Higgins L, Robertson I, Khan W, Barry K
Department of Surgery, Mayo General Hospital, Co Mayo, Ireland.
BMJ Case Rep. 2013 Jul 10;2013:bcr2013009450. doi: 10.1136/bcr-2013-009450.
A 67-year-old woman presented with synchronous breast and colonic tumours, in the absence of family history. Following multidisciplinary discussion, the patient was started on endocrine therapy for breast cancer. Initial surgical management consisted of right hemicolectomy together with segmental resection of a serosal deposit adherent to the distal ileum, for a moderately differentiated pT4NO caecal carcinoma. Three months later, right mastectomy and axillary clearance confirmed node positive invasive ductal carcinoma. The original treatment plan was to prioritise adjuvant chemotherapy for breast cancer postmastectomy. However, the subsequent CT finding of an enlarged, suspicious mesenteric lymph node mass on repeat staging raised concern regarding its origin. Image-guided biopsy revealed metastatic colonic adenocarcinoma and the patient was switched to a colon cancer chemotherapy regime. Following adjuvant chemotherapy for colonic carcinoma, an en-bloc surgical resection of the enlarging metastatic nodal mass was performed with clear resection margins. The patient is currently asymptomatic.
一名67岁女性在无家族病史的情况下出现了同步性乳腺和结肠肿瘤。经过多学科讨论后，患者开始接受乳腺癌内分泌治疗。初始手术治疗包括右半结肠切除术以及对附着于回肠末端的浆膜下转移灶进行节段性切除，以治疗中度分化的pT4NO盲肠癌。三个月后，右乳切除术及腋窝清扫术证实为淋巴结阳性浸润性导管癌。最初的治疗计划是优先进行乳腺癌乳房切除术后的辅助化疗。然而，后续CT检查发现再次分期时肠系膜淋巴结肿大且可疑，这引发了对其来源的担忧。影像引导下活检显示为转移性结肠腺癌，患者转而接受结肠癌化疗方案。在进行结肠癌辅助化疗后，对不断增大的转移性淋巴结肿块进行了整块手术切除，切缘清晰。患者目前无症状。
