浅谈骨转移性乳腺癌.ppt

Metastatic Breast cancer Case Report General informationGeneral information Name:WU ChunHong Age:40y Sex:Female Date of admission:February 9th,2011 Date of discharge:April 23th,2011 Chief complaintChief complaint She got hypoesthesia of lower limbs and inability to walk for more than a month History of pHistory of present resent illnessillness The patient felt pain on the back by no obvious incentives in June 2010 The pain was tingling,especially in night-time The patient took orally traditional Chinese medicine,but had not tangible effects Past,Personal&Family History No hepatitis,hypertension,or diabetes No smoking,alcohol or drug abuse No inherited diseases No history of drug allergy Normal menstruation Clinical findingsClinical findings The left breast The left breast presented with presented with diffused diffused erythema and erythema and edema,edema,induration induration about size of about size of 3.0cm*3.0cm3.0cm*3.0cm Ultrasound Ultrasound examinationexamination a 3 cm left breast mass and a normal right breast Thoracic MRI examination Thoracic MRI examination HighHigh-density mass was shown on the seventh density mass was shown on the seventh thoracic,and bone destruction also had been found.thoracic,and bone destruction also had been found.Enhanced MRIEnhanced MRI Laboratory examination 2011-02-09 1.Hepatic functions ALT 40 U/L AST 20 U/L TB Normal 3.Tumor markers CA19-9 Normal 2.Blood routine test Hb 82 g/L RBC 4.541012/L WBC 6.1109/L PLT 201 109/L puncture biopsy She received ultrasound guided breast core needle puncture biopsy Puncture tissue pathology:The left breast invasive ductal carcinoma Primary diagnosisPrimary diagnosis Breast cancer with bone metastasis TreatmentTreatment On February 11,2011 in orthopedic department,The Patient received the seventh thoracic tumor resection and pedicle screw fixation Histological examination Seventh thoracic Seventh thoracic tumors was identified tumors was identified as metastatic as metastatic carcinoma,and the carcinoma,and the immunohistochemistry immunohistochemistry results showed the results showed the possibility of breast possibility of breast cancer bone cancer bone metastasis was very metastasis was very largelarge IMMUNOHISTOCHEMICAL results ER+PR+CerbB2-CK20-EMA+,Ckpan+,CK5/6-Treatment The patient recovered well,and then transferred into our department Chemotherapy two times before operation:February 23,2011 March 20,2011 The chemotherapy plan was TEC TreatmentTreatment After the chemotherapy The lesions area of left breast showed no reduction Treatment Modified radical Modified radical mastectomy on marchmastectomy on march 31,201131,2011 Bilateral Bilateral oophorectomyoophorectomy On the same dayOn the same day Histological examination The left breast The left breast invasive ductal invasive ductal carcinomacarcinoma The basal resection The basal resection margin of tumor was margin of tumor was close to the close to the surrounding normal surrounding normal tissuetissue The axillary lymph The axillary lymph nodes metastasis nodes metastasis(13/15)(13/15)Immunohistochemical ER+PR+CerbB2-E-cad+,Ki6750%+,P53+,Ck5/6-Treatment After operation,the patient continued to receive chemotherapy and radiotherapy.Thank you