以單側上臂淋巴水腫為表現的乳癌之病例報告

Breast Cancer Presenting as Unilateral Arm Lymphedema: A Case Report

10.3966/168232812015092503006

林宜衡(Yi-Heng Lin)；林幸慧(Shing- Huey Lin)；杜世興(Shih-Hsin Tu)

上臂腫脹 ； 乳癌 ； 淋巴水腫 ； 改良型乳房根治切除術 ； arm swelling ； breast cancer ； lymphedema ； modified radical mastectomy

台灣家庭醫學雜誌

25卷3期（2015 / 09 / 01）

217 - 222

繁體中文

乳癌術後發生上臂淋巴水腫在臨床上並非罕見，有些疾病如蜂窩性組織炎、骨折、血管炎、深部靜脈栓塞等也會造成上臂淋巴循環障礙，但以上臂淋巴水腫為臨床表現的原發性乳癌較少見。本文報告一位61歲女性因呈現一年以上右上臂不痛不癢的淋巴水腫，先後接受保守性藥物治療但不見具體成效，因此至本院求診，最後病理報告證實為浸潤性乳管癌併淋巴腺轉移。上臂淋巴水腫的真正病因在基層醫療院所可能會被忽略，藉由本篇文章可提供基層醫師對此疾病進一步的認知，了解上臂淋巴水腫的可能原因、鑑別診斷的方法和轉診時機，以免錯失及延誤病患的診斷及治療時機。

Lymphedema of the upper limb is not uncommon in patients receiving breast cancer treatment and has been reported in patients with associated conditions like cellulitis, fractures, vasculitis, and deep vein thrombosis of the upper limb. However, primary breast cancer with lymphedema as its initial presentation is rare. A 61-year-old woman with a nontender and nonpruritic lymphedema on her right arm for a year was referred to the authors' hospital after conservative unsuccessful treatment. She was diagnosed with invasive ductal carcinoma with lymph node metastasis. Lymphedema of the upper limb is a symptom that could be ignored easily in primary medical care. The case is accordingly presented to raise physician awareness and early recognition of the disease.

1. (2013).The diagnosis and treatment of peripheral lymphedema: 2013 consensus document of the International Society of Lymphology.Lymphology,46,1-11.
2. National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE). http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm. Accessed April 28, 2015
3. Mohler III ER, Mondry TE: Clinical manifestations and diagnosis of lymphedema. In: UpToDate, Gralow JR, Nekhlyudov L, eds. UpToDate, Walthum, MA, 2015. Accessed June 18, 2014
4. American Physical Therapy Association(2001).Guide to Physical Therapist Practice.Alexandria, VA:APTA.
5. DiSipio, T,Rye, S,Newman, B(2013).Incidence of unilateral arm lymphedema after breast cancer: a systematic review and metaanalysis.Lancet Oncol,14,500-15.
6. Erickson, VS,Pearson, ML,Patricia, A,Adams, GJ,Kahn, KL(2001).Arm edema in breast cancer patients.J Natl Cancer Inst,93,96-111.
7. Greene, AK,Maclellan, RA(2013).Obesity-induced upper extremity lymphedema.Plast Recontr Surg Glob Open,1,e59.
8. Moshiri, M,Katz, DS,Boris, M,Yung, E(2002).Using lymphoscintigraphy to evaluate suspected lymphedema of the extremities.Am J Roentgenol,178,405-12.
9. Shannon, C,Walsh, G,Sapunar, F,A'Hern, R,Smith, I(2002).Occult primary breast carcinoma presenting as axillary lymphadenopathy.Breast,11,414-8.
10. Ugur, S,Arici, C,Yaprak, M(2013).Risk factors of breast cancer-related lymphedema.Lymphat Res Biol,11,72-5.
11. Warren, AG,Brorson, H,Borud, LJ,Slavin, SA(2007).Lymphedema: a comprehensive review.Ann Plast Surg,59,464-72.
12. Zakaria, S,Johnson, R,Pockaj, BA,Degnim, AC(2007).Breast cancer presenting as unilateral arm edema.J Gen Intern Med,22,675-6.

1. 江靜宜(2021)。照護一位乳癌術後合併身體心像紊亂之護理經驗。彰化護理，28(1)，70-82。