Armas Isabel, Brandão Mariana, Guerreiro Inês, Guerreiro Inês, Lobo João, Freitas Carla, Pinto-de-Sousa João, de Sousa Joaquim Abreu
Unidade Local de Saúde do Nordeste, General Surgery. Bragança, Portugal.
Instituto Português de Oncologia do Porto, Medical Oncology. Porto, Portugal.
Autops Case Rep. 2019 Feb 25;9(1):e2018071. doi: 10.4322/acr.2018.071. eCollection 2019 Jan-Mar.
Intestinal lipomatosis is rare and often asymptomatic but can present with intestinal obstruction. Occasionally, metastatic breast cancer is identified in the ovary before a breast primary is discovered. We report the case of a 50-year-old woman diagnosed with synchronous intestinal obstruction due to lipomatosis, and incidental ovarian metastases from breast cancer. The patient presented with a 12-day history of nausea, diffuse abdominal pain, and constipation. An abdominal x-ray showed air-fluid levels, and computed tomography documented small bowel distention. An explorative laparotomy was performed, which revealed small bowel distention, an obstructive lesion of the ileocecal valve, three terminal ileum lesions, ascites, and heterogeneous ovaries. Right ileocolic resection and left oophorectomy were performed. The pathological diagnosis revealed lipomatous submucosal lesion of the ileocecal valve and ileum, and 17 lymph nodes, which were all negative for malignant cells. The oophorectomy revealed ovarian metastasis from breast carcinoma. Ascitic fluid was positive for malignant cells. Mammography and breast/axillary ultrasonography showed a solid nodule of the left breast, ductal carcinoma, and multiple enlarged left axillary lymph nodes, which were positive for neoplastic cells. Immunohistochemical evaluation showed hormonal receptor positivity and C-erb2 negativity. Breast magnetic resonance imaging showed a 14 mm left nodule and a positron emission tomography scan revealed F-FDG uptake in the left breast, left axillary lymph nodes, right ovary, and peritoneum. The tumor was staged as stage IV ductal breast carcinoma, cT1N1M1, Grade 2, Luminal B-like. The multidisciplinary oncological meeting proposed chemotherapy, and a re-staging breast MRI after chemotherapy, which showed a complete response. The patient started treatment with letrozole and remains disease-free 22 months after finishing chemotherapy.
肠脂肪过多症罕见且通常无症状，但可表现为肠梗阻。偶尔，在发现原发性乳腺癌之前，会在卵巢中发现转移性乳腺癌。我们报告一例50岁女性病例，该患者被诊断为因脂肪过多症导致的同步性肠梗阻，以及偶然发现的乳腺癌卵巢转移。患者有12天的恶心、弥漫性腹痛和便秘病史。腹部X光显示气液平面，计算机断层扫描记录了小肠扩张。进行了剖腹探查术，发现小肠扩张、回盲瓣梗阻性病变、三处回肠末端病变、腹水和双侧卵巢不均质。实施了右半结肠切除术和左侧卵巢切除术。病理诊断显示回盲瓣和回肠的脂肪性黏膜下病变，以及17个淋巴结，所有淋巴结均未发现恶性细胞。卵巢切除术显示为乳腺癌卵巢转移。腹水检查发现恶性细胞阳性。乳房X光摄影和乳腺/腋窝超声检查显示左乳实性结节、导管癌以及多个左侧腋窝淋巴结肿大，淋巴结肿瘤细胞阳性。免疫组化评估显示激素受体阳性，C-erb2阴性。乳腺磁共振成像显示左乳有一个14毫米的结节，正电子发射断层扫描显示左乳、左腋窝淋巴结、右卵巢和腹膜有F-FDG摄取。肿瘤分期为IV期导管性乳腺癌，cT1N1M1，2级，Luminal B样。多学科肿瘤学会议建议进行化疗，并在化疗后重新进行乳腺MRI分期，结果显示完全缓解。患者开始使用来曲唑治疗，化疗结束22个月后仍无疾病进展。
