Nakakuma Takashi, Takahashi Kana, Ueno Souichirou, Tabei Toshio, Inada Tadahiro, Kondou Yasushi, Kosaka Yoshimasa, Sengoku Norihiko
Dept. of Breast Surgery, Ageo Central General Hospital.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2018-2020.
A 65-year-old woman was treated with breast-conserving therapy for dissection of the left breast and axillary lymph nodes. Histopathological diagnosis was invasive breast cancer(scirrhous), T1cN2M0, stageⅡB, ER+/PgR+/HER2-. Approximately 4 years later, a mass found in her left breast was confirmed to be ipsilateral breast tumor recurrence(IBTR). Left mastectomy was performed because no clear metastasis was found on whole-body examination. Histopathological diagnosis was invasive breast cancer(solid-tubular), ER-/PgR-/HER2-. IBTR was of a different type, compared to the primary breast cancer. In the follow-up period, multiple axillary lymph node metastases were found in the right axilla. Histopathologically, 20 lymph node metastases were found, and ER-/PgR-/HER2-breast cancer-related lymph node recurrence was diagnosed. Postoperative adjuvant chemotherapy(PTX, TS-1)was administered. In the 10 years following IBTR, there has been no recurrence, and it is thought to be completely cured. Usually, contralateral axillary lymph node recurrence is treated the same way as distant metastases because they are extra-regional lymph nodes; however, this strategy is not applicable to IBTR. When surgery is performed for IBTR, the contralateral axillary lymph node may become a new sentinel lymph node, and thus, sufficient examination and accurate risk assessment may be necessary before surgery for local control.
一名65岁女性因左乳及腋窝淋巴结清扫接受保乳治疗。组织病理学诊断为浸润性乳腺癌（硬癌），T1cN2M0，ⅡB期，ER+/PgR+/HER2-。大约4年后，其左乳发现的肿物确诊为同侧乳腺肿瘤复发（IBTR）。因全身检查未发现明确转移，遂行左乳切除术。组织病理学诊断为浸润性乳腺癌（实体管状癌），ER-/PgR-/HER2-。IBTR与原发性乳腺癌类型不同。在随访期间，右侧腋窝发现多发腋窝淋巴结转移。组织病理学检查发现20处淋巴结转移，诊断为ER-/PgR-/HER2-乳腺癌相关淋巴结复发。术后给予辅助化疗（紫杉醇、替吉奥）。IBTR后的10年里未再复发，认为已完全治愈。通常，对侧腋窝淋巴结复发因其为区域外淋巴结，治疗方式与远处转移相同；然而，该策略不适用于IBTR。对IBTR进行手术时，对侧腋窝淋巴结可能成为新的前哨淋巴结，因此，在进行手术以实现局部控制之前，可能需要进行充分检查和准确的风险评估。
