隐匿性乳腺癌3例诊治体会

Diagnosis and treatment of occult breast cancer:a report of 3 cases

目的回顾性分析3例以腋窝淋巴结转移癌为首发表现的隐匿性乳腺癌(OBC)病人的临床资料,探讨其诊断与治疗经验。方法选取贵州医科大学附属医院2015年12月至2021年1月收治的因腋下无痛性肿块而就诊的OBC病人3例,观察其临床特点,分析其诊断、治疗及预后。结果3例病人均病理确诊为淋巴结转移性腺癌,结合免疫组织化学并经乳房检查、氟-18标记氟代脱氧葡萄糖正电子发射计算机断层显像(18F-FDG PET/CT)、全身其他系统检查阴性而明确诊断OBC。3例病人均接受新辅助化疗,均行全乳切除+腋窝淋巴结清扫,术后均接受放疗,2例行内分泌治疗。3例病人均获随访,随访时间为12~72个月,1例病人术后2年出现同侧锁骨上淋巴结转移,经化疗联合分子靶向治疗后未见复发转移;其余2例均无瘤生存至今,未见局部复发和远处转移。结论OBC发病隐匿,以腋下无痛性肿物就诊的中老年女性应首先考虑为OBC。在诊断上除腋窝淋巴结活检、免疫组织化学分析及常规的乳腺相关检查外,18F-FDG PET/CT的应用有助于排除相关转移癌部位而明确OBC的临床诊断。在治疗上,新辅助化疗可提高临床缓解率,改善病人预后。

Objective To retrospectively analyze the clinical data of 3 cases of occult breast cancer with axillary lymph node metastasis as initial manifestation,and to explore its diagnosis and treatment.Methods Three OBC patients were selected,who sought medical advice due to painless axillary mass and were admitted to The Affiliated Hospital of Guizhou Medical University from December 2015 to January 2021.The clinical characteristics were observed,and the diagnosis,therapy and prognosis were analyzed.Results Axillary lymph node specimens of all three cases were diagnosed as metastatic adenocarcinoma by histopathological examination,and immunohistochemical analysis confirmed the diagnosis of OBC.Physical examination,Fluorine-18 labeled fluorodeoxyglucose positron emission computed tomography(18F-FDG PET/CT)and tests of other systems revealed no evidence of occult primary cancers or extramammary tumors.All of the patients were treated with neoadjuvant chemotherapy.Afterwards,all patients were given modified radical mastectomy.After surgical intervention,three patients were treated with adjuvant radiation therapy,and two of them were treated with endocrinotherapy afterwards.Follow-up ranged from 12-72 months.Two years after surgery,one patient had ipsilateral supraclavicular lymph node metastasis.And she was free of disease relapse and metastasis through being treated with chemotherapy and target therapy.The other two patients were still alive without local recurrence and distant metastasis of tumor.Conclusions OBC occurs to patients occultly,and it should be taken into consideration in middle-aged and old women presenting with painless axillary masses.Biopsy,immunohistochemistry and routine breast exams can help to diagnose.Besides,18F-FDG PET/CT is essential to exclude the presence of occult primary cancers and extra-mammary tumors so as to confirm the clinical diagnosis of OBC.As for treatment,neoadjuvant chemotherapy can improve the clinical response rate and prognosis.