Morisaki Tamami, Noda Satoru, Ishihara Sae, Asano Yuka, Kashiwagi Shinichiro, Takashima Tsutomu, Onoda Naoyoshi, Ohira Masaichi
Dept. of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2021 Mar;48(3):437-439.
A 52-year-old woman experienced right breast pain and detected a mammary tumor 6 months ago. She then noticed rapid enlargement of the tumor, which was suspected to be a borderline malignant phyllodes tumor. The tumor size was approximately 15 cm and presented with skin congestion but without infiltration. The tumor showed internal heterogeneous echo and rich blood flow signals on breast ultrasonography. Ultrasonography also showed swelling of the axillary lymph node. Lymph node cytology revealed the presence of atypical cells in the lymph node, and CT scan showed lymph node metastasis in the right axilla and no distant metastases. We performed mastectomy with lymph node sampling. Pathological examination of the specimens confirmed a malignant phyllodes tumor and a metastatic lymph node. One month later, a subcutaneous mass and multiple pulmonary nodules were identified on a chest CT scan. Chest wall irradiation(45 Gy)and chemotherapy were performed, but the number of pulmonary nodules, pleural effusion, and size of the subcutaneous mass continued to increase. Although she underwent another chemotherapeutic treatment, she died 5 months after the surgery. Thus, we report a case of a malignant phyllodes tumor with an extremely rare lymph node metastasis, which rapidly progressed even though multimodal therapy was performed.
一名52岁女性6个月前出现右乳疼痛并发现乳腺肿瘤。随后她注意到肿瘤迅速增大，怀疑为交界性恶性叶状肿瘤。肿瘤大小约15 cm，伴有皮肤充血但无浸润。乳腺超声检查显示肿瘤内部回声不均匀且血流信号丰富。超声检查还显示腋窝淋巴结肿大。淋巴结细胞学检查发现淋巴结中存在非典型细胞，CT扫描显示右腋窝淋巴结转移且无远处转移。我们进行了乳房切除术及淋巴结取样。标本的病理检查证实为恶性叶状肿瘤及转移淋巴结。1个月后，胸部CT扫描发现皮下肿块和多个肺结节。进行了胸壁照射（45 Gy）及化疗，但肺结节数量、胸腔积液及皮下肿块大小持续增加。尽管她接受了另一次化疗，但术后5个月死亡。因此，我们报告一例恶性叶状肿瘤伴极其罕见的淋巴结转移病例，尽管进行了多模式治疗，病情仍迅速进展。
