男性早期乳癌：一病例報告

Early-stage Male Breast Cancer: A Case Report

10.7023/TJFM.201206.0079

陳薇光(Wei-Kuang Chen)；鄒孟婷(Meng-Ting Tsou)；張源清(Yuan-Ching Chang)；林憶珊(Yi-Shan Lin)

male breast cancer ； breast ultrasonography ； mammography ； invasive ductal carcinoma

台灣家庭醫學雜誌

22卷2期（2012 / 06 / 01）

79 - 88

繁體中文

男性乳癌（male breast cancer）相較於女性乳癌，發生率極低，僅佔所有乳癌的百分之一不到。大部分民眾對男性乳癌缺乏認識，甚至誤以為乳癌是女性的專利，因此針對這個疾病往往警覺性不足，甚或可能導致求診時機延誤。本文報告一位57歲中年男性，在就診前一至兩週開始出現左側乳房疼痛，且在左側乳房發現腫塊。理學檢查在左側乳暈下面的地方摸到一伴隨著壓痛感之腫塊及輕微乳頭凹陷；經安排乳房超音波（breast ultrasonography）及乳房攝影（mammography）後，發現左側乳暈下區域有一界限不清的異質性腫塊，且合併有左側乳頭凹陷及乳暈下皮膚增厚之情形。轉介外科進行切片後，病理報告顯示為侵襲性腺管癌（invasive ductal carcinoma），其後病患接受左側乳房根除術，之後進行荷爾蒙治療並持續追蹤。本篇文章針對男性早期乳癌做一簡要介紹，主要目的是想藉此病例增加基層醫師對男性乳癌的認識、提高對具有危險因子之男性罹患乳癌的警覺性，並在適當時候提供相關諮詢及建議，掌握早期診斷及適時轉介的時機，以期給予病患最適切的照護。

Compared to female breast cancer, the incidence of male breast cancer is relatively low, as these cases make up less than one percent of all cases of breast cancer. Public awareness of this disease is generally insufficient and this might lead to a delay in diagnosis. We present the case of a 57-year-old male who complained of pain in the left breast and a palpable mass which had developed over the previous two weeks. Physical examination revealed a tender mass in the left subareolar region as well as mild nipple retraction. Breast ultrasonography and mammography showed an ill-defined heterogeneous mass in the left subareolar area, accompanied by nipple retraction and thickening of the subareolar skin. The patient was then referred to the Department of General Surgery for a biopsy and the pathology report revealed invasive ductal carcinoma. The patient underwent a total left mastectomy and has continued to receive chemotherapy. The purpose of this report is to raise awareness of male breast cancer and to remind primary care physicians to be more cognizant of the associated risk factors as well as the management of the disease so that an early diagnosis can be made and a higher quality of care delivered.

1. U.S. Preventive Services Task Force. Screening for breast cancer. http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm. Accessed January 7, 2012.
2. Department of Health, Executive Yuan, R. O.C. (Taiwan). http:/www.doh.gov.tw/ Accessed November 16, 2011.
3. Bureau of Health Promotion, Department of Health, R.O.C. (Taiwan). (http://www.bhp.doh.gov.tw/BHPnet/Portal/)
4. National Comprehensive Cancer Network (NCCN) guidelines. http://www.nccn.org. Accessed November 17, 2011.
5. Aebi, S.,Davidson, T.,Gruber, G.(2011).Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.Ann Oncol,22,vi12-24.
6. Anderson, W.F.,Althuis, M.D.,Brinton, L.A.,Devesa, S.S.(2004).Is male breast cancer similar or different than female breast cancer?.Breast Cancer Res Treat,83,77-86.
7. Anelli, T.F.,Anelli, A.,Tran, K.N.,Lebwohl, D.E.,Borgen, P.I.(1994).Tamoxifen administration is associated with a high rate of treatment-limiting symptoms in male breast cancer patients.Cancer,74,74-7.
8. Appelbaum, A.H.,Evans, G.F.,Levy, K.R.,Amirkhan, R.H.,Schumpert, T.D.(1999).Mammographic appearances of male breast disease.Radiographics,19,559-68.
9. Berg, W.A.,Blume, J.D.,Cormack, J.B.(2008).Combined screening with ultrasound and mammography vs mannography alone in women at elevated risk of breast cancer.JAMA,299,2151-63.
10. Bloom, K.J.,Govil, H.,Gattuso, P.,Reddy, V.,Francescatti, D.(2001).Status of HER-2 in male and female breast carcinoma.Am J Surg,182,389-92.
11. Brinton, L.A.,Richesson, D.A.,Gierach, G.L.(2008).Prospective evaluation of risk factors for male breast cancer.J Natl Cancer Inst,100,1477-81.
12. Cutuli, B.,Lacroze, M.,Dilhuydy, J.M.(1995).Male breast cancer: results of the treatments and prognostic factors in 397 cases.Eur J Cancer,31,1960-4.
13. Evans, G.F.,Anthony, T.,Turnage, R.H.(2001).The diagnostic accuracy of mammography in the evaluaiton of male breast disease.Am J Surg,181,96-100.
14. Giordano, S.H.,Buzdar, A.U.,Hortobagyi, G.N.(2002).Breast cancer in men.Ann Intern Med,137,678-87.
15. Giordano, S.H.,Cohen, D.S.,Buzdar, A.U.,Perkins, G.,Hortobagyi, G.N.(2004).Breast carcinoma in men: a poluation-based study.Cancer,101,51-7.
16. Giordano, S.H.,Perkins, G.H.,Broglio, K.(2005).Adjuvant systemic therapy for male breast carcinoma.Cancer,104,2359-64.
17. Harris, L,Fritsche, H,Mennel, R(2007).American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer.J Clin Oncol,25,5287-312.
18. Hooley, R.J.,Andrejeva, L.,Scoutt, L.M.(2011).Breast cancer screening and problem solving using mammography, ultrasound and magnetic resonance imaging.Ultrasound Q,27,23-47.
19. Joshi, A.,Kapila, K.,Verma, K.(1999).Fine needle aspiration cytology in the management of male breast masses. Nineteen years of experience.Acta Cytol,43,334-8.
20. Kolb, T.M.,Lichy, J.,Newhouse, J.H.(2002).Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27, 285 patient evaluations.Radiology,225,165-75.
21. Lee, C.H.,Dershaw, D.D.,Kopans, D.(2010).Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer.J Am Coll Rad,7,18-27.
22. Lyman, G.H.,Giuliano, A.E.,Somerfield, M.R.(2005).American Society of Clinical Oncology guidelines recommendations for sentinel lymph node biopsy in early-stage breast cancer.J Clin Oncol,23,7703-20.
23. Miao, H.,Verkooijen, H.M.,Chia, K.S.(2011).Incidence and outcome of male breast cancer: an international population-based study.J Clin Oncol,29(33)
24. Morrow, M.,Strom, E.A.,Bassett, L.W.(2002).Standard for breast conservation therapy in the management of invasive breast carcinoma.CA Cancer J Clin,52,277-300.
25. Nelson, H.D.,Tyne, K.,Naik, A.(2009).Screening for breast cancer: an update for the U.S. Preventive Services Task Force.Ann Intern Med,151,727-37.
26. Rayson, D.,Erlichman, C.,Suman, V.J.(1998).Molecular markers in male breast carcinoma.Cancer,83,1947-55.
27. Sasco, A.J.,Lowenfels, A.B.,Pasker-de, Jong P.(1993).Review article: epidemiology of male breast cancer. A meta-analysis of published case-control studies and discussion of selected aetiological factors.Int J Cancer,53,538-49.
28. Satram-Hoang, S.,Ziogas, A.,Anton-Culver, H.(2007).Risk of second primary cancer in men with breast cancer.Breast Cancer Research,9,R10-6.
29. Singletary, S.E.,Allred, C.,Ashley, P.(2002).Revision of the American Joint Committee on Cancer Staging System for breast cacner.J Clin Oncol,20,3628-36.
30. Tai, Y.C.,Domchek, S.,Parmigiani, G.,Chen, S.(2007).Breast cancer risk among male BRCA1 and BRCA2 mutation carriers.J Natl Cancer Inst,99,1811-4.
31. Thomas, D.B.(1993).Breast cancer in men.Epidemiol Rev,15,220-31.
32. Tice, J.A.,Kerlikowske, K.(2009).Screening and prevention of breast cancer in primary care.Prim Care Clin Office Pract,36,533-58.
33. Weber-Chappuis, K.,Bieri-Burger, S.,Hurlimann, J.(1996).Comparison of prognostic markers deteted b immunohistochemistry in male and female breast carcinomas.Eur J Cancer,32A,1686-92.