巨大乳腺紡錘細胞癌術後,再発肺転移病変に対して切除を行った1例

A case of large breast spindle cell carcinoma which resected pulmonary metastasis 3 years after the primary surgery

Creators Yano Yuka

Creators Kuga Takayuki

Creators Harada Takasuke

Creators Sano Fumiho

Creators Inokuchi Toshihiro

Creators Fujii Yasuhiro

稀な乳腺紡錘細胞癌の1例を経験したので報告する.症例は52歳,女性.右乳房腫瘤を自覚し前医を受診した.針生検で乳癌と診断され当科に紹介された.右乳房に13cm大の巨大な腫瘤を認めた.T4bN1M0 cStageIIIB乳癌の診断で術前化学療法(FEC, DTX)が行われた.化学療法後,胸筋温存乳房切除術が行われた.病理組織診断は,乳腺紡錘細胞癌,n0, ER･PgR境界域,HER2陰性,MIB-1 index 60%,T4cN0M0 ypStageIIIBであった.化学療法の臨床病理学的治療効果はGrade1aであった.術後内分泌療法(anastrozol)が行なわれていたが,術後3年目のCTにて右肺S6区域に結節状陰影が認められ,診断目的に胸腔鏡下肺部分切除術が施行された.病理組織診断は乳腺紡錘細胞癌の肺転移であった.再発巣切除後内分泌化学療法(Capecitabine+ Fulvestrant)を行い,初回手術から7年経過しているが新たな病変はみられていない.

We report a rare case of spindle cell carcinoma of breast. A 52-year-old woman was admitted to hospital due to right large breast tumor. Core needle biopsy had demonstrated invasive carcinoma in previous hospital. After neoadjuvant chemotherapy, total mastectomy and axillary lymph node dissection were performed. Histopathologic analysis showed spindle cell carcinoma. Immunohistochemical staining showed that the cancer cells were slightly positive for estrogen receptor antibody, negative for progesterone receptor antibody and negative for HER2/neu protein. Postoperative adjuvant endocrine therapy was performed. 3 years later, CT revealed a solitary mass on the lower lobe of right lung. A partial lobectomy was performed utilizing VATS. Pathological diagnosis showed lung metastasis of spindle cell breast carcinoma. Postoperative endocrine therapy and chemotherapy was performed. The patient is doing well, without recurrence and metastasis 4 years after lung surgery.

[ISSN]0513-1731

[NCID]AN00243156