Syamsu Salman Ardi, Setiady Rino, Smaradania Nilam, Irsandy Febie, Faruk Muhammad
Division of Oncology, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Division of Oncology, Department of Surgery, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia.
Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
Int J Surg Case Rep. 2022 Aug;97:107398. doi: 10.1016/j.ijscr.2022.107398. Epub 2022 Jul 9.
Among women, breast cancer (BC) is the most prevalent type of cancer and the top cause of cancer deaths. Although non-Hodgkin lymphoma (NHL) is the most prevalent hematological cancer, it is rarely reported synchronous with BC. Moreover, which malignancy appears first can rarely be explained because they are usually detected incidentally while diagnosing and treating other malignancies. This paper reports a case of invasive ductal carcinoma (IDC) concomitant with NHL.
A 35-year-old woman presented with simultaneous IDC in the left breast and NHL in a lymph node in the neck. The patient underwent a modified radical mastectomy for stage IIIA IDC and received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy for stage I NHL.
Treating BC and NHL remains challenging due to their significantly different management, the lack of guidelines for treating BC and lymphoma simultaneously, and uncertainty about whether synchronous tumors should be treated separately as distinct clinical entities or as one disease with treatment covering both. Therefore, the best approach continues to be focusing on the most biologically aggressive malignancies.
The enlargement of lymph nodes not in the lymphatic drainage of the primary tumor should be suspected of indicating multiple primary malignancies until proven otherwise. For patients with luminal-B BC, NHL chemotherapy can involve receiving the R-CHOP regimen, including doxorubicin and cyclophosphamide, which can help to mitigate BC.
在女性中,乳腺癌(BC)是最常见的癌症类型,也是癌症死亡的首要原因。虽然非霍奇金淋巴瘤(NHL)是最常见的血液系统癌症,但与BC同时发生的情况很少见。此外,很难解释哪种恶性肿瘤先出现,因为它们通常是在诊断和治疗其他恶性肿瘤时偶然发现的。本文报告一例浸润性导管癌(IDC)合并NHL的病例。
一名35岁女性,同时出现左乳IDC和颈部淋巴结NHL。患者因IIIA期IDC接受了改良根治性乳房切除术,并因I期NHL接受了利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松(R-CHOP)化疗。
治疗BC和NHL仍然具有挑战性,因为它们的管理方式差异很大,缺乏同时治疗BC和淋巴瘤的指南,以及对于同步肿瘤是应作为不同的临床实体分别治疗还是作为一种疾病进行涵盖两者的治疗存在不确定性。因此,最佳方法仍然是关注最具生物学侵袭性的恶性肿瘤。
在未得到其他证明之前,应怀疑原发肿瘤淋巴引流区域以外的淋巴结肿大表明存在多种原发性恶性肿瘤。对于管腔B型BC患者,NHL化疗可采用包括阿霉素和环磷酰胺的R-CHOP方案,这有助于减轻BC。