Shinseki Kayoko, Takahashi Masaya, Kushima Akihiro, Nakamoto Toshihiro, Wakata Mitsuo, Nakajima Takuya, Toda Takumi, Ito Kanako, Fujibayashi Mariko
Dept. of Surgery, Tachikawa Sogo Hospital.
Gan To Kagaku Ryoho. 2020 Dec;47(12):1703-1705.
We experienced a case of right sided accessory breast cancer complicated by contralateral breast cancer. A 50-year-old woman came to us for an examination because a tumor in her left breast was pointed out at breast cancer screening. A breast MRI confirmed a tumor in her left breast and a tumor continuing from the skin to the subcutis of the right axilla. A skin biopsy for the tumor in the right axilla and a core needle biopsy(CNB)for the tumor in the left breast were performed. The pathological result of the CNB for the left breast indicated an invasive ductal carcinoma of the tubular formative scirrhous type. Although the tumor of the right axilla was poorly differentiated adenocarcinoma demonstrating cord-like arrays, it was examined by skin biopsy and therefore no deep part of the tissue was included. We conducted immunostaining, in consideration of the possibility of metastasis from the left sided breast cancer. ER, PgR, mammaglobin, GATA 3 were positive, strongly suggesting that the tumor in the right axilla was also derived from a mammary gland. We also performed a wide local excision of the right axilla plus axillary dissection(level Ⅰ)in addition to conducting a left mastectomy plus sentinel lymph node biopsy, in consideration of the possibility of primary right sided accessory breast cancer. The pathological result following surgery confirmed a difference in the histologic features between both sides, residual normal accessory mammary glands around the tumor on the right side, and the presence of rich DCIS and a lobular replacement image, leading to a definitive diagnosis of primary invasive ductal carcinoma of the accessory breast on the right side.
我们遇到了一例右侧副乳腺癌合并对侧乳腺癌的病例。一名50岁女性因在乳腺癌筛查中发现左乳有肿瘤前来我们处检查。乳腺MRI证实左乳有肿瘤，且有一个肿瘤从皮肤延续至右侧腋窝皮下。对右侧腋窝肿瘤进行了皮肤活检，对左侧乳房肿瘤进行了粗针穿刺活检（CNB）。左侧乳房CNB的病理结果显示为管状形成型硬癌的浸润性导管癌。尽管右侧腋窝肿瘤为低分化腺癌，呈条索状排列，但由于是通过皮肤活检进行检查，因此未包含组织深部。考虑到左侧乳腺癌转移的可能性，我们进行了免疫染色。雌激素受体（ER）、孕激素受体（PgR）、乳腺珠蛋白、GATA 3均为阳性，强烈提示右侧腋窝肿瘤也起源于乳腺。考虑到原发性右侧副乳腺癌的可能性，我们在进行左侧乳房切除加前哨淋巴结活检的同时，还对右侧腋窝进行了广泛局部切除加腋窝清扫（Ⅰ级）。手术后的病理结果证实两侧组织学特征存在差异，右侧肿瘤周围残留正常副乳腺组织，且存在丰富的导管原位癌（DCIS）和小叶替代图像，最终确诊为右侧原发性副乳腺浸润性导管癌。
