Kimura Mariko, Narui Kazutaka, Shima Hidetaka, Ikejima Shizune, Muto Mayu, Satake Toshihiko, Tanabe Mikiko, Inayama Yoshiaki, Adachi Shoko, Yamada Akimitsu, Shimada Kazuhiro, Sugae Sadatoshi, Ichikawa Yasushi, Ishikawa Takashi, Endo Itaru
Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Surg Case Rep. 2020 Aug 8;6(1):203. doi: 10.1186/s40792-020-00962-2.
Nipple-areola complex (NAC) reconstruction is a technique used in breast reconstructive surgery, which is performed during the final stage of breast reconstruction after total mastectomy of primary breast cancer. Composite nipple grafts utilizing the contralateral NAC are common; however, to our knowledge, there are no reports of new primary invasive ductal carcinoma development within the graft. Here, we describe one such case for the first time.
A 54-year-old woman was referred to us by the Department of Plastic and Reconstructive Surgery in our medical center for further evaluation of right nipple erosion. She had undergone total mastectomy of the right breast following a breast cancer diagnosis 15 years ago, at which time tumor biological profiling revealed the following: estrogen receptor (ER), positive; progesterone receptor (PgR), negative; and human epidermal growth factor receptor 2 (HER2), undetermined. She received adjuvant chemotherapy and endocrine therapy. She defaulted endocrine therapy for a few years, and 7 years after surgery, she underwent autologous breast reconstruction with a deep inferior epigastric perforator (DIEP) flap. In the following year, NAC reconstruction was performed using a composite graft technique. Seven years after the NAC reconstruction, erosion appeared on the nipple grafted from its contralateral counterpart; scrape cytology revealed malignancy. The skin on the right side of her chest around the NAC and subcutaneous fat tissue consisted of transferred tissue from the abdomen, as the DIEP flap and grafted nipple were located on the graft skin. The right nipple carcinoma arose from the tissue taken from the left nipple. Magnetic resonance imaging (MRI) or computed tomography showed no malignant findings in the left breast. As the malignant lesion seemed limited to the area around the grafted right nipple on MRI, surgical resection with sufficient lateral and deep margins was performed around the right nipple. Pathological findings revealed invasive ductal carcinoma with comedo ductal components infiltrating the graft skin and underlying adipose tissue. Immunohistochemistry revealed positive for ER, PgR, and HER2.
To our knowledge, this is the first case involving the development of invasive ductal carcinoma in a nipple graft constructed on the skin of a DIEP flap, with the origin from the contralateral breast's nipple.
乳头乳晕复合体（NAC）重建是一种用于乳房重建手术的技术，在原发性乳腺癌全乳切除术后的乳房重建最后阶段进行。利用对侧NAC的复合乳头移植很常见；然而，据我们所知，尚无关于移植体内发生新的原发性浸润性导管癌的报道。在此，我们首次描述了这样一个病例。
一名54岁女性被我们医疗中心的整形外科转诊，以进一步评估右乳头糜烂情况。她在15年前被诊断为乳腺癌后接受了右乳全切除术，当时肿瘤生物学特征显示如下：雌激素受体（ER）阳性；孕激素受体（PgR）阴性；人表皮生长因子受体2（HER2）未确定。她接受了辅助化疗和内分泌治疗。她有几年未进行内分泌治疗，术后7年，她接受了带蒂腹直肌下动脉穿支（DIEP）皮瓣自体乳房重建。次年，采用复合移植技术进行了NAC重建。NAC重建7年后，移植自对侧的乳头出现糜烂；刮片细胞学检查显示为恶性。她胸部右侧NAC周围的皮肤和皮下脂肪组织由腹部转移组织构成，因为DIEP皮瓣和移植乳头位于移植皮肤上。右乳头癌起源于取自左乳头的组织。磁共振成像（MRI）或计算机断层扫描显示左乳无恶性病变。由于MRI显示恶性病变似乎局限于移植的右乳头周围区域，因此在右乳头周围进行了具有足够外侧和深部切缘的手术切除。病理结果显示为浸润性导管癌，伴有粉刺样导管成分，浸润移植皮肤和下方脂肪组织。免疫组化显示ER、PgR和HER2均为阳性。
据我们所知，这是首例在DIEP皮瓣皮肤上构建的乳头移植体中发生浸润性导管癌的病例，其起源于对侧乳房的乳头。
