1 case of breast-soaked small lobe cancer in the skin

1 Clinical datathe patient, aged 62, with an upper skin swelling in the upper left breast for 5 years and aggravation for 1 yearPatients found 6 years ago in the upper part of the left breast appeared a red knot, no obvious self-conscious symptoms, in the local surgery, color super showed no obvious abnormalities of the two-sided breast, no treatmentAfter the nodulegradual gradually increased, nearly 1 year increase obvious, in the local hospital, the line of breast color super, target, MRI and abdominal color super, lung X-ray and other examination, no abnormality, the local breast surgery recommended dermatology consultation, then came to this hospitalThe patient was physically healthy and had no family history of cancerPhysical examination: The system check is not abnormalDermatology: The upper quadrant of the left breast sees a skin swelling, about 10 cm x 10 cm, hard, protruding, red, smooth surface without breaking (Figure 1)The pathological indication of the skin loss tissue: epidermis did not see abnormal, the dense tumor cells between the dermis collagen fibers were immersed, the adhesion of the tumor cell was more consistent, the tumor cell size was more consistent, the nucleus was small, the normal bias, there was no obvious nuclear division, the flaky or nest-like distribution (Figure 2)ImmuneGroup Weaving Chemical Results: AE1/AE3, ER (s) , PR (s), GATA3 (plus), HER-2 (plus), P120 (plus), Wim (-) , CD4 (-), CD34 (s) -), CD56 (-), CD68 (-), CK7 (-) , CK20 (-), S-100 (-), LCA (-), P63 (-), E Cadherin (-) (Figure 3)diagnosisis breast-soaked small leaf cancer and skin invasionIt is recommended that the operation be completely removed and performed a breast-related examination, when the patient refused, six months later in the local hospital surgery to remove the swellingAt present, the patient is in good condition, regular review did not find breast tumor2 Discussionbreast cancerare divided into leachated cancer, non-immersive cancer and rare cancer, invasive small lobe cancer accounted for 5% to 15% of invasive breast cancerThe patient's clinical manifestations are nodules visible to the naked eye of the upper left breast, pathological manifestations are immersion of dense tumor cells between dermis codialcose fibers, and chemical tumor cell expression of the disease-free tissue: AE1/AE3, ER (s) , PR (s) , GATA3 (s) , HER-2 () can be diagnosed as breast cancerMost patients with small leaf cancer P120 plasma positive, and this patient P120 slurry membrane is positive, at this time E-cadherin expression is particularly important, E-cadherin in small leaf cancer 95% negative (lost), this patient E-cadherin negative, can be diagnosed as breast-soaked small leaf cancerBecause the patient's immersive small lobe cancer occurs in the skin above the breast, not the breast area, there are two considerations, one is the skin metastasis of breast cancer; However, the patient's physical examination is not under armpits and other areas of the swelling, so the side milk bad change is unlikelyMost metastatic tumors will find primary lesions, there are also reports of metastatic tumors as the first symptoms of visceral tumors, this patient breast small lobe cancer occurred in the skin outside the breast, the patient bed examination and imaging examination (including breast color super, antimony, MRI examination, etc.) have not found the primary lesions of the breast, clinically referred to as the hidden breast cancer (occultbreast, OBC) 3% to 30% [3] 。 The growth pattern of immersive small lobe cancer is unique, diffuse and does not disrupt the normal structure of the breastAs a result, it is often difficult to find a physical examination or X-rayA study of 95 cases of hidden breast cancer summary analysis found that mastectomy combined armpit lymph node cleaning or armpit lymph node cleaning combined radiotherapy compared armpit lymph node cleaning surgery can significantly improve the patient's non-local recurrence survival rate (loco recurrent-free, LRFS) and non-recurrence metastasis-free survival rate (recurrence/metastasis-free, RFS)Schoenlaub et alcounted 200 cases of skin metastasis cancer, of which 64 were represented by primary breast cancer with skin metastasis cancer, with a median survival of 138 months with a 10-year survival rate of only 31% (2/64) to indicate the importance of early diagnosisThe patient underwent a local tumor enlargement ectomy, followed up for 1 year, did not recur, and continued to follow upreferences