以原因不明发热为主要表现的乳腺癌骨髓转移一例及诊断思维分析  

One case report of bone marrow metastasis of triple negative breast cancer with unidentified fever and clinical diagnostic thinking analysis

作　　者：盛佳钰[1] 江科[1] 严兆霞 梁宏莉[1] 李琼[1] 季亚婕[1] 刘钰 薛晓红[1] 

机构地区：[1]上海中医药大学附属岳阳中西医结合医院乳腺病科,上海200437

出　　处：《中国肿瘤外科杂志》2018年第4期248-250,共3页Chinese Journal of Surgical Oncology

基　　金：上海中医药大学预算内项目(30304113568);第4批上海近代中医流派传承项目

摘　　要：目的探讨乳腺癌骨髓转移的临床特点及诊断思维。方法报告1例乳腺癌骨髓转移病例,收集临床资料并结合临床判断和处理等方面存在的缺陷复习相关文献。结果患者以不明原因发热为首发症状,通过空芯针穿刺明确为乳腺恶性肿瘤。但患者持续高热,多种抗生素治疗无效,用药期间出现血小板及血红蛋白进行性降低及全身骨痛。后经骨扫描、骨髓穿刺活检诊断为乳腺癌骨髓转移,予单周紫杉醇联合卡铂化疗1疗程后体温正常。结论乳腺癌骨髓转移早期易被忽视,当有骨痛并突发原因不明的贫血和血小板减少时,应考虑骨髓转移,骨髓穿刺是简单而有效的确诊手段。Objective To investigate the clinical features of breast cancer bone marrow metastasis and clinical diagnostic thinking process. Methods Report a case of bone marrow metastasis of breast cancer. Analysis of the clinical data in the collection, analysis, judgment and treatment of the shortcomings, and review the relevant literature. Results In this case, the first symptom of fever was unexplained. Through the hollow needle puncture method clear pathology of breast cancer. However, patients continued to suffer from fever, multi-line antibiotic therapy ineffective. During treatment, patients with thrombocytopenia and hemoglobin decreased and the phenomenon of systemic bone pain. After bone scan, bone marrow biopsy diagnosed as breast cancer bone marrow metastasis. Given paclitaxel ＋ carboplatin single-week regimen chemotherapy, body temperature returned to normal after a course of treatment. Conclusion Early breast cancer bone marrow metastasis easily overlooked. When patients have bone pain and sudden unexplained anemia and thrombocytopenia, the possibility of bone marrow metastasis should be considered. Bone marrow aspiration is a simple and effective diagnostic tool.

关 键 词：发热待查 乳腺癌 骨髓转移 

分 类 号：R737.9[医药卫生—肿瘤]