临床误诊误治
臨床誤診誤治
림상오진오치
CLINICAL MISDIAGNOSIS & MISTHERAPY
2015年
6期
23-25
,共3页
乳腺肿瘤%骨转移%宫颈转移%Mummaglobin%巨囊液蛋白-15
乳腺腫瘤%骨轉移%宮頸轉移%Mummaglobin%巨囊液蛋白-15
유선종류%골전이%궁경전이%Mummaglobin%거낭액단백-15
Breast neoplasm%Metastasis%cervical%Mummaglobin%GCDFP-15
目的：探讨双侧乳腺癌伴骨及宫颈转移的临床诊治要点。方法对我院收治的双侧乳腺癌伴骨及宫颈转移1例的临床资料进行回顾性分析。结果本例52岁,因发现右乳腺包块1月余入院。乳腺彩色多普勒超声检查示：双乳腺实性占位性病变。双侧乳腺肿块穿刺病理报告为乳腺浸润性小叶癌。 ECT全身骨扫描示全身多发性肿瘤骨转移。妇科B超示宫颈低回声占位性病变。予新辅助化疗后行双侧乳腺改良根治术+宫颈赘生物电切术。术后病理诊断：双乳浸润性小叶癌（低分化)伴腋窝淋巴结转移,临床病理分期Ⅳ期（T1b,N3,M1)。宫颈赘生物免疫组化：CK（+++),S100（+),Ki67约3%（+),Mummaglobin（+),巨囊液蛋白-15（+),CerbB2（-),ER约40%（+),PR约20%（+),考虑为转移性低分化小叶癌。术后予化疗、内分泌治疗等全身治疗。患者每3个月复诊,病情平稳,坚持行内分泌治疗。结论乳腺癌骨转移较常见,而宫颈转移较为少见,组织病理学及免疫组化检查对诊断具有重要价值。
目的：探討雙側乳腺癌伴骨及宮頸轉移的臨床診治要點。方法對我院收治的雙側乳腺癌伴骨及宮頸轉移1例的臨床資料進行迴顧性分析。結果本例52歲,因髮現右乳腺包塊1月餘入院。乳腺綵色多普勒超聲檢查示：雙乳腺實性佔位性病變。雙側乳腺腫塊穿刺病理報告為乳腺浸潤性小葉癌。 ECT全身骨掃描示全身多髮性腫瘤骨轉移。婦科B超示宮頸低迴聲佔位性病變。予新輔助化療後行雙側乳腺改良根治術+宮頸贅生物電切術。術後病理診斷：雙乳浸潤性小葉癌（低分化)伴腋窩淋巴結轉移,臨床病理分期Ⅳ期（T1b,N3,M1)。宮頸贅生物免疫組化：CK（+++),S100（+),Ki67約3%（+),Mummaglobin（+),巨囊液蛋白-15（+),CerbB2（-),ER約40%（+),PR約20%（+),攷慮為轉移性低分化小葉癌。術後予化療、內分泌治療等全身治療。患者每3箇月複診,病情平穩,堅持行內分泌治療。結論乳腺癌骨轉移較常見,而宮頸轉移較為少見,組織病理學及免疫組化檢查對診斷具有重要價值。
목적：탐토쌍측유선암반골급궁경전이적림상진치요점。방법대아원수치적쌍측유선암반골급궁경전이1례적림상자료진행회고성분석。결과본례52세,인발현우유선포괴1월여입원。유선채색다보륵초성검사시：쌍유선실성점위성병변。쌍측유선종괴천자병리보고위유선침윤성소협암。 ECT전신골소묘시전신다발성종류골전이。부과B초시궁경저회성점위성병변。여신보조화료후행쌍측유선개량근치술+궁경췌생물전절술。술후병리진단：쌍유침윤성소협암（저분화)반액와림파결전이,림상병리분기Ⅳ기（T1b,N3,M1)。궁경췌생물면역조화：CK（+++),S100（+),Ki67약3%（+),Mummaglobin（+),거낭액단백-15（+),CerbB2（-),ER약40%（+),PR약20%（+),고필위전이성저분화소협암。술후여화료、내분비치료등전신치료。환자매3개월복진,병정평은,견지행내분비치료。결론유선암골전이교상견,이궁경전이교위소견,조직병이학급면역조화검사대진단구유중요개치。
Objective To study the clinical diagnosis and treatment of bilateral breast cancer with bone and cervical metastasis. Methods We retrospectively analyzed the clinical data of a case of bilateral breast cancer with bone and cervical metastasis in our hospital. Results The patient was a 52-year-old female,admitted for the right breast mass, which had been found more than one month before. Breast ultrasound showed substantial occupying lesions of bilateral breasts. The pathologic results of bilateral breast mass indicated all invasive lobular carcinoma. ECT of the whole body bone scanning showed systemic multiple bone metastases. B ultrasound in gynecology showed cervical hypoechoic occupying lesion. After the neoadjuvant chemotherapy, we performed operations of bilateral breast modified radical mastectomy and cervical neoplasm electrotomy. The postoperative pathological results showed that the bilateral breast tumors were invasive lobular carcinoma associated with axilla-ry lymph node metastasis. The pathological staging was IV( T1b ,N3 ,M1 ) . The result of immunohistochemistry showed that CK, S100, Mummaglobin and GCDFP-15 were positive, Ki67 was about 3% positive,ER was about 40% positive,PR was about 20% positive,while CerbB2 was negative. Then, the patient accepted the postoperative systemic treatment,such as chemother-apy, and endocrine therapy. The patient was checked every three months with a stable condition, and continued endocrine therapy. Conclusion The bone metastasis from breast cancer is a common condition,while the occurrence of metastasis to the neck of uterus is rare. The histopathological analysis combined with immunohistochemical detection is of great value in diagno-sis and treatment.
