Essola B, Malvaux P, Landenne J, Kargar S, Dopchie C, Waignein F, Sleiman W Bou, Hauters P
Services de Chirurgie Digestive, Centre Hospitalier de Wallonie Picarde, Site Notre-Dame, Tournai.
Rev Med Brux. 2012 May-Jun;33(3):171-5.
The breast carcinoma metastases preferentially in the axillary lymph nodes, bones, lungs, liver and soft tissues. Gastrointestinal or bladder dissemination is very rare. We report the case of a 63-year-old female with a clinical presentation of acute cholecystitis, who underwent laparoscopic cholecystectomy in emergency. The gallbladder showed a nodule at the infundibulum, which was responsible for the gallbladder hydrops with macroscopic features of a cholangiocarcinoma. Histological examination disclosed a metastasis from a lobular breast carcinoma with positive hormone receptors, but no overexpression of the Neu oncogene. Immunohistochemistry showed positive staining for cytokeratin7 suggesting a lesion of breast origin. The absence of E-cadherin was consistent with lobular carcinoma while negative CA 19.9 excluded cholangiocarcinoma. The patient had received 15 years previously a right mastectomy with axillary dissection followed by chemotherapy and radiotherapy for breast carcinoma of ductal type labeled SBR stage III, pT3N1 M0, showing hormone receptors but absent Neu oncogene. Proofreading of the mastectomy histological slide concluded that it was a lobular rather than a ductal type carcinoma, confirming the finding of a gallbladder metastasis 15 years after the mastectomy. The patient showed no local recurrence or contralateral lesions on magnetic resonance imaging (MRI). The bone scan showed metastases in the skull, scapula, right rib cage, thoracolumbar spine and pelvis, also confirmed by MRI. A treatment with exemestane and zoledronic acid was introduced. The follow-up at 6 months showed regression of the bone lesions and absence of parenchymal new locations.
乳腺癌转移多发生于腋窝淋巴结、骨骼、肺、肝脏及软组织。胃肠道或膀胱转移极为罕见。我们报告一例63岁女性，临床表现为急性胆囊炎，急诊行腹腔镜胆囊切除术。胆囊漏斗部见一结节，导致胆囊积水，具有胆管癌的宏观特征。组织学检查显示为小叶型乳腺癌转移，激素受体阳性，神经原癌基因无过表达。免疫组化显示细胞角蛋白7阳性染色，提示病变起源于乳腺。E-钙黏蛋白缺失与小叶癌相符，CA 19.9阴性排除胆管癌。该患者15年前因导管型乳腺癌行右乳房切除术及腋窝淋巴结清扫术，术后接受化疗和放疗，标记为SBR III期，pT3N1 M0，有激素受体但无神经原癌基因。乳房切除组织学切片复查结果显示为小叶型而非导管型癌，证实乳房切除术后15年出现胆囊转移。患者磁共振成像（MRI）检查未显示局部复发或对侧病变。骨扫描显示颅骨、肩胛骨、右肋骨、胸腰椎及骨盆有转移，MRI检查也证实了这一点。开始使用依西美坦和唑来膦酸治疗。6个月随访显示骨病变消退，实质脏器无新发病灶。
