Kitano Yurie, Oura Shoji
Department of Surgery, Kishiwada Tokushukai Hospital 4-27-1, Kamori-cho, Kishiwada-city, Osaka, Japan.
Radiol Case Rep. 2024 Feb 27;19(5):1926-1929. doi: 10.1016/j.radcr.2024.02.011. eCollection 2024 May.
A 73-year-old woman was pointed out of her right breast tumor on screening computed tomography (CT). Mammography showed distortion of the mammary gland and skin retraction. Ultrasound (US) showed an irregular tumor with hyperechoic haloes adjacent to the anterior tumor borders. Neither lymphadenopathy nor image findings suggesting lymph node metastasis were detected on US and CT. Core needle biopsy pathologically showed the tumor to be invasive lobular carcinoma. Under the preoperative diagnosis of node-negative breast cancer, the patient underwent mastectomy and sentinel node biopsy. Due to no sentinel node detection, a small but hard lymph node was identified and submitted for frozen section as a sampling node. After confirming the lymph node metastasis on frozen section, axillary lymph node dissection revealed 12 lymph node metastases. Postoperative pathological study showed cancer cell infiltration to the dermis near the nipple-areolar complex. In addition, immmunostaining showed the tumor to have low proliferative biology, i.e., Ki-67 labelling index of 10%. Breast surgeons should note that indolent invasive lobular carcinoma with cancer cell infiltration to the skin near the nipple-areolar complex can have multiple lymph node metastases even though showing neither lymphadenopathy nor image findings suggesting lymph node metastasis.
一名73岁女性在胸部计算机断层扫描（CT）筛查时被发现右乳有肿瘤。乳房X线摄影显示乳腺结构紊乱和皮肤回缩。超声（US）显示肿瘤不规则，肿瘤前缘有高回声晕。超声和CT均未发现淋巴结肿大或提示淋巴结转移的影像学表现。粗针穿刺活检病理显示肿瘤为浸润性小叶癌。在术前诊断为无淋巴结转移的乳腺癌后，患者接受了乳房切除术和前哨淋巴结活检。由于未检测到前哨淋巴结，因此识别出一个小而硬的淋巴结并作为采样淋巴结进行冰冻切片检查。在冰冻切片确认淋巴结转移后，腋窝淋巴结清扫发现12个淋巴结转移。术后病理研究显示癌细胞浸润至乳头乳晕复合体附近的真皮。此外，免疫染色显示肿瘤具有低增殖生物学特性，即Ki-67标记指数为10%。乳腺外科医生应注意，即使没有淋巴结肿大或提示淋巴结转移的影像学表现，伴有癌细胞浸润至乳头乳晕复合体附近皮肤的惰性浸润性小叶癌也可能发生多枚淋巴结转移。
