内容紹介
Summary
We report a case of a non-invasive ductal carcinoma revealed on long-term follow-up of spontaneous nipple discharge. The patient, a 36-year-old woman, had noticed spontaneous nipple discharge from both breasts over a 3-year period. Mammography and ultrasonography did not reveal any lesions in the breasts. The nipple discharge from her left breast stopped 36 months after initial clinical assessment. However, the nipple discharges from her right breast transformed into a bloody discharge from a single duct. Ultrasonography showed a tumor, 6 mm in diameter, in the upper-outer quadrant of her right breast. A core needle biopsy for breast tumor led to a pathological diagnosis of non-invasive ductal carcinoma. We conducted a whole-body clinical examination but no metastatic lesions were detected. Subsequently, we performed breast-conserving surgery and sentinel lymph node biopsy. The pathological diagnosis was non-invasive ductal carcinoma in situ. The tumor was positive for estrogen and progesterone receptors, but negative for HER2/neu. The Ki-67 labeling index was 5%. The surgical margin was negative. We diagnosed the tumor as TisN0M0=Stage 0. Endocrine therapy comprising tamoxifen(20 mg/day)was initiated. Four years after surgery, she was well without any metastases.
要旨
36か月にわたる経過観察の末に発見され,診断に難渋した非浸潤性乳管癌を経験した。症例は36歳,女性。両側乳頭異常分泌を主訴に来院した。3年前に出産・断乳後,乳汁分泌が継続していた。精査の結果,明らかな病変を認めなかったため,経過を観察していた。36か月目の検査時に右側分泌は単孔性・血性に変化しており,超音波検査で右乳房C領域に直径6 mmの腫瘤性病変を認めた。針生検で乳管癌,ER陽性,PgR陽性,HER2陰性,Ki-67 5%と診断された。全身検索の結果,他臓器転移を認めなかった。乳房温存手術+センチネルリンパ節生検術を施行した。病理組織診断は非浸潤性乳管癌,切除断端陰性,TisN0M0=Stage 0と診断された。残存乳房への放射線治療の後,tamoxifenの内服のみで経過を観察している。術後4年目の現在,再発を認めていない。断乳後も長期にわたって継続する乳頭分泌は注意深く観察する必要があると考えられた。
目次
We report a case of a non-invasive ductal carcinoma revealed on long-term follow-up of spontaneous nipple discharge. The patient, a 36-year-old woman, had noticed spontaneous nipple discharge from both breasts over a 3-year period. Mammography and ultrasonography did not reveal any lesions in the breasts. The nipple discharge from her left breast stopped 36 months after initial clinical assessment. However, the nipple discharges from her right breast transformed into a bloody discharge from a single duct. Ultrasonography showed a tumor, 6 mm in diameter, in the upper-outer quadrant of her right breast. A core needle biopsy for breast tumor led to a pathological diagnosis of non-invasive ductal carcinoma. We conducted a whole-body clinical examination but no metastatic lesions were detected. Subsequently, we performed breast-conserving surgery and sentinel lymph node biopsy. The pathological diagnosis was non-invasive ductal carcinoma in situ. The tumor was positive for estrogen and progesterone receptors, but negative for HER2/neu. The Ki-67 labeling index was 5%. The surgical margin was negative. We diagnosed the tumor as TisN0M0=Stage 0. Endocrine therapy comprising tamoxifen(20 mg/day)was initiated. Four years after surgery, she was well without any metastases.
要旨
36か月にわたる経過観察の末に発見され,診断に難渋した非浸潤性乳管癌を経験した。症例は36歳,女性。両側乳頭異常分泌を主訴に来院した。3年前に出産・断乳後,乳汁分泌が継続していた。精査の結果,明らかな病変を認めなかったため,経過を観察していた。36か月目の検査時に右側分泌は単孔性・血性に変化しており,超音波検査で右乳房C領域に直径6 mmの腫瘤性病変を認めた。針生検で乳管癌,ER陽性,PgR陽性,HER2陰性,Ki-67 5%と診断された。全身検索の結果,他臓器転移を認めなかった。乳房温存手術+センチネルリンパ節生検術を施行した。病理組織診断は非浸潤性乳管癌,切除断端陰性,TisN0M0=Stage 0と診断された。残存乳房への放射線治療の後,tamoxifenの内服のみで経過を観察している。術後4年目の現在,再発を認めていない。断乳後も長期にわたって継続する乳頭分泌は注意深く観察する必要があると考えられた。