特異な再発形式を示した乳癌の1例

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  • A CASE OF BREAST CANCER SHOWING ATYPICAL METASTATIC ROUTES

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A 56-year-old woman was admitted to the hospital because of a tumor of 1.5cm in diameter in upper outer quadrant of the right breast in July 1994. A biopsy revealed cancer, and on September 7, she underwent a quadrantectomy with axillary dissection. Pathological examinations showed papillotubular carcinoma [nO, ly(-), v(-), ER(-), and PgR(-)]. Postoperative irradiation with 60 Gy and adjuvant chemoendocrine therapy were started. Thereafter, the patient experienced left axillary metastases in May, 1996, and was admitted to the hospital because of abruptly accumulated ascites in September. Echography and CT revealed no metastatic lesion in the liver. With puncture of ascites and systemic MF (mitomycin C and 5-FU) therapy, ascites disappeared almost completely. In October, however, left pleural effusion appeared that disappeared by intrathoracic drainage. Adenocarcinoma cells were found in both ascites and pleural effusion containing only CA15-3 in high levels. Thereafter, the patient was readmitted because of ascites with no metastasis in the liver in January 1997. She underwent puncture of ascites, followed by medication of CDDP# intraperitoneally and systemic CAF plus MPA*. These treatments succeeded temporally in decreasing ascites. She was discharged from the hospital on April 12, 1997, when no liver metastasis was revealed on CT. But ascites became apparent and intestinal obstruction developed. The patient died on September 11.<br> It is assumed that lymphagenic metastases might occur in this case.<br> #CDDP: cisplatin<br> *CAF: cyclophosphamide + adriamycin + 5-FU<br> MPA: medroxy progesterone acetate

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