Andjelić-Dekić Nataša, Božović-Spasojević Ivana, Milošević Snežana, Matijašević Miodrag, Karadžić Katarina
Srp Arh Celok Lek. 2014 Sep-Oct;142(9-10):597-601. doi: 10.2298/sarh1410597a.
Isolated adrenal metastases of invasive ductal breast carcinoma are extremely rare. We report a case with isolated left adrenal metastases, verified three years after diagnosed breast carcinoma.
A 58-year-old female patient with a right breast tumor, clinically staged as IIIA (T2N2M0) started neoadjuvant anthracycline chemotherapy after biopsy which revealed invasive ductal breast carcinoma. Immunohistochemical findings of tumor biopsy showed hormonal steroid receptors for estrogen and progesterone negative, and human epidermal growth factor receptor 2 (HER2) positive. After 4 cycles of chemotherapy and partial tumor regression the patient underwent radical mastectomy. Definite histopathological analysis confirmed the diagnosis of invasive ductal carcinoma. The patient continued treatment with adjuvant chemotherapy to cumulative dose of anthracyclines, postoperative radiotherapy and adjuvant trastuzumab for one year. Three years later abdominal computerized tomography showed tumor in the left adrenal gland as the only metastatic site. Left adrenalectomy was performed and histopathological finding confirmed breast cancer metastases. Postoperatively, the patient received 6 cycles of docetaxel with trastuzumab and continued trastuzumab until disease progression. One year after left adrenalectomy control abdominal computerized tomography showed a right adrenal tumor with retroperitoneal lymphadenopathy. Treatment with capecitabine was continued for one year, but eventually she developed brain metastasis causing lethal outcome.
In order to better understand metastatic pathways of invasive ductal breast carcinoma, publications of individual patient cases diagnosed with rare metastatic sites should be encouraged. This might improve our understanding of metastatic behavior of breast cancer and stimulate further clinical research.
浸润性导管乳腺癌的孤立性肾上腺转移极为罕见。我们报告一例孤立性左肾上腺转移病例，在乳腺癌确诊三年后得到证实。
一名58岁女性患者，右乳肿瘤，临床分期为IIIA期（T2N2M0），活检显示为浸润性导管乳腺癌后开始新辅助蒽环类化疗。肿瘤活检的免疫组化结果显示雌激素和孕激素的激素类固醇受体为阴性，人表皮生长因子受体2（HER2）为阳性。经过4个周期的化疗和部分肿瘤退缩后，患者接受了根治性乳房切除术。明确的组织病理学分析证实为浸润性导管癌。患者继续接受辅助化疗，累积使用蒽环类药物剂量，术后放疗，并接受辅助曲妥珠单抗治疗一年。三年后，腹部计算机断层扫描显示左肾上腺有肿瘤，为唯一转移部位。进行了左肾上腺切除术，组织病理学检查证实为乳腺癌转移。术后，患者接受了6个周期的多西他赛联合曲妥珠单抗治疗，并继续使用曲妥珠单抗直至疾病进展。左肾上腺切除术后一年，腹部计算机断层扫描显示右肾上腺肿瘤伴腹膜后淋巴结肿大。继续使用卡培他滨治疗一年，但最终她发生脑转移导致死亡。
为了更好地了解浸润性导管乳腺癌的转移途径，应鼓励发表罕见转移部位的个体病例报告。这可能会提高我们对乳腺癌转移行为的理解，并促进进一步的临床研究。
