内容紹介
Summary
We report a radiation-associated angiosarcoma(RAAS)of the breast, which is a rare but important complication after breast-conserving surgery(BCS)and radiotherapy(RT)for breast cancer. A 72-year-old woman had undergone BCS for invasive ductal carcinoma of the right breast(pT2pN1M0, StageⅡB), followed by RT of 50 Gy; she was treated with doxifluridine and anastrozole for 5 year. She noticed a bloody cutaneous bulla in the right breast 64 months later, and the skin lesions gradually expanded. She was brought to our clinic for the treatment of massive bleeding from the skin lesions. Ulcer biopsy revealed cutaneous AS(cells were CD31[+], CD34[+], VEGF[-], and VEGF-R[+]). She underwent mastectomy and latissimus dorsal flap surgery. She died of local recurrence and liver metastasis 13 months later. RAAS is rare, but it should be considered in patients with skin lesions, such as erosion and bloody bulla, after BCS and RT for breast cancer. To our knowledge, only 12 cases of RAAS, including the present case, have been reported in Japan, and we reviewed the Japanese RAAS cases in comparison with those reported in the Western literature.
要旨
乳癌術後の放射線治療(radiotherapy: RT)によりまれに二次性に血管肉腫が発症する。今回,乳房温存手術後に発生した放射線誘発血管肉腫(radiation-associated angiosarcoma: RAAS)の1例を経験した。症例は72歳,女性。5年4か月前に右乳癌に対し乳房温存手術を施行した。浸潤性乳管癌,pT2pN1M0,StageⅡB,ER(+),PgR(-),HER2(1+)であった。術後,温存乳房に50 Gyの照射と,doxifluridineとanastrozoleを5年投与した。術後5年4か月目に温存乳房皮膚に血疱が出現し拡大,その7か月後に大量出血を来した。病変部皮膚生検によりhigh gradeの血管肉腫と判明した。血管内皮増殖因子受容体(VEGF-R)(+),CD31(+),CD34(+)であった。急速に拡大し,その1か月後に乳房切除+広背筋皮弁を施行した。術後化学療法とRTを拒否し,術後6か月で創部局所再発した。その後,胸腔浸潤,肝転移へ進行し,術後1年1か月後に死亡した。RAASは急速に進展し現状では有効な治療法がないが,進行緩徐例やタキサンやRTが有効との報告もある。その発生と進展に血管内皮増殖因子の関与が示唆され,これを標的とした分子標的療法が有効である可能性がある。
目次
We report a radiation-associated angiosarcoma(RAAS)of the breast, which is a rare but important complication after breast-conserving surgery(BCS)and radiotherapy(RT)for breast cancer. A 72-year-old woman had undergone BCS for invasive ductal carcinoma of the right breast(pT2pN1M0, StageⅡB), followed by RT of 50 Gy; she was treated with doxifluridine and anastrozole for 5 year. She noticed a bloody cutaneous bulla in the right breast 64 months later, and the skin lesions gradually expanded. She was brought to our clinic for the treatment of massive bleeding from the skin lesions. Ulcer biopsy revealed cutaneous AS(cells were CD31[+], CD34[+], VEGF[-], and VEGF-R[+]). She underwent mastectomy and latissimus dorsal flap surgery. She died of local recurrence and liver metastasis 13 months later. RAAS is rare, but it should be considered in patients with skin lesions, such as erosion and bloody bulla, after BCS and RT for breast cancer. To our knowledge, only 12 cases of RAAS, including the present case, have been reported in Japan, and we reviewed the Japanese RAAS cases in comparison with those reported in the Western literature.
要旨
乳癌術後の放射線治療(radiotherapy: RT)によりまれに二次性に血管肉腫が発症する。今回,乳房温存手術後に発生した放射線誘発血管肉腫(radiation-associated angiosarcoma: RAAS)の1例を経験した。症例は72歳,女性。5年4か月前に右乳癌に対し乳房温存手術を施行した。浸潤性乳管癌,pT2pN1M0,StageⅡB,ER(+),PgR(-),HER2(1+)であった。術後,温存乳房に50 Gyの照射と,doxifluridineとanastrozoleを5年投与した。術後5年4か月目に温存乳房皮膚に血疱が出現し拡大,その7か月後に大量出血を来した。病変部皮膚生検によりhigh gradeの血管肉腫と判明した。血管内皮増殖因子受容体(VEGF-R)(+),CD31(+),CD34(+)であった。急速に拡大し,その1か月後に乳房切除+広背筋皮弁を施行した。術後化学療法とRTを拒否し,術後6か月で創部局所再発した。その後,胸腔浸潤,肝転移へ進行し,術後1年1か月後に死亡した。RAASは急速に進展し現状では有効な治療法がないが,進行緩徐例やタキサンやRTが有効との報告もある。その発生と進展に血管内皮増殖因子の関与が示唆され,これを標的とした分子標的療法が有効である可能性がある。