Asakura Hirofumi, Takashima Hitoshi, Mitani Masahiro, Haba Reiji, Seo Reiko, Yokoe Koiku, Toyama Yoshihiro, Ohkawa Motoomi
Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kagawa 761-0793, Japan.
Int J Clin Oncol. 2005 Aug;10(4):285-8. doi: 10.1007/s10147-005-0485-x.
Occult breast cancer presenting with axillary lymph node metastases is uncommon, and inflammatory breast cancer (IBC), as a subtype, is quite rare. Here we describe a case of IBC, which arose as an unknown primary carcinoma; the patient presented with axillary lymph node metastasis, and was successfully treated with trastuzumab and vinorelbine. Specifically, a 55-year-old woman presented with right axillary lymphadenopathy. Although she underwent various examinations, the primary site of the disease was not revealed. Axillary lymph node dissection was performed, and the lesion was diagnosed as a poorly differentiated adenocarcinoma. The patient chose to be treated by alternative medicine. About 6 months later, she was referred to our hospital, due to marked bilateral neck and axillary lymph node swelling. She presented with diffuse right breast enlargement, redness, and peau d'orange. Computed tomography (CT) of the breast showed skin thickening and swelling of the right breast.F-18 Fluorodeoxyglucose positron emission tomography (FDG-PET) showed FDG uptake in the right breast. The patient was clinically diagnosed with IBC. Because overexpression of the human epidermal growth factor receptor 2 (HER2) was found in the specimen from her right axillary lymph node, she was treated with trastuzumab and vinorelbine. Two months after the start of chemotherapy, CT revealed a complete response in the lymph nodes, and the skin thickening and parenchymal edema of the right breast had improved. FDG-PET was also performed at this time, and revealed no FDG uptake in either the right breast or the lymph nodes.
以腋窝淋巴结转移为表现的隐匿性乳腺癌并不常见，而炎性乳腺癌（IBC）作为一种亚型则极为罕见。在此，我们描述一例IBC病例，其最初表现为原发灶不明的癌；该患者出现腋窝淋巴结转移，并接受曲妥珠单抗和长春瑞滨治疗后获得成功。具体情况如下，一名55岁女性因右侧腋窝淋巴结肿大就诊。尽管她接受了各种检查，但疾病的原发部位仍未明确。遂进行了腋窝淋巴结清扫术，术后病变被诊断为低分化腺癌。该患者选择采用替代医学进行治疗。大约6个月后，由于双侧颈部和腋窝淋巴结明显肿大，她被转诊至我院。她表现为右侧乳房弥漫性增大、发红及橘皮样改变。乳房计算机断层扫描（CT）显示右侧乳房皮肤增厚及肿胀。F-18氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）显示右侧乳房有FDG摄取。该患者临床诊断为IBC。由于在其右侧腋窝淋巴结标本中发现人表皮生长因子受体2（HER2）过表达，她接受了曲妥珠单抗和长春瑞滨治疗。化疗开始两个月后，CT显示淋巴结完全缓解，右侧乳房的皮肤增厚及实质水肿也有所改善。此时也进行了FDG-PET检查，结果显示右侧乳房及淋巴结均无FDG摄取。
