER2陽性であったため抗癌剤とトラスツズマブの治療を十分に行えば,局所のコントロールは可能と考えられた。