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病例35-2018:一名有背痛和久远乳腺癌病史的68岁女性
Case 35-2018 — A 68-Year-Old Woman with Back Pain and a Remote History of Breast Cancer


Aditya Bardia ... 肿瘤 • 2018.11.15
相关阅读
• ASCO 2018报告——乳腺癌 • 第40届圣安东尼奥乳腺癌年度研讨会

病历陈述


Diane P. Doyle女士,护理学硕士(内科):一名有双侧乳腺癌病史的68岁女性因背痛和盆部疼痛,在本院肿瘤科门诊接受了评估。

在本次评估前25年,在常规妇科检查期间,发现患者左侧乳房有一个小肿块。乳房X线照片显示无异常。对乳房肿块进行了活检,对活检标本的检查显示有雌激素受体(ER)阳性、孕激素受体(PR)阳性浸润癌的证据。进行了左侧乳房部分切除术和腋窝淋巴结清扫术,对标本的检查显示存在两个分离且不同的原发肿瘤。组织病理学分析显示ER阳性浸润性导管癌(第一原发肿瘤,直径为3 cm)和浸润性小叶癌(第二原发肿瘤,直径为3 cm)。在10个切除的腋窝淋巴结中,2个为乳腺癌阳性。骨扫描和胸片未显示转移性疾病的证据,血电解质水平和肝肾功能检查结果正常。

患者参加了一项临床试验1,在这项试验中,患者被随机分配接受4个周期环磷酰胺、多柔比星、氨甲蝶呤和氟尿嘧啶的初始治疗,随后接受乳房放疗。根据临床试验方案,患者未接受他莫昔芬治疗,但定期接受主动监测。

初次诊断后12年时(本次评估前13年时),常规监测乳房X线照相显示右侧乳房有一簇钙化。进行了切除活检,对活检标本的检查显示导管原位癌和小叶肿瘤形成的证据,切缘阳性。肿瘤直径为1.2 cm,ER阳性,并且呈中度分化(3级中的2级)。BRCA突变的基因检测结果为阴性。患者接受了右侧乳房部分切除术,随后接受了辅助放疗,并计划完成5年的阿那曲唑辅助治疗。





作者信息

Aditya Bardia, M.D., M.P.H., Meline D. Hovnanian, M.D., Elena F. Brachtel, M.D., and Valentina Nardi, M.D.
From the Departments of Medicine (A.B.), Radiology (M.D.H.), and Pathology (E.F.B., V.N.), Massachusetts General Hospital, and the Departments of Medicine (A.B.), Radiology (M.D.H.), and Pathology (E.F.B., V.N.), Harvard Medical School — both in Boston.

 

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