Igarashi T, Itoh K, Fujii H, Ohtsu T, Minami H, Sasaki Y, Shimizu W, Ogino T, Muramatsu M
Division of Oncology and Hematology, National Cancer Center Hospital East, Tokyo, Japan.
Jpn J Clin Oncol. 1998 Apr;28(4):270-5. doi: 10.1093/jjco/28.4.270.
We report a case of isolated local recurrence of breast cancer, which was accompanied by idiopathic thrombocytopenic purpura (ITP) and benign monoclonal gammopathy that presented 24 years after the patient underwent mastectomy. A 72-year-old female patient with a chest wall tumor was referred to our hospital in November 1994. Twenty-four years previously she had surgically treated breast cancer, of which the pathology was scirrhous carcinoma. Needle biopsy of the tumor revealed tubular carcinoma, which is compatible with local recurrence of breast cancer. She had no evidence of regional lymph node involvement or distant metastasis. Hematological and serological examination revealed a low platelet count accompanied by M-proteinemia (IgG, kappa-type) and a mild increase in platelet-associated IgG. She was initially treated with extensive-field chest wall radiation (60 Gy), followed by systemic administration of tamoxifen. Complete local control of isolated local recurrence (LR) was achieved after radiation therapy (RT) and the patient has been progression-free for more than 2 years. Platelet count recovered gradually to a normal level after achievement of complete remission induced by radiation and tamoxifen. This may be the first case suggestive of a paraneoplastic syndrome of immune thrombocytopenia accompanied by local recurrence of breast cancer.
我们报告一例乳腺癌孤立性局部复发病例，该病例伴有特发性血小板减少性紫癜（ITP）和良性单克隆丙种球蛋白病，发生于患者乳房切除术后24年。1994年11月，一名患有胸壁肿瘤的72岁女性患者被转诊至我院。24年前她接受了乳腺癌手术治疗，病理结果为硬癌。肿瘤穿刺活检显示为管状癌，符合乳腺癌局部复发。她没有区域淋巴结受累或远处转移的证据。血液学和血清学检查显示血小板计数低，伴有M蛋白血症（IgG，κ型），血小板相关IgG轻度升高。她最初接受了扩大野胸壁放疗（60 Gy），随后全身给予他莫昔芬。放疗后孤立性局部复发（LR）得到完全局部控制，患者已无进展超过2年。放疗和他莫昔芬诱导完全缓解后，血小板计数逐渐恢复至正常水平。这可能是首例提示免疫性血小板减少副肿瘤综合征伴乳腺癌局部复发的病例。
