内容紹介
Summary
A woman in her early 60s noticed bilateral breast masses and visited a different hospital. Core needle biopsy showed diffuse large B-cell lymphoma of the right breast and invasive ductal carcinoma of the left breast. After referral to our department, PET-CT was performed. Compared with mild fluorodeoxyglucose accumulation in left breast cancer(BC), highly accumulated lesions were found on the right breast, left anterior chest wall, nasopharynx, and tonsil. The right breast lesion was the largest with a diameter of 30 mm and was considered the primary lesion of malignant lymphoma(ML). The ML was classified as stage Ⅳ, pathologically proven with erythema of the left breast and nasopharynx. Three courses of R-CHOP were performed. However, due to suspicion of heart failure, chemotherapy was changed to R-CEOP(non-anthracycline-containing regimen)and 3 courses were additionally performed. The therapeutic effect of R-Chemo for ML was CR. Left BC showed a tendency of shrinkage. After intrathecal administration of anticancer drugs to prevent infiltration of ML into the central nervous system and preoperative endocrine therapy with aromatase inhibitor, left lumpectomy and sentinel lymph node biopsy were performed. BC was classified as clinical stageⅠA and had an estrogen receptor score of 3b. Postoperative whole breast radiotherapy was completed, and the planned internal use of exemestane was more than 5 years. With multidisciplinary therapy, 3.5 years had passed since the initial treatment without recurrence.
要旨
患者は60歳台前半,女性。両側乳房腫瘤で前医初診し,針生検にて右乳房びまん性大細胞型B細胞リンパ腫(diffuse large B-cell lymphoma: DLBCL),左乳房浸潤性乳管癌(invasive ductal carcinoma: IDC)を認めた。当科紹介となり,PET-CTにて,左乳癌はfluorodeoxyglucose(FDG)集積軽度だが,右乳房,左前胸壁,上咽頭,両側扁桃に高集積病変がみられた。右乳房病変30 mmが最大であり,悪性リンパ腫の原発病巣と判断した。左乳房皮膚紅斑,上咽頭からもDLBCLを検出しstage Ⅳと判断した。R-CHOP 3コース施行後,心不全の疑いでR-CEOPに変更し3コース追加し,DLBCLはCRの治療効果を得た。左乳癌は縮小傾向を認めた。DLBCL中枢神経再発予防の髄注4回およびアロマターゼ阻害薬による乳癌術前内分泌療法の後,左乳房部分切除およびセンチネルリンパ節郭清を施行した。stageⅠA,estrogen receptor(ER)score 3bであり,術後乳房照射を行いexemestane(EXE)内服中である。集学的治療にて,初回治療から3.5年無再発で経過している。
目次
A woman in her early 60s noticed bilateral breast masses and visited a different hospital. Core needle biopsy showed diffuse large B-cell lymphoma of the right breast and invasive ductal carcinoma of the left breast. After referral to our department, PET-CT was performed. Compared with mild fluorodeoxyglucose accumulation in left breast cancer(BC), highly accumulated lesions were found on the right breast, left anterior chest wall, nasopharynx, and tonsil. The right breast lesion was the largest with a diameter of 30 mm and was considered the primary lesion of malignant lymphoma(ML). The ML was classified as stage Ⅳ, pathologically proven with erythema of the left breast and nasopharynx. Three courses of R-CHOP were performed. However, due to suspicion of heart failure, chemotherapy was changed to R-CEOP(non-anthracycline-containing regimen)and 3 courses were additionally performed. The therapeutic effect of R-Chemo for ML was CR. Left BC showed a tendency of shrinkage. After intrathecal administration of anticancer drugs to prevent infiltration of ML into the central nervous system and preoperative endocrine therapy with aromatase inhibitor, left lumpectomy and sentinel lymph node biopsy were performed. BC was classified as clinical stageⅠA and had an estrogen receptor score of 3b. Postoperative whole breast radiotherapy was completed, and the planned internal use of exemestane was more than 5 years. With multidisciplinary therapy, 3.5 years had passed since the initial treatment without recurrence.
要旨
患者は60歳台前半,女性。両側乳房腫瘤で前医初診し,針生検にて右乳房びまん性大細胞型B細胞リンパ腫(diffuse large B-cell lymphoma: DLBCL),左乳房浸潤性乳管癌(invasive ductal carcinoma: IDC)を認めた。当科紹介となり,PET-CTにて,左乳癌はfluorodeoxyglucose(FDG)集積軽度だが,右乳房,左前胸壁,上咽頭,両側扁桃に高集積病変がみられた。右乳房病変30 mmが最大であり,悪性リンパ腫の原発病巣と判断した。左乳房皮膚紅斑,上咽頭からもDLBCLを検出しstage Ⅳと判断した。R-CHOP 3コース施行後,心不全の疑いでR-CEOPに変更し3コース追加し,DLBCLはCRの治療効果を得た。左乳癌は縮小傾向を認めた。DLBCL中枢神経再発予防の髄注4回およびアロマターゼ阻害薬による乳癌術前内分泌療法の後,左乳房部分切除およびセンチネルリンパ節郭清を施行した。stageⅠA,estrogen receptor(ER)score 3bであり,術後乳房照射を行いexemestane(EXE)内服中である。集学的治療にて,初回治療から3.5年無再発で経過している。