Noguchi Eiichiro, Kamio Takako, Kamio Hidenori, Miura Hiroko, Tamaki Masako, Nishizawa Masako, Aoyama Kei, Oochi Tetsuya, Kameoka Shingo
Department of Surgery II, Tokyo Women's Medical University, Tokyo 162-8666, Japan.
Oncol Lett. 2014 Dec;8(6):2448-2452. doi: 10.3892/ol.2014.2594. Epub 2014 Oct 9.
The case of a 72-year-old female who identified a lymph node enlargement in the left axilla is reported in the present study. A lymph node biopsy revealed a metastatic adenocarcinoma of the axillary lymph node. Following various assessments, the patient was diagnosed with occult breast cancer and lymph node metastases, for which treatment was initiated. Trastuzumab monotherapy was administered as the patient was elderly, positive for the hepatitis B virus and exhibited the following immunostaining/immunohistochemical analysis results: Estrogen receptor (ER) negative (-), progesterone receptor (PgR) negative (-) and human epidermal growth factor receptor 2 (HER2) positive (3+). Breast ultrasonography was performed 10 months after the initial trastuzumab administration and the left axillary lymph node enlargement had reduced in size and severity. However, a skin rash (erythema) was observed encompassing the left breast and extending into the axilla. As determined by the result of a skin biopsy of this area, the patient was diagnosed with occult breast cancer with cutaneous metastases. The immunohistochemical analysis results obtained from the skin biopsy were similar to those obtained from the lymph nodes: ER (-), PgR (-) and HER2 (3+). Therefore, the patient was switched from trastuzumab to lapatinib monotherapy. The erythema completely disappeared after two months of treatment. At present (34 months following lapatinib monotherapy initiation) no new lesions or severe side-effects have been observed.
本研究报告了一例72岁女性患者，其发现左腋窝淋巴结肿大。淋巴结活检显示为腋窝淋巴结转移性腺癌。经过各项评估，该患者被诊断为隐匿性乳腺癌伴淋巴结转移，并开始接受治疗。由于患者年事已高、乙肝病毒检测呈阳性且免疫染色/免疫组化分析结果如下：雌激素受体（ER）阴性（-）、孕激素受体（PgR）阴性（-）、人表皮生长因子受体2（HER2）阳性（3+），故给予曲妥珠单抗单药治疗。在首次使用曲妥珠单抗治疗10个月后进行了乳腺超声检查，左腋窝淋巴结肿大的大小和严重程度均有所减轻。然而，观察到左侧乳房出现皮疹（红斑）并延伸至腋窝。根据该区域皮肤活检结果，患者被诊断为隐匿性乳腺癌伴皮肤转移。皮肤活检获得的免疫组化分析结果与淋巴结活检结果相似：ER（-）、PgR（-）、HER2（3+）。因此，将患者的治疗从曲妥珠单抗改为拉帕替尼单药治疗。治疗两个月后红斑完全消失。目前（开始拉帕替尼单药治疗34个月后）未观察到新的病变或严重副作用。
