Shibata Shino, Shiraishi Kenshiro, Yamashita Hideomi, Kobayashi Reiko, Nakagawa Keiichi
Department of Radiation Oncology, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa 212-0014, Japan; Department of Radiology, University of Tokyo Hospital, Tokyo 113-0033, Japan.
Department of Radiology, University of Tokyo Hospital, Tokyo 113-0033, Japan.
Oncol Lett. 2016 Apr;11(4):2520-2524. doi: 10.3892/ol.2016.4221. Epub 2016 Feb 10.
The present study reports a case of low-grade fibromyxoid sarcoma that occurred in a 62-year-old woman 9 years subsequent to whole breast irradiation for a carcinoma of the left breast, and 18 years following chemotherapy and radiotherapy (RT) for non-Hodgkin's lymphoma (NHL; diagnosed at the age of 43). The patient was 53 years of age when a cT2N0M0 stage IIA breast tumor was identified and excised. A 2.5 cm diameter nodule with dimpling in the upper-outer region of the left breast was detected. Pathological examination revealed that the tumor was an invasive ductal carcinoma, of a solid tubular type. The patient was treated with post-surgical whole breast RT. The left breast received 46 Gy in 23 fractions (2 Gy per fraction) for 4 weeks and 3 days, followed by a cone down boost of 14 Gy in 7 fractions (2 Gy per fraction); therefore a total dose of 60 Gy in 30 fractions was administered. In total, 9 years subsequent to RT, the patient observed a small lump in the left chest wall. The patient underwent excision of the tumor and pectoralis major fascia. Microscopically, the tumor consisted of atypical spindle cells with myxoid stroma. Pathologists concluded that the tumor was a low-grade fibromyxoid sarcoma. Since the tumor developed from tissue in a previously irradiated region, it was considered to be RT-induced, and was classified using the radiation-induced sarcoma (RIS) criteria as dictated by Cahan. Although the majority of RIS cases are angiosarcomas, a rare, low-grade fibromyxoid sarcoma was observed in the present study. The present study hypothesizes that there may have been an overlap region between the RT for supraclavicular nodes of NHL and the whole breast RT for primary breast cancer, due to the results of a retrospective dose reconstruction undertaken by the present study. The patient remained clinically stable for 4 years thereafter, until 2008 when the patient experienced a local relapse and underwent surgery. On 19 October 2011, the patient succumbed to RIS. The current study suggests that the RT history of a patient requires consideration due to the possible development of RIS, including the development of a low-grade fibromyxoid sarcoma, which may lead to a poor prognosis.
本研究报告了一例低度纤维黏液样肉瘤病例，该病例发生在一名62岁女性身上，她在左侧乳腺癌全乳放疗9年后，以及在非霍奇金淋巴瘤（NHL；43岁时确诊）化疗和放疗（RT）18年后发病。患者53岁时发现并切除了cT2N0M0 IIA期乳腺肿瘤。在左乳外上区域检测到一个直径2.5 cm、有酒窝征的结节。病理检查显示肿瘤为实性管状型浸润性导管癌。患者接受了术后全乳放疗。左乳在4周零3天内分23次给予46 Gy（每次2 Gy），随后缩野加量分7次给予14 Gy（每次2 Gy）；因此总共分30次给予60 Gy的剂量。放疗9年后，患者发现左胸壁有一个小肿块。患者接受了肿瘤及胸大肌筋膜切除术。显微镜下，肿瘤由具有黏液样基质的非典型梭形细胞组成。病理学家得出结论，该肿瘤为低度纤维黏液样肉瘤。由于肿瘤发生于先前放疗区域的组织，故认为是放疗诱发的，并根据卡汉规定的放射性肉瘤（RIS）标准进行分类。尽管大多数RIS病例为血管肉瘤，但本研究中观察到了一例罕见的低度纤维黏液样肉瘤。本研究通过回顾性剂量重建结果推测，NHL锁骨上淋巴结放疗与原发性乳腺癌全乳放疗之间可能存在重叠区域。此后患者临床稳定4年，直至2008年出现局部复发并接受手术。2011年10月19日，患者死于RIS。本研究表明，由于可能发生RIS，包括发生低度纤维黏液样肉瘤，其预后可能较差，因此需要考虑患者的放疗史。
