Ulcerative Carcinoma of the Breast With Zosteriform Skin Metastases
Ulcerative Carcinoma of the Breast With Zosteriform Skin Metastases
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伴有带状疱疹样皮肤转移的乳腺癌溃疡性癌
DOI：
10.1111/j.1075-122x.2006.00285.x
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
P. Fabbri
中科院分区：
文献类型：
--
作者：
D. Torchia;G. Palleschi;M. Terranova;E. Antiga;Lucilla Melani;M. Caproni;P. Fabbri
体格检查时，左乳房前外侧部分相对于对侧乳房明显缩小，触诊时出现硬结，并被一层厚厚的纤维蛋白和坏死组织覆盖（图1a）。此外，患者躯干同侧有许多带状疱疹样的肿胀斑块、溃疡结节和浆液性水疱（图1b），切开活检标本和组织学检查证实左乳病变为癌（导管型，浸润性，G2级），其他皮肤病变为转移瘤。细胞学检查和直接免疫荧光试验上进行的水疱病变呈阴性。除了低色素性小细胞性贫血和低白蛋白血症外，我们为排除任何内部受累而进行的所有临床和实验室检测均未显示。肿瘤分期为T4cN0M1，开始姑息性放疗。在1年随访时，患者仍然存活，没有任何明显的内脏受累。患者就诊时，癌细胞已经侵入并破坏了左乳房的下部，这是一种在发达国家不常见的“怪物”图像。临床和实验室检查排除了内部转移的存在，直到诊断后1年。这种相对良性的疾病过程似乎非常令人惊讶，考虑到局部的侵袭性，
On physical examination, the anterolateral portion of the left breast was markedly reduced with respect to the contralateral one, indurated at palpation, and covered by a thick mantle of fibrin and necrotic tissue (Fig. 1a). Moreover, the patient had numerous erythematous plaques, ulcerated nodules, and serohematic blisters localized in a zosteriform pattern on the homolateral aspect of the trunk (Fig. 1b).Incisional biopsy specimens and histologic examination confirmed that the left breast lesion was a carcinoma (ductal type, infiltrating, grade G2) and the other skin lesions were metastases. Cytologic examination and direct immunofluorescence assays performed on a blistering lesion were negative. All the clinical and laboratory assays that we performed in order to rule out any internal involvement were unrevealing except for hypochromic microcytic anemia and hypoalbuminemia. The neoplasm was staged as T4cN0M1 and palliative radiotherapy was started. At the 1 year follow-up, the patient was still alive without any apparent involvement of internal organs. The patient presented when the cancer had already invaded and destroyed the lower portion of the left breast, a “monstre” picture that is uncommon in developed countries. Clinical and laboratory investigations excluded the presence of internal metastases until 1 year after the diagnosis. Such a relatively benign disease course appeared very surprising, considering the local invasivity of the