Cerebral Metastases in Breast Cancer
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《新英格兰医药杂志》
A 52-year-old woman received a diagnosis of stage II hormone-receptor–negative, HER2-positive breast carcinoma (2 of 13 nodes positive). She underwent a left segmental mastectomy, axillary dissection, adjuvant chemotherapy (doxorubicin and cyclophosphamide, followed by cyclophosphamide, methotrexate, and fluorouracil), and local radiotherapy. Two years later, she had recurrent disease with left cervical lymphadenopathy and pulmonary metastases. Her metastatic disease remained well controlled by treatment with trastuzumab and systemic chemotherapy (docetaxel, then vinorelbine). Six years after her initial diagnosis, she presented with headaches and unsteadiness. Four months earlier, computed tomographic (CT) scanning of the brain was normal. Repeated CT and magnetic resonance imaging (Panel A, coronal T1-weighted image with gadolinium enhancement) revealed numerous calcified masses in the cerebrum, cerebellum, and brain stem (arrows). The patient's condition worsened rapidly despite high doses of corticosteroids, and she was not considered an appropriate candidate for whole-brain radiotherapy. She died one month later. A postmortem examination confirmed the presence of calcified, necrotic cerebral metastases (arrows in Panel B, coronal section). HER2-positive breast cancer has a higher rate of brain metastases than HER2-negative cancers, as seen in this case.
Hannah Rouse, M.B., B.S.
Sarah-Jane Dawson, M.B., B.S.
St. Vincent's Hospital
Victoria 3065, Australia
Hannah Rouse, M.B., B.S.
Sarah-Jane Dawson, M.B., B.S.
St. Vincent's Hospital
Victoria 3065, Australia