Lin Xue, Matsumoto Yoshiaki, Nakakimura Tomomi, Ono Kazuo, Umeoka Shigeaki, Torii Masae, Yoshibayashi Hiroshi, Toi Masakazu
Department of Breast Surgery, Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
Department of Breast Surgery, Kyoto University Hospital, 54 Kawaharacho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Surg Case Rep. 2020 Jun 19;6(1):143. doi: 10.1186/s40792-020-00905-x.
Solid papillary carcinoma (SPC) of the breast is a rare breast cancer that accounts for less than 1% of all breast cancers. The optimal clinical management of SPC remains controversial. Here, we report a case of invasive SPC with neuroendocrine differentiation in addition to review of the current literature.
A premenopausal 46-year-old female presented with a mass in her left breast that tended to increase in size over a 10-month period. Mammography and ultrasonography revealed a mass in the left upper-inner quadrant. The resulting images suggested a category 3 breast tumor according to the Breast Imaging Reporting and Data System (BI-RADS). A core needle biopsy (CNB) was performed, and the pathological findings showed a solid papillary pattern and atypical cells suggestive of noninvasive SPC. After a left partial mastectomy and sentinel lymph node biopsy (SLNB), the specimens were sent for histopathological analysis for further investigation. Postoperative pathological findings suggested invasive SPC. Whole-breast radiation therapy and adjuvant hormonal therapy were performed as postoperative treatments. Three years after surgery, multiple lung metastases were detected, and the patient was treated with a gonadotropin-releasing hormone agonist and an aromatase inhibitor. Five months later, multiple liver metastases and bone metastases appeared, and oral 5-fluorouracil was chosen for the subsequent treatment. The patient has been treated for 5 years to date, and she is continuing to take oral 5-fluorouracil and is alive without any further disease progression.
We report a rare case of premenopausal invasive SPC with multiple metastases. Further study is needed to clarify the molecular characteristics and clinical behaviors of SPC and to explore the optimal treatment strategy.
乳腺实性乳头状癌（SPC）是一种罕见的乳腺癌，占所有乳腺癌的比例不到1%。SPC的最佳临床管理仍存在争议。在此，我们报告一例具有神经内分泌分化的浸润性SPC病例，并对当前文献进行综述。
一名46岁的绝经前女性因左乳肿块就诊，该肿块在10个月内有增大趋势。乳腺X线摄影和超声检查显示左乳内上象限有一肿块。根据乳腺影像报告和数据系统（BI-RADS），所得图像提示为3类乳腺肿瘤。进行了粗针穿刺活检（CNB），病理结果显示为实性乳头状结构和非典型细胞，提示为非浸润性SPC。在进行左乳部分切除术和前哨淋巴结活检（SLNB）后，将标本送去进行组织病理学分析以作进一步研究。术后病理结果提示为浸润性SPC。术后进行了全乳放疗和辅助激素治疗。术后三年，检测到多处肺转移，患者接受促性腺激素释放激素激动剂和芳香化酶抑制剂治疗。五个月后，出现多处肝转移和骨转移，随后选择口服5-氟尿嘧啶进行治疗。该患者至今已接受治疗5年，她仍在继续口服5-氟尿嘧啶，目前存活且无疾病进一步进展。
我们报告了一例罕见的绝经前浸润性SPC伴多处转移的病例。需要进一步研究以阐明SPC的分子特征和临床行为，并探索最佳治疗策略。
