Pulmonary Tumor Embolism 18 Years after Surgery for Paget's Disease of the Breast

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  • 乳房Paget病術後18年目に発症した肺腫瘍塞栓症の1例
  • 症例 乳房Paget病術後18年目に発症した肺腫瘍塞栓症の1例
  • ショウレイ チブサ Pagetビョウ ジュツゴ 18ネンメ ニ ハッショウ シタ ハイ シュヨウ ソクセンショウ ノ 1レイ

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Abstract

A rare case of pulmonary tumor embolism is reported. A 62-year-old woman underwent a mastectomy for left breast cancer in September 1994. The histopathologic diagnosis was Paget's disease of the breast (pT1 mic N0M0, Stage IA). In July 2009, she was found to have an abnormal shadow on chest X-ray. CT showed axillary, supraclavicular, and mediastinal lymph node enlargement. Biopsy showed recurrent lymph node metastases that were ER/PgR-negative and HER2-positive. Paclitaxel and trastuzumab were started, and a partial response (PR) was achieved after 4 cycles of treatment. However, the patient refused to continue chemotherapy and discontinued her follow-up appointments.<BR>In January 2013, the patient was hospitalized for exertional dyspnea, and cardiac catheterization showed pulmonary hypertension. Pulmonary arterial microthrombosis of unknown cause was suspected, and anticoagulant therapy was started. However, treatment was ineffective, and on hospital day 4, the patient's respiratory status worsened and she died. Autopsy examination showed tumor cell invasion in the pulmonary arterioles and in the liver, thyroid, and bone marrow microvessels. The diagnosis was pulmonary tumor embolism.

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