Yamashita Takashi, Watahiki Mana, Asai Katsuyuki
Division of General Thoracic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan.
Division of Breast Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan.
Am J Case Rep. 2020 Sep 24;21:e925275. doi: 10.12659/AJCR.925275.
BACKGROUND Breast cancer is becoming a common disease in women. It progresses slowly and may recur after a long time. Therefore, when a tumor is found in the chest of a patient with a history of breast cancer, an immediate concern is whether it is a primary tumor or a metastatic tumor. However, mediastinal metastasis is extremely unlikely to occur before lung metastasis, and breast cancer is not likely to have a solitary mediastinal metastasis. Additionally, patients should not undergo invasive procedures unnecessarily, so careful consideration is required. CASE REPORT We present 2 cases. In case 1, a 48-year-old woman with a history of breast cancer had a mediastinal tumor. Based on imaging findings, cystic thymoma was suspected. Thoracoscopic intraoperative rapid biopsy showed a lymphocyte-predominant tumor tissue; therefore, the tumor was resected via a median sternotomy. The final pathological diagnosis was breast cancer metastasis. In case 2, a 47-year-old woman who underwent breast cancer resection 15 years earlier was referred for upper limb edema. Based on imaging findings, a left medial vein occlusion due to mediastinal tumor was diagnosed. Our experience in case 1 suggested that a biopsy alone should be performed first. A tumor biopsy was performed through a small transverse neck incision in case 2, and the final diagnosis was metastatic breast cancer of the mediastinum. CONCLUSIONS In patients with a suspected primary mediastinal tumor on imaging, the possibility of a metastatic tumor should be considered if they have a history of breast cancer, regardless of how long in the past it was.
背景 乳腺癌正成为女性中的常见疾病。其进展缓慢，且可能在很长时间后复发。因此，当在有乳腺癌病史的患者胸部发现肿瘤时， immediately concern is whether it is a primary tumor or a metastatic tumor. However, mediastinal metastasis is extremely unlikely to occur before lung metastasis, and breast cancer is not likely to have a solitary mediastinal metastasis. Additionally, patients should not undergo invasive procedures unnecessarily, so careful consideration is required. 病例报告 我们呈现2例病例。病例1中，一名48岁有乳腺癌病史的女性患有纵隔肿瘤。基于影像学表现，怀疑为囊性胸腺瘤。胸腔镜术中快速活检显示以淋巴细胞为主的肿瘤组织；因此，通过正中胸骨切开术切除肿瘤。最终病理诊断为乳腺癌转移。病例2中，一名15年前接受过乳腺癌切除术的47岁女性因上肢水肿前来就诊。基于影像学表现，诊断为纵隔肿瘤导致的左内侧静脉闭塞。我们在病例1中的经验表明应首先仅进行活检。病例2通过颈部小横切口进行了肿瘤活检，最终诊断为纵隔转移性乳腺癌。结论 对于影像学上疑似原发性纵隔肿瘤的患者，如果有乳腺癌病史，无论过去多久，都应考虑转移瘤的可能性。
