Lytic Lesions in Breast Cancer
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《新英格兰医药杂志》
A previously healthy 54-year-old woman presented with a two-week history of pelvic pain. On physical examination, she had limited movement, without tenderness in the bones. An initial radiographic survey of skeletal bone showed multiple lytic lesions in the axial skeleton (Panel A, arrow), the ribs, the skull (Panel B, arrow), bilaterally in the pelvis, both femurs (Panel C, arrow), and both humeri (Panel D, arrow). Blood tests showed normocytic normochromic anemia with a hematocrit of 24.9 percent, along with a sedimentation rate of 140 mm per hour. Calcium levels and the results of kidney-function and liver-function tests were normal. The patient was admitted with a provisional diagnosis of multiple myeloma, but no evidence of paraprotein was detected in the blood or urine. Bone marrow biopsy revealed carcinoma cells that were positive for CA 15-3, estrogen receptor (+1), and HER-2 (+2); the serum CA 15-3 level was elevated, at 106 U per milliliter (normal range, 0.3 to 28.0). These findings are consistent with metastatic breast disease. Subsequent mammography and needle biopsy showed only fibrocystic breast disease. The patient has had a response to chemotherapy with doxorubicin and cyclophosphamide, together with analgesics and bisphosphonates.
Daniela Katz, M.D.
Hadassah–Hebrew University Medical Center
Jerusalem 91120, Israel
Dvora Aharoni, M.D.
Shaare Zedek Medical Center
Jerusalem 91031, Israel
Daniela Katz, M.D.
Hadassah–Hebrew University Medical Center
Jerusalem 91120, Israel
Dvora Aharoni, M.D.
Shaare Zedek Medical Center
Jerusalem 91031, Israel