Lu Hongrui, Yang Xiaodong, Zhu Ziguan, Zhu Xiuming, Guo Enqi, Yuan Rong
Plastic & Reconstructive Surgery Center, Department of Hand and Reconstructive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
Oncology Center, Department of Medical Oncology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
Gland Surg. 2022 Jul;11(7):1264-1269. doi: 10.21037/gs-22-344.
Stewart-Treves syndrome (STS) is a lymphatic sarcoma secondary to chronic lymphedema of the extremities. Most STS patients have a history of breast cancer and have undergone radical mastectomy and postoperative radiation and chemotherapy. It usually occurs 11 to 12 years after surgery, and about 0.45% of patients are estimated to have the disease. The characteristics of STS include that it is clinically relatively rare, has a high degree of malignancy, can spread easily in the absence of timely treatment, and has low survival rate. Herein, we report a case of STS which developed 13 years after breast cancer-related lymphoedema (BCRL). It allows doctors to recognize and detect the disease earlier.
A 74-year-old woman had undergone modified radical mastectomy 13 years ago for invasive ductal breast cancer in her left breast. After multiple rounds of postoperative chemoradiotherapy, multiple purple lesions were found in the left upper limb during physical examination in April 2021. The lesions spread rapidly and were varied in size. An immediate skin biopsy reported the lesions as STS. The patient was diagnosed with lymphangiosarcoma with metastasis (STS). The surgical method was shoulder joint amputation, chest wall resection, and local flap transfer. After surgery, the patient underwent 6 rounds of paclitaxel 300 mg + carboplatin 300 mg chemotherapy. After chemotherapy, the patient's wound healed and the suspected metastasis disappeared. At the time of writing, she has survived for more than 13 months, and her quality of life has improved significantly, to the satisfaction of the patient and her family. The patient is able to eat normally and lead a normal life with some assistance, without significant weight loss.
Although rare, STS is a serious invasive complication of breast cancer surgery. To increase their relative survival time, patients with BCRL need to identify and thoroughly investigate rapidly progressing skin lesions, and undergo timely surgery.
斯图尔特 - 特里夫斯综合征（STS）是一种继发于四肢慢性淋巴水肿的淋巴肉瘤。大多数STS患者有乳腺癌病史，且已接受根治性乳房切除术及术后放疗和化疗。它通常在术后11至12年发生，估计约0.45%的患者会患此病。STS的特点包括临床相对罕见、恶性程度高、若不及时治疗容易扩散且生存率低。在此，我们报告一例在乳腺癌相关淋巴水肿（BCRL）13年后发生的STS病例。这有助于医生更早地识别和检测该疾病。
一名74岁女性13年前因左乳浸润性导管癌接受了改良根治性乳房切除术。经过多轮术后放化疗后，2021年4月体检时发现左上肢有多个紫色病变。病变迅速扩散且大小不一。立即进行的皮肤活检报告病变为STS。该患者被诊断为伴有转移的淋巴管肉瘤（STS）。手术方式为肩关节截肢、胸壁切除及局部皮瓣转移。术后，患者接受了6轮紫杉醇300mg + 卡铂300mg化疗。化疗后，患者伤口愈合，疑似转移灶消失。在撰写本文时，她已存活超过13个月，生活质量显著改善，患者及其家属均感满意。患者能够正常进食，在一些帮助下能过上正常生活，体重无明显减轻。
尽管罕见，但STS是乳腺癌手术严重的侵袭性并发症。为延长相对生存时间，BCRL患者需要识别并彻底检查迅速进展的皮肤病变，并及时进行手术。
