Appendicitis caused by the metastasis of HER2-positive breast cancer
Appendicitis caused by the metastasis of HER2-positive breast cancer
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DOI：
10.1186/s40792-016-0235-5
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发表时间：
2016-09-28
影响因子：
0.8
通讯作者：
Yoshida, Kazuhiro
中科院分区：
文献类型：
--
作者：
Mori, Ryutaro;Futamura, Manabu;Yoshida, Kazuhiro
转移性乳腺癌的适当治疗必须根据癌症的免疫组织化学表型来选择。然而，对转移性病变进行活检是困难的。我们在此报告一例由转移性乳腺癌引起的偶发性阑尾炎患者，根据切除后的病理诊断选择有效的治疗方法，成功治疗。患者为56岁女性，右侧乳腺癌，雌激素受体（ER）（+）、孕激素受体（PgR）（+）、人表皮生长因子受体2 (HER2)（3+）、Ki67免疫组化状态为40%。她接受表柔比星和环磷酰胺治疗，随后接受多西紫杉醇和曲妥珠单抗治疗，并进行全乳切除术并腋窝清扫。此后，她接受了乳房切除术后放疗、辅助曲妥珠单抗和辅助来曲唑激素治疗。术后1年8个月，患者右侧肾积水，主动脉旁淋巴结肿大，改为氟维司汀治疗。然而，她又出现了左侧肾积水和多发性骨转移，并开始了帕妥珠单抗、曲妥珠单抗和多西他赛治疗。六个周期后，她的疾病得到了良好的控制，并引入了帕妥珠单抗和曲妥珠单抗的维持。然而，又过了7个月，她出现了新的椎体转移和急性阑尾炎，并进行了腹腔镜阑尾切除术。切除阑尾的病理检查显示，在浆膜下和肌肉层有一些非典型细胞簇，其免疫组化状态为ER（+）、PgR（-）、HER2（3+）和E-cadherin（-）。诊断为乳腺浸润性小叶癌（ILC）的阑尾转移。此后，她接受曲妥珠单抗- dm1治疗，病情再次得到良好控制。由乳腺癌引起的阑尾炎非常罕见。然而，ILC有时会在腹腔发生转移；因此阑尾肿瘤应包括在鉴别诊断中。转移性肿瘤的病理诊断对于选择有效的治疗方法非常有用。
The appropriate therapy for metastatic breast cancer must be selected based on the immunohistochemical phenotype of the cancer. However, biopsy for metastatic lesions is difficult. We herein report a patient with incidental appendicitis caused by a metastatic breast cancer which was successfully treated with effective therapy chosen based on the pathological diagnosis obtained on resection. The patient was a 56-year-old female with right breast cancer and an immunohistochemical status of estrogen receptor (ER) (+), progesterone receptor (PgR) (+), human epidermal growth factor receptor 2 (HER2) (3+), and Ki67 40 %. She received epirubicin and cyclophosphamide therapy followed by docetaxel and trastuzumab, and total mastectomy with axillary dissection was performed. Thereafter, she received postmastectomy radiation, adjuvant trastuzumab, and adjuvant hormone therapy with letrozole. One year and 8 months after the operation, she developed right hydronephrosis and swollen para-aortic lymph nodes and her hormone therapy was changed to fulvestrant therapy. However, she additionally developed left hydronephrosis and multiple bone metastases, and pertuzumab, trastuzumab, and docetaxel therapy was started. After six cycles, her disease became well-controlled, and maintenance with pertuzumab and trastuzumab was introduced. However, after another 7 months, she developed new vertebral metastasis and acute appendicitis and laparoscopic appendectomy was performed. A pathological investigation of the resected appendix revealed some clusters of atypical cells in the subserosa and muscle layer, which showed an immunohistochemical status of ER (+), PgR (-), HER2 (3+), and E-cadherin (-). These findings led to the diagnosis as appendiceal metastasis of invasive lobular carcinoma (ILC) from the breast. Thereafter, she received trastuzumab-DM1 and her disease was well-controlled again. Appendicitis caused by breast cancer is very rare. However, ILC sometimes develops metastases in the abdominal cavity; an appendiceal tumor should therefore be included in the differential diagnosis. A pathological diagnosis of metastatic tumor could be very useful for selecting the effective therapy.