Department of Breast Endocrine Surgery, Mitsui Memorial Hospital, Kandaizumicho-1, Chiyoda-ku, Tokyo, 101-8643, Japan.
Breast Cancer. 2011 Oct;18(4):324-7. doi: 10.1007/s12282-009-0151-7. Epub 2009 Aug 22.
Herein we report a 62-year-old woman with an excisable breast tumor in whom needle tract seeding was suspected during preoperative ultrasound and magnetic resonance imaging (MRI). A tumor of the right breast was observed during initial examination, and she was referred to our hospital after fine-needle aspiration cytology led to diagnosis of breast cancer, even though core needle biopsy results were negative. Mammography showed a high-density mass with a portion of the margin exhibiting very fine serrations. Ultrasonography revealed a circular mass with a border that was indistinct in some regions, and a hypoechoic band that extended from the tumor toward the skin. A mass was observed on MRI, with a linear enhancement extending on the skin side, and needle tract seeding was suspected. Fine-needle aspiration cytology revealed malignancy, and the histological appearance was consistent with mucinous carcinoma. T1cN0M0 stage I breast cancer was diagnosed, and wide excision and sentinel lymph node biopsy were performed. The skin directly above the tumor was concurrently excised to remove the biopsy puncture site. Histopathological diagnosis confirmed mucinous carcinoma, with the tumor observed to extend linearly into the subcutaneous adipose tissue in a pattern corresponding to the biopsy puncture site. The stump of the excised breast was negative for cancer cells. The possibility of tumor seeding must be considered during fine-needle aspiration cytology and biopsy. As demonstrated in this case, diagnosis of such seeding through preoperative imaging may enable extraction of the entire lesion, including the needle tract.
在此,我们报告了一例 62 岁女性,术前超声和磁共振成像(MRI)怀疑针道播散。初步检查发现右乳肿瘤,细针穿刺细胞学检查诊断为乳腺癌后转至我院,尽管粗针活检结果为阴性。乳腺 X 线摄影显示高密度肿块,部分边缘呈极细锯齿状。超声显示边界在某些区域不清晰的圆形肿块,肿瘤向皮肤延伸的低回声带。MRI 上可见一肿块,线性增强向皮肤侧延伸,怀疑针道播散。细针穿刺细胞学检查显示恶性,组织学表现与黏液癌一致。诊断为 T1cN0M0 期 I 型乳腺癌,行广泛切除和前哨淋巴结活检。同时切除肿瘤上方的皮肤以切除活检穿刺部位。组织病理学诊断证实为黏液癌,肿瘤呈线性延伸至皮下脂肪组织,与活检穿刺部位相对应。切除乳房的残端未发现癌细胞。在细针穿刺细胞学和活检过程中必须考虑肿瘤播散的可能性。如本例所示,通过术前影像学诊断这种播散,可能能够切除包括针道在内的整个病变。