内容紹介
Summary
Breast cancer spreading beyond the regional lymph nodes from the primary lesion is considered to be difficult to cure. Although systemic therapy is common for the treatment of metastatic breast cancer, standard therapy is difficult in some cases. We encountered a case of advanced-stage breast cancer detected by cervical lymphadenopathy in an elderly patient. An 82-year-old woman consulted an otolaryngologist for left cervical lymphadenopathy. On receiving the biopsy result, she was referred for a suspected metastatic lymph node from breast cancer. The tumor was 40 mm in diameter and was palpable in the CD area of her left breast, accompanied by pain. Ultrasonography showed an irregular-shaped mass. Core needle biopsy was performed, and the pathological diagnosis was invasive lobular carcinoma. Her body check-up revealed multiple enlarged lymph nodes from the left axilla to the supraclavicular and cervical areas. We diagnosed her clinical stage with T2N3cM1, stage Ⅳ(LYM). We proceeded with surgery to alleviate the symptom. Breast reduction surgery was performed for the left breast. The pathological findings from the surgically resected specimens indicated invasive lobular carcinoma. After the surgery, 5-fluorouracil(5-FU)drug was orally administered. Cervical lymphadenopathy decreased, and visceral metastasis has not appeared.
要旨
乳癌は原発巣から領域リンパ節を越えて進展すると治癒は困難とされる。転移乳癌の治療としては全身療法が一般的であるが,標準治療が困難な症例も存在する。われわれは,頸部リンパ節腫脹を契機に発見された高齢者進行乳癌の1例を経験したので報告する。症例は82歳,女性。左頸部リンパ節腫脹を主訴に耳鼻科を受診した。生検の結果,乳癌からのリンパ節転移の疑いで当科を紹介受診した。左乳房CD領域に4 cm大の腫瘤を触知し,深部に痛みを伴っていた。超音波検査で39×31 mmの不整形混合エコー腫瘤を認めた。針生検では浸潤性小葉癌と診断された。全身検索にて左腋窩から鎖骨上,頸部にかけ複数の腫大リンパ節を認め,左乳癌,T2N3cM1,stage Ⅳ(LYM)と診断した。乳房痛の症状緩和目的に手術を先行し,Bt+Ax(Ⅱ)を施行した。病理組織学的診断は浸潤性小葉癌でリンパ節転移を認めた。術後は経口5-FU系薬剤の投与を行い,頸部リンパ節腫脹は縮小傾向を認め術後1年10か月現在,明らかな内臓転移は認めていない。
目次
Breast cancer spreading beyond the regional lymph nodes from the primary lesion is considered to be difficult to cure. Although systemic therapy is common for the treatment of metastatic breast cancer, standard therapy is difficult in some cases. We encountered a case of advanced-stage breast cancer detected by cervical lymphadenopathy in an elderly patient. An 82-year-old woman consulted an otolaryngologist for left cervical lymphadenopathy. On receiving the biopsy result, she was referred for a suspected metastatic lymph node from breast cancer. The tumor was 40 mm in diameter and was palpable in the CD area of her left breast, accompanied by pain. Ultrasonography showed an irregular-shaped mass. Core needle biopsy was performed, and the pathological diagnosis was invasive lobular carcinoma. Her body check-up revealed multiple enlarged lymph nodes from the left axilla to the supraclavicular and cervical areas. We diagnosed her clinical stage with T2N3cM1, stage Ⅳ(LYM). We proceeded with surgery to alleviate the symptom. Breast reduction surgery was performed for the left breast. The pathological findings from the surgically resected specimens indicated invasive lobular carcinoma. After the surgery, 5-fluorouracil(5-FU)drug was orally administered. Cervical lymphadenopathy decreased, and visceral metastasis has not appeared.
要旨
乳癌は原発巣から領域リンパ節を越えて進展すると治癒は困難とされる。転移乳癌の治療としては全身療法が一般的であるが,標準治療が困難な症例も存在する。われわれは,頸部リンパ節腫脹を契機に発見された高齢者進行乳癌の1例を経験したので報告する。症例は82歳,女性。左頸部リンパ節腫脹を主訴に耳鼻科を受診した。生検の結果,乳癌からのリンパ節転移の疑いで当科を紹介受診した。左乳房CD領域に4 cm大の腫瘤を触知し,深部に痛みを伴っていた。超音波検査で39×31 mmの不整形混合エコー腫瘤を認めた。針生検では浸潤性小葉癌と診断された。全身検索にて左腋窩から鎖骨上,頸部にかけ複数の腫大リンパ節を認め,左乳癌,T2N3cM1,stage Ⅳ(LYM)と診断した。乳房痛の症状緩和目的に手術を先行し,Bt+Ax(Ⅱ)を施行した。病理組織学的診断は浸潤性小葉癌でリンパ節転移を認めた。術後は経口5-FU系薬剤の投与を行い,頸部リンパ節腫脹は縮小傾向を認め術後1年10か月現在,明らかな内臓転移は認めていない。