リスク低減乳房切除術にて発見された非浸潤性乳管癌の1例

症例は47歳，女性．乳癌で34歳（左乳房部分切除術+センチネルリンパ節生検）と44歳（右乳房全切除術+センチネルリンパ節生検）時に加療した．両側乳癌既往，若年発症，家族歴から遺伝学的検査の提供推奨と判断した．BRCA遺伝学的検査を行い，BRCA1に病的バリアントを認め，遺伝性乳癌卵巣癌症候群と診断された．予防手術の希望があり，女性診療科にてリスク低減卵管卵巣摘出術を施行された．マンモグラフィー，乳腺超音波，乳房MRIで乳房内に病変がないことを確認し，左温存乳房に対するリスク低減乳房切除術を施行した．術後病理結果で2mm大の非浸潤性乳管癌（エストロゲンレセプター（ER）陽性）を認めた．右乳癌術後...

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Published in日本臨床外科学会雑誌 Vol. 83; no. 8; pp. 1407 - 1412
Main Authors 田中, 裕子, 吹野, 俊介, 大田, 里香子, 若原, 誠
Format Journal Article
LanguageJapanese
Published 日本臨床外科学会 2022
Subjects
オカルト癌
リスク低減乳房切除術
遺伝性乳癌卵巣癌症候群
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ISSN1345-2843
1882-5133
DOI10.3919/jjsa.83.1407

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Abstract 症例は47歳，女性．乳癌で34歳（左乳房部分切除術+センチネルリンパ節生検）と44歳（右乳房全切除術+センチネルリンパ節生検）時に加療した．両側乳癌既往，若年発症，家族歴から遺伝学的検査の提供推奨と判断した．BRCA遺伝学的検査を行い，BRCA1に病的バリアントを認め，遺伝性乳癌卵巣癌症候群と診断された．予防手術の希望があり，女性診療科にてリスク低減卵管卵巣摘出術を施行された．マンモグラフィー，乳腺超音波，乳房MRIで乳房内に病変がないことを確認し，左温存乳房に対するリスク低減乳房切除術を施行した．術後病理結果で2mm大の非浸潤性乳管癌（エストロゲンレセプター（ER）陽性）を認めた．右乳癌術後に対しタモキシフェン+LH-RHアゴニスト加療中であったが，リスク低減卵管卵巣摘出後はホルモン剤をアナストロゾールに変更し，経過観察中である．
AbstractList 症例は47歳，女性．乳癌で34歳（左乳房部分切除術+センチネルリンパ節生検）と44歳（右乳房全切除術+センチネルリンパ節生検）時に加療した．両側乳癌既往，若年発症，家族歴から遺伝学的検査の提供推奨と判断した．BRCA遺伝学的検査を行い，BRCA1に病的バリアントを認め，遺伝性乳癌卵巣癌症候群と診断された．予防手術の希望があり，女性診療科にてリスク低減卵管卵巣摘出術を施行された．マンモグラフィー，乳腺超音波，乳房MRIで乳房内に病変がないことを確認し，左温存乳房に対するリスク低減乳房切除術を施行した．術後病理結果で2mm大の非浸潤性乳管癌（エストロゲンレセプター（ER）陽性）を認めた．右乳癌術後に対しタモキシフェン+LH-RHアゴニスト加療中であったが，リスク低減卵管卵巣摘出後はホルモン剤をアナストロゾールに変更し，経過観察中である．
Author 大田, 里香子
若原, 誠
田中, 裕子
吹野, 俊介
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References 1) 日本遺伝性乳癌卵巣癌総合診療制度機構/編:遺伝性乳癌卵巣癌（HBOC）診療ガイドライン2021年版．金原出版，東京，2021，p22-24，113-121，166-167
9) Hoogerbrugge N, Bult P, de Widt-Levert LM, et al : High prevalence of premalignant lesions in prophylactically removed breasts from women at hereditary risk for breast cancer. J Clin Oncol 2003 ; 21 : 41-45
14) Evans DG, Ingham SL, Baildam A, et al : Contralateral mastectomy improves survival in women with BRCA1/2-associated breast cancer. Breast Cancer Res Treat 2013 ; 140 : 135-142
3) Li X, You R, Wang X, et al : Effectiveness of Prophylactic Surgeries in BRCA1 or BRCA2 Mutation Carriers : A Meta-analysis and Systematic Review. Clin Cancer Res 2016 ; 22 : 3971-3981
8) 加藤貴美，津田　均:リスク低減乳房切除検体の病理学的検査．乳癌の臨　2020;35:347-353
4) Xiao YL, Wang K, Liu Q, et al : Risk Reduction and Survival Benefit of Risk-Reducing Salpingo-oophorectomy in Hereditary Breast Cancer : Meta-analysis and Systematic Review. Clin Breast Cancer 2019 ; 19 : e48-65
10) Isern AE, Loman N, Malina J, et al : Histopathological findings and follow-up after prophylactic mastectomy and immediate breast reconstruction in 100 women from families with hereditary breast cancer. Eur J Surg Oncol 2008 ; 34 : 1148-1154
16) Erdahl LM, Boughey JC, Hoskin TL, et al : Contralateral Prophylactic Mastectomy : Factors Predictive of Occult Malignancy or High-Risk Lesion and the Impact of MRI and Genetic Testing. Ann Surg Oncol 2016 ; 23 : 72-77
17) 喜多久美子，山内英子:乳癌診療の現状と課題6．リスク低減乳房切除術の現状と課題．日外会誌　2021;122:320-324
6) Pierce LJ, Phillips KA, Griffith KA, et al : Local therapy in BRCA1 and BRCA2 mutation carriers with operable breast cancer : comparison of breast conservation and mastectomy. Breast Cancer Res Treat 2010 ; 121 : 389-398
7) 喜多久美子，山内英子:BRCA変異を有するHBOCにおけるリスク低減乳房切除の適応．乳癌の臨　2020;35:319-325
12) Mattos D, Gfrerer L, Ling ITC, et al : Occult histopathology and its predictors in contralateral and bilateral prophylactic mastectomies. Ann Surg Oncol 2016 ; 23 : 767-775
2) Kuchenbaecker KB, Hopper JL, Barnes DR, et al : Risk of Breast, Ovarian, and Contralateral Breast Cancer for BRCA1 and BRCA2 Mutation Carriers. JAMA 2017 ; 317 : 2402-2416
5) Valachis A, Nearchou AD, Lind P : Surgical management of breast cancer in BRCA-mutation carriers : a systematic review and meta-analysis. Breast Cancer Res Treat 2014 ; 144 : 443-455
11) Kaas R, Verhoef S, Wesseling J, et al : Prophylactic mastectomy in BRCA1 and BRCA2 mutation carriers. Ann Surg 2010 ; 251 : 488-492
13) van Sprundel TC, Schmidt MK, Rookus MA, et al : Risk reduction of contralateral breast cancer and survival after contralateral prophylactic mastectomy in BRCA1 or BRCA2 mutation carriers. Br J Cancer 2005 ; 93 : 287-292
15) Yamauchi H, Okawa M, Yokoyama S, et al : High rate of occult cancer found in prophylactic mastectomy specimens despite thorough presurgical assessment with MRI and ultrasound : findings from the Hereditary Breast and Ovarian Cancer Registration 2016 in Japan. Breast Cancer Res Treat 2018 ; 172 : 679-687
References_xml – reference: 11) Kaas R, Verhoef S, Wesseling J, et al : Prophylactic mastectomy in BRCA1 and BRCA2 mutation carriers. Ann Surg 2010 ; 251 : 488-492
– reference: 15) Yamauchi H, Okawa M, Yokoyama S, et al : High rate of occult cancer found in prophylactic mastectomy specimens despite thorough presurgical assessment with MRI and ultrasound : findings from the Hereditary Breast and Ovarian Cancer Registration 2016 in Japan. Breast Cancer Res Treat 2018 ; 172 : 679-687
– reference: 8) 加藤貴美，津田　均:リスク低減乳房切除検体の病理学的検査．乳癌の臨　2020;35:347-353
– reference: 16) Erdahl LM, Boughey JC, Hoskin TL, et al : Contralateral Prophylactic Mastectomy : Factors Predictive of Occult Malignancy or High-Risk Lesion and the Impact of MRI and Genetic Testing. Ann Surg Oncol 2016 ; 23 : 72-77
– reference: 4) Xiao YL, Wang K, Liu Q, et al : Risk Reduction and Survival Benefit of Risk-Reducing Salpingo-oophorectomy in Hereditary Breast Cancer : Meta-analysis and Systematic Review. Clin Breast Cancer 2019 ; 19 : e48-65
– reference: 5) Valachis A, Nearchou AD, Lind P : Surgical management of breast cancer in BRCA-mutation carriers : a systematic review and meta-analysis. Breast Cancer Res Treat 2014 ; 144 : 443-455
– reference: 6) Pierce LJ, Phillips KA, Griffith KA, et al : Local therapy in BRCA1 and BRCA2 mutation carriers with operable breast cancer : comparison of breast conservation and mastectomy. Breast Cancer Res Treat 2010 ; 121 : 389-398
– reference: 12) Mattos D, Gfrerer L, Ling ITC, et al : Occult histopathology and its predictors in contralateral and bilateral prophylactic mastectomies. Ann Surg Oncol 2016 ; 23 : 767-775
– reference: 9) Hoogerbrugge N, Bult P, de Widt-Levert LM, et al : High prevalence of premalignant lesions in prophylactically removed breasts from women at hereditary risk for breast cancer. J Clin Oncol 2003 ; 21 : 41-45
– reference: 2) Kuchenbaecker KB, Hopper JL, Barnes DR, et al : Risk of Breast, Ovarian, and Contralateral Breast Cancer for BRCA1 and BRCA2 Mutation Carriers. JAMA 2017 ; 317 : 2402-2416
– reference: 14) Evans DG, Ingham SL, Baildam A, et al : Contralateral mastectomy improves survival in women with BRCA1/2-associated breast cancer. Breast Cancer Res Treat 2013 ; 140 : 135-142
– reference: 7) 喜多久美子，山内英子:BRCA変異を有するHBOCにおけるリスク低減乳房切除の適応．乳癌の臨　2020;35:319-325
– reference: 3) Li X, You R, Wang X, et al : Effectiveness of Prophylactic Surgeries in BRCA1 or BRCA2 Mutation Carriers : A Meta-analysis and Systematic Review. Clin Cancer Res 2016 ; 22 : 3971-3981
– reference: 17) 喜多久美子，山内英子:乳癌診療の現状と課題6．リスク低減乳房切除術の現状と課題．日外会誌　2021;122:320-324
– reference: 1) 日本遺伝性乳癌卵巣癌総合診療制度機構/編:遺伝性乳癌卵巣癌（HBOC）診療ガイドライン2021年版．金原出版，東京，2021，p22-24，113-121，166-167
– reference: 10) Isern AE, Loman N, Malina J, et al : Histopathological findings and follow-up after prophylactic mastectomy and immediate breast reconstruction in 100 women from families with hereditary breast cancer. Eur J Surg Oncol 2008 ; 34 : 1148-1154
– reference: 13) van Sprundel TC, Schmidt MK, Rookus MA, et al : Risk reduction of contralateral breast cancer and survival after contralateral prophylactic mastectomy in BRCA1 or BRCA2 mutation carriers. Br J Cancer 2005 ; 93 : 287-292
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SubjectTerms オカルト癌
リスク低減乳房切除術
遺伝性乳癌卵巣癌症候群
Title リスク低減乳房切除術にて発見された非浸潤性乳管癌の1例
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