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弥漫性骨髓转移作为隐匿性乳腺癌的首发表现

Diffuse Bone Marrow Metastasis as the Initial Presentation of an Occult Breast Cancer.

作者信息

Fan Frank S, Yang Chung-Fan, Wang Yi-Fen

机构信息

Section of Hematology and Oncology, Department of Medicine, Changhua Hospital, Ministry of Health and Welfare, Chang-Hua County, Taiwan.

Department of Pathology, Changhua Hospital, Ministry of Health and Welfare, Chang-Hua County, Taiwan.

出版信息

Case Rep Oncol Med. 2018 Jul 22;2018:2946409. doi: 10.1155/2018/2946409. eCollection 2018.

DOI:10.1155/2018/2946409
PMID:30140477
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6081566/
Abstract

INTRODUCTION

Breast cancer is one of the malignancies which tend to involve the bone marrow, but initial presentation with diffuse bone marrow metastasis from an occult breast cancer is very rare. Prognosis is generally very poor for marrow metastasis from solid tumors except that breast cancer is a treatable disease even in such a dismal condition.

CASE

A 64-year-old woman's headache was found to result from diffuse adenocarcinoma metastasis in the bone marrow from an unknown primary site. Intensive immunohistochemistry study of bone marrow biopsy specimen confirmed the disease nature to be an estrogen receptor-positive/human epidermal growth factor receptor 2-negative breast cancer. Mammography and magnetic resonance imaging of breasts revealed a suspicious primary lesion in the right breast. Treatment with tamoxifen alone achieved a sustained response.

DISCUSSION

Mucin 1 (MUC1), also known as cancer antigen 15-3 (CA 15-3), facilitates motility and metastatic potential of breast cancer cells. Interleukin-1 (IL-1) drives breast cancer cell growth and colonization in bone marrow adipose tissue niche. Receptor activator of nuclear factor kappa-B (RANK) and its ligand (RANKL) activate osteoclasts to make a favorable bone marrow microenvironment for tumor cells. Agents against MUC1, IL-1, and RANKL might be of therapeutic effect for patients like ours.

摘要

引言

乳腺癌是一种易于累及骨髓的恶性肿瘤，但隐匿性乳腺癌以弥漫性骨髓转移为首发表现极为罕见。除乳腺癌即使在这种严峻情况下仍为可治疗疾病外，实体瘤骨髓转移的预后通常非常差。

病例

一名64岁女性的头痛被发现是由不明原发部位的弥漫性腺癌骨髓转移所致。对骨髓活检标本进行的强化免疫组织化学研究证实疾病性质为雌激素受体阳性/人表皮生长因子受体2阴性乳腺癌。乳房钼靶摄影和磁共振成像显示右乳有一个可疑的原发病变。仅用他莫昔芬治疗取得了持续缓解。

讨论

粘蛋白1（MUC1），也称为癌抗原15-3（CA 15-3），可促进乳腺癌细胞的运动性和转移潜能。白细胞介素-1（IL-1）驱动乳腺癌细胞在骨髓脂肪组织微环境中生长和定植。核因子κB受体激活剂（RANK）及其配体（RANKL）激活破骨细胞，为肿瘤细胞营造有利的骨髓微环境。针对MUC1、IL-1和RANKL的药物可能对我们这样的患者有治疗作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7f2/6081566/a734fbc6cf28/CRIONM2018-2946409.010.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7f2/6081566/c8bc687c6c60/CRIONM2018-2946409.007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7f2/6081566/b0f424221d8a/CRIONM2018-2946409.008.jpg
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