植東 ゆみ¹, 松下 陽子¹, 岡山 幸成¹, 西村 理², 松末 智², 小橋 陽一郎³

Yumi UEHIGASHI¹, Yoko MATSUSHITA¹, Yukinari OKAYAMA¹, Satoru NISHIMURA², Satoru MATSUSUE², Yoichiro KOBASHI³

¹天理よろづ相談所病院臨床病理部, ²天理よろづ相談所病院腹部一般外科, ³天理よろづ相談所病院医学研究所病理

¹Department of Clinical Pathology, Tenri Hospital, ²Department of General Surgery, Tenri Hospital, ³Department of Pathology, Tenri Hospital

キーワード : breast carcinoma, calcification, mucinous carcinoma, ultrasonography

乳房超音波断層法(以下US)で, 多発粗大石灰化を伴う乳腺腫瘍として描出された乳腺粘液癌の1例を経験したので, US像を中心に報告する. 症例は47歳女性. 1年前より右乳房腫瘤を自覚していたが, 増大を認めて本院を受診した. USで右A領域に3 cmの多発粗大石灰化を伴う境界不明瞭な腫瘤およびその乳頭側に1 cm大の形状不整な低エコー腫瘤を認め, 共に悪性を疑った. 主病変は, マンモグラフィで粗大樹枝状の石灰化を認め, 穿刺吸引細胞診でclass Ⅴ粘液癌と診断された. MRIでも娘結節を認め, 胸筋温存乳房切除術が施行された. 病理組織学的に両病変とも粘液癌で, 主病変の腫瘤内部や周囲に粗大な石灰化を伴っていた. 自験例は多発粗大石灰化とそれに伴う音響陰影を特徴とし, 粘液癌として非典型的な像を呈した.

Ultrasonography detected apparent echoes of especially coarse calcifications in a case of mucinous carcinoma of the breast. A 47 year-old female visited this institution with a mass of increasing size in her right breast for 1 year. The ultrasonogram showed two mass lesions: a primary lesion 3 cm in diameter with a margin partially obscured by coarse calcification echoes, and a daughter lesion 1 cm in diameter near the nipple that accompanied no calcification echo. Mammogram of the right breast showed a group of coarse, amorphous calcifications, and MRI depicted both the main and daughter tumor. Mastectomy was carried out when fine-needle aspiration cytologic examination of the primary tumor led to a diagnosis of class V mucinous carcinoma. Both lesions were diagnosed as mucinous carcinomas on histologic examination, and coarse calcifications were found in and around the main tumor. Mucinous carcinomas with coarse calcifications have been rarely reported. Definite diagnosis of breast tumors with coarse calcification echoes on ultrasonogram requires further examination.