Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan.
Department of Surgery, Gifu Kouseiren Kumiai Kosei Hospital, Takayama, Gifu, Japan.
Am J Case Rep. 2023 Jun 12;24:e939639. doi: 10.12659/AJCR.939639.
BACKGROUND Ventriculoperitoneal shunts are commonly used in neurosurgery for the treatment of hydrocephalus. This case report details an unusual instance where breast cancer developed along the pathway of an existing ventriculoperitoneal shunt. CASE REPORT An 86-year-old woman, who previously underwent ventriculoperitoneal shunt placement for normal-pressure hydrocephalus, visited our hospital upon detecting a mass in her left breast. The physical examination discovered an irregular mass located at the 9 o'clock position of the left breast. Subsequent breast ultrasonography identified a 36 mm mass with indistinct borders, rough margins, and signs of skin infiltration. Invasive ductal carcinoma of a triple-negative subtype was diagnosed through a core-needle biopsy. Contrast-enhanced computed tomography indicated the ventriculoperitoneal shunt's pathway, running from the left ventricle, passing through the center of the breast mass, and leading into the abdominal cavity. Fears of shunt occlusion and potential infection due to the untreated breast cancer prompted surgical intervention after consultation with the neurosurgeon. The surgery involved rerouting the ventriculoperitoneal shunt from the left thoracoabdomen to the right, performing a left mastectomy, and removing the fistula in the abdominal wall to minimize the risk of cancer recurrence along the shunt pathway. Postoperative histopathological examination confirmed the initial diagnosis of invasive ductal carcinoma of a triple-negative subtype, with no malignancy detected in the removed abdominal wall fistula. CONCLUSIONS Taking into account prior cases of cancer metastasizing distantly due to ventriculoperitoneal shunts, our case emphasizes the necessity to consider additional preventative measures against cancer seeding. This approach is particularly significant when treating breast cancer that arises along the pathway of a ventriculoperitoneal shunt, apart from performing conventional breast cancer surgery.
脑室-腹腔分流术常用于神经外科治疗脑积水。本病例报告详细介绍了一种不常见的情况，即乳腺癌沿着现有脑室-腹腔分流术的路径发展。
一位 86 岁女性，因正常压力性脑积水行脑室-腹腔分流术，因发现左乳肿块就诊于我院。体格检查发现左乳房 9 点钟位置有一不规则肿块。随后的乳腺超声检查发现一个 36 毫米的肿块，边界不清，边缘粗糙，有皮肤浸润的迹象。通过芯针活检诊断为三阴性型浸润性导管癌。增强 CT 提示脑室-腹腔分流术的路径，从左心室开始，穿过乳腺肿块中心，进入腹腔。由于未治疗的乳腺癌存在分流管阻塞和潜在感染的风险，在与神经外科医生协商后，决定进行手术干预。手术包括将脑室-腹腔分流管从左胸腹部重新安置到右侧，进行左乳房切除术，并切除腹壁瘘，以最大限度地降低分流管路径上癌症复发的风险。术后组织病理学检查证实了最初的诊断，即三阴性型浸润性导管癌，在切除的腹壁瘘中未发现恶性肿瘤。
考虑到先前有因脑室-腹腔分流术而发生远处转移的癌症病例，我们的病例强调需要考虑额外的预防措施来防止癌症种植。在治疗沿脑室-腹腔分流术路径发生的乳腺癌时，除了进行常规乳腺癌手术外，这种方法尤为重要。
