Sonographic and Pathologic Features of Metastatic Synovial Sarcoma of the Lung Presenting as a Breast Neoplasm
Sonographic and Pathologic Features of Metastatic Synovial Sarcoma of the Lung Presenting as a Breast Neoplasm
复制标题
表现为乳腺肿瘤的肺转移性滑膜肉瘤的超声检查和病理特征
DOI：
10.1111/j.1075-122x.2004.21329.x
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Richard C. Johnson
中科院分区：
文献类型：
--
作者：
D. Banerjee;S. J. Gorse;M. Cotter;Richard C. Johnson
一名28岁的女性在乳房诊所就诊时，左侧乳房有明显肿块。在其他方面，她当时都很健康。四年前，她因滑膜肉瘤接受了左上叶肺切除，随后接受了术后辅助化疗。经检查发现，她的左乳房外上象限有一个25毫米的离散肿块。乳房超声检查证实存在边界清晰的实质性肿块，血流增加(图1)。大口径针吸活检可见小圆形细胞弥漫性增殖，胞核为卵圆形，染色质细小，核仁小，周围有少量嗜酸性细胞质。偶见有丝分裂影。这与恶性小圆细胞瘤一致(图2)。肿瘤细胞bcl2染色阳性，其他标志物阴性。在皇家布朗普顿医院进行了原始肺切除手术的皇家布朗普顿医院检查了幻灯片，发现其外观与复发的肉瘤一致。随后的分期检查，包括腹部超声、计算机断层扫描、支气管镜检查和骨扫描，没有发现肿瘤的任何其他转移灶。因此，乳房病变是一个孤立的沉积物。她接受了全乳房切除术，并立即使用带蒂腹直肌横肌皮瓣(TRAM)进行重建。乳房切除标本的组织学检查显示一个与活检相似的局限性肿瘤。她经历了一段平淡无奇的术后时期，并在6个月的随访中表现良好。致谢
A 28-year-old woman presented to the breast clinic with a palpable lump in the left breast. She was otherwise healthy at the time. Four years earlier she had undergone a left upper lobe lung resection for a synovial sarcoma followed by postoperative adjuvant chemotherapy. On examination she was found to have a 25 mm discrete palpable mass in the upper outer quadrant of her left breast. An ultrasound of the breast confirmed the presence of a well-defined solid mass with increased blood flow (Fig. 1). A large-bore needle biopsy showed a diffuse proliferation of small round cells with oval nuclei, fine chromatin, and small nucleoli surrounded by a small amount of eosinophilic cytoplasm. Occasional mitotic figures were seen. This is consistent with a malignant small round cell tumor (Fig. 2). The tumor cells showed positive staining for bcl2, but were negative for other markers. Review of the slides at the Royal Brompton Hospital, where the original lung resection had been done, found that the appearance was consistent with recurrent sarcoma. Subsequent staging investigations, including abdominal ultrasound, computed tomography (CT) scan, bronchoscopy, and bone scan did not reveal any other metastatic lesions from the tumor. The breast lesion was therefore an isolated deposit. She was treated with total mastectomy and immediate reconstruction using a pedicled transverse rectus abdominis myocutaneous (TRAM) flap. Histology of the mastectomy specimen showed a circumscribed tumor similar in appearance to the biopsy. She had an uneventful postoperative period and was well at her 6-month follow-up. Acknowledgments