2年半の放置期間で転移巣は著明に増大した潜在性乳癌の1例 [in Japanese] A CASE OF OCCULT BREAST CANCER WITH REMARKABLY GROWN METASTATIC FOCI WHILE THE PRIMARY FOCI HAD BEEN OCCULTING IN A 2.5-YEAR PERIOD [in Japanese]
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症例は73歳の女性. 1997年12月に右前腋窩部の腫瘤を自覚したが放置していた. 2000年5月になり,同部の腫瘤に疼痛を認めさらに右鎖骨上窩にも腫瘤を自覚し当科に受診した.前腋窩部腫瘤の吸引細胞診の結果class V: adenocarcinomaで,造影MRIでのみ右乳房内に腫瘤を認め潜在性乳癌と診断し定型的乳房切除術+R3リンパ節郭清を施行した。病理組織所見では,原発巣は右乳房CA領域のinvasive lobular carcinomaで一部にsignet ring cellへの脱分化が見られたが,転移巣はsignet ring cellで占められていた. signet ring cellに脱分化し悪性度の高い増殖能を獲得した腫瘍細胞が転移巣で急速に増大したものと考えられた. 2年半の間,潜在性乳癌の自然経過を観察しえた興味深い症例と考え,若干の文献的考察を加え報告した.
A case of occult breast cancer is reported. The patient was a 73-year-old woman. She had noticed a right anterior axillary tumor of 1cm in diameter in December 1997, but she left it alone. Thereafter the tumor multiplied and increased in size. On 24<sup>th</sup> of May 2000, she was seen at the hospital because of pain on the axillary tumors when another tumor of the right supraclavicular fossa appeared besides the axillary tumors. Aspiration cytology, taken from the right anterior axillary tumor, revealed class V of adenocarcinoma. Despite absence of distinguishable tumors in bilateral breasts by other modalities, magnetic resonance mammography (MRM) showed an enhanced lesion 1.5cm in diameter in the right breast. Occult breast cancer was diagnosed. On 29<sup>th</sup> of June, a standard mastectomy with R3 dissection was performed. Histological findings of the lesion in the right breast that seemed to be primary lesion showed mainly invasive lobular carcinoma, and partially signet ring cell carcinoma, but signet ring cell carcinoma occupied metastatic tumors. It suggest that a part of the primary lesion had dedifferentiated into signet ring cell and caused massive lymph nodes metastases.<br> This case probably shows the natural course of the occult breast cancer because it had been left alone for two and a half years.
- Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 62(4), 889-893, 2001-04-25
Japan Surgical Association