内容紹介
Summary
Breast cancer in male is comparatively rare. We encountered a case of breast cancer in an elderly male who was treated with consideration of age. A 78-year-old male consulted our hospital with a lump on his right breast. The tumor was 3 cm in diameter and was palpable in the E area of his right breast, accompanied by pain. Mammography showed an indistinct mass in the S area. Ultrasonography revealed a well-defined and rough, lobulated mass. Core needle biopsy was performed, and the pathological diagnosis was invasive ductal carcinoma. Metastatic work-up revealed no evidence of metastasis. The patient underwent mastectomy with sentinel lymph node(SN)biopsy and axial lymph node dissection(Ax)because of positive metastasis in an SN. The pathological findings from the surgically resected specimens indicated solid-tubular carcinoma. Lymph node metastases were observed in an SN(1/1)and Ax(1/3). On immunohistochemistry, tumor cells tested positive for estrogen and progesterone receptors and negative for HER2/neu protein expression. The Ki-67 labeling index was 14%. Postoperatively, the patient has not received chemotherapy, but received hormone therapy as adjuvant therapy considering his age. Nine months after the surgery, the patient is well, and metastasis has not appeared.
要旨
男性乳癌は全乳癌の約1%と比較的まれな疾患である。われわれは,年齢を考慮して治療を行った高齢者男性乳癌の症例を経験したので,若干の文献的考察を加え報告する。症例は78歳,男性。右乳房腫瘤を主訴に当科を受診した。視触診で右乳房E領域に3 cm大の腫瘤を触知した。マンモグラフィ検査で右乳房S領域に境界不明瞭な腫瘤を認めた。乳房超音波検査で右乳房E領域に33×31 mmの境界明瞭粗造な分葉状低エコー腫瘤を認め,針生検の結果,浸潤性乳管癌の診断であった。全身検索にて明らかな遠隔転移は認めず,胸筋温存乳房切除術およびセンチネルリンパ節生検術を施行した。術中迅速診断にてセンチネルリンパ節転移は陽性であったため,腋窩リンパ節郭清術を追加施行した。病理組織学的検査にて充実腺管癌(t=3.5 cm,nuclear grade 3,ly+,v+,SN 1/1,levelⅠ 0/2,levelⅡ 1/1,ER+,PgR+,HER2 0,Ki-67 14%)であった。高齢であることから術後化学療法は施行せず,タモキシフェンの投与を行った。術後9か月が経過しているが,無再発生存中である。
目次
Breast cancer in male is comparatively rare. We encountered a case of breast cancer in an elderly male who was treated with consideration of age. A 78-year-old male consulted our hospital with a lump on his right breast. The tumor was 3 cm in diameter and was palpable in the E area of his right breast, accompanied by pain. Mammography showed an indistinct mass in the S area. Ultrasonography revealed a well-defined and rough, lobulated mass. Core needle biopsy was performed, and the pathological diagnosis was invasive ductal carcinoma. Metastatic work-up revealed no evidence of metastasis. The patient underwent mastectomy with sentinel lymph node(SN)biopsy and axial lymph node dissection(Ax)because of positive metastasis in an SN. The pathological findings from the surgically resected specimens indicated solid-tubular carcinoma. Lymph node metastases were observed in an SN(1/1)and Ax(1/3). On immunohistochemistry, tumor cells tested positive for estrogen and progesterone receptors and negative for HER2/neu protein expression. The Ki-67 labeling index was 14%. Postoperatively, the patient has not received chemotherapy, but received hormone therapy as adjuvant therapy considering his age. Nine months after the surgery, the patient is well, and metastasis has not appeared.
要旨
男性乳癌は全乳癌の約1%と比較的まれな疾患である。われわれは,年齢を考慮して治療を行った高齢者男性乳癌の症例を経験したので,若干の文献的考察を加え報告する。症例は78歳,男性。右乳房腫瘤を主訴に当科を受診した。視触診で右乳房E領域に3 cm大の腫瘤を触知した。マンモグラフィ検査で右乳房S領域に境界不明瞭な腫瘤を認めた。乳房超音波検査で右乳房E領域に33×31 mmの境界明瞭粗造な分葉状低エコー腫瘤を認め,針生検の結果,浸潤性乳管癌の診断であった。全身検索にて明らかな遠隔転移は認めず,胸筋温存乳房切除術およびセンチネルリンパ節生検術を施行した。術中迅速診断にてセンチネルリンパ節転移は陽性であったため,腋窩リンパ節郭清術を追加施行した。病理組織学的検査にて充実腺管癌(t=3.5 cm,nuclear grade 3,ly+,v+,SN 1/1,levelⅠ 0/2,levelⅡ 1/1,ER+,PgR+,HER2 0,Ki-67 14%)であった。高齢であることから術後化学療法は施行せず,タモキシフェンの投与を行った。術後9か月が経過しているが,無再発生存中である。