内容紹介
Summary
A 57-year-old woman with a history of interstitial pneumonia since 5 years ago was diagnosed with a 10 mm diameter tumor during the medical examination and consultation at the hospital. The tumor was palpable in the AC area of her right breast. An ultrasonography showed an irregular-shaped mass. A vacuum-assisted biopsy was performed, and the pathological diagnosis was suspicious for malignancy. Then, we performed an excisional biopsy and confirmed the definitive diagnosis of invasive ductal carcinoma. However, surgical margins were positive on the skin and lateral side; therefore, we conducted a two-stage surgery. Interstitial pneumonia was in the active phase, and she was administered sufficient amount of immunosuppressive drugs. Therefore, we performed additional resection under local anesthesia, not general anesthesia. Interstitial pneumonia did not worsen perioperatively, and the postoperative course was uneventful. Surgeries performed while the patient is administered with immunosuppressive drugs may cause infections and delayed wound healing. Thus, perioperative complications should be carefully considered.
要旨
症例は57歳,女性。検診で異常を指摘され,当科を受診した。視触診で右乳房AC区域に10 mm大の腫瘤を触知した。乳房超音波検査で同部位に8×8 mmの境界不明瞭な不整形低エコー腫瘤を認め,吸引式組織生検の結果,乳癌疑いの診断であった。摘出生検を施行し浸潤性乳管癌の確定診断を得たが,切除断端が皮膚側および内側方で陽性であったため,二期的手術を検討した。活動期間質性肺炎の併存があり,免疫抑制剤投与中であったことから,局所麻酔下にて追加切除術を施行した。周術期に間質性肺炎の増悪は認めず,合併症なく経過した。免疫抑制剤使用下での手術においては感染や創傷治癒の遅延などが懸念される。そのため,周術期における合併症には十分な注意が必要であると考えられた。
目次
A 57-year-old woman with a history of interstitial pneumonia since 5 years ago was diagnosed with a 10 mm diameter tumor during the medical examination and consultation at the hospital. The tumor was palpable in the AC area of her right breast. An ultrasonography showed an irregular-shaped mass. A vacuum-assisted biopsy was performed, and the pathological diagnosis was suspicious for malignancy. Then, we performed an excisional biopsy and confirmed the definitive diagnosis of invasive ductal carcinoma. However, surgical margins were positive on the skin and lateral side; therefore, we conducted a two-stage surgery. Interstitial pneumonia was in the active phase, and she was administered sufficient amount of immunosuppressive drugs. Therefore, we performed additional resection under local anesthesia, not general anesthesia. Interstitial pneumonia did not worsen perioperatively, and the postoperative course was uneventful. Surgeries performed while the patient is administered with immunosuppressive drugs may cause infections and delayed wound healing. Thus, perioperative complications should be carefully considered.
要旨
症例は57歳,女性。検診で異常を指摘され,当科を受診した。視触診で右乳房AC区域に10 mm大の腫瘤を触知した。乳房超音波検査で同部位に8×8 mmの境界不明瞭な不整形低エコー腫瘤を認め,吸引式組織生検の結果,乳癌疑いの診断であった。摘出生検を施行し浸潤性乳管癌の確定診断を得たが,切除断端が皮膚側および内側方で陽性であったため,二期的手術を検討した。活動期間質性肺炎の併存があり,免疫抑制剤投与中であったことから,局所麻酔下にて追加切除術を施行した。周術期に間質性肺炎の増悪は認めず,合併症なく経過した。免疫抑制剤使用下での手術においては感染や創傷治癒の遅延などが懸念される。そのため,周術期における合併症には十分な注意が必要であると考えられた。