School of Clinical Medicine, University of Cambridge, Cambridge, UK
School of Clinical Medicine, University of Cambridge, Cambridge, UK.
BMJ Case Rep. 2021 May 10;14(5):e237516. doi: 10.1136/bcr-2020-237516.
A 40-year-old woman was referred to the Breast Unit with a solid lump in her right breast. Investigations revealed an invasive lobular carcinoma. The patient underwent a right-sided mastectomy and sentinel lymph node (LN) biopsy, which confirmed axillary LN involvement. The postsurgery staging CT showed unusual enlargement of mediastinal and hilar LN bilaterally. This was consistent with positron emission tomography/CT and MRI, which further established the presence of several bone lesions. Determining the pathology within the LN and bones was pivotal in providing an accurate diagnosis and deciding subsequent management. However, histopathological analysis of the initial endobronchial ultrasound-guided fine-needle aspiration biopsy of mediastinal LN failed to identify definitive metastatic breast cancer cells. The case was extensively discussed in several multidisciplinary team meetings. Collective evidence, including clinical presentation, comparative imaging analysis, and further biopsies confirmed sarcoidosis with bone involvement-mimicking metastatic disease.
一位 40 岁女性因右侧乳房内有实性肿块被转至乳腺科。检查发现为浸润性小叶癌。患者接受了右侧乳房切除术和前哨淋巴结 (LN) 活检，证实腋窝 LN 受累。术后分期 CT 显示双侧纵隔和肺门 LN 异常增大。这与正电子发射断层扫描/CT 和 MRI 一致，进一步证实存在多处骨病变。确定 LN 和骨骼中的病理学对于提供准确的诊断和决定后续治疗至关重要。然而，最初经支气管内超声引导下细针抽吸活检纵隔 LN 的组织病理学分析未能确定明确的转移性乳腺癌细胞。在多次多学科团队会议上对此病例进行了广泛讨论。包括临床表现、对比影像学分析和进一步活检在内的综合证据证实了伴有骨受累的类转移疾病的结节病。
