Sunami Takeshi, Kitayama Kishu, Nakazawa Kazunori, Sakashita Katsuya, Tezuka Kenji, Yukimoto Kiyotaka, Sawada Ryugo
Dept. of Surgery, PL General Hospital.
Gan To Kagaku Ryoho. 2020 Dec;47(13):2168-2170.
The patient was a 73-year-old woman who had undergone breast-conserving surgery followed by irradiation (50 Gy/25 Fr)to the residual breast for left breast cancer 4 years before. Computed tomography for routine examination revealed a soft tissue mass on her left chest wall. Ultrasonography showed a hypoechoic mass with heterogeneous internal echo, 3.5×3.0×1.5 cm in size. Core-needle biopsy was performed, and histological examination revealed proliferation of spindle-shaped or pleomorphic and highly atypical cells. On immunohistochemistry, the tumor was negative for AE1/AE3, CD34, SMA, desmin, and S-100 and focally positive for CD68. Based on these findings, undifferentiated sarcoma was suspected. The patient underwent wide local excision of the chest wall with a surgical margin of 3-4 cm from the tumor edge. The histological diagnosis was undifferentiated pleomorphic sarcoma. Judging from the clinical course, this tumor was radiation-induced sarcoma. The patient remains disease-free 54 months after the operation.
患者为一名73岁女性，4年前因左乳腺癌接受了保乳手术，术后对残留乳房进行了放射治疗（50 Gy/25次分割）。常规检查的计算机断层扫描显示其左胸壁有一软组织肿块。超声检查显示为低回声肿块，内部回声不均匀，大小为3.5×3.0×1.5 cm。进行了粗针活检，组织学检查显示梭形或多形性且高度非典型细胞增生。免疫组织化学检查显示，肿瘤对AE1/AE3、CD34、平滑肌肌动蛋白（SMA）、结蛋白和S-100呈阴性，对CD68呈局灶性阳性。基于这些发现，怀疑为未分化肉瘤。患者接受了胸壁广泛局部切除，手术切缘距肿瘤边缘3 - 4 cm。组织学诊断为未分化多形性肉瘤。从临床病程判断，该肿瘤为放射诱导性肉瘤。术后54个月患者仍无疾病复发。
