PDF(Pubmed)
Abstract：
BACKGROUND: The incidence of colon cancer is increasing worldwide. Treatments for colon cancer include surgery and surgery combined with chemotherapy and radiotherapy, but the median survival rate is still poor. Colon cancer most commonly metastasizes to the lymph nodes, lungs, liver, peritoneum, and brain, but breast metastasis is rare. There is no agreement on its treatment.
METHODS: A 23-year-old woman was admitted to our hospital for further treatment with a history of acute abdominal pain, nausea, and vomiting. Her physical examination and computed tomography scan revealed an abdominal tumor. Transverse colectomy was successfully performed. Histopathological examination revealed that the tumor was a mucosecretory adenocarcinoma with signet ring cells. The patient inadvertently found a mass in the outer upper quadrant of the right breast after four cycles of XELOX chemotherapy [oxaliplatin 130 mg/m2, d1, intravenous (iv) drip for 2 h; capecitabine 1000 mg/m2, po, bid, d1-d14]. After discussion with the patient, we performed a lumpectomy and frozen biopsy. The latter revealed that the breast tumor was intestinal metastasis. Genetic testing showed wild-type RAS and BRAF. So we replaced the original chemotherapy with FOLFIRI [irinotecan 180 mg/m2, d1, iv drip for 3-90 min; leucovorin 400 mg/m2, d1, iv drip for 2 h; 5-fluorouracil (5-FU) 400 mg/m2, d1 and 5-FU 1200 mg/(m2 d) × 2 d, continuous iv drip for 46-48 h] + cetuximab (500 mg/m2, d1, iv drip for 2 h). Serum levels of tumor markers returned to normal after several treatment cycles, and there was no evidence of tumor recurrence or metastasis.
CONCLUSIONS: Breast metastasis from colon cancer is rare. Radical breast surgery should be avoided unless needed for palliation. Chemotherapy combined with targeted therapy should be the first choice.
METHODS: A 23-year-old woman was admitted to our hospital for further treatment with a history of acute abdominal pain, nausea, and vomiting. Her physical examination and computed tomography scan revealed an abdominal tumor. Transverse colectomy was successfully performed. Histopathological examination revealed that the tumor was a mucosecretory adenocarcinoma with signet ring cells. The patient inadvertently found a mass in the outer upper quadrant of the right breast after four cycles of XELOX chemotherapy [oxaliplatin 130 mg/m2, d1, intravenous (iv) drip for 2 h; capecitabine 1000 mg/m2, po, bid, d1-d14]. After discussion with the patient, we performed a lumpectomy and frozen biopsy. The latter revealed that the breast tumor was intestinal metastasis. Genetic testing showed wild-type RAS and BRAF. So we replaced the original chemotherapy with FOLFIRI [irinotecan 180 mg/m2, d1, iv drip for 3-90 min; leucovorin 400 mg/m2, d1, iv drip for 2 h; 5-fluorouracil (5-FU) 400 mg/m2, d1 and 5-FU 1200 mg/(m2 d) × 2 d, continuous iv drip for 46-48 h] + cetuximab (500 mg/m2, d1, iv drip for 2 h). Serum levels of tumor markers returned to normal after several treatment cycles, and there was no evidence of tumor recurrence or metastasis.
CONCLUSIONS: Breast metastasis from colon cancer is rare. Radical breast surgery should be avoided unless needed for palliation. Chemotherapy combined with targeted therapy should be the first choice.
摘要：
背景：结肠癌的发病率在全球范围内呈上升趋势。结肠癌的治疗包括手术和手术联合化疗和放疗，但中位生存率仍然很低。结肠癌最常转移到淋巴结,肺,肝脏,腹膜,和大脑，但乳腺转移很少见.对其待遇没有达成一致。
方法：一名23岁女性因急性腹痛病史入院接受进一步治疗，恶心,和呕吐。她的体格检查和计算机断层扫描显示腹部肿瘤。成功进行了横向结肠切除术。组织病理学检查显示，该肿瘤是带有印戒细胞的粘液分泌型腺癌。患者在四个周期的XELOX化疗[奥沙利铂130mg/m2，d1，静脉（iv）滴注2h；卡培他滨1000mg/m2，po，bid,d1-d14]。在与病人讨论之后,我们进行了肿块切除术和冷冻活检.后者提示乳腺肿瘤为肠转移。基因检测显示为野生型RAS和BRAF。因此，我们用FOLFIRI代替原来的化疗[伊立替康180mg/m2，d1，静脉滴注3-90分钟；亚叶酸400mg/m2，d1，静脉滴注2小时；5-氟尿嘧啶（5-FU）400mg/m2，d1和5-FU1200mg/（m2d）×2d，连续静脉滴注46-48h]+西妥昔单抗（500mg/m2，d1，静脉滴注2h）。几个治疗周期后，血清肿瘤标志物水平恢复正常，没有肿瘤复发或转移的证据。
结论：结肠癌的乳腺转移是罕见的。除非需要缓解，否则应避免根治性乳房手术。化疗联合靶向治疗应成为首选。
方法：一名23岁女性因急性腹痛病史入院接受进一步治疗，恶心,和呕吐。她的体格检查和计算机断层扫描显示腹部肿瘤。成功进行了横向结肠切除术。组织病理学检查显示，该肿瘤是带有印戒细胞的粘液分泌型腺癌。患者在四个周期的XELOX化疗[奥沙利铂130mg/m2，d1，静脉（iv）滴注2h；卡培他滨1000mg/m2，po，bid,d1-d14]。在与病人讨论之后,我们进行了肿块切除术和冷冻活检.后者提示乳腺肿瘤为肠转移。基因检测显示为野生型RAS和BRAF。因此，我们用FOLFIRI代替原来的化疗[伊立替康180mg/m2，d1，静脉滴注3-90分钟；亚叶酸400mg/m2，d1，静脉滴注2小时；5-氟尿嘧啶（5-FU）400mg/m2，d1和5-FU1200mg/（m2d）×2d，连续静脉滴注46-48h]+西妥昔单抗（500mg/m2，d1，静脉滴注2h）。几个治疗周期后，血清肿瘤标志物水平恢复正常，没有肿瘤复发或转移的证据。
结论：结肠癌的乳腺转移是罕见的。除非需要缓解，否则应避免根治性乳房手术。化疗联合靶向治疗应成为首选。
