内容紹介
Summary
A 63-year-old woman experienced left cervical lymph node swelling since May 2012. Based on PET-CT findings, metastases of a malignant tumor to the mediastinal, axillary, and left cervical lymph nodes were suspected. Her left cervical lymph node biopsy revealed metastatic carcinoma of occult cancer, because no primary tumor could be identified despite the specific examinations. She rejected further therapeutic intervention. In July 2013, she was admitted because of anemia, cardiac failure, and fever. She was diagnosed with bone marrow carcinomatosis from occult cancer based on her bone marrow biopsy. Metastatic breast cancer was mostly considered because she tested positive for estrogen and progesterone receptors, CA15-3 levels were increased, and her axillary lymph nodes were swollen. Fulvestrant and zoledronic acid were administered and continued for 20 months, with improvement in anemia and tumor marker levels, and also maintenance of partial response.
要旨
症例は63歳,女性。左頸部リンパ節腫大を認め,PET-CTで腋窩や左頸部のリンパ節などに集積を認めた。左頸部リンパ節生検はmetastatic carcinomaであったが,臓器に腫瘍性病変を認めず原発不明癌と診断した。本人の希望で約1年間無治療であったが,感染症と貧血で入院した際の骨髄生検で骨髄癌腫症と診断した。estrogen receptor(ER)・progesterone receptor(PgR)陽性,CA15-3高値,腋窩リンパ節腫大から転移乳癌と考えfulvestrant(FUL)とzoledronic acid(ZOL)を開始した。以降CA15-3は低下,画像上もpartial response(PR)を維持し,約20か月間FULを継続することができた。
目次
A 63-year-old woman experienced left cervical lymph node swelling since May 2012. Based on PET-CT findings, metastases of a malignant tumor to the mediastinal, axillary, and left cervical lymph nodes were suspected. Her left cervical lymph node biopsy revealed metastatic carcinoma of occult cancer, because no primary tumor could be identified despite the specific examinations. She rejected further therapeutic intervention. In July 2013, she was admitted because of anemia, cardiac failure, and fever. She was diagnosed with bone marrow carcinomatosis from occult cancer based on her bone marrow biopsy. Metastatic breast cancer was mostly considered because she tested positive for estrogen and progesterone receptors, CA15-3 levels were increased, and her axillary lymph nodes were swollen. Fulvestrant and zoledronic acid were administered and continued for 20 months, with improvement in anemia and tumor marker levels, and also maintenance of partial response.
要旨
症例は63歳,女性。左頸部リンパ節腫大を認め,PET-CTで腋窩や左頸部のリンパ節などに集積を認めた。左頸部リンパ節生検はmetastatic carcinomaであったが,臓器に腫瘍性病変を認めず原発不明癌と診断した。本人の希望で約1年間無治療であったが,感染症と貧血で入院した際の骨髄生検で骨髄癌腫症と診断した。estrogen receptor(ER)・progesterone receptor(PgR)陽性,CA15-3高値,腋窩リンパ節腫大から転移乳癌と考えfulvestrant(FUL)とzoledronic acid(ZOL)を開始した。以降CA15-3は低下,画像上もpartial response(PR)を維持し,約20か月間FULを継続することができた。