Okamura Shu, Yanagisawa Tetsu, Ohishi Kazuhito, Murata Kohei, Nushijima Yoichiro, Hamano Rie, Fukuchi Nariaki, Ebisui Chikara, Yokouchi Hideoki, Kinuta Masakatsu
Dept. of Surgery, Suita Municipal Hospital.
Gan To Kagaku Ryoho. 2016 Nov;43(12):2047-2049.
We herein report the case of a 75-year-old female patient who underwent 4 surgeries for bilateral breast cancer and its recurrence. When she presented at a clinic with an irritable colon, a fist-sized tumor was palpated in the right upper abdomen at her first medical examination. Abdominal CT scan at the clinic revealed a tumor with a maximum diameter of 10 cm on the right side of the transverse colon and multiple swollen mesenteric lymph nodes. Therefore, the patient was referred to our hospital for surgery. Colonoscopy revealed stenosis of the same lesion with an edematous mucosa and sclerosis. Using immunohistochemistry, a biopsy specimen from the lesion tested positive for CK AE1+AE3, and negative for CD20(-)and CD3 (-). As a result, the tumor was diagnosed as a poorly differentiated adenocarcinoma. We performed right hemicolectomy to avoid her intestinal obstruction. Tumor cells were mainly present at the subserosa, according to HEstaining. Using immunostaining, the cells were tested for the following markers: CDX2(-), GCDFP15(weakly positive), CK7(strongly positive), CD20(partially positive), E R(+), PgR(-), and HER2(1+), characterizing the tumor as metastasis of breast cancer. Although gastro-intestinal metastasis from breast cancer is rare, and colon metastasis is even rarer, it might be necessary to rule out the possibility of a metastatic colon tumor from breast cancer when treating patients with a colon tumor who have undergone surgery for breast cancer.
我们在此报告一例75岁女性患者,其因双侧乳腺癌及其复发接受了4次手术。当她因结肠易激在诊所就诊时,首次体检在右上腹触及一个拳头大小的肿瘤。诊所的腹部CT扫描显示横结肠右侧有一个最大直径为10 cm的肿瘤以及多个肿大的肠系膜淋巴结。因此,该患者被转诊至我院进行手术。结肠镜检查显示同一病变处狭窄,黏膜水肿且硬化。通过免疫组织化学方法,病变活检标本的CK AE1+AE3检测呈阳性,CD20(-)和CD3 (-)检测呈阴性。结果,肿瘤被诊断为低分化腺癌。为避免肠梗阻,我们进行了右半结肠切除术。根据苏木精-伊红染色,肿瘤细胞主要位于浆膜下层。通过免疫染色,对细胞进行了以下标志物检测:CDX2(-)、GCDFP15(弱阳性)、CK7(强阳性)、CD20(部分阳性)、ER(+)、PgR(-)和HER2(1+),将该肿瘤特征化为乳腺癌转移。尽管乳腺癌的胃肠道转移罕见,结肠转移更为罕见,但在治疗有过乳腺癌手术史且患有结肠肿瘤的患者时,可能有必要排除乳腺癌转移至结肠肿瘤的可能性。