神経内分泌型非浸潤性乳管癌2例の治療経験

Two cases of neuroendocrine ductal carcinoma in situ(NE-DCIS)of the breast

Creators Kubo Hidefumi

Creators Nagaoka Chisato

Creators Kimura Yuta

Creators Kawaoka Toru

Creators Miyahara Makoto

Creators Shimizu Ryouichi

Creators Yamashita Yoshimi

Creators Nagashima Yukiko

Creators Yamamoto Shigeru

Creators Nagano Hiroaki

今回,我々は神経内分泌型非浸潤性乳管癌(neuroendocrine ductal carcinoma in situ,以下NE-DCIS)の2例を経験したので文献的考察を加えて報告する.2症例ともに乳房部分切除後に残存乳房への放射線照射を追加し,現在外来にて経過観察中である.自験2症例の臨床所見は既報のNE-DCISとは若干異なり,比較的境界明瞭であるが辺縁不整な孤立性腫瘤を形成し,血性乳頭分泌はいずれも認めなかった.NE-DCISは針もしくはマンモトーム生検では乳頭腫などの良性的な細胞所見を有することが多く,自験2例とも針生検のみでは悪性と確定されず,迅速病理でも確定されなかった.画像所見で悪性が示唆され自験例2のような乳頭状増殖病変を伴う場合は,安易な経過観察や針生検を繰り返すことなく,積極的にwide excisionも行うべきと考えられる.病理学的検索でも細胞形態の詳細な観察と神経内分泌系マーカーの免疫細胞･組織化学的検索の併用を行うことが重要である.NE-DCISは現在比較的稀な疾患で新しい疾患概念であるため予後や病態についてはまだ十分に解明されていない.今後は症例を蓄積し,治療や予後に関して検討していく必要がある.

We herein report two cases of neuroendocrine ductal carcinoma in situ of the breast with some reference to literature.In both of two cases, wide excision of the tumor was performed and breast irradiation was done after surgery. Our 2 cases were slightly different from typical characteristic findings of NE-DCIS. NE-DCIS often has benign cytological findings and is easily misdiagnosed as papilloma by needle or mammotome biopsy. Our 2 cases also were not diagnosed as malignancy, not even by frozen section diagnosis during surgery. NE-DCIS is often involved in cases like our case 2 with papillary lesion, we have to perform wide excision actively without observing pointlessly or repeating needle biopsy. Although it is often difficult to definitely diagnose NE-DCIS by needle biopsy, careful evaluation of cell morphology and immunohisto/cytochemical studies enable an accurate diagnosis.NE-DCIS is a relatively rare entity. We must further accumulate clinical cases to study the therapeutic methods and the prognosis of the disease.

[ISSN]0513-1731

[NCID]AN00243156