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摘要: 隐匿性乳腺癌(occult breast cancer, OBC), 是较少见的特殊类型乳腺癌, 指经临床体检和影像学检查未发现乳房内包块而以腋窝淋巴结转移或其他远处转移为首发症状, 并经病理证实来源于乳腺组织的乳腺癌。对转移淋巴结进行组织病理学检查是OBC诊断的关键。对于钼靶和超声阴性的OBC, 增强核磁共振(MRI)检查在寻找原发灶方面有重要作用, 且有助于OBC的术前定位和指导手术方案。其手术治疗方法的选择尚有争议。现介绍1例晚期转移性OBC, 经多学科联合诊治、予以个体化综合治疗的成功经验, 为OBC的诊治提供更多思路, 强调多学科协作诊疗模式。Abstract: Occult breast carcinoma(occult breast cancer, OBC) is a rare and special type of breast cancer.OBC does show breast mass via clinical examination and imaging studies.Axillary lymph node metastasis or other distant metastases are the first symptoms for OBC; the cancer comes from the breast tissue, as confirmed by pathology.The histopathological examination of the metastatic lymph nodes is the key to the diagnosis of OBC.Enhanced MRI has an important role in indentifying the primary tumor for mammography and ultrasound negative OBC, and contribute to the preoperative occult breast positioning and guiding surgery program.However, surgical treatment for OBC remains controversial.In this study, we introduce one case with advanced metastatic OBC.The successful experience of the multidisciplinary joint diagnosis and individualized comprehensive treatment provide more ideas for the diagnosis and treatment of OBC, emphasizing the multiple disciplinary team treatment model.
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图 1 2012-04-23左锁上淋巴结切检病理切片及免疫组化
A：HE；B：EMA（+）；C：ER（85%）；D：PR（80%）；E：CA-153（+）；F：GCDFP-15（+）；G：MG（+）；H：CK7（+）
Figure 1. 2012-04-23 Left supraclavicular lymph node pathological and immunohistochemical examination
图 5 乳腺MRI检诊OBC推荐程序
Figure 5. Recommended procedures of breast MRI detection and diagnosis of OBC
表 1 隐匿性乳腺癌患者治疗经过
Table 1. Treatment of the patient with occult breast cancer
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