Asano Michiko, Matsuo Kiyoshi, Ueda Yusuke, Tsushima Mizuho, Mizuta Makoto, Fujiwara Keiichi, Yonei Toshiro, Sato Toshio
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center.
Nihon Kokyuki Gakkai Zasshi. 2009 Jul;47(7):602-7.
A 55-year-old woman had a history of left mastectomy due to early breast cancer in 1998. She had been suffering from dyspnea on effort and dry cough since August in 2007, and visited our hospital 6 months later because the symptoms had been becoming worse. She was hypoxic and her chest radiograph showed bilateral diffuse shadows, so she was hospitalized. The specimen of transbronchial lung biopsy showed undifferentiated adenocarcinoma cells in lymphatics identified by lymphatic endothelium antibody D2-40 stain, so we diagnosed carcinomatous lymphangiosis. It also revealed the cells staining positive for Cytokeratin 7, negative for Cytokeratin 20, and positive for both estrogen receptor and progesterone receptor. These features were identical to the immunohistological findings of the specimen from the previously resected breast cancer. Chemotherapy with docetaxel was effective and improved her respiratory condition and the chest radiograph. The immunohistological findings are useful for diagnosis and selection of cancer therapy. We cannot find any case reports of recurrence with carcinomatous lymphangiosis over 10 years after resection of breast cancer in Japan. We must keep in mind that some cancers relapse after a long disease-free interval.
一名55岁女性在1998年因早期乳腺癌接受了左乳切除术。自2007年8月起，她开始出现劳力性呼吸困难和干咳症状，6个月后因症状加重前来我院就诊。她存在缺氧情况，胸部X线片显示双侧弥漫性阴影，遂住院治疗。经支气管肺活检标本经淋巴管内皮抗体D2-40染色显示淋巴管内有未分化腺癌细胞，因此我们诊断为癌性淋巴管炎。同时还发现细胞角蛋白7染色阳性，细胞角蛋白20染色阴性，雌激素受体和孕激素受体均为阳性。这些特征与之前切除的乳腺癌标本的免疫组织学结果一致。多西他赛化疗有效，改善了她的呼吸状况和胸部X线表现。免疫组织学结果对癌症诊断和治疗选择很有用。在日本，我们未发现乳腺癌切除术后10年以上出现癌性淋巴管炎复发的病例报告。我们必须牢记，有些癌症会在长时间无病间隔后复发。
