Kosmidis Christoforos, Varsamis Nikolaos, Anthimidis Georgios, Baka Sofia, Valoukas Dimitrios, Koletsa Triantafyllia, Zarampouka Katerina, Koimtzis Georgios, Georgakoudi Eleni, Zarogoulidis Paul, Efthymiadis Christoforos
Department of Surgery, Interbalkan European Medical Center, Thessaloniki, Greece.
Department of Oncology, Interbalkan European Medical Center, Thessaloniki, Greece.
Int J Gen Med. 2018 Oct 11;11:399-403. doi: 10.2147/IJGM.S176052. eCollection 2018.
Breast cancer is the most common malignancy in women worldwide. Long-term survivors among patients treated for breast cancer are at a high risk for developing a second primary malignancy. Hepatocellular carcinoma is the most frequent primary hepatic malignancy and should be ruled out in breast cancer patients who are diagnosed with solitary hepatic lesions. False diagnosis may lead to inappropriate oncologic staging and treatment of the disease.
We present the case of a 73-year-old female patient who had been treated for invasive ductal breast cancer 7 years ago and was diagnosed with a solid hepatic lesion at segments VI and VII and a small, calcified lesion at the tail of the pancreas on follow-up with an abdominal computed tomography. Oncology council decided that both lesions could be resected after determining whether they were metastatic or second primary malignancies. The patient underwent laparotomy and rapid biopsy which showed primary hepatocellular carcinoma and fibrosis of the pancreas. We performed hepatic segmentectomy (VI-VII) and cholecystectomy, while the pancreatic lesion was left intact. The postoperative course of the patient was uncomplicated and she remains disease free 2 years after the operation without any adjuvant therapy.
All hepatic lesions detected in breast cancer patients should be evaluated with open mind and liver biopsy should be performed to get a definitive diagnosis and implement the proper treatment strategy.
乳腺癌是全球女性中最常见的恶性肿瘤。接受乳腺癌治疗的患者中的长期幸存者发生第二原发性恶性肿瘤的风险很高。肝细胞癌是最常见的原发性肝脏恶性肿瘤，在诊断为孤立性肝脏病变的乳腺癌患者中应予以排除。误诊可能导致疾病的肿瘤分期和治疗不当。
我们报告一例73岁女性患者，7年前接受浸润性导管癌治疗，随访腹部计算机断层扫描时，在肝段VI和VII发现一个实性肝脏病变，在胰尾部发现一个小的钙化病变。肿瘤学委员会决定，在确定这两个病变是转移性还是第二原发性恶性肿瘤后均可切除。患者接受了剖腹手术和快速活检，结果显示为原发性肝细胞癌和胰腺纤维化。我们进行了肝段切除术（VI - VII）和胆囊切除术，而胰腺病变未处理。患者术后过程顺利，术后2年未接受任何辅助治疗，仍无疾病复发。
对于乳腺癌患者中检测到的所有肝脏病变，应持开放态度进行评估，并应进行肝脏活检以获得明确诊断并实施适当的治疗策略。
