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NEJM:色素斑-浸润性乳腺癌的皮肤表现-病例报道

2017-11-02 xing.T MedSci原创

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真皮癌病灶内的腺体被黑色素颗粒大量沉积的黑色素细胞所包围（如图B， Fontana–Masson 染色）。乳腺癌黑色素细胞定植随之而来的色素沉着可能发生镜下偶尔可以表现为皮肤的变化。在这个病例中，癌组织出现在乳头附近，传统的乳腺显像检查对肿瘤检测无效。

患者为一位62岁的女性，因左侧乳头僵硬而到乳腺外科诊所就诊。触诊左侧乳房、钼靶、超声检查均未见异常。然而，左侧乳晕可见一个明显的最大直径为5mm的色素斑（如图A箭头所示）。

病人接受了乳晕皮肤活检。组织病理检查发现为真皮浸润性腺癌。在免疫组化检测中，癌细胞的雌激素和孕激素受体为强阳性，而人表皮生长因子受体2为阴性。



真皮癌病灶内的腺体被黑色素颗粒大量沉积的黑色素细胞所包围（如图B， Fontana–Masson 染色）。乳腺癌黑色素细胞定植随之而来的色素沉着可能发生镜下偶尔可以表现为皮肤的变化。在这个病例中，癌组织出现在乳头附近，传统的乳腺显像检查对肿瘤检测无效。

病人接受了部分乳房切除术，病理检查显示为浸润性导管癌，最大尺寸为9mm，没有转移的证据。该患者接受了抗雌激素治疗和放疗。最后一次随访在开始治疗10个月后，改患者仍然很好，没有进一步的症状。

原始出处：

Takashi Oide, et al.Pigmented Macule — A Skin Manifestation of Invasive Breast Cancer.NEJM.2017.http://www.nejm.org/doi/full/10.1056/NEJMicm1704791

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1680461, encodeId=b73816804610b, content=<a href='/topic/show?id=9e5c86e0712' target=_blank style='color:#2F92EE;'>#色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86707, encryptionId=9e5c86e0712, topicName=色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=343027846633, createdName=sunylz, createdTime=Sun Feb 18 00:58:00 CST 2018, time=2018-02-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=259340, encodeId=79b0259340d5, content=学习了.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLC1BMzZWdMSPQWuib6BtQGicK8ygGBM6YakpfkRc67soFSuKbZr86enL1KggQZEZbgWSeicJibafmYfQ3AibicIHMwwicmDShfRFvvI38/0, createdBy=272a110164, createdName=laoli, createdTime=Tue Nov 07 06:45:12 CST 2017, time=2017-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1461261, encodeId=ef02146126143, content=<a href='/topic/show?id=4ebd65e084e' target=_blank style='color:#2F92EE;'>#浸润性乳腺癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65708, encryptionId=4ebd65e084e, topicName=浸润性乳腺癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=91ec6409669, createdName=xuyu, createdTime=Fri Nov 03 22:58:00 CST 2017, time=2017-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=258177, encodeId=2b322581e78d, content=学习了.受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/y6Sk2KiaDibWSs0icexcRzKWXKao9dILdyaB6olvWApA1uiaapa4T9XMiaU7hTZA04uj2iavabfdCT5iaO6AYue5qSJ7MzXaAVSqh6j/0, createdBy=08e01983553, createdName=执迷不悔, createdTime=Thu Nov 02 23:01:27 CST 2017, time=2017-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=258015, encodeId=8230258015fe, content=是很好的学习材料.不错.以后会多学习., beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Thu Nov 02 08:49:42 CST 2017, time=2017-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=257999, encodeId=025525e99958, content=陈vv刚刚还好还好还好还好哈就, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b0171930782, createdName=为你把脉, createdTime=Thu Nov 02 08:02:37 CST 2017, time=2017-11-02, status=1, ipAttribution=)]
    2018-02-18 sunylz

    #色素#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1680461, encodeId=b73816804610b, content=<a href='/topic/show?id=9e5c86e0712' target=_blank style='color:#2F92EE;'>#色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86707, encryptionId=9e5c86e0712, topicName=色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=343027846633, createdName=sunylz, createdTime=Sun Feb 18 00:58:00 CST 2018, time=2018-02-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=259340, encodeId=79b0259340d5, content=学习了.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLC1BMzZWdMSPQWuib6BtQGicK8ygGBM6YakpfkRc67soFSuKbZr86enL1KggQZEZbgWSeicJibafmYfQ3AibicIHMwwicmDShfRFvvI38/0, createdBy=272a110164, createdName=laoli, createdTime=Tue Nov 07 06:45:12 CST 2017, time=2017-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1461261, encodeId=ef02146126143, content=<a href='/topic/show?id=4ebd65e084e' target=_blank style='color:#2F92EE;'>#浸润性乳腺癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65708, encryptionId=4ebd65e084e, topicName=浸润性乳腺癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=91ec6409669, createdName=xuyu, createdTime=Fri Nov 03 22:58:00 CST 2017, time=2017-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=258177, encodeId=2b322581e78d, content=学习了.受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/y6Sk2KiaDibWSs0icexcRzKWXKao9dILdyaB6olvWApA1uiaapa4T9XMiaU7hTZA04uj2iavabfdCT5iaO6AYue5qSJ7MzXaAVSqh6j/0, createdBy=08e01983553, createdName=执迷不悔, createdTime=Thu Nov 02 23:01:27 CST 2017, time=2017-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=258015, encodeId=8230258015fe, content=是很好的学习材料.不错.以后会多学习., beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Thu Nov 02 08:49:42 CST 2017, time=2017-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=257999, encodeId=025525e99958, content=陈vv刚刚还好还好还好还好哈就, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b0171930782, createdName=为你把脉, createdTime=Thu Nov 02 08:02:37 CST 2017, time=2017-11-02, status=1, ipAttribution=)]
    2017-11-07 laoli

    学习了.谢谢分享!

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1680461, encodeId=b73816804610b, content=<a href='/topic/show?id=9e5c86e0712' target=_blank style='color:#2F92EE;'>#色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86707, encryptionId=9e5c86e0712, topicName=色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=343027846633, createdName=sunylz, createdTime=Sun Feb 18 00:58:00 CST 2018, time=2018-02-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=259340, encodeId=79b0259340d5, content=学习了.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLC1BMzZWdMSPQWuib6BtQGicK8ygGBM6YakpfkRc67soFSuKbZr86enL1KggQZEZbgWSeicJibafmYfQ3AibicIHMwwicmDShfRFvvI38/0, createdBy=272a110164, createdName=laoli, createdTime=Tue Nov 07 06:45:12 CST 2017, time=2017-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1461261, encodeId=ef02146126143, content=<a href='/topic/show?id=4ebd65e084e' target=_blank style='color:#2F92EE;'>#浸润性乳腺癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65708, encryptionId=4ebd65e084e, topicName=浸润性乳腺癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=91ec6409669, createdName=xuyu, createdTime=Fri Nov 03 22:58:00 CST 2017, time=2017-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=258177, encodeId=2b322581e78d, content=学习了.受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/y6Sk2KiaDibWSs0icexcRzKWXKao9dILdyaB6olvWApA1uiaapa4T9XMiaU7hTZA04uj2iavabfdCT5iaO6AYue5qSJ7MzXaAVSqh6j/0, createdBy=08e01983553, createdName=执迷不悔, createdTime=Thu Nov 02 23:01:27 CST 2017, time=2017-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=258015, encodeId=8230258015fe, content=是很好的学习材料.不错.以后会多学习., beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Thu Nov 02 08:49:42 CST 2017, time=2017-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=257999, encodeId=025525e99958, content=陈vv刚刚还好还好还好还好哈就, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b0171930782, createdName=为你把脉, createdTime=Thu Nov 02 08:02:37 CST 2017, time=2017-11-02, status=1, ipAttribution=)]
    2017-11-03 xuyu

    #浸润性乳腺癌#

    0

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    2017-11-02 执迷不悔

    学习了.受益匪浅

    0

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    2017-11-02 李东泽

    是很好的学习材料.不错.以后会多学习.

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1680461, encodeId=b73816804610b, content=<a href='/topic/show?id=9e5c86e0712' target=_blank style='color:#2F92EE;'>#色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86707, encryptionId=9e5c86e0712, topicName=色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=343027846633, createdName=sunylz, createdTime=Sun Feb 18 00:58:00 CST 2018, time=2018-02-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=259340, encodeId=79b0259340d5, content=学习了.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLC1BMzZWdMSPQWuib6BtQGicK8ygGBM6YakpfkRc67soFSuKbZr86enL1KggQZEZbgWSeicJibafmYfQ3AibicIHMwwicmDShfRFvvI38/0, createdBy=272a110164, createdName=laoli, createdTime=Tue Nov 07 06:45:12 CST 2017, time=2017-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1461261, encodeId=ef02146126143, content=<a href='/topic/show?id=4ebd65e084e' target=_blank style='color:#2F92EE;'>#浸润性乳腺癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65708, encryptionId=4ebd65e084e, topicName=浸润性乳腺癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=91ec6409669, createdName=xuyu, createdTime=Fri Nov 03 22:58:00 CST 2017, time=2017-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=258177, encodeId=2b322581e78d, content=学习了.受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/y6Sk2KiaDibWSs0icexcRzKWXKao9dILdyaB6olvWApA1uiaapa4T9XMiaU7hTZA04uj2iavabfdCT5iaO6AYue5qSJ7MzXaAVSqh6j/0, createdBy=08e01983553, createdName=执迷不悔, createdTime=Thu Nov 02 23:01:27 CST 2017, time=2017-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=258015, encodeId=8230258015fe, content=是很好的学习材料.不错.以后会多学习., beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Thu Nov 02 08:49:42 CST 2017, time=2017-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=257999, encodeId=025525e99958, content=陈vv刚刚还好还好还好还好哈就, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b0171930782, createdName=为你把脉, createdTime=Thu Nov 02 08:02:37 CST 2017, time=2017-11-02, status=1, ipAttribution=)]
    2017-11-02 为你把脉

    陈vv刚刚还好还好还好还好哈就

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