IV-DSAが癌の広がり診断に有用であった非触知乳癌の1例

我々は過去500例以上の乳癌に術前intravenous digital subtraction angiography (IV-DSA)を施行し,乳管内非浸潤癌巣(intraductal cancer spread)をふくめた癌の広がり診断に有用であることを報告してきた.今回IV-DSAにより癌巣の広がりを描出できた非触知乳癌を経験したので報告する.症例は55歳女性で,1982年右乳癌で乳房切除術を施行し,1999年1月マンモグラフィーで左乳房C領域に限局した微小石灰化を認めステレオ下生検(stereotactic needle biopsy)を施行し,非浸潤性乳管癌(ductal carcinoma in situ, DCIS)の診断を得た.触診,超音波検査では異常はなかったがIV-DSAでC領域を中心として乳房ほぼ全域に広がる濃染像を認めた.乳房切除術の適応となる広範囲のDCISと診断したが,患者とも相談の上,quadrantectomyを施行した.組織学的には小浸潤巣(minimal invasive foci)を伴うpapillo-tubular carcinomaで,surgial marginが広範囲にわたって陽性であり,後日腋窩郭清を伴う乳房切除術を追加施行した.なお切除標本には癌遺残が著明であった.非触知乳癌における癌の広がり診断には従来の画像検査に加えてMRI,CTなどが行われるがIV-DSAも重要な検査手段になり得ると考えられた.In a recent case of non-palpable breast cancer we used intravenous digital subtraction angiography to examine the cancerous spread. We describe the usefulness of this technique and report the clinical course of this case. The patient was a 55-year-old female who underwent a mastectomy in 1982 due to cancer in the right breast. Mammography conducted in January 1999 revealed microcalcification in area C of the left breast. According to results obtained from a stereotactic needle biopsy, we made a diagnosis of non-infiltrating ductal carcinoma in situ. Although no abnormal findings were observed in palpation and ultrasound examination, intravenous digital subtraction angiography disclosed high-density lesions extending almost entirely over the left breast, especially in area C. A quadrantectomy was selected as the initial surgery. Histologically the lesion was regarded as being papillo-tubular carcinoma accompanied by minimal invasive foci. The surgical margins proved positive and we performed a mastectomy with dissection of axillary nodes. A substantial volume of cancerous remnant was detected in the resected specimen. This study demonstrates that intravenous digital subtraction angiography is an useful technique for examination of the spread of non-palpable breast cancer

IV-DSAが癌の広がり診断に有用であった非触知乳癌の1例

我々は過去500例以上の乳癌に術前intravenous digital subtraction angiography (IV-DSA)を施行し,乳管内非浸潤癌巣(intraductal cancer spread)をふくめた癌の広がり診断に有用であることを報告してきた.今回IV-DSAにより癌巣の広がりを描出できた非触知乳癌を経験したので報告する.症例は55歳女性で,1982年右乳癌で乳房切除術を施行し,1999年1月マンモグラフィーで左乳房C領域に限局した微小石灰化を認めステレオ下生検(stereotactic needle biopsy)を施行し,非浸潤性乳管癌(ductal carcinoma in situ, DCIS)の診断を得た.触診,超音波検査では異常はなかったがIV-DSAでC領域を中心として乳房ほぼ全域に広がる濃染像を認めた.乳房切除術の適応となる広範囲のDCISと診断したが,患者とも相談の上,quadrantectomyを施行した.組織学的には小浸潤巣(minimal invasive foci)を伴うpapillo-tubular carcinomaで,surgial marginが広範囲にわたって陽性であり,後日腋窩郭清を伴う乳房切除術を追加施行した.なお切除標本には癌遺残が著明であった.非触知乳癌における癌の広がり診断には従来の画像検査に加えてMRI,CTなどが行われるがIV-DSAも重要な検査手段になり得ると考えられた.In a recent case of non-palpable breast cancer we used intravenous digital subtraction angiography to examine the cancerous spread. We describe the usefulness of this technique and report the clinical course of this case. The patient was a 55-year-old female who underwent a mastectomy in 1982 due to cancer in the right breast. Mammography conducted in January 1999 revealed microcalcification in area C of the left breast. According to results obtained from a stereotactic needle biopsy, we made a diagnosis of non-infiltrating ductal carcinoma in situ. Although no abnormal findings were observed in palpation and ultrasound examination, intravenous digital subtraction angiography disclosed high-density lesions extending almost entirely over the left breast, especially in area C. A quadrantectomy was selected as the initial surgery. Histologically the lesion was regarded as being papillo-tubular carcinoma accompanied by minimal invasive foci. The surgical margins proved positive and we performed a mastectomy with dissection of axillary nodes. A substantial volume of cancerous remnant was detected in the resected specimen. This study demonstrates that intravenous digital subtraction angiography is an useful technique for examination of the spread of non-palpable breast cancer