原発不明左鎖骨上神経内分泌腫瘍が併存した右乳癌の1例

症例は48歳，女性．左鎖骨上に圧痛を伴う腫瘤を自覚し受診．胸腹部CTで左鎖骨上に2cm大の腫瘤と，右乳房外側に造影効果のある腫瘤を認めた．超音波で左鎖骨上に分葉形腫瘤と右乳房CD境界に不整形腫瘤を認めた．右乳房生検は浸潤性乳管癌の診断，左鎖骨上腫瘤穿刺吸引細胞診は悪性疑いの診断であった．右乳癌の左鎖骨上リンパ節への単独転移は積極的に疑わず，左鎖骨上腫瘤切開生検を施行し，neuroendocrine tumor（NET）-G1の診断となった．NET原発巣検索を行ったが原発巣は指摘できなかった．左鎖骨上腫瘍摘出術を行い，NET G2の診断に至った．NET摘出より1カ月後，右乳房切除およびセンチネル...

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Published in日本臨床外科学会雑誌 Vol. 82; no. 12; pp. 2123 - 2129
Main Authors 間下, 優子, 肌附, 宏, 望月, 能成, 横井, 一樹, 野田, 純代, 杉本, 博行
Format Journal Article
LanguageJapanese
Published 日本臨床外科学会 2021
Subjects
NET
乳癌
鎖骨上リンパ節転移
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ISSN1345-2843
1882-5133
DOI10.3919/jjsa.82.2123

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Abstract 症例は48歳，女性．左鎖骨上に圧痛を伴う腫瘤を自覚し受診．胸腹部CTで左鎖骨上に2cm大の腫瘤と，右乳房外側に造影効果のある腫瘤を認めた．超音波で左鎖骨上に分葉形腫瘤と右乳房CD境界に不整形腫瘤を認めた．右乳房生検は浸潤性乳管癌の診断，左鎖骨上腫瘤穿刺吸引細胞診は悪性疑いの診断であった．右乳癌の左鎖骨上リンパ節への単独転移は積極的に疑わず，左鎖骨上腫瘤切開生検を施行し，neuroendocrine tumor（NET）-G1の診断となった．NET原発巣検索を行ったが原発巣は指摘できなかった．左鎖骨上腫瘍摘出術を行い，NET G2の診断に至った．NET摘出より1カ月後，右乳房切除およびセンチネルリンパ節生検を施行．センチネルリンパ節は右腋窩に存在し，転移は認めなかった．今回，左鎖骨上腫瘍生検を行ったことで乳癌に対して適切な治療ができた．NETは経過観察中，乳癌はタモキシフェン内服治療中で再発なく経過している．
AbstractList 症例は48歳，女性．左鎖骨上に圧痛を伴う腫瘤を自覚し受診．胸腹部CTで左鎖骨上に2cm大の腫瘤と，右乳房外側に造影効果のある腫瘤を認めた．超音波で左鎖骨上に分葉形腫瘤と右乳房CD境界に不整形腫瘤を認めた．右乳房生検は浸潤性乳管癌の診断，左鎖骨上腫瘤穿刺吸引細胞診は悪性疑いの診断であった．右乳癌の左鎖骨上リンパ節への単独転移は積極的に疑わず，左鎖骨上腫瘤切開生検を施行し，neuroendocrine tumor（NET）-G1の診断となった．NET原発巣検索を行ったが原発巣は指摘できなかった．左鎖骨上腫瘍摘出術を行い，NET G2の診断に至った．NET摘出より1カ月後，右乳房切除およびセンチネルリンパ節生検を施行．センチネルリンパ節は右腋窩に存在し，転移は認めなかった．今回，左鎖骨上腫瘍生検を行ったことで乳癌に対して適切な治療ができた．NETは経過観察中，乳癌はタモキシフェン内服治療中で再発なく経過している．
Author 横井, 一樹
杉本, 博行
望月, 能成
野田, 純代
間下, 優子
肌附, 宏
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References 4) Classification of neuroendocrine neoplasm : lights and shadow, (Accessed Aug. 2, 2021, at https://link.springer.com/content/pdf/10.1007/s11154-020-09612-2.pdf
11) Estourgie SH, Nieweg OE, Olmos RAV, et al : Lymphatic drainage patterns from the breast. Ann Surg 2004 ; 239 : 232-237
3) El-Nagger AK, Chan JKC, Grandis JR, et al : WHO Classification of Head and Neck Tumours. 4th edition, vol.9, World Health Organization, Lyon, 2017, p95-98
13) Chkheidze R, Sanders MAG, Haley B, et al : Isolated contralateral axillary lymph node involvement in breast cancer represents a locally advanced disease not distant metastases. Clin Breast Cancer 2017 ; 18 : 298-304
2) 若岡敬紀，水田啓介，柴田博史他:頭頚部神経内分泌小細胞癌8症例の治療経験．日耳鼻会報　2017;120:202-208
12) Magnoni F, Cokkeoni M, Mattar D, et al : Contralateral axillary lymph node metastases from breast carcinoma : is it time to review TNM cancer staging? Ann Surg Oncol 2020 ; 27 : 4488-4499
5) Perez-Ordonez B : Neuroendocrine Carcinomas of the Larynx and Head and Neck : Challenges in Classification and Grading. Head Neck Pathol 2018 ; 12 : 1-8
15) Strazzanti A, Gangi S, Trovato C, et al : Contralateral lymph node metastasis in a woman with new primary breast cancer : Systemic desease or locoregional diffusion? Int J Surg 2018 ; 53 : 400-402
8) 國又　肇，館花明彦，浜口洋平他:乳癌と小細胞癌を含む胆嚢癌の同時性重複癌の1例．臨外　2017;72:1377-1382
9) Chen SH, Chen MF, Hwang TL, et al : Prediction of supraclavicular lymph node metastasis in breast carcinoma. Int J Radiat Oncol Biol Phys 2002 ; 52 : 614-619
6) Rindi G, Klimstra D, Abedo-Ardekani B, et al : A common classification framework for neuroendocrine neoplasm : an International Agency for Research on Cancer and World Health Organization expert consensus proposal. Mod Pathol 2018 ; 31 : 1770-1786
1) Ohmoto A, Sato Y, Asaka R, et al : Clinicopathological and genomic features in patients with head and neck neuroendocrine carcinoma. Mod Pathol 2021 ; 34 : 1979-1989
10) Krag DN, Anderson SJ, Julian TB, et al : Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer : results from the NSABP B-32 randomised phase III trial. Lancet Oncol 2007 ; 8 : 881-888
14) 木本真緒，花村典子，由井　朋他:乳房温存術後に乳房内再発と対側腋窩リンパ節転移をきたした乳癌の1例．日臨外会誌　2016;77:1912-1916
7) Yao JC, Hassan M, Phan A, et al : One hundred years after “carcinoid” : epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 2008 ; 26 : 3063-3072
References_xml – reference: 5) Perez-Ordonez B : Neuroendocrine Carcinomas of the Larynx and Head and Neck : Challenges in Classification and Grading. Head Neck Pathol 2018 ; 12 : 1-8
– reference: 11) Estourgie SH, Nieweg OE, Olmos RAV, et al : Lymphatic drainage patterns from the breast. Ann Surg 2004 ; 239 : 232-237
– reference: 13) Chkheidze R, Sanders MAG, Haley B, et al : Isolated contralateral axillary lymph node involvement in breast cancer represents a locally advanced disease not distant metastases. Clin Breast Cancer 2017 ; 18 : 298-304
– reference: 3) El-Nagger AK, Chan JKC, Grandis JR, et al : WHO Classification of Head and Neck Tumours. 4th edition, vol.9, World Health Organization, Lyon, 2017, p95-98
– reference: 14) 木本真緒，花村典子，由井　朋他:乳房温存術後に乳房内再発と対側腋窩リンパ節転移をきたした乳癌の1例．日臨外会誌　2016;77:1912-1916
– reference: 7) Yao JC, Hassan M, Phan A, et al : One hundred years after “carcinoid” : epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 2008 ; 26 : 3063-3072
– reference: 12) Magnoni F, Cokkeoni M, Mattar D, et al : Contralateral axillary lymph node metastases from breast carcinoma : is it time to review TNM cancer staging? Ann Surg Oncol 2020 ; 27 : 4488-4499
– reference: 1) Ohmoto A, Sato Y, Asaka R, et al : Clinicopathological and genomic features in patients with head and neck neuroendocrine carcinoma. Mod Pathol 2021 ; 34 : 1979-1989
– reference: 4) Classification of neuroendocrine neoplasm : lights and shadow, (Accessed Aug. 2, 2021, at https://link.springer.com/content/pdf/10.1007/s11154-020-09612-2.pdf)
– reference: 6) Rindi G, Klimstra D, Abedo-Ardekani B, et al : A common classification framework for neuroendocrine neoplasm : an International Agency for Research on Cancer and World Health Organization expert consensus proposal. Mod Pathol 2018 ; 31 : 1770-1786
– reference: 10) Krag DN, Anderson SJ, Julian TB, et al : Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer : results from the NSABP B-32 randomised phase III trial. Lancet Oncol 2007 ; 8 : 881-888
– reference: 15) Strazzanti A, Gangi S, Trovato C, et al : Contralateral lymph node metastasis in a woman with new primary breast cancer : Systemic desease or locoregional diffusion? Int J Surg 2018 ; 53 : 400-402
– reference: 2) 若岡敬紀，水田啓介，柴田博史他:頭頚部神経内分泌小細胞癌8症例の治療経験．日耳鼻会報　2017;120:202-208
– reference: 8) 國又　肇，館花明彦，浜口洋平他:乳癌と小細胞癌を含む胆嚢癌の同時性重複癌の1例．臨外　2017;72:1377-1382
– reference: 9) Chen SH, Chen MF, Hwang TL, et al : Prediction of supraclavicular lymph node metastasis in breast carcinoma. Int J Radiat Oncol Biol Phys 2002 ; 52 : 614-619
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SubjectTerms NET
乳癌
鎖骨上リンパ節転移
Title 原発不明左鎖骨上神経内分泌腫瘍が併存した右乳癌の1例
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