目的:由于炎性乳腺癌发病罕见,且初始症状常为炎症表现,在诊疗过程中常常被误诊、漏诊,本文通过1例炎性乳腺癌新辅助化疗病例及文献复习,进一步提高对炎性乳腺癌的认识。方法:回顾性分析1例临床分期为T4dN1M0的炎性乳腺癌患者,新辅助化疗后行乳腺癌根治术,术后行放疗加内分泌治疗,观察其疗效,并回顾分析相关文献。结果:该炎性乳腺癌患者经新辅助化疗 + 手术、放疗 + 内分泌治疗,随诊至今患者暂无转移复发。
Objective: Because inflammatory breast cancer is rare, and the initial symptom is often inflamma-tion, it is often misdiagnosed and missed in the diagnosis and treatment process. This article will further improve the understanding of inflammatory breast cancer through a case of inflammatory breast cancer with neoadjuvant chemotherapy and a literature review. Methods: A case of inflam-matory breast cancer with the clinical stage of T4dN1M0 was retrospectively analyzed. After neo-adjuvant chemotherapy, radical mastectomy was performed, followed by radiotherapy and endo-crine therapy. The efficacy was observed and the related literature was reviewed. Results: After neoadjuvant chemotherapy, surgery, radiotherapy, endocrinotherapy, the patient has no metasta-sis and recurrence.
炎性乳腺癌,新辅助放疗,乳腺癌改良根治术, Inflammatory Breast Cancer Neoadjuvant Radiotherapy Modified Radical Mastectomy摘要
Objective: Because inflammatory breast cancer is rare, and the initial symptom is often inflammation, it is often misdiagnosed and missed in the diagnosis and treatment process. This article will further improve the understanding of inflammatory breast cancer through a case of inflammatory breast cancer with neoadjuvant chemotherapy and a literature review. Methods: A case of inflammatory breast cancer with the clinical stage of T4dN1M0 was retrospectively analyzed. After neoadjuvant chemotherapy, radical mastectomy was performed, followed by radiotherapy and endocrine therapy. The efficacy was observed and the related literature was reviewed. Results: After neoadjuvant chemotherapy, surgery, radiotherapy, endocrinotherapy, the patient has no metastasis and recurrence.
Keywords:Inflammatory Breast Cancer, Neoadjuvant Radiotherapy, Modified Radical Mastectomy
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
1. 引言
炎性乳腺癌(Inflammatory breast cancer, IBC)是一种罕见的局部晚期乳腺癌,占所有乳腺癌病例的1%至5%,但其死亡率占乳腺癌类型的8%~10% [1] [2]。IBC的影像学和病理学研究现虽有了较大进展,但其诊疗现状仍不容乐观 [3]。
2. 临床资料
患者,女,47岁,以“左乳腺疼痛伴肿胀1周余”之主诉于2022-2-24入院。入院前于外院(西安北车医院)行乳腺B超示左乳内可见较大范围的偏低回声区,多考虑:炎性。于外院未做治疗,为求进一步诊治,遂于2022-2-24就诊于我院门诊,查体示左乳弥漫性肿大、潮红、橘皮征,乳腺表面未见红肿及破溃,左乳乳晕上方可触及质硬肿物,大小约5 cm × 6 cm,边界不清,活动性差,触痛明显,双侧腋窝及锁骨上未触及肿大淋巴结。
入院后行乳腺B超示左侧乳腺皮下脂肪水肿增厚,回声增强,于上象限乳晕旁可见低回声区,范围约47 mm × 24 mm × 56 mm,边界不清,形态欠规则,内回声欠均匀。左腋下可见数个低回声结节,较大一约13 mm × 8 mm。右侧乳腺低回声结节BI-RADS 3类。乳腺肿物及淋巴结穿刺病理为:左乳腺穿刺组织内见浸润性癌,非特殊型(Nottingham分级)。免疫组化:ER (80%,中–强+)、PR(−)、HER-2(2+)、Ki-67指数约为30%。FISH检测报告提示HER-2(−)。左腋窝淋巴结穿刺涂片示:(左腋窝淋巴结)见转移性癌细胞团。病理分期为ⅢB期(cT4dN1M0)。入院后完善检查行上腹部B超(肝、胆、胰、脾、肾),胸部CT平扫、妇科B超、颅脑磁共振、全身显像,评估患者一般情况后根据NCCN指南给予AT方案(白蛋白紫杉醇300 mg + 表柔比星100 mg)治疗6周期,过程顺利,后于我院肿瘤外科行乳腺改良根治术,术后病理:(左乳)新辅助治疗后乳腺组织内见浸润性癌(非特殊型,组织学分级:2级),脉管内见癌栓,肿瘤最大直径约9 cm,乳头内见癌组织。基地切缘、皮肤外上、外下、内上、内下、下切缘未见癌组织。左腋窝淋巴结5/18枚见癌转移,5枚转移淋巴结内1枚见治疗反应。免疫组化:ER(+) (中,80%)、PR(−)、HER-2(2+),Ki-67(5%)。病理分期:ypT3N2aM0。术后行放疗加内分泌治疗,随诊至今患者暂无转移复发。
3. 讨论
炎性乳腺癌(Inflammatory breast cancer, IBC)是一种罕见的局部晚期乳腺癌,占所有乳腺癌病例的1%至5%,但其死亡率占乳腺癌类型的8%~10% [1] [2]。无论分子亚型如何,IBC的预后都较差,三阴性IBC患者的预后最差,10年总生存率为17.8% [4]。目前国内外关于IBC的大样本随访研究很少,其发病原因及发病机制尚无统一认识。据国外文献报道IBC的发病与如月经初潮提前和绝经过晚、零胎次、缺乏母乳喂养、肥胖、激素替代治疗、乳腺癌家族、饮酒和吸烟血型及免疫等因素有一定关联,但是尚未明确 [5]。
刘茹艳,霍斌亮. 炎性乳腺癌1例Inflammatory Breast Cancer: A Case Report[J]. 临床医学进展, 2022, 12(10): 9564-9568. https://doi.org/10.12677/ACM.2022.12101383
参考文献ReferencesChakraborty, P., George, J.T., Woodward, W.A., et al. (2021) Gene Expression Profiles of Inflammatory Breast Cancer Reveal High Heterogeneity across the Epithelial-Hybrid-Mesenchymal Spectrum. Translational Oncology, 14, Article ID: 101026. <br>https://doi.org/10.1016/j.tranon.2021.101026Hance, K.W., Anderson, W.F., Devesa, S.S., et al. (2005) Trends in Inflammatory Breast Carcinoma Incidence and Survival: The Surveillance, Epidemiology, and End Re-sults Program at the National Cancer Institute. JNCI: Journal of the National Cancer Institute, 97, 966-975. <br>https://doi.org/10.1093/jnci/dji172Yamauchi, H., Woodward, W.A., Valero, V., et al. (2012) Inflammatory Breast Cancer: What We Know and What We Need to Learn. Oncologist, 17, 891-899. <br>https://doi.org/10.1634/theoncologist.2012-0039Masuda, H., Brewer, T.M., Liu, D.D., et al. (2014) Long-Term Treatment Efficacy in Primary Inflammatory Breast Cancer by Hormonal Receptor- and HER2-Defined Sub-types. Annals of Oncology, 25, 384-391.
<br>https://doi.org/10.1093/annonc/mdt525Anderson, W.F., Schairer, C., Chen, B.E., et al. (2005) Epidemiology of Inflammatory Breast Cancer (IBC). Breast Disease, 22, 9-23. <br>https://doi.org/10.3233/BD-2006-22103Pence, L.J., Kourtidis, A., Feathers, R.W., et al. (2021) PLEKHA7, an Apical Adherens Junction Protein, Suppresses Inflammatory Breast Cancer in the Context of High E-Cadherin and p120-Catenin Expression. International Journal of Molecular Sciences, 22, 1275. <br>https://doi.org/10.3390/ijms22031275Hester, R.H., Hortobagyi, G.N. and Lim, B. (2021) Inflammatory Breast Cancer: Early Recognition and Diagnosis Is Critical. Am J Obstet Gynecol, 225, 392-396. <br>https://doi.org/10.1016/j.ajog.2021.04.217王欣冉, 张建国. 炎性乳腺癌的诊断与治疗进展[J]. 中国现代普通外科进展, 2019, 22(4): 308-311.Van Der Auwera, I., Limame, R., Van Dam, P., et al. (2010) Integrated miRNA and mRNA Expression Profiling of the Inflammatory Breast Cancer Subtype. British Journal of Cancer, 103, 532-541. <br>https://doi.org/10.1038/sj.bjc.6605787Lehman, H.L., Van Laere, S.J., Van Golen, C.M., et al. (2012) Regulation of Inflammatory Breast Cancer Cell Invasion through Akt1/PKBα Phosphorylation of RhoC GTPase. Molec-ular Cancer Research, 10, 1306-1318.
<br>https://doi.org/10.1158/1541-7786.MCR-12-0173Bozzetti, F., Saccozzi, R., De Lena, M., et al. (1981) In-flammatory Cancer of the Breast: Analysis of 114 Cases. Journal of Surgical Oncology, 18, 355-361. <br>https://doi.org/10.1002/jso.2930180405Schlichting, J.A., Soliman, A.S., Schairer, C., et al. (2012) Inflam-matory and Non-Inflammatory Breast Cancer Survival by Socioeconomic Position in the Surveillance, Epidemiology, and End Results Database, 1990-2008. Breast Cancer Research and Treatment, 134, 1257-1268. <br>https://doi.org/10.1007/s10549-012-2133-2Bertucci, F., Ueno, N.T., Finetti, P., et al. (2014) Gene Expression Profiles of Inflammatory Breast Cancer: Correlation with Response to Neoadjuvant Chemotherapy and Metastasis-Free Survival. Annals of Oncology, 25, 358-365.
<br>https://doi.org/10.1093/annonc/mdt496Genet, D., Lejeune, C., Bonnier, P., et al. (2007) Concomitant Inten-sive Chemoradiotherapy Induction in Non-Metastatic Inflammatory Breast Cancer: Long-Term Follow-Up. British Jour-nal of Cancer, 97, 883-887.
<br>https://doi.org/10.1038/sj.bjc.6603987Perez, C.A., Graham, M.L., Taylor, M.E., et al. (1994) Management of Locally Advanced Carcinoma of the Breast. I. Noninflammatory. Cancer, 74, 453-465. <br>https://doi.org/10.1002/cncr.2820741335Dawood, S., Merajver, S.D., Viens, P., et al. (2011) International Expert Panel on Inflammatory Breast Cancer: Consensus Statement for Standardized Diagnosis and Treatment. Annals of Oncology, 22, 515-523.
<br>https://doi.org/10.1093/annonc/mdq345Harvey, H.A., Lipton, A., Lawrence, B.V., et al. (1982) Estrogen Re-ceptor Status in Inflammatory Breast Carcinoma. Journal of Surgical Oncology, 21, 42-44. <br>https://doi.org/10.1002/jso.2930210111Nguyen, D.M., Sam, K., Tsimelzon, A., et al. (2006) Molecular Het-erogeneity of Inflammatory Breast Cancer: A Hyperproliferative Phenotype. Clinical Cancer Research, 12, 5047-5054.
<br>https://doi.org/10.1158/1078-0432.CCR-05-2248Zell, J.A., Tsang, W.Y., Taylor, T.H., et al. (2009) Prog-nostic Impact of Human Epidermal Growth Factor-Like Receptor 2 and Hormone Receptor Status in Inflammatory Breast Cancer (IBC): Analysis of 2,014 IBC Patient Cases from the California Cancer Registry. Breast Cancer Research, 11, Article No. R9. <br>https://doi.org/10.1186/bcr2225Walshe, J.M. and Swain, S.M. (2005) Clinical Aspects of In-flammatory Breast Cancer. Breast Disease, 22, 35-44.
<br>https://doi.org/10.3233/BD-2006-22105Harbeck, N. and Gnant, M. (2017) Breast Cancer. Lancet, 389, 1134-1150.
<br>https://doi.org/10.1016/S0140-6736(16)31891-8Braal, C.L., Jongbloed, E.M., Wilting, S.M., et al. (2021) In-hibiting CDK4/6 in Breast Cancer with Palbociclib, Ribociclib, and Abemaciclib: Similarities and Differences. Drugs, 81, 317-331.
<br>https://doi.org/10.1007/s40265-020-01461-2Slade, D. (2020) PARP and PARG Inhibitors in Cancer Treat-ment. Genes & Development, 34, 360-394.
<br>https://doi.org/10.1101/gad.334516.119Nunnery, S.E. and Mayer, I.A. (2020) Targeting the PI3K/AKT/mTOR Pathway in Hormone-Positive Breast Cancer. Drugs, 80, 1685-1697. <br>https://doi.org/10.1007/s40265-020-01394-w