A case of breast cancer of the T1 stage diagnosed because of cerebellum metastasis and treated by combined modality therapy

われわれは小脳転移を契機に診断された径2cm以下のT1乳癌を経験した.症例は61歳,女性.嘔気で近医を受診し神経学的所見でつぎ足歩行が困難であった.脳CT/MRIで小脳の小腫瘤を指摘され,精査目的で当院脳神経外科へ紹介された.MMG,USにて左乳房に径1.5cm大の腫瘤が指摘された.針生検では診断は確定されなかった.PET/CTで左乳房内の結節性集積,左腋窩リンパ節腫大,さらに両側肺野の多発結節が指摘された.乳癌を原発とした小脳･肺･リンパ節転移と診断され,Life-threateningなものより順次治療することとした.最初に小脳転移に対し開頭腫瘍切除と腫瘍床へのサイバーナイフを追加した.その5週後よりEC全身療法を4コース投与した.左腋窩リンハﾟ節と両肺野結節は概ね消退し,PETでも小脳転移巣周囲のSUV集積は低下したままであった.しかしUSで左乳房の陰影は残存しており再度針生検を行ったところ,scirrhous carcinomaの診断を得たため最終化学療法投与より4週以上経過してBp+SLNを追加した.その後は現在まで明らかな再発は認めていない.一般的に脳転移に対する抗がん剤は血液脳関門が存在するため奏効しにくく未だ多くの課題が残る.しかしながら,脳転移に対して手術後に放射線治療や化学療法を行うことで長期生存できる可能性があることが示唆された.

We experienced a 2cm less of breast cancer with isolated cerebellum metastasis. A 61-year-old woman was referred for nausea and gait disturbance. CT(computed tomography)scan and MRI(magnetic resonance imaging)for the brainsystem revealed a mass in the cerebellum.MMG(Mammography)and US(ultrasonography)revealed a mass 1.5cm in diameter, but which was not diagnosed on needle biopsy. Subsequent PET(positron emission tomography)revealed abnormal accumulation of the left breast and the left axilla and CT revealed multiple lung metastases. We diagnosed a breast cancer with metastasis of the lung and the left axilla and the cerebellum. We decided to treat it from life-threatening lesion in order. At first, the cerebellum metastasis was removed surgically and received cyber knife therapy. 5 weeks after the surgery, she was administered four cycles of the combined chemotherapy of EC(epirubicin/cyclophosphamide)regimen. She achieved clinical PR(partial response),but a mass shadow of the breast cancer in US was remained after the chemotherapy. We tried the needle biopsy again, and scirrhous carcinoma was diagnosed pathologically. Then, a partial mastectomy with SLN(sentinel lymph node)biopsy was performed over 4 weeks after chemotherapy. To date, there was no subsequent growth of metastatic tumors, and good control was obtained.In general, chemotherapy alone against metastatic brain tumor is not effective because of the Blood Brain Barrier, but operation followed by combination therapy of chemotherapy and radiation may prolong survival time.

乳癌　

脳転移　

T1病期　

血液脳関門　

化学療法