Kitahara Miyuki, Hozumi Yasuo, Takeuchi Naoto, Ichinohe Satoko, Fujiwara Saori, Machinaga Mitsuki, Saitoh Hitoaki, Iijima Tatsuo
Department of Breast Surgery, Ibaraki Prefectural Central Hospital and Ibaraki Cancer Center, Kasama, Japan.
Department of Diagnostic Pathology, Ibaraki Prefectural Central Hospital and Ibaraki Cancer Center, Kasama, Japan.
Case Rep Oncol. 2020 Sep 29;13(3):1196-1201. doi: 10.1159/000510308. eCollection 2020 Sep-Dec.
In the absence of clear interstitial invasion, encapsulated papillary carcinoma (EPC) of the breast may be attributed to an extremely good prognosis if handled similarly to ductal carcinoma in situ (DCIS) with suitable local treatment. Here, we report our experience with a case of EPC of the breast that presented with carcinomatous pleuritis and lymphangitis carcinomatosa postoperatively, which rapidly resulted in a poor outcome. A 67-year-old woman was diagnosed with DCIS of the left breast and underwent left partial mastectomy and sentinel lymph node biopsy. EPC was diagnosed because the pathological examination showed no sign of interstitial infiltration. Postoperative radiation therapy was performed. Five years and 9 months postoperatively, the patient began experiencing cough and shortness of breath on exertion. Imaging showed right pleural effusion and consolidation of the lung field, but nothing suggesting local recurrence in the preserved left breast, local lymph nodes, or opposite breast was observed. Postoperative recurrence of breast cancer, carcinomatous pleuritis, and lymphangitis carcinomatosa were diagnosed based on the results of pleural fluid cytology. One month later, multiple brain metastases were found, and the patient died of the primary disease 5 months after recurrence. After surgery for EPC without clear interstitial infiltration, there was a small possibility of a poor outcome from distant metastasis. Therefore, although distant metastasis is uncommon, regular examination and testing should be performed.
在无明确间质浸润的情况下，乳腺包膜内乳头状癌（EPC）若采用与导管原位癌（DCIS）相似的合适局部治疗方法，其预后可能极佳。在此，我们报告一例乳腺EPC病例的诊治经验，该患者术后出现癌性胸膜炎和癌性淋巴管炎，迅速导致预后不良。一名67岁女性被诊断为左乳DCIS，接受了左乳部分切除术和前哨淋巴结活检。因病理检查未显示间质浸润迹象，故诊断为EPC。术后进行了放射治疗。术后五年零九个月，患者开始出现咳嗽和劳力性气短。影像学检查显示右侧胸腔积液和肺野实变，但未观察到保留的左乳、局部淋巴结或对侧乳房有局部复发迹象。根据胸腔积液细胞学检查结果，诊断为乳腺癌术后复发、癌性胸膜炎和癌性淋巴管炎。一个月后，发现多处脑转移，患者复发后5个月死于原发性疾病。对于无间质浸润的EPC进行手术后，存在远处转移导致预后不良的小概率事件。因此，尽管远处转移并不常见，但仍应进行定期检查和检测。
