以肠梗阻为首发症状的隐匿性乳腺癌1例  

A case of occult breast cancer presenting with intestinal obstruction as the initial symptom

作　　者：王紫娟 唐林 黄小辉 王桃丽 连红月 谭米多 WANG Zijuan;TANG Lin;HUANG Xiaohui;WANG Taoli;LIAN Hongyue;TAN Miduo(Department of Breast Surgery,Zhuzhou Hospital Affiliated to Xiangya School of Medicine,Central South University,Zhuzhou Hunan 412007;Department of Anesthesiology,Zhuzhou Hospital Affiliated to Xiangya School of Medicine,Central South University,Zhuzhou Hunan 412007;Department of Pathology,Zhuzhou Hospital Affiliated to Xiangya School of Medicine,Central South University,Zhuzhou Hunan 412007;Department of Radiology,Zhuzhou Hospital Affiliated to Xiangya School of Medicine,Central South University,Zhuzhou Hunan 412007,China)

机构地区：[1]中南大学湘雅医学院附属株洲医院乳腺外科,湖南株洲412007 [2]中南大学湘雅医学院附属株洲医院麻醉科,湖南株洲412007 [3]中南大学湘雅医学院附属株洲医院病理科,湖南株洲412007 [4]中南大学湘雅医学院附属株洲医院影像科,湖南株洲412007

出　　处：《中南大学学报(医学版)》2024年第12期2016-2022,共7页Journal of Central South University :Medical Science

基　　金：湖南省自然科学基金(2024JJ7654)。

摘　　要：隐匿性乳腺癌(occult breast cancer,OBC)是指体格检查、影像学检查及病理学检查均未能确认原发病灶的乳腺癌。本研究报告1例以肠梗阻为首发症状的OBC患者的临床资料。患者为67岁女性,无任何原发疾病而以肠梗阻为主要表现就诊于中南大学湘雅医学院附属株洲医院。腹部增强CT示直肠下段及升结肠增厚,肿瘤性病变可能。胸部CT示左侧腋窝多发淋巴结肿大。肠镜检查仅表现为黏膜充血、粗糙及肥厚。考虑肠道肿瘤性病变,行腹腔镜下直肠狭窄根治性切除术,术后病理诊断为直肠低分化腺癌,免疫组织化学染色结果显示雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、GATA结合蛋白3(GATA binding protein 3,GATA3)、细胞角蛋白7(cytokeratin 7,CK7)表达均为阳性,考虑乳腺癌转移。乳腺MRI示双侧乳腺多发增生结节[乳腺影像报告与数据系统(breast imaging reporting and data system,BI-RADS)2]。右乳内下肿块、双侧腋窝及双侧锁骨上窝淋巴结活检结果:右乳乳腺组织未见明确癌;右侧腋窝淋巴结见小灶癌组织;左、右锁骨上窝及左腋窝淋巴结低分化癌,考虑乳腺来源。最终诊断为OBC伴淋巴结转移及直肠转移。术后16个月患者死亡。OBC通常难以找到乳腺原发病灶,OBC消化道转移尤其罕见,其临床表现往往被转移灶症状掩盖,容易被忽视,临床医生需重视;因病情进展迅速,易出现多器官损伤,预后极差,故应早期发现OBC原发病灶,以改善患者的预后。Occult breast cancer(OBC)refers to a type of breast cancer where no primary lesion is detected through physical examination,imaging,and pathology.This report presents a clinical case of OBC with intestinal obstruction as the initial symptom.A 67-year-old female with no underlying conditions presented to Zhuzhou Hospital Affiliated to Xiangya School of Medicine,Central South University with intestinal obstruction.Contrast-enhanced CT of the abdomen showed thickening of the lower rectum and ascending colon,suggestive of a neoplastic lesion.Chest CT showed multiple enlarged lymph nodes in the left axilla.Colonoscopy revealed only mucosal congestion,roughness,and thickening.Suspecting an intestinal tumor,laparoscopic radical resection of the rectal stenosis was performed.Postoperative pathology indicated poorly differentiated adenocarcinoma of the rectum.Immunohistochemistry showed positive expression of estrogen receptor(ER),progesterone receptor(PR),GATA-binding protein 3(GATA3),and cytokeratin 7(CK7),suggesting breast cancer metastasis.Breast MRI revealed multiple proliferative nodules in both breasts(breast imaging reporting and data system,BI-RADS 2).Biopsies of the right lower-inner breast,bilateral axillary,and supraclavicular lymph nodes were performed.No carcinoma was found in the right breast tissues;however,small foci of carcinoma was detected in the right axillary lymph nodes,and poorly differentiated carcinoma of suspected breast origin was found in the bilateral supraclavicular and left axillary lymph nodes.The final diagnosis was OBC with lymph node and rectal metastasis.The patient died 16 months postoperatively.OBC often lacks identifiable primary breast lesions,and gastrointestinal metastases are particularly rare.Clinical manifestations are frequently masked by symptoms of metastatic lesions,making diagnosis challenging.Clinicians should maintain a high index of suspicion.Due to rapid disease progression and multiorgan involvement,prognosis is extremely poor.Early identification of the primary lesi

关 键 词：隐匿性乳腺癌 肠梗阻 转移性肿瘤 直肠肿瘤 淋巴结活检 

分 类 号：R73[医药卫生—肿瘤]