Yousef George M, Gabril Manal Y, Al-Haddad Sahar, Mulligan Anna Marie, Honey R John
Department of Laboratory Medicine, and the Keenan Research Centre in the Li Ka Shing Knowledge Institute, St, Michael's Hospital, Toronto, Ontario, Canada.
J Med Case Rep. 2010 Jun 9;4:175. doi: 10.1186/1752-1947-4-175.
Invasive lobular carcinoma of the breast represents approximately 6.3% of mammary malignancies. Distant metastasis of invasive lobular carcinoma to the peritoneum or retroperitoneum has been reported fairly frequently.
We report the case of a 59-year-old Caucasian-Canadian woman with invasive lobular carcinoma of the breast presenting with retroperitoneal fibrosis and bilateral ureteral obstruction. Intra-operative pathology consultation did not reveal malignancy. The diagnosis, however, was confirmed on permanent sections by histological appearance in addition to immunohistochemistry. To the best of our knowledge, this is the first reported case of invasive lobular carcinoma of the breast presenting with retroperitoneal fibrosis.
In a case of unexplained ureteric obstruction and retroperitoneal fibrosis, more comprehensive physical examination and additional ancillary studies may be warranted to rule out malignancy as an underlying etiology. This case also emphasizes that intra-operative frozen section consultation cannot always be fully relied upon to exclude a malignancy as the etiology of retroperitoneal fibrosis. Moreover, in permanent histopathology sections, immunohistochemistry testing can be of value to rule out metastatic disease where the morphology is not salient. There is a need for a thorough physical examination of patients with retroperitoneal fibrosis, including the breast and gynecological organs.
乳腺浸润性小叶癌约占乳腺恶性肿瘤的6.3%。乳腺浸润性小叶癌远处转移至腹膜或腹膜后已被相当频繁地报道。
我们报告一例59岁的加拿大白人女性，患有乳腺浸润性小叶癌，表现为腹膜后纤维化和双侧输尿管梗阻。术中病理会诊未发现恶性肿瘤。然而，通过组织学表现及免疫组化在永久切片上确诊。据我们所知，这是首例报道的以腹膜后纤维化表现的乳腺浸润性小叶癌病例。
在不明原因的输尿管梗阻和腹膜后纤维化病例中，可能需要更全面的体格检查及其他辅助检查以排除恶性肿瘤作为潜在病因。该病例还强调术中冰冻切片会诊不能总是完全依赖于排除恶性肿瘤作为腹膜后纤维化的病因。此外，在永久组织病理学切片中，免疫组化检测对于形态不显著时排除转移性疾病可能有价值。对于腹膜后纤维化患者，包括乳腺和妇科器官在内的全面体格检查很有必要。
