Breast cancer skin metastases
Introduction
Introduction to skin metastasis of breast cancer Breast cancer (ceastcarcinoma) metastasis often occurs in the trunk, but can also occur in other parts, such as the upper limbs and head, breast cancer spread by lymphatic vessels, there are 4 types of metastasis, respectively, inflammatory cancer, telangiectasia Cancer, nodular carcinoma, and sputum thyroidoma, type 5 occurs through blood circulation and is quite rare. basic knowledge The proportion of illness: 0.0025% Susceptible people: women Mode of infection: non-infectious Complications: hair loss
Cause
Breast cancer skin metastasis
(1) Causes of the disease
Age (18%):
In women, the incidence rate increases with age, is rare before menarche, and is rare before 20 years old, but the incidence rate rises rapidly after 20 years old, 45 to 50 years old, but relatively flat, after menopause The incidence rate continues to rise, reaching its peak at around 70 years of age, and the mortality rate also rises with age. After the age of 25, the mortality rate gradually rises until the old age.
Ovarian function (30%):
The mammary gland is regulated by ovarian hormones. Estrogen is a basic stimulant of mammary gland development and is one of the prerequisites for the onset of breast tumors. It has been suggested that the abnormal increase in estrone and estradiol and the deficiency of estriol are one of the causes of breast tumors, and have been supported by clinical examination and animal experiments. And male breast cancer patients are rare, about 1% of female patients, which also suggests that it may be related to male ovarian hormones.
Genetic factors (10%):
Family women with a first-degree family of breast cancer have a breast cancer risk two to three times that of the normal population.
Second-hand smoke (10%):
Second-hand smoke can also induce breast cancer, and data shows that breast cancer has become the most common cancer. There are many reasons for breast cancer, and secondhand smoke is one of the reasons.
(two) pathogenesis
The pathogenesis is still unclear.
Prevention
Breast cancer skin metastasis prevention
1. Ingest more foods rich in cellulose:
Both obesity and weight gain can lead to breast cancer. Usually, you should take less animal fat, absorb more fibrous foods, vegetables, fruits, cereals and beans, thereby reducing the body's estrogen that may cause breast cancer, reducing the incidence of breast cancer.
2, develop a good habit of exercise:
According to medical experts, women who exercise regularly have a 30% lower risk of developing breast cancer than women who are not exercising. Doing more exercise is not only good for your health, but also prevents breast cancer.
3, regular breast examination:
1 Women aged 20-40 should have a breast self-test within one week after the monthly holiday; every 2 years, a clinical examination or mammography is performed by a professional physician.
2 Women aged 40-49 years old, in addition to regular monthly breast self-examination, it is better to do a professional breast examination every year.
3 Women over the age of 50 should have a breast self-test every month and have a clinical breast examination and mammography every year.
Although women are at risk of developing breast cancer, as long as you insist on doing the above, you will be able to stay away from the threat of breast cancer and achieve early detection and early treatment.
Complication
Breast skin metastasis complications Complications
1. Changes in the skin and contour of the breast: Cooper ligaments invading the skin can form a "dimple sign"; tumor cells block the subcutaneous capillary lymphatic vessels, causing skin edema, and the follicles are depressed to form "orange peel sign"; when the skin is widely invaded At the time, most hard nodules or small strips can be formed in the epidermis, and even into a piece, such as the lesion extending to the back and the contralateral chest wall can restrict breathing, forming a thyroid carcinoma; inflammatory breast cancer will have a significant increase in the breast, Skin congestion and redness, local skin temperature increased; in addition, advanced breast cancer will appear skin ulceration to form cancerous ulcers.
2. Lymph node enlargement: ipsilateral axillary lymph nodes can be swollen, advanced breast cancer can cause swelling to the contralateral axillary lymph node; in other cases, the ipsilateral and or contralateral supraclavicular lymph nodes can be reached.
Symptom
Symptoms of skin metastasis of breast cancer Common symptoms Breast metastasis of the distal side of the pectoralis major muscle... Nodular papular alopecia, alopecia, alopecia, endometriosis
Breast cancer metastasis often occurs in the trunk, but it can also occur in other parts, such as the upper extremities and the head. Breast cancer is spread by lymphatic vessels. There are 4 types of metastases, which are inflammatory cancer and telangiectasia. Sexual cancer, nodular carcinoma and sputum thyroidoma, type 5 occurs through blood circulation, which is quite rare, and several types can occur simultaneously in the same patient.
1. Inflammatory carcinoma: The red skin of the breast skin and adjacent skin is slightly hardened, similar to erysipelas and cellulitis, with local temperature increase and clear boundary.
2. telangictatic carcinoma: manifested as clusters, purple red papules, small herpes, similar to vascular lymphangioma, may be associated with excessive coloration.
3. Nodular carcinoma: Asymptomatic hard nodules can be seen in the skin and subcutaneous tissue, which can form ulcers and excessive coloration.
4. Carcinoma en cuirasse: Diffuse scleroderma-like induration often occurs in the breast and surrounding skin of the cancer.
5. Hematogenous dissemination from breast carcinoma: usually only a single distant metastasis is seen, but some patients may have multiple metastases, which are common in the scalp. Initially, metastasis occurs in the scalp, but the epidermis Before the bulge, the lesion was similar to alopecia areata, so some people called it alopecia.
Examine
Breast skin metastasis examination
Histopathology:
1. In inflammatory cancer, the tumor cells in the intradermal and subcutaneous lymphatic vessels can be clustered or infiltrated into a strip. The tumor cells are the same as the primary tumors, and they are heteromorphic, with large nuclei and polymorphism. Capillary congestion, in addition to edema in the dermis, mild lymphoid cell infiltration around the blood vessels.
2. In telangiectasia, the cancer cells are exuded from the dilated small blood vessels and lymphatic vessels in the upper part of the dermis. In addition to the tumor mass, many red blood cells are seen in the blood vessels. Because there are many vasodilatations under the epidermis, clinical Similar to hemorrhagic blisters.
3. In nodular carcinoma, there are tumor cell masses of different sizes in the dermis nodules, surrounded by fibrosis, and some tumor cell masses can be arranged in glandular shape.
4. In thyroid carcinoma, the scleroderma-like induration area is fibrotic, and the tumor cells are similar to fibroblasts. The nucleus is long but large, polygonal, and basophilic is stronger than fibroblasts, and even tumor cells Often scattered in a single distribution, but in some parts of a small mass, or in a single line between the thickened collagen fiber bundles, showing a sentinel phenomenon, is valuable for diagnosis.
5. The tissue structure of blood-derived metastatic carcinoma varies with clinical manifestations, nodular lesions, infiltration of tumor cells with different sizes of dermis, similar to lesions of nodular metastatic carcinoma, tumor cells can be arranged in glandular shape It can be seen in the flat lesion of tumor alopecia, which can be similar to the tissue of the armor cancer. A single row of tumor cells can be seen between the thickened collagen fiber bundles.
Immunohistochemistry: tumor cell epithelial membrane antigen and keratin positive, the sensitivity, specificity and positive predictive value of skin metastatic breast cancer were 71%, respectively, using anti-heavy cyst disease liquid protein-15 (GCDFP-15) antibody. 91% and 94%, anti-estrogen receptor protein sensitivity, specificity and positive predictive value were 73%, 100% and 100%, respectively, about 48% of breast cancer S-100 protein positive, 71% breast cancer patients Monoclonal carcinoembryonic antigen (CEA) is positive.
Diagnosis
Diagnosis and differentiation of breast cancer skin metastasis
diagnosis
According to clinical manifestations, the characteristics of skin lesions and histopathological features can be diagnosed. The following points should be noted:
1. Clinically short-term (6 to 12 months) rapid growth of tumor nodules, distributed in the vicinity of the primary tumor surgery area or the corresponding lymphatic drainage area, and its histopathological morphology is similar to the primary tumor, especially When it is characterized by multiple or multifocal tumors, it should be considered as metastatic cancer of the skin.
2. Tumor plugs are found in the skin or subcutaneous fat vessels or lymphatic vessels. The distribution configuration of the cancer is narrow and trapezoidal at the bottom, generally not connected with the epidermis, there is very little inflammatory cell infiltration around the tumor cells, and no sweat gland ductal keratin membrane Differentiation, etc., are often characteristic of metastatic skin tumors.
3. It is helpful to distinguish by means of immunohistochemical markers. For example, the tumor originated from the sweat gland-derived tumor is positive for GCDFP-15, while the tumors of the prostate and thyroid metastasized to the skin are positive for PSA and TG, respectively. In addition, metastatic skin in the umbilical cord Nodules must be excluded from endometriosis or implanted nodules, and should also be distinguished from yolk sac or urinary tract embryo residues.
Differential diagnosis
In the umbilical abdomen metastatic skin nodules must be excluded from endometriosis or implanted nodules, and should also be distinguished from yolk sac or urinary tract embryo residues.
