Yoneyama Kimiyasu, Nakagawa Motohito, Hara Asuka, Sasaki Aya
Department of Breast Surgery, Hiratsuka City Hospital, Hiratsuka, Japan.
Department of Breast Surgery, Hiratsuka City Hospital, Hiratsuka, Japan.
Int J Surg Case Rep. 2023 Apr;105:108067. doi: 10.1016/j.ijscr.2023.108067. Epub 2023 Mar 28.
Infarction occurs occasionally in benign mammary tumors but is extremely rare in breast cancer, with few cases having been reported.
A 53-year-old woman presented to our hospital with a mass and pain in the upper lateral region of the right breast. She underwent a needle biopsy and was histologically diagnosed as having invasive carcinoma. A ring-enhancing spherical mass was seen on contrast-enhanced computed tomography and magnetic resonance images. She underwent a right partial mastectomy with sentinel lymph node biopsy for T2N0M0 breast cancer. Macroscopically, the tumor was a yellow mass. Histopathologically, the site contained extensively necrotic tissue with foam cell aggregation, lymphocytic infiltration, and fibrosis in the periphery. No viable tumor cells were observed. The patient was followed up without postoperative chemotherapy or radiotherapy.
Ultrasound examination performed before the biopsy showed blood flow inside the tumor, but a review of the histopathological tissue after surgery revealed generally low viability of the tumor cells in the biopsy specimen, and the possibility that the tumor had a strong tendency to be necrotic from the beginning was considered. It is presumed that some immunological mechanism was working.
We have encountered a case of breast cancer with complete infarct necrosis. Infarct necrosis may be present if a contrast-enhanced image shows ring-like contrast.
梗死偶尔会发生于良性乳腺肿瘤，但在乳腺癌中极为罕见，仅有少数病例报道。
一名53岁女性因右乳外上象限肿物及疼痛就诊于我院。她接受了针吸活检，组织学诊断为浸润性癌。在增强计算机断层扫描和磁共振图像上可见环形强化的球形肿物。她因T2N0M0期乳腺癌接受了保乳手术及前哨淋巴结活检。肉眼可见肿瘤为黄色肿物。组织病理学检查显示，该部位有广泛坏死组织，周边有泡沫细胞聚集、淋巴细胞浸润及纤维化。未观察到存活的肿瘤细胞。患者术后未接受化疗或放疗，进行随访。
活检前的超声检查显示肿瘤内部有血流，但术后对组织病理学检查结果的复查显示，活检标本中的肿瘤细胞总体活力较低，考虑肿瘤可能从一开始就有强烈的坏死倾向。推测有某种免疫机制在起作用。
我们遇到了一例发生完全梗死性坏死的乳腺癌病例。如果增强图像显示环形强化，则可能存在梗死性坏死。
