Breast Metastasis from Pulmonary Adenocarcinoma

肺腺癌轉移至乳房

王鼎堯(Ting-Yao Wang) ； 陳秉聰(Ping-Tsung Chen) ； 陳苡揚(Yi-Yang Chen) ； 李錦輝(Kam-Fai Lee) ； 官鋒澤(Feng-Che Kuan) ； 黃慈恩(Chi-En Huang) ； 李冠德(Kuan-Der Lee) ； 陳志丞(Chih-Cheng Chen) ； 呂長賢(Chang-Hsien Lu)

《台灣癌症醫學雜誌》 29卷3期 (2013/08) Pp. 141-149

https://doi.org/10.6323/JoCRP.2013.29.3.5

摘要

一名52歲的台灣女性罹患轉移性肺腺癌患者，在接受酪胺酸激酶抑制劑（tyrosine kinase inhibitors, TKI）治療六個月後，發現右側乳房出現持續變大的硬塊。該乳房硬塊經切片病理檢查顯示為侵襲性癌，而免疫組織化學（immunohistochemistry, IHC）染色結果顯示：甲狀腺轉錄因子-1（thyroid transcription factor-1, TTF-1），細胞角蛋白7（Cytokeratin 7, CK7），napsin A（Nap-A），雌激素受體（estrogen receptor, ER）為陽性反應；黃體素受體（progesterone receptor , PR）和HER2/neu則為陰性。單從組織學上來分別腫瘤是肺腺癌轉移至乳房或是次發性的乳癌相當的困難，IHC標記常被利用來分辨腫瘤的原發部位。不論是乳癌具有TTF-1和Nap-A的表現或是乳房以外的癌症轉移至乳房，兩種情形在臨床上都相當的罕見。我們回顧過去的文獻中相關於這兩種罕見的情況，並以此病例探討IHC 標記在分辨轉移性肺腺癌和原發性乳癌的角色。根據臨床表現及免疫組織化學染色的結果，我們診斷此病例為肺腺癌之乳房轉移，並依此提出了下一步的治療計劃。

關鍵字

肺腺癌 ； 乳房轉移 ； 免疫組織化學染色 ； 鑑別診斷

並列摘要

A 52-year-old Taiwanese woman presented with a progressively enlarged right breast mass after 6 months of tyrosine kinase inhibitor (TKI) treatment for metastatic lung adenocarcinoma. A core needle biopsy of the breast lesion revealed invasive carcinoma with positive immunohistochemical (IHC) staining for thyroid transcription factor-1 (TTF-1), cytokeratin 7 (CK7), napsin A (Nap-A), estrogen receptor (ER), and a negative result for progesterone receptor (PR) and HER2/neu. It is difficult to distinguish the histology between metastatic lung adenocarcinoma and metachronous breast cancer. However, IHC markers can help to differentiate the site of origin. A primary breast cancer with expression of TTF-1 and Nap-A is uncommon, and metastasis to the breast is a rare clinical manifestation. We reviewed the literature for both of these rare conditions, and discussed the utility of IHC markers to distinguish lung metastasis from primary breast cancer in this case. We ultimately diagnosed that this female patient had lung adenocarcinoma with breast metastasis, and a further treatment plan was devised.

並列關鍵字

metastatic lung adenocarcinoma ； breast metastasis ； immnunohistochemical staining ； differential diagnosis