双侧乳腺癌伴骨及宫颈转移一例报告并文献复习  

A Case Report and a Review of the Literature of Bilateral Breast Cancer with Bone and Cervical Metastasis

作　　者：陆晓峰[1] 苏磊[1] 王雪晨[1] 

机构地区：[1]南京大学医学院附属鼓楼医院普通外科,南京210008

出　　处：《临床误诊误治》2015年第6期23-25,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨双侧乳腺癌伴骨及宫颈转移的临床诊治要点。方法对我院收治的双侧乳腺癌伴骨及宫颈转移1例的临床资料进行回顾性分析。结果本例52岁,因发现右乳腺包块1月余入院。乳腺彩色多普勒超声检查示:双乳腺实性占位性病变。双侧乳腺肿块穿刺病理报告为乳腺浸润性小叶癌。ECT全身骨扫描示全身多发性肿瘤骨转移。妇科B超示宫颈低回声占位性病变。予新辅助化疗后行双侧乳腺改良根治术+宫颈赘生物电切术。术后病理诊断:双乳浸润性小叶癌(低分化)伴腋窝淋巴结转移,临床病理分期Ⅳ期(T1b,N3,M1)。宫颈赘生物免疫组化:CK(+++),S100(+),Ki67约3%(+),Mummaglobin(+),巨囊液蛋白-15(+),Cerb B2(-),ER约40%(+),PR约20%(+),考虑为转移性低分化小叶癌。术后予化疗、内分泌治疗等全身治疗。患者每3个月复诊,病情平稳,坚持行内分泌治疗。结论乳腺癌骨转移较常见,而宫颈转移较为少见,组织病理学及免疫组化检查对诊断具有重要价值。Objective To study the clinical diagnosis and treatment of bilateral breast cancer with bone and cervical metastasis. Methods We retrospectively analyzed the clinical data of a case of bilateral breast cancer with bone and cervical metastasis in our hospital. Results The patient was a 52-year-old female,admitted for the right breast mass, which had been found more than one month before. Breast ultrasound showed substantial occupying lesions of bilateral breasts. The pathologic results of bilateral breast mass indicated all invasive lobular carcinoma. ECT of the whole body bone scanning showed systemic multiple bone metastases. B ultrasound in gynecology showed cervical hypoechoic occupying lesion. After the neoadjuvant chemotherapy, we performed operations of bilateral breast modified radical mastectomy and cervical neoplasm electrotomy. The postoperative pathological results showed that the bilateral breast tumors were invasive lobular carcinoma associated with axilla-ry lymph node metastasis. The pathological staging was IV（ T1b ,N3 ,M1 ） . The result of immunohistochemistry showed that CK, S100, Mummaglobin and GCDFP-15 were positive, Ki67 was about 3% positive,ER was about 40% positive,PR was about 20% positive,while CerbB2 was negative. Then, the patient accepted the postoperative systemic treatment,such as chemother-apy, and endocrine therapy. The patient was checked every three months with a stable condition, and continued endocrine therapy. Conclusion The bone metastasis from breast cancer is a common condition,while the occurrence of metastasis to the neck of uterus is rare. The histopathological analysis combined with immunohistochemical detection is of great value in diagno-sis and treatment.

关 键 词：乳腺肿瘤 骨转移 宫颈转移 Mummaglobin 巨囊液蛋白-15 

分 类 号：R737.9[医药卫生—肿瘤]