Onesti M G, Mazzocchi M, Di Ronza S, Martano A, Scuderi N
Dipartimento di Chirurgia Plastica e Ricostruttiva, Università degli Studi di Perugia.
G Chir. 2011 Jan-Feb;32(1-2):37-40.
Lymphoma was one of the first cancers curable by radiotherapy and/or chemotherapy. However the increased risk of second malignancies in lymphoma survivors appeared to be the price of success of modern treatment modalities. In particular, breast cancer has been a major concern among women irradiated for lymphoma at a young age. There are several reports of breast cancer after Hodgkin's lymphoma, but few after non-Hodgkin's lymphoma. Owing to the particularity of this condition and the difficulties in its diagnosis and treatment, we wish to report the case of ductal infiltrant carcinoma of the breast in a young woman survived to a non-Hodgkin's lymphoma. Women who are survivors of pediatric lymphoma have a significantly increased risk of subsequent breast cancer compared with the general population and are at a high risk of developing bilateral disease within a short interval. Several studies have shown that the relative risk for secondary breast cancer becomes significantly increased between 5 and 9 years and rises dramatically between 15 and 19 years after lymphoma treatment. Screening programs to detect breast cancer should be initiated early after Hodgkin's and non-Hodgkin's lymphomas. Screening have to include breast self examinations every month, clinical breast examinations every 6 months, and mammography every 2-3 years. The patients should start breast self-examination at puberty. In these high-risk patients, "aggressive" biopsy is appropriate for suspicious lesions.
淋巴瘤是最早可通过放疗和/或化疗治愈的癌症之一。然而,淋巴瘤幸存者发生第二原发恶性肿瘤的风险增加似乎是现代治疗方式成功的代价。特别是,乳腺癌一直是年轻时因淋巴瘤接受放疗的女性中的一个主要问题。有几篇关于霍奇金淋巴瘤后发生乳腺癌的报道,但非霍奇金淋巴瘤后发生乳腺癌的报道较少。鉴于这种情况的特殊性及其诊断和治疗的困难,我们希望报告一例非霍奇金淋巴瘤存活的年轻女性发生乳腺导管浸润癌的病例。与一般人群相比,儿童淋巴瘤幸存者后续发生乳腺癌的风险显著增加,且在短时间内发生双侧疾病的风险很高。几项研究表明,淋巴瘤治疗后5至9年,继发乳腺癌的相对风险显著增加,15至19年时急剧上升。对于霍奇金淋巴瘤和非霍奇金淋巴瘤患者,应在治疗后尽早启动乳腺癌筛查项目。筛查必须包括每月一次的乳房自我检查、每6个月一次的临床乳房检查以及每2至3年一次的乳房X线摄影检查。患者应在青春期开始乳房自我检查。在这些高危患者中,对于可疑病变进行“积极”活检是合适的。