A Case Report of Chest Wall Resection for Solitary Recurrent Breast Cancer Involving the Sternal Chest Wall

• Published in: Japanese Journal of National Medical Services Vol. 52; no. 2; pp. 118 - 121
• Main Authors: YOKOTA Tohru, KANNO Keiichi, YOSHINARI Daisuke, ROPPONGI Takashi, FUJII Takanao
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of National Medical Services 1998; 一般社団法人 国立医療学会
• Subjects: breast cancer; chest wall relapse; chest wall resection; recurrent breast cancer; 乳癌; 乳癌胸壁再発; 再発乳癌; 胸壁切除術
• ISSN: 0021-1699; 1884-8729
• DOI: 10.11261/iryo1946.52.118

Treatment of patients with recurrent breast cancer involving sternal chest wall is one of the most difficult treatment of recurrent breast cancer. We report a case of chest wall resection for solitary recurrent breast cancer involving sternum. A 40-year-old woman who had modified radical mastectomy for right breast cancer (TlaNOMO-St I) on June 23, 1993, was admitted to the hospital because of a mass in the anterior chest wall on Feb 23, 1995. Since fine needle aspiration cytology of this tumor was positive, she underwent chest wall resection for recurrent breast cancer involving sternal chest wall on March 15, 1995. Microscopic examination revealed the tumor invaded the sternum, ribs, parietal pleura and right brachiocephaic vein. She received adjuvant radiotherapy and chemoendocrine therapy, nevertheless, she died of liver metastasis eight month later after operation. Although a consensus of opinion regarding the treatment of local relapse does not exist, aggressive rather than palliative therapeutic approaches have been supported by most authors as an attempt to achieve local control and to improve survival. We thought that her poor prognosis was caused by a short disease free interval and tumoral invasion to the wall of right brachiocephalic vein. 症例は40歳女性. 右乳癌, TlaNOMO-StIにて1993年6月30日に胸筋温存乳房切除術を受けた. 術後外来にて化学内分泌療法を受けていたが, 1995年2月23日, 術後1年8ヵ月に胸骨を含む前胸壁に再発した. 他臓器に転移なく1995年3月胸骨を含む前胸壁切除術を施行した. 病理所見では腫瘍は胸骨, 肋骨, 壁側胸膜, 右腕頭静脈壁へ浸潤していた. 術後, 薬剤を変更して化学内分泌療法と局所への放射線療法を施行したが, 術後8ヵ月に肝転移にて死亡した. 乳癌の胸骨再発は, 胸骨の解剖学的特徴により乳癌胸壁再発のなかでも治療の困難なものの一つである. その治療法については一致した意見はないが, 局所のコントロールと生存率の改善のために積極的な胸壁切除術が現在最も支持されている. 本症例は, 2年以内の短い再発期間, 胸骨傍リンパ節転移より右腕頭静脈への浸潤所見が予後不良の原因と思われた.