Thrombotic Microangiopathy and Leukoerythroblastosis Associated with Metastatic Infiltrating Lobular Carcinoma

轉移性浸潤乳房小葉癌伴隨阻塞性微血管病變和白血球紅血球芽細胞症

賴冠銘(Guan-Min Lai) ； 林岳民(Yueh-Min Lin) ； 鍾智淵(Chin-Yuan Chung)

《台灣癌症醫學雜誌》 1卷3期 (2014/12) Pp. 241-247

https://doi.org/10.6323/JCRP.2014.1.3.08

摘要

一名56歲的女性一開始表現為陰道出血和呼吸困難。血液相顯示血栓性微血管病變：微血管病性溶血性貧血，血小板減少症，紅血球白血球芽細胞症，血清肌酸酐，乳酸脫氫酶和鹼性磷酸酶也升高。骨髓病理切片顯示轉移性浸潤性乳房小葉癌和局部骨髓壞死。原發病灶後來被確認為右乳房。我們的結論是血栓性微血管病變，紅血球白血球芽細胞症，乳酸脫氫酶和鹼性磷酸酶升高的症狀表示骨髓轉移而不是血栓性血小板減少性紫斑症或彌散性血管內凝血。如果有以上症狀應迅速做骨髓切片檢查，然後做積極賀爾蒙治療或化療而不是支持性療法或無效的血漿置換，進而達到血液相的改善。

關鍵字

浸潤性乳小葉癌 ； 血栓性微血管病變 ； 微血管病性溶血性貧血 ； 乳癌 ； 紅血球白血球芽細胞症

並列摘要

A 56-year-old female presenting with vaginal bleeding and exertional dyspnea for 2 weeks was admitted to hospital. The clinical course and blood analysis revealed several uncommon signs of thrombotic microangiopathy: microangiopathic hemolytic anemia (schistocytes, decreased haptoglobin, and a negative direct Coombs’ test), thrombocytopenia, leukoerythroblastic blood film, creatinine, lactate dehydrogenase, and alkaline phosphatase were also elevated. Bone marrow biopsy revealed metastatic infiltrating lobular carcinoma and focal bone marrow necrosis; and the primary lesion was subsequently identified in the right breast. We concluded that microangiopathic hemolytic anemia, thrombocytopenia, leukoerythroblastic blood film, lactate dehydrogenase, and alkaline phosphatase strongly indicated a disseminated malignancy with bone marrow involvement rather than thrombotic thrombocytopenic purpura or disseminated intravascular coagulation, which are also common in a disseminated malignancy. In breast cancer cases with hematological signs, prompt the bone marrow examination is more improtant than tranditional systemic hormone or systemic chemotherapy or ineffective supportive treatment such as plasma exchange in order to obtain hematological repsonse.

並列關鍵字

infiltrating lobular carcinoma ； thrombotic microangiopathy ； microangiopathic hemolytic anemia ； leukoerythroblastosis ； breast cancer