Takabatake Daisuke, Taira Naruto, Aogi Kenjiro, Ohsumi Shozo, Takashima Shigemitsu, Inoue Takeshi, Nishimura Rieko
Department of Breast Oncology, National Hospital Organization, National Shikoku Cancer Center, 160 Ko, Minamiumemoto, Matsuyama, Ehime, 791-0280, Japan.
Breast Cancer. 2008;15(2):181-4. doi: 10.1007/s12282-007-0027-7. Epub 2008 Feb 16.
We report two cases of occult breast cancer in which masses were completely nonpalpable and positron emission tomography-computed tomography (PET-CT) was extremely helpful in identifying the primary tumor. Case 1 involved a 56-year-old woman with enlarged lymph nodes 3 cm in size in the axilla. Based on excisional biopsy, axillary lymph node metastasis of breast cancer was suspected but an obvious primary tumor in the breast was not identifiable on mammography, contrast-enhanced CT, or ultrasonography. Faint accumulation of fluorodeoxyglucose (FDG) was noted only on PET-CT, so the site was considered to be the primary site, and operation was performed. As a result of postoperative pathological examination, ductal carcinoma in-situ (DCIS) was diagnosed. Case 2 involved a 55-year-old woman with enlarged lymph nodes 3 cm in size in the axilla. Based on the excisional biopsy, axillary lymph node metastasis of breast cancer was suspected. In this case as well, an obvious primary tumor was not identifiable with palpation or mammography. On PET-CT, faint accumulation of FDG was noted in the vicinity of the CD regions, or upper and lower outer quadrants. When contrast-enhanced CT and ultrasonography were performed, a faint nodular opacity less than 1 cm in size corresponding to this site was found and diagnosed as the primary site, operation was subsequently performed. Pathologic diagnosis indicated invasive cancer. PET-CT is a helpful option for the diagnosis of occult breast cancer with primary sites that conventional imaging studies have difficulty identifying.
我们报告两例隐匿性乳腺癌病例，其肿块完全无法触及，而正电子发射断层扫描-计算机断层扫描（PET-CT）在识别原发性肿瘤方面非常有帮助。病例1为一名56岁女性，腋窝有3厘米大小的肿大淋巴结。根据切除活检，怀疑为乳腺癌腋窝淋巴结转移，但在乳腺X线摄影、增强CT或超声检查中均未发现明显的乳腺原发性肿瘤。仅在PET-CT上发现氟脱氧葡萄糖（FDG）有轻度聚集，因此该部位被认为是原发部位，并进行了手术。术后病理检查结果诊断为导管原位癌（DCIS）。病例2为一名55岁女性，腋窝有3厘米大小的肿大淋巴结。根据切除活检，怀疑为乳腺癌腋窝淋巴结转移。在该病例中，触诊或乳腺X线摄影也未发现明显的原发性肿瘤。在PET-CT上，在CD区域附近或乳腺外上象限及外下象限发现FDG有轻度聚集。当进行增强CT和超声检查时，在对应部位发现一个小于1厘米的微弱结节状混浊影，并诊断为原发部位，随后进行了手术。病理诊断为浸润性癌。对于传统影像学检查难以识别原发部位的隐匿性乳腺癌，PET-CT是一种有用的诊断方法。
