Katano Kaoru, Yoshimitsu Yutaka, Kyuno Takahiro, Haba Yusuke, Maeda Tsutomu, Kitamura Seiko
Department of Surgery, Houju Memorial Hospital, 11-71 Midorigaoka, Nomi, Ishikawa, 923-1226, Japan.
Department of Pathology, Houju Memorial Hospital, 11-71 Midorigaoka, Nomi, Ishikawa, 923-1226, Japan.
Surg Case Rep. 2020 Dec 7;6(1):311. doi: 10.1186/s40792-020-01088-1.
Spontaneous regression (SR) of a malignant tumor is the partial or complete disappearance of primary or metastatic tumor tissue in the absence of treatment, which can be temporary or permanent. Here, we report an extremely rare case of male breast cancer that exhibited temporary SR followed by reappearance 8 months after tumor disappearance.
A 70-year-old man presented at our hospital with a primary complaint of pain and a lump in his left breast. Ultrasonography revealed a hypoechoic lesion measuring 12 mm × 10 mm × 8 mm. Fine-needle aspiration cytology revealed numerous necrotic and degenerated cells and few sheet-like clusters of atypical ductal epithelial cells. The atypical cells had mildly enlarged nuclei with nucleoli, were focally overlapped and formed tubular patterns. The cytological diagnosis indicated a suspicion of malignancy. Core needle biopsy (CNB) revealed necrotic and degenerated cells with microcalcification. The pathological diagnosis was indeterminate because there was no area of viable atypical cells. An excisional biopsy of the left breast lesion was scheduled one month later. However, it was difficult to detect the tumor during physical examination and ultrasonography performed 1 month after the patient's first visit. The operation was canceled, and the patient received follow-up observation. After 8 months of follow-up, ultrasonography and computed tomography (CT) revealed reappearance of a 0.6-cm-diameter breast tumor in the same place. CNB was performed again and revealed invasive ductal carcinoma. A total mastectomy with sentinel lymph node biopsy was performed 13 months after the first tumor disappeared. Histopathological examination revealed invasive cribriform carcinoma without sentinel lymph node metastasis. The patient did not have any complications, and adjuvant therapy with tamoxifen was started. The patient was alive without recurrence 7 months after surgery.
Temporary SR followed by tumor reappearance can occur in breast cancer cases, and it is important to follow patients even if their breast tumor has seemingly disappeared. When breast tumors disappear without treatment, clinicians must be aware of the possibility of SR of cancer and should follow the patient for early detection of tumor reappearance.
恶性肿瘤的自发消退（SR）是指在未接受治疗的情况下，原发性或转移性肿瘤组织部分或完全消失，这种消失可以是暂时的或永久的。在此，我们报告一例极为罕见的男性乳腺癌病例，该病例出现了暂时的自发消退，在肿瘤消失8个月后又再次出现。
一名70岁男性因左侧乳房疼痛和肿块为主诉前来我院就诊。超声检查发现一个低回声病灶，大小为12毫米×10毫米×8毫米。细针穿刺细胞学检查发现大量坏死和退变细胞以及少量片状非典型导管上皮细胞簇。这些非典型细胞的细胞核轻度增大，有核仁，局部重叠并形成管状结构。细胞学诊断提示怀疑为恶性肿瘤。粗针穿刺活检（CNB）显示有坏死和退变细胞以及微钙化。由于没有存活的非典型细胞区域，病理诊断不明确。计划在1个月后对左侧乳房病变进行切除活检。然而，在患者首次就诊1个月后进行体格检查和超声检查时，很难检测到肿瘤。手术取消，患者接受随访观察。随访8个月后，超声检查和计算机断层扫描（CT）显示在同一部位再次出现一个直径0.6厘米的乳腺肿瘤。再次进行粗针穿刺活检，结果显示为浸润性导管癌。在第一个肿瘤消失13个月后进行了全乳房切除术加前哨淋巴结活检。组织病理学检查显示为浸润性筛状癌，无前哨淋巴结转移。患者没有任何并发症，开始接受他莫昔芬辅助治疗。术后7个月患者存活且无复发。
乳腺癌病例可出现暂时的自发消退后肿瘤再次出现的情况，即使乳房肿瘤看似已消失，对患者进行随访也很重要。当乳房肿瘤未经治疗而消失时，临床医生必须意识到癌症自发消退的可能性，并应对患者进行随访以便早期发现肿瘤再次出现。
