Изолированный метастаз в кожу головы при оккультном раке молочной железы. Клинический случай

Изолированный метастаз в кожу головы при оккультном раке молочной железы. Клинический случай

Огнерубов Н.А., Сергеев Р.С., Хижняк А.О., Огнерубова М.А., Джабраилов М.А. Изолированный метастаз в кожу головы при оккультном раке молочной железы. Клинический случай. Современная Онкология. 2024;26(1):112–117. DOI: 10.26442/18151434.2024.1.202655

© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.

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Ognerubov NA, Sergeev RS, Hizhnyak AO, Ognerubova MA, Dzhabrailov MA. Isolated metastasis to the scalp in occult breast cancer: a clinical case. Journal of Modern Oncology. 2024;26(1):112–117.
DOI: 10.26442/18151434.2024.1.202655

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Аннотация

Злокачественные опухоли остаются серьезной социально-экономической проблемой здравоохранения во всем мире. Среди них рак молочной железы (РМЖ) у женщин занимает 1‑е место в структуре заболеваемости и 4‑е – смертности. Оккультный РМЖ встречается от 0,1 до 1% среди всех его случаев. При этом варианте метастазы в кожу волосистой части головы наблюдаются крайне редко. В статье представлен случай метастатического поражения кожи волосистой части головы при оккультном РМЖ. Пациентка С., 82 года, обратилась за медицинской помощью по поводу опухоли кожи в теменной области, которую обнаружила сама около 2 лет назад. В последнее время отмечает ее рост, появление локальной алопеции и гиперемии вокруг. Проведено комплексное обследование. При цитологическом исследовании пунктата из опухоли выявлены клетки злокачественного новообразования. По данным маммографии и ультразвукового исследования в молочных железах и лимфатических узлах специфических изменений не выявлено. При спиральной компьютерной томографии органов грудной клетки и органов брюшной полости признаков опухоли не обнаружено. Выполнено оперативное лечение в объеме иссечения. При гистологическом исследовании – в опухоли картина метастаза аденокарциномы. Иммуногистохимическое заключение: клетки опухоли диффузно и сильно экспрессируют рецепторы эстрогенов, диффузно и слабо – рецепторы прогестерона, сильно и очагово-диффузно – раковый эмбриональный антиген (CEA), а также антиген эпителиальной мембраны (EMA). Индекс пролиферативной активности Ki‑67 – менее 20%, Her2‑neu 0. Учитывая морфологию и данные иммуногистохимического исследования, имеет место метастаз РМЖ, молекулярно-биологический вариант – люминальный тип А. При сцинтиграфии костей скелета – метастатическое поражение отсутствует. Установлен диагноз: оккультная форма РМЖ, стадия IV cTxN0M1, метастаз в кожу волосистой части головы. Назначена гормонотерапия ингибиторами ароматазы. При динамическом наблюдении на протяжении 6 мес признаков возврата заболевания нет. Изолированное метастазирование в кожу волосистой части головы при оккультном РМЖ является чрезвычайно редким явлением. Практическим врачам необходимо помнить о таком варианте отдаленного метастазирования злокачественных опухолей, что следует учитывать при проведении дифференциальной диагностики.

Ключевые слова: рак молочной железы, оккультная форма, метастазы в кожу головы, хирургическое лечение, гормонотерапия

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Malignancies remain a serious socio-economic health problem worldwide. Among them, breast cancer (BC) in women ranks 1st in the structure and 4th in mortality. Occult breast cancer accounts for 0.1 to 1% of all BC. In this type, metastases to the scalp are extremely rare. This article presents a case of metastatic lesion of the scalp in occult breast cancer. Patient S., 82 years old, presented with a skin tumor in the parietal region, which she noticed about 2 years ago. It has grown recently, with local alopecia and hyperemia around the lesion. A comprehensive examination was performed. Cytology of the punctate showed malignant cells. Mammography and ultrasound showed no specific changes in the breast and lymph nodes. Spiral computed tomography of the chest and abdomen showed no signs of tumor. The lesion was surgically removed. Histological examination revealed adenocarcinoma metastasis. Immunohistochemical examination revealed tumor cells with diffuse and strong expression of estrogen receptors, diffuse and weak expression of progesterone receptors, strong and focal-diffuse expression of cancer embryonic antigen (CEA), and epithelial membrane antigen (EMA). The proliferative activity index of Ki-67 was less than 20%, Her2-neu 0. Considering the morphology and immunohistochemical data, the lesion was a metastasis of breast cancer with a luminal type A molecular biological variant. Skeletal bone scintigraphy revealed no metastatic lesions. The patient was diagnosed with an occult type of breast cancer, stage IV cTxN0M1, with metastasis to the scalp. Hormone therapy with aromatase inhibitors was administered. There were no signs of recurrence during the follow-up for 6 months. Isolated scalp metastasis in occult breast cancer is extremely rare. Practitioners should consider this type of distant metastasis of malignancies in differential diagnosis.

Keywords: breast cancer, occult type, scalp metastases, surgical treatment, hormone therapy

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Список литературы

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29. Enomoto LM, Levine EA, Shen P, Votanopoulos KI. Role of surgery for metastatic melanoma. Surg Clin North Am. 2020;100(1):127-39. DOI:10.1016/j.suc.2019.09.011
30. Hu SCS, Chen GS, Lu YW, et al. Cutaneous metastases from different internal malignancies: a clinical and prognostic appraisal. J Eur Acad Dermatol Venereol. 2008;22(6):735-40. DOI:10.1111/j.1468‑3083.2008.02590.x
31. Poovaneswaran S, Lee ZEJ, Lim WY, et al. Cutaneous lesions as a presenting sign of metastases in male breast cancer: a rare clinical entity. Med J Malaysia. 2013;68(2):168-70. Available at: https://www.scopus.com/inward/record.uri?eid=2‑s2.0‑84876905197%26partnerID=40%26md5=b4d2aacf84d1461.... Accessed: 05.09.2023
32. Pizzuti L, Sergi D, Barba M, Vici P. Unusual long-lasting cutaneous complete response to lapatinib and capecitabine in a heavily pretreated HER2-positive plurimetastatic breast cancer paient. Tumori. 2013;99(3): e127-30. Available at: https://www.scopus.com/inward/record.uri?eid=2‑s2.0‑84886056753%26partnerID=40%26md5=b04f94305a41606.... Accessed: 05.09.2023
33. Takayama S, Satomi K, Yoshida M, et al. Spontaneous regression of occult breast cancer with axillary lymph node metastasis: A case report. Int J Surg Case Rep. 2019;63:75‑9. DOI:10.1016/j.ijscr.2019.09.017

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1. Prabhu S, Pai SB, Handattu S, et al. Cutaneous metastases from carcinoma breast: the common and the rare. Indian J Dermatol Venereol Leprol. 2009;75:499‑502.
2. Chiu CS, Lin CY, Kuo TT, et al. Malignant cutaneous tumors of the scalp: a study of demographic characteristics and histologic distributions of 398 Taiwanese patients. J Am Acad Dermatol. 2007;56(3):448‑52. DOI:10.1016/j.jaad.2006.08.060
3. da Costa REAR, Dos Reis CA, Moura RD, et al. Cutaneous metastasis of occult breast cancer: a case report. Pan Afr Med J. 2021;40:23. DOI:10.11604/pamj.2021.40.23.31009
4. Giovanna FM, Plutino FM, Turano L, et al. Isolated cutaneous metastasis of scalp in breast cancer: A case-report. Oncol Radiother. 2023;17(1):13‑7.
5. Fayanju OM, Jeffe DB, Margenthaler JA. Occult primary breast cancer at a comprehensive cancer center. J Surg Res. 2013;185(2):684‑9. DOI:10.1016/j.jss.2013.06.020
6. Di Chio F, Santangelo G, Fiorentino F, et al. Occult breast cancer in a female with benign lesions. J Cancer Res Ther. 2019;15(5):1170‑2.
7. Kaklamani Kaklamani VV, Gradishar WW. Waltham; 2022. UpToDate. Axillary node metastases with occult primary breast cancer.
8. Terada M, Adachi Y, Sawaki M, et al. Occult breast cancer may originate from ectopic breast tissue present in axillary lymph nodes. Breast Cancer Res Treat. 2018;172(1):1‑7. DOI:10.1007/s10549‑018‑4898‑4
9. Moore S. Cutaneous metastatic breast cancer. Clin J Oncol Nurs. 2002;6(5):255‑60. DOI:10.1188/02.CJON.255‑260
10. Chisti MA, Alfadley AA, Banka N, Ezzat A. Cutaneous metastasis from breast carcinoma: a brief report of a rare variant and proposed morphological classification. Gulf J Oncol. 2013;1(14):90-4. Available at: https://www.scopus.com/inward/record.uri?eid=2‑s2.0‑84910067414%26partnerID=40%26md5=e5a9e8bcbddbf61.... Accessed: 05.09.2023
11. Alizadeh N, Mirpour H, Azimi SZ. Scalp metastasis from occult primary breast carcinoma: a case report and review of the literature. Int J Womens Dermatol. 2018;4(4):230‑5.
12. Khodorovich ОS, Solodkiy VA, Kalinina-Masri AA, et al. Occult breast cancer. Literature review and case series. Tumors of female reproductive system. 2020;16(4):46‑53 (in Russian). DOI:10.17650/1994‑4098‑2020‑16‑4–46‑53
13. Aleman Espino A, Bernal IC, Guarecuco JE, et al. Adenocarcinoma of the Breast Presenting as Occult Breast Cancer With Axillary and Supraclavicular Lymph Node Metastasis: A Case Report. Cureus. 2023;15(5): e39583. DOI:10.7759/cureus.39583
14. Globocan cancer observatory, 2022. Available at: https://gco.iarc.fr/Accessed: 10.09.2023.
15. Bittencourt MJS, Carvalho AH, Nascimento BA, et al. Cutaneous metastasis of a breast cancer diagnosed 13 years before. An Bras Dermatol. 2015;90:134‑7.
16. Huang S, Parekh V, Waisman J et al. Cutaneous metastasectomy: Is there a role in breast cancer? A systematic review and overview of current treatment modalities. J Surg Oncol. 2022;126(2):217‑38. DOI:10.1002/jso.26870
17. Ferreira VA, Spelta K, Martins Diniz L, Lucas EA. Exuberant case of cutaneous metastasis of breast cancer. An Bras Dermatol. 2018;93:429‑31.
18. Kuwayama T, Sato T, Nakagawa T, et al. A case of scalp metastases from breast cancer successfully treated with letrozole. Gan To Kagaku Ryoho. 2011;38(12):2183‑5.
19. Cohen-Kurzrock RA, Riahi RR. Cutaneous Metastatic Breast Cancer Masked by Hidradenitis Suppurativa. Cureus. 2021;13(1):e12862. DOI:10.7759/cureus.12862
20. Huang KY, Zhang J, Fu WF, et al. Different Clinicopathological Characteristics and Prognostic Factors for Occult and Non-occult Breast Cancer: Analysis of the SEER Database. Front Oncol. 2020;10:1420. DOI:10.3389/fonc.2020.01420
21. Paolino G, Pampena R, Grassi S, et al. Alopecia neoplastica as a sign of visceral malignancies: a systematic review. J Eur Acad Dermatol Venereol. 2019;33(6):1020‑8. DOI:10.1111/jdv.15498
22. Rocha M, Azevedo D, Teira A, Barbosa M. Not everything is as it seems: a rare form of metastatic breast cancer. Autops Case Rep. 2019;9(2):e2018085. DOI:10.4322/acr.2018.085
23. Henriques L, Palumbo M, Guay MP, et al. Imiquimod in the treatment of breast cancer skin metastasis. J Clin Oncol. 2014;32(8): e22-5. DOI:0.1200/JCO.2012.46.4883
24. Kong JH, Park YH, Kim JA, et al. Patterns of skin and soft tissue metastases from breast cancer according to subtypes: relationship between EGFR overexpression and skin manifestations. Oncology. 2011;81(1):55-62. DOI:10.1159/000331417
25. Rollins-Raval M, Chivukula M, Tseng GC, et al. An immunohistochemical panel to differentiate metastatic breast carcinoma to skin from primary sweat gland carcinomas with a review of the literature. Arch Pathol Lab Med. 2011;135(8):975‑83. DOI:10.5858/2009‑0445-OAR2
26. Liu YF, Liu LY, Xia SL, et al. An unusual case of Scalp Metastasis from Breast Cancer. World Neurosurg. 2020;137:261‑5.
27. Allison R, Mang T, Hewson G, et al. Photodynamic therapy for chest wall progression from breast carcinoma is an underutilized treatment modality. Cancer. 2001;91(1):1-8. DOI:10.1002/1097‑0142(20010101)91:1<1:: AID-CNCR1>3.0.CO;2-P
28. Nelson DW, Fischer TD, Graff-Baker AN, et al. Impact of effective systemic therapy on metastasectomy in stage IV melanoma: a matched-pair analysis. Ann Surg Oncol. 2019;26(13):4610-8. DOI:10.1245/s10434‑019‑07487‑5
29. Enomoto LM, Levine EA, Shen P, Votanopoulos KI. Role of surgery for metastatic melanoma. Surg Clin North Am. 2020;100(1):127-39. DOI:10.1016/j.suc.2019.09.011
30. Hu SCS, Chen GS, Lu YW, et al. Cutaneous metastases from different internal malignancies: a clinical and prognostic appraisal. J Eur Acad Dermatol Venereol. 2008;22(6):735-40. DOI:10.1111/j.1468‑3083.2008.02590.x
31. Poovaneswaran S, Lee ZEJ, Lim WY, et al. Cutaneous lesions as a presenting sign of metastases in male breast cancer: a rare clinical entity. Med J Malaysia. 2013;68(2):168-70. Available at: https://www.scopus.com/inward/record.uri?eid=2‑s2.0‑84876905197%26partnerID=40%26md5=b4d2aacf84d1461.... Accessed: 05.09.2023
32. Pizzuti L, Sergi D, Barba M, Vici P. Unusual long-lasting cutaneous complete response to lapatinib and capecitabine in a heavily pretreated HER2-positive plurimetastatic breast cancer paient. Tumori. 2013;99(3): e127-30. Available at: https://www.scopus.com/inward/record.uri?eid=2‑s2.0‑84886056753%26partnerID=40%26md5=b04f94305a41606.... Accessed: 05.09.2023
33. Takayama S, Satomi K, Yoshida M, et al. Spontaneous regression of occult breast cancer with axillary lymph node metastasis: A case report. Int J Surg Case Rep. 2019;63:75‑9. DOI:10.1016/j.ijscr.2019.09.017

Авторы

Н.А. Огнерубов*¹, Р.С. Сергеев², А.О. Хижняк³, М.А. Огнерубова³, М.А. Джабраилов^3,4

¹Пензенский институт усовершенствования врачей – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Пенза, Россия;
²ГБУЗ «Областной онкологический клинический диспансер», Пенза, Россия;
³ГБУЗ «Тамбовский областной онкологический клинический диспансер», Тамбов, Россия;
⁴ФГБОУ ВО «Тамбовский государственный университет им. Г.Р. Державина», Тамбов, Россия
*ognerubov_n.a@mail.ru

________________________________________________

Nikolai A. Ognerubov*¹, Ruslan S. Sergeev², Aleksej O. Hizhnyak³, Marina A. Ognerubova³, Magomed A. Dzhabrailov^3,4

¹Penza Institute for Advanced Training of Physicians – branch of the Russian Medical Academy of Continuous Professional Education, Penza, Russia;
²Regional Oncological Clinical Dispensary, Penza, Russia;
³Tambov Regional Oncological Clinical Dispensary, Tambov, Russia;
⁴Derzhavin Tambov State University, Tambov, Russia
*ognerubov_n.a@mail.ru

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