A case of squamous cell carcinoma of the breast ocurred 5 years after surgery of papillotubular carcinoma of the breast

症例は80歳女性.約5年前に他院にて右乳癌に対して乳房温存手術+腋窩リンパ節郭清が施行された(T2N1M0p-stage II B,乳頭腺管癌,HER2-R(1+),ER:1+<10%, PgR-).術後anastrozole投与継続中であったが,術後2年目に右肺下葉に転移性腫瘍が出現した.その7ヵ月後同腫瘍は増悪しcapecitabine へ変更された.術後3年4ヵ月後,胸部局所に腫瘤が出現し肺転移も増大した.その後腫瘍より排膿を来すようになったため当科を2014年12月受診した.PET/CTで局所再発部の異常集積と多発肺転移･リンパ節転移が認められたが,転移病変はすべて小さくnon-life threateningと判断し,2015年1月右乳房全摘術を施行した.病理で腫瘤は角化傾向が著明な扁平上皮癌であった.また,その周囲では乳管癌細胞も増生しており混合型と診断された.扁平上皮癌と乳頭腺管癌の両者はepidermisで境界され,病理上扁平上皮癌はde novoに発生した可能性も示唆された.術後14日目に軽快退院し,術後TS-1内服を開始したが,強い嘔気が出現したため1ヵ月で中止した.患者･家族の同意の下,今後はBSCのみを行うこととした.乳癌術後に急速に増大する局所再発を認めた際には扁平上皮癌の異時発生も念頭に置く必要がある.

A 80-year-old woman was admitted to another hospital because of a right breast tumor about 5 years ago. She received muscle preserving partial mastectomy of the right breast and axillary lymph node dissection. The pathological diagnosis revealed papillotubular carcinoma of the right breast(pT2N1M0:p-stage II B, HER2-R(1+),ER1+<10%, PgR-).She had been administered anastorozole after the surgery, but CT revealed lung metastases and bilateral axillary lymph node metastases 2 years after the surgery. 7 monthes later, these metastases were getting progress in size, so the medicine was changed from anastrozole to capecitabine.3 years and 4 monthes after the surgery, a local recurrence of the breast was found and was considered to have rapid progression, so she visited our hospital December in 2014. Though there were multiple lung metastases and multiple lymph nodes in PET/CT, we considered these metastases as non life treadning disease. We performed a right modified radical mastectomy January in 2015. Histlogically the tumor was mixed squamous cell carcinoma and papillotubular carcinoma of the breast. There were over lying epidermis between squamous cell carcinoma and papillotubular carcinoma.It suggested the possibility that squamous cell carcinoma occurred in de novo pattern in this case. With good clinical course, the patient discharged on 14 post operative day. S-1 was administered, but was withdrawn after 1 month due to severe nausea, so we are observing her carefully without chemotherapy.We had better consider the squamous cell carcinoma when the patient have a local recurrent mass with rapid growth in size.

扁平上皮癌

乳頭腺管癌

乳癌