Terasaki Azusa, Bando Hiroko, Ueda Aya, Okazaki Mai, Hashimoto Sachie, Iguchi-Manaka Akiko, Kondo Yuzuru, Hara Hisato
Department of Breast-Thyroid-Endocrine Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki Japan.
Department of Breast and Endocrine Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki Japan.
Int Cancer Conf J. 2023 Feb 20;12(2):143-148. doi: 10.1007/s13691-023-00594-x. eCollection 2023 Apr.
Seeding of cancer cells along the needle tract during core needle biopsy is a well-known phenomenon, with a reported frequency of between 22 and 50% [Hoorntje et al. in Eur J Surg Oncol 30:520-525, 2004;Liebens et al. in Maturitas 62:113-123, 2009;Diaz et al. in AJR Am J Roentgenol 173:1303-1313, 1999;]. Local recurrence due to needle tract seeding is rare because the immune system eliminates the cancer cells in most cases. In addition, most local recurrences due to needle tract seeding occur as invasive carcinoma after diagnosis of invasive ductal carcinoma of the breast or mucinous carcinoma, and needle tract seeding due to noninvasive carcinoma is uncommon. We herein report a rare case of local breast cancer recurrence histologically resembling Paget disease, presumably due to needle tract seeding after core needle biopsy for diagnosis of ductal carcinoma in situ of the breast. After receiving a diagnosis of ductal carcinoma in situ, the patient underwent skin-sparing mastectomy and breast reconstruction with a latissimus dorsi musculocutaneous flap. The pathological study showed ER/PgR-negative ductal carcinoma in situ, and no postoperative radiation therapy or systemic therapy was administered. Six months after the surgery, the patient had a breast cancer recurrence histologically resembling Paget disease, presumably in the scar of her core needle biopsy. The pathological study showed Paget disease localized in the epidermis, no invasive carcinoma, and no lymph node metastasis. It was morphologically similar to the primary lesion and was diagnosed as a local recurrence due to needle tract seeding.
在粗针活检过程中，癌细胞沿针道种植是一种众所周知的现象，报道的发生率在22%至50%之间[Hoorntje等人，《欧洲外科肿瘤学杂志》30:520 - 525，2004年；Liebens等人，《成熟度》62:113 - 123，2009年；Diaz等人，《美国放射学杂志》173:1303 - 1313，1999年]。由于针道种植导致的局部复发很少见，因为在大多数情况下免疫系统会清除癌细胞。此外，大多数因针道种植导致的局部复发发生在乳腺浸润性导管癌或黏液癌诊断后出现浸润性癌，而非浸润性癌导致的针道种植并不常见。我们在此报告一例罕见的局部乳腺癌复发病例，组织学上类似于佩吉特病，推测是由于在粗针活检诊断乳腺导管原位癌后针道种植所致。在被诊断为导管原位癌后，患者接受了保留皮肤的乳房切除术和背阔肌肌皮瓣乳房重建术。病理研究显示雌激素受体/孕激素受体阴性的导管原位癌，未进行术后放疗或全身治疗。手术后六个月，患者出现组织学上类似于佩吉特病的乳腺癌复发，推测发生在她粗针活检的瘢痕处。病理研究显示佩吉特病局限于表皮，无浸润性癌，无淋巴结转移。其形态与原发灶相似，被诊断为因针道种植导致的局部复发。
