1、General informationGeneral information Name:WU ChunHong Age:40y Sex:Female Date of admission:February 9th,2011 Date of discharge:April 23th,2011Chief complaintChief complaint She got hypoesthesia of lower limbs and inability to walk for more than a monthHistory of pHistory of present resent illnessi
2、llness The patient felt pain on the back by no obvious incentives in June 2010 The pain was tingling,especially in night-time The patient took orally traditional Chinese medicine,but had not tangible effectsPast,Personal&Family History No hepatitis,hypertension,or diabetes No smoking,alcohol or drug
3、 abuse No inherited diseases No history of drug allergy Normal menstruationClinical findingsClinical findingsThe left breast The left breast presented with presented with diffused diffused erythema and erythema and edema,edema,induration induration Ultrasound Ultrasound examinationexaminationa 3 cm
4、left breast mass and a normal right breast Thoracic MRI examination Sex:FemaleIMMUNOHISTOCHEMICAL resultsShe received ultrasound guided breast core needle puncture biopsyChemotherapy two times before operation:The pain was tingling,especially in night-timeThe patient took orally traditional Chinese
5、medicine,but had not tangible effectsShe got hypoesthesia of lower limbs and inability to walk for more than a monthDate of admission:February 9th,2011The Patient receivedThe axillary lymph nodes metastasis(13/15)CA19-9 NormalHistory of present illnessThe patient felt pain on the back by no obvious
6、incentives in June 2010Thoracic MRI examinationpuncture biopsyAST 20 U/LNo history of drug allergySex:FemaleShe received ultrasound guided breast core needle puncture biopsyImmunohistochemicalThoracic MRI examinationHigh-density mass was shown on the seventh High-density mass was shown on the sevent
7、h thoracic,and bone destruction also had been found.thoracic,and bone destruction also had been found.Enhanced MRIEnhanced MRILaboratory examination 2011-02-09 1.Hepatic functions ALT 40 U/L AST 20 U/L TB Normal3.Tumor markers CA19-9 Normal 2.Blood routine test Hb 82 g/L RBC 4.541012/L WBC 6.1109/L
8、PLT 201 109/L puncture biopsy She received ultrasound guided breast core needle puncture biopsy Puncture tissue pathology:The left breast invasive ductal carcinomaPrimary diagnosisPrimary diagnosis Breast cancer with bone metastasisTreatmentTreatmentOn February 11,2011 in orthopedic department,The P
9、atient receivedthe seventh thoracic tumor resection and pedicle screw fixationHistological examinationSeventh thoracic Seventh thoracic tumors was identified tumors was identified as metastatic as metastatic carcinoma,and the carcinoma,and the immunohistochemistry immunohistochemistry results showed
10、 the results showed the possibility of breast possibility of breast cancer bone cancer bone metastasis was very metastasis was very largelargeIMMUNOHISTOCHEMICAL resultsER+PR+CerbB2-CK20-EMA+,Ckpan+,CK5/6-TreatmentThe patient recovered well,and then transferred into our departmentChemotherapy two ti
11、mes before operation:February 23,2011 March 20,2011 The chemotherapy plan was TECTreatmentTreatmentAfter the chemotherapyThe lesions area of left breast showed no reduction TreatmentModified radical Modified radical mastectomy on marchmastectomy on march31,201131,2011Bilateral oophorectomyBilateral
12、oophorectomyOn the same dayOn the same dayHistological examinationThe left breast The left breast invasive ductal invasive ductal carcinomacarcinomaThe basal resection The basal resection margin of tumor was margin of tumor was close to the close to the surrounding normal surrounding normal tissueti
13、ssueThe axillary lymph The axillary lymph nodes metastasis nodes metastasis(13/15)(13/15)Sex:FemaleHistory of present illnessAfter the chemotherapyPrimary diagnosisShe received ultrasound guided breast core needle puncture biopsyThe Patient receivedEnhanced MRINo hepatitis,hypertension,or diabetesPu
14、ncture tissue pathology:The left breast invasive ductal carcinomaIMMUNOHISTOCHEMICAL resultsER+PR+ER+PR+Thoracic MRI examinationSex:FemaleDate of admission:February 9th,2011Chief complaintthe seventh thoracic tumor resection and pedicle screw fixationThe patient felt pain on the back by no obvious i
15、ncentives in June 2010Normal menstruationHistological examinationThe basal resection margin of tumor was close to the surrounding normal tissueImmunohistochemicalER+PR+CerbB2-E-cad+,Ki6750%+,P53+,Ck5/6-Treatment After operation,the patient continued to receive chemotherapy and radiotherapy.Thank you
16、History of pHistory of present resent illnessillness The patient felt pain on the back by no obvious incentives in June 2010 The pain was tingling,especially in night-time The patient took orally traditional Chinese medicine,but had not tangible effectsPast,Personal&Family History No hepatitis,hyper
17、tension,or diabetes No smoking,alcohol or drug abuse No inherited diseases No history of drug allergy Normal menstruationUltrasound Ultrasound examinationexaminationa 3 cm left breast mass and a normal right breast IMMUNOHISTOCHEMICAL resultsER+PR+CerbB2-CK20-EMA+,Ckpan+,CK5/6-TreatmentTreatmentAfte
18、r the chemotherapyThe lesions area of left breast showed no reduction IMMUNOHISTOCHEMICAL resultsa normal right breasta normal right breastBlood routine test Hb 82 g/L RBC 4.Past,Personal&Family HistoryEnhanced MRINo smoking,alcohol or drug abuseAST 20 U/LThe patient felt pain on the back by no obvi
19、ous incentives in June 2010Chemotherapy two times before operation:ER+PR+the seventh thoracic tumor resection and pedicle screw fixationThe Patient receivedALT 40 U/LHistory of present illnessER+PR+She received ultrasound guided breast core needle puncture biopsyPrimary diagnosisShe received ultraso
20、und guided breast core needle puncture biopsypuncture biopsyNormal menstruationthe seventh thoracic tumor resection and pedicle screw fixationPrimary diagnosisName:WU ChunHongThe patient felt pain on the back by no obvious incentives in June 2010Blood routine test Hb 82 g/L RBC 4.Bilateral oophorect
21、omyHistological examinationHistory of present illnessNo inherited diseasesALT 40 U/LCerbB2-CK20-541012/L WBC 6.Enhanced MRIThe left breast invasive ductal carcinomaThe patient felt pain on the back by no obvious incentives in June 2010Tumor markersE-cad+,Ki6750%+,P53+,Ck5/6-ImmunohistochemicalThe ax
22、illary lymph nodes metastasis(13/15)The patient recovered well,and then transferred into our departmentNo hepatitis,hypertension,or diabetesShe received ultrasound guided breast core needle puncture biopsyAfter the chemotherapyAfter the chemotherapyThe Patient receivedThoracic MRI examinationNo hist
23、ory of drug allergyBreast cancer with bone metastasisImmunohistochemicalTumor markersGeneral informationThoracic MRI examinationpuncture biopsyAST 20 U/LIMMUNOHISTOCHEMICAL resultsThe patient felt pain on the back by no obvious incentives in June 2010a normal right breastAfter operation,the patient
24、continued to receive chemotherapy and radiotherapy.History of present illnessER+PR+General informationThe left breast presented with diffused erythema and edema,indurationModified radical mastectomy on marchThe patient felt pain on the back by no obvious incentives in June 2010No hepatitis,hypertens
25、ion,or diabetesThoracic MRI examinationMarch 20,2011No smoking,alcohol or drug abuseLaboratory examinationThe Patient receivedALT 40 U/Lthe seventh thoracic tumor resection and pedicle screw fixationIMMUNOHISTOCHEMICAL resultsThe lesions area of left breast showed no reductionNo hepatitis,hypertension,or diabetesER+PR+E-cad+,Ki6750%+,P53+,Ck5/6-No history of drug allergypuncture biopsyChemotherapy two times before operation:After the chemotherapyBilateral oophorectomya normal right breastClinical findingsImmunohistochemicalER+PR+CerbB2-E-cad+,Ki6750%+,P53+,Ck5/6-
