临床挑战:晚期乳腺癌女性丹毒样皮疹一例(上)

10-29 23:58 首页 SIBCS



  2017年8月17日,《美国医学会杂志肿瘤学分册》临床挑战栏目在线发表亚利桑那大学的病例分析:晚期乳腺癌女性丹毒样皮疹一例。


  患者女性,60多岁,胸部和背部进行性无症状皮疹3个月,既往有复杂的乳腺癌病史。


  1991年,首次确诊左侧乳腺癌,接受了肿瘤切除术、放疗、环磷酰胺+甲氨蝶呤+氟尿嘧啶治疗。


  2001年,由于局部病变复发,接受了左侧乳房切除术、腋窝淋巴结清扫、他莫昔芬+阿那曲唑辅助治疗。


  2014年,出现右侧腋窝淋巴结肿大,发现有转移性疾病,遂接受右侧腋窝淋巴结清扫、多柔比星+环磷酰胺治疗。


  其最近的乳腺钼靶和正电子发射断层扫描计算机断层扫描(PET/CT)显示无活动病变的证据。


  体检时明显可见其胸部、背部、右肩上散在丹毒样皮疹,如图1A所示。


  病变触诊温热、坚硬,但无触痛。


  血液生化指标、全血细胞计数、肝肾功能检测结果均正常。


  病变皮肤活检如图1B所示。


图1 A、临床体检示前胸散在丹毒样皮疹。B、组织病理学分析(苏木精-伊红染色,原始放大倍数×100)。



JAMA Oncol. 2017 Aug 17. [Epub ahead of print]


An Erysipeloid Cutaneous Eruption in a Woman With Advanced Breast Cancer.


Alexander CE, Maarouf M, Kurtzman DJB.


University of Arizona, Tucson.


A woman in her 60s with a history of metastatic breast cancer presented with a 3-month history of a progressive, asymptomatic cutaneous eruption of nontender discrete erysipeloid plaques on her chest and back. What is your diagnosis?


Case


A woman in her 60s presented with a 3-month history of a progressive, asymptomatic cutaneous eruption on her chest and back. She had a complex history of breast cancer on the left side that was first diagnosed in 1991 and was treated with lumpectomy, radiotherapy, cyclophosphamide, methotrexate, and fluorouracil. In 2001, she experienced local disease recurrence and underwent complete mastectomy with axillary lymph node dissection on the left side and received adjuvant treatment with tamoxifen citrate and anastrozole. In 2014, she developed axillary lymphadenopathy on the right side and was found to have metastatic disease. She subsequently underwent axillary lymph node dissection on the right side, followed by treatment with doxorubicin hydrochloride and cyclophosphamide. Her most recent mammogram and positron-emission tomography–computed tomography (PET/CT) showed no evidence of active disease. At the time of her evaluation, the patients physical examination was remarkable for discrete erysipeloid plaques on her chest, back, and right shoulder (Figure 1A). The lesions were warm and indurated but nontender to palpation. Serum chemistry profile, complete blood cell counts, and hepatic and renal function testing had normal results. Lesional skin biopsies were performed (Figure 1B).


Figure 1. A, Clinical examination shows discrete erysipeloid plaques on the anterior chest. B, Histopathologic analysis (hematoxylin-eosin stain, original magnification ×100).


What Is Your Diagnosis?

  1. Carcinoma erysipeloides (cutaneous metastases of breast cancer)

  2. Erysipelas

  3. Radiation dermatitis

  4. Radiation-induced morphea


PMID: 28817747


DOI: 10.1001/jamaoncol.2017.2325




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