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子宫肌瘤合并乳腺癌转移1例报告

Uterine myoma combined with breast cancer metastasis: a case report

  • 摘要: 1 例61岁患者因“绝经后子宫肌瘤明显增大2个月”于2024年11月入院。患者8年前确诊子宫肌瘤,2023 年 4 月行右侧乳腺癌改良根治术,术后病理示浸润性癌(SBR分级Ⅲ级)。入院后检查发现子宫后壁囊实性团块,CA153升高(273 U/mL),行经腹全子宫+双附件切除术,术后苏木精-伊红染色提示子宫平滑肌瘤伴浸润性小叶癌累及;免疫组化示广谱细胞角蛋白(pan-cytokeratin, CKpan;+)、GATA结合蛋白3(GATA3,+)、desmin(肌+)、雌激素受体(estrogen receptor, ER; 90%+ + +)等,确诊为乳腺癌子宫肌层转移。术后采用 CDK4/6抑制剂+阿那曲唑联合唑来膦酸综合治疗。浸润性小叶癌转移至子宫肌层罕见。乳腺癌患者出现子宫肌瘤快速增大时应警惕转移可能,须结合病理检查判断。

     

    Abstract: A 61-year-old patient was admitted in November 2024 with the chief complaint of “marked enlargement of uterine myoma for 2 months after menopause”. This patient was diagnosed with uterine myoma 8 years ago and underwent modified radical mastectomy for right breast cancer in April 2023. Postoperative pathology revealed invasive carcinoma (SBR grade Ⅲ). Upon admission, examination results showed a cystic-solid mass in the posterior wall of the uterus and an elevated CA153 level of 273 U/mL. Transabdominal total hysterectomy and bilateral adnexectomy were performed. HE staining postoperatively indicated uterine myoma with involvement of invasive lobular carcinoma. Immunohistochemistry showed positivity for pan-cytokeratin (CKpan, +), GATA3 (+), desmin (muscle+), and estrogen receptor (ER, 90%+ + +), confirming the diagnosis of breast cancer metastasis to the uterine myometrium. CDK4/6 inhibitor, anastrozole, and zoledronic acid were used after surgery. Metastasis of invasive lobular carcinoma to the uterine myometrium is rare. Rapid enlargement of uterine myoma in breast cancer patients should alert clinicians to consider the possibility of metastasis, which must be confirmed by pathological examination.

     

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