Takaoka Kazusane, Oura Shoji
Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, JPN.
Cureus. 2025 Jun 10;17(6):e85725. doi: 10.7759/cureus.85725. eCollection 2025 Jun.
A 42-year-old woman noticed a left breast mass and was diagnosed with florid adenosis by vacuum-assisted biopsy (VAB) 10 years before. Semiannual ultrasound follow-ups showed gradual shrinkage of the florid adenosis nodule as time passed after VAB, but showed a slight increase in size after her marriage at the age of 40. Thereafter, the sudden rapid growth of the nodule made us again examine it in detail. Magnetic resonance imaging of the masses, including a daughter nodule in the nipple direction, showed low signals on T1-weighted images, slightly high signals on fat-suppressed T2-weighted images, and persistent rim enhancement on subtraction images. The patient underwent core needle biopsy under the tentative diagnosis of breast cancer. Pathological study showed atypical cells growing in a papillary fashion with bleeding and necrosis, leading to the diagnosis of invasive ductal carcinoma. Immunostaining showed estrogen and progesterone receptor negativity, human epidermal growth factor receptor type 2 negativity, and a high Ki-67 labeling index of 60%. The patient, therefore, underwent nipple-preserving mastectomy and sentinel biopsy followed by immediate breast reconstruction using an extended latissimus dorsi musculocutaneous flap. Postoperative pathological study showed that the breast cancer had similar pathological findings to those of the core needle biopsy specimen and a higher Ki-67 labeling index of 70%. The patient recovered uneventfully and was discharged on the 9th day after the operation. The patient has received dose-dense chemotherapy and is scheduled for periodical checkups on an outpatient basis. Breast specialists should note that even pathologically proven florid adenosis nodules might develop breast cancer.
一名42岁女性10年前发现左乳肿块，经真空辅助活检（VAB）诊断为 florid腺病。半年一次的超声随访显示，VAB后随着时间推移，florid腺病结节逐渐缩小，但在她40岁结婚后结节大小略有增加。此后，结节突然快速生长，促使我们再次对其进行详细检查。对包括乳头方向的一个子结节在内的肿块进行磁共振成像检查，结果显示在T1加权图像上呈低信号，在脂肪抑制T2加权图像上呈稍高信号，在减影图像上有持续的边缘强化。患者在初步诊断为乳腺癌后接受了粗针活检。病理研究显示非典型细胞呈乳头状生长，伴有出血和坏死，最终诊断为浸润性导管癌。免疫组化显示雌激素和孕激素受体阴性，人表皮生长因子受体2阴性，Ki-67标记指数高，为60%。因此，该患者接受了保乳乳房切除术和前哨淋巴结活检，随后立即使用背阔肌肌皮瓣进行乳房重建。术后病理研究表明，乳腺癌的病理表现与粗针活检标本相似，Ki-67标记指数更高，为70%。患者恢复顺利，术后第9天出院。患者已接受剂量密集化疗，并计划在门诊定期复查。乳腺专科医生应注意，即使是经病理证实的florid腺病结节也可能发展为乳腺癌。
