Liu Jun, Wei Hongquan, Zhu Keqing, Lai Liqin, Han Xiaoyu, Yang Yue
Department of Pathology, the TongDe Hospital of Zhejiang Province Department of Pathology, Zhejiang University School of Medicine, Hangzhou, China.
Medicine (Baltimore). 2017 Dec;96(48):e8911. doi: 10.1097/MD.0000000000008911.
Although still relatively rare, multiple primary malignant neoplasms (MPMNs) have been increasingly reported in recent years.
A 65-year-old man was referred to our hospital for a painless, incidental left axillary lump. Ultrasound showed enlarged left axillary lymph nodes. An excisional biopsy was conducted on 3 lymph nodes. The pathological diagnosis was determined to be metastatic adenocarcinoma and mantle cell lymphoma (MCL) in the lymph nodes. Further physical examination of the patient yielded a 1.5-cm hard, left subareolar mass.
The patient underwent modified radical mastectomy. The diagnosis was grade II invasive ductal carcinoma (stage IIA). The axillary lymph node showed MCL (stage I, group A), but not metastatic ductal carcinoma. The patient received chemotherapy, including 6 courses of CHOP (A chemotherapy protocol consists of cyclophosphamide 1.2 g day 1, doxorubicin 80 mg day 1, vindesine 4 mg day1, and prednisone 90 mg from day 1 to 5) for lymphoma and breast cancer. The patient was also administered endocrine therapy. After a 54-month follow-up, the patient was well with no evidence of disease.
MPMNs are easily misdiagnosed as a primary and metastatic tumor, leading to delayed or erroneous treatment. Male breast cancer in a patient with MCL is rare. Early diagnosis and proper therapy are necessary for an optimal prognosis. Further studies are required to define the mechanisms and risk factors of MPMNs.
尽管多原发性恶性肿瘤（MPMNs）仍然相对罕见，但近年来其报告数量日益增加。
一名65岁男性因左侧腋窝无痛性偶然发现的肿块被转诊至我院。超声检查显示左侧腋窝淋巴结肿大。对3个淋巴结进行了切除活检。病理诊断为淋巴结转移性腺癌和套细胞淋巴瘤（MCL）。对患者进一步体格检查发现左侧乳晕下有一个1.5厘米的硬块。
患者接受了改良根治性乳房切除术。诊断为II级浸润性导管癌（IIA期）。腋窝淋巴结显示为MCL（I期，A组），但无转移性导管癌。患者接受了化疗，包括6个疗程的CHOP方案（一种化疗方案，由环磷酰胺1.2克第1天、阿霉素80毫克第1天、长春地辛4毫克第1天以及泼尼松90毫克从第1天至第5天组成）用于淋巴瘤和乳腺癌的治疗。患者还接受了内分泌治疗。经过54个月的随访，患者情况良好，无疾病迹象。
MPMNs容易被误诊为原发性和转移性肿瘤，导致治疗延迟或错误。MCL患者中男性乳腺癌罕见。早期诊断和恰当治疗对于获得最佳预后是必要的。需要进一步研究来确定MPMNs的机制和危险因素。
