Omi Yoko, Kamio Hidenori, Yoshida Yusaku, Masui Kenta, Yamamoto Tomoko, Nagashima Yoji, Okamoto Takahiro
Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.
Department of Diagnostic Pathology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.
Surg Case Rep. 2021 Aug 19;7(1):188. doi: 10.1186/s40792-021-01273-w.
Metastasis to the breast is rare. We herein report a patient with metastatic medullary thyroid carcinoma to the breast for whom measuring the calcitonin level was an important clue to the correct diagnosis.
A 54-year-old woman visited our hospital for the treatment of recurrent metastatic medullary thyroid carcinoma due to multiple endocrine neoplasia 2A and breast cancer. Positron emission tomography performed before the operation for metastatic medullary thyroid carcinoma recurrence in the neck showed the accumulation of F-fluorodeoxyglucose in the bilateral breast at sites other than the disease in the neck. Ultrasonography revealed multiple tumors in both breasts. A core needle biopsy of three breast tumors was performed. Microscopically, the tumor cells showed solid growth and did not show a tubular structure. She was diagnosed with triple-negative invasive ductal carcinoma. Post-operative positron emission tomography was performed as the serum calcitonin level increased after the operation. The accumulation of F-fluorodeoxyglucose in the bilateral breast tumors and lymph nodes in the neck was noted. The possibility of the breast tumors being metastasis of metastatic medullary thyroid carcinoma was considered. Needle aspiration was performed for three breast tumors. The calcitonin level of the washout fluid was measured and found to be ≥ 17,500 pg/mL. Immunohistochemistry showed that the tumor cells were calcitonin-positive and gross cystic disease fluid protein-15-negative. Vandetanib was started as recurrent metastatic medullary thyroid carcinoma with breast metastasis was finally diagnosed. The serum calcitonin level decreased after 1 month.
Although breast metastasis of medullary thyroid carcinoma is rare, a correct diagnosis is indispensable for appropriate treatment. When a breast tumor shows atypical morphological features for breast cancer according to the histopathology in a patient with a history of cancer, metastasis to the breast should be considered. Calcitonin measurement of the needle washout fluid was useful for confirming metastatic medullary thyroid carcinoma.
甲状腺髓样癌转移至乳腺较为罕见。我们在此报告一例甲状腺髓样癌转移至乳腺的患者，其中测量降钙素水平是正确诊断的重要线索。
一名54岁女性因多发性内分泌腺瘤病2A和乳腺癌前来我院治疗复发性转移性甲状腺髓样癌。在颈部进行甲状腺髓样癌转移复发手术前进行的正电子发射断层扫描显示，双侧乳腺中除颈部病变部位外的其他部位有氟脱氧葡萄糖积聚。超声检查发现双侧乳腺有多个肿瘤。对三个乳腺肿瘤进行了粗针活检。显微镜下，肿瘤细胞呈实性生长，未显示管状结构。她被诊断为三阴性浸润性导管癌。术后由于血清降钙素水平升高，进行了正电子发射断层扫描。发现双侧乳腺肿瘤和颈部淋巴结有氟脱氧葡萄糖积聚。考虑乳腺肿瘤为转移性甲状腺髓样癌转移的可能性。对三个乳腺肿瘤进行了针吸活检。测量冲洗液的降钙素水平，发现≥17,500 pg/mL。免疫组化显示肿瘤细胞降钙素阳性，巨大囊肿病液蛋白-15阴性。最终诊断为复发性转移性甲状腺髓样癌伴乳腺转移，开始使用凡德他尼治疗。1个月后血清降钙素水平下降。
尽管甲状腺髓样癌转移至乳腺罕见，但正确诊断对于恰当治疗必不可少。当有癌症病史的患者乳腺肿瘤根据组织病理学表现出非典型的乳腺癌形态特征时，应考虑乳腺转移。针吸冲洗液的降钙素测量有助于确诊转移性甲状腺髓样癌。
