A case of meningeal dissemination with local metastases to bilateral optic nerve following peritonitis carcinomatosa 7 years after the surgery for breast cancer.

本邦では乳癌の髄膜播種は比較的まれである.今回われわれは術後7年目に癌性腹膜炎に続いて両側視神経転移を伴う髄膜播種を呈した進行乳癌の1例を経験したので文献的考察を加えて報告する.症例は60歳女性.左乳癌(T2N1M0,Stage･B)に対し胸筋温存乳房切除を行った.術後補助療法としてweeklyパクリタキセルを6コース投与しその後5年間アロマターゼ阻害剤(以下,AI剤)の内服を投与した.術後7年4ヵ月目に右尿管狭窄･右水腎症を来し癌性腹膜炎を疑い6コースのエピルビシン(EPI)+シクロホスファミド(CPA)療法(以下,EC療法)を施行した.化学療法が奏効し水腎症は消失したが,その約6ヵ月後に突然の頭痛に続いて視力低下を来したため再入院となった.造影MRI検査と髄液細胞診から乳癌による髄膜癌腫症と診断した.MRIでは両側視神経に限局した転移も疑われた.急速に全身状態が悪化し入院後わずか7日目に死亡した.乳癌髄膜播種の予後は極めて不良で集学的治療を行っても6ヵ月以内にほとんどが死亡し予後の改善が得られていないのが現状である.

Meningeal dissemination from breast cancer is reportedly rare in Japan. We describe a case of meningeal dissemination with local metastases to the bilateral optic nerve after peritonitis carcinomatosa in a patient who underwent surgery for breast cancer 7 years previously. The patiet was a 60-year-old woman with left breast cancer who underwent a muscle-preserving radical mastectomy(Br+Ax).The tumor was classified as T2N1M0Stage･B. She received 6 cycles of paclitaxel every week, after which an aromatase inhibitor(exemestane)was administered for 5 years. Right ureteral stenosis and right hydronephrosis developed 7 years and 4 months after surgery. These findigs were compatible with peritonitis carcinomatosa resulting from breast, therefore, 6 cycles of the epirubicin-cyclo-phosphamide regimen were administered, and hydronephrosis was successfully resolved. However, 6 months later, she was readmitted to our hospital presenting with a sudden headache and, vision loss in both eyes. The patient was diagnosed with meningeal carcinomatosis breast cancer by enhanced magnetic resonance imaging(MRI)and cerebrospinal fluid cytology, and she died on the seventh day after readmission. MRI also revealed local metastases to the bilateral optic nerve. Despite various interventions, most patients with meningeal dissemination from breast cancer have poor prognosis within 6 months after diagnosis.

乳癌

髄膜播種

視神経転移