三重原發性癌（惡性黑色瘤、乳癌、甲狀腺癌）－病例報告

Triple Primary Tumors of the Skin, Breast and Thyroid: A Case Report

10.7023/TJFM.200403.0053

蘇珮甄(Pei-Chen Su)；蔡悅琪(Yueh-Chi Tsai)；劉漢鼎(Han-Ting Liu)；杜世興(Shih-Hsin Tu)；黃世鴻(Shih-Huag Huang)；賴允亮(Yuen-Liang Lai)；楊圳隆(Tsen-Long Yang)；陳碧芳(Be-Fong Chen)；蘇茂仁(Mao-Jen Su)；鐘嫈嫈(Jin-Jin Tjung)

malignant melanoma ； breast cancer ； thyroid papillary carcinoma ； double primary tumors ； metachronous triple primary tumors

台灣家庭醫學雜誌

14卷1期（2004 / 03 / 01）

53 - 61

繁體中文

癌症是二十世紀三大重大疾病之一，由於醫學的進步，現今癌症的治療已使得癌症的治癒率及存活率大大提升。所以現在對癌症病人的照顧除了著重治療外，更應重視因為癌症長期存活率的提升而同時罹患其他疾病的可能性，包括發生轉移性病灶、產生二重或三重原發性癌症等。 本病例是一位61歲女性在1990年被診斷出右側腋下有一惡性黑色瘤，在本院接受廣泛性切除併皮瓣移植術。 1994年發現右側浸潤性管狀乳癌，經改良型乳房根除術後，並接受化學治療及放射線治療，且持續在本院追蹤至手術後滿五年。2002年9月因為肩痛及腰痛在另一醫學中心被診斷為多處骨頭轉移而再次接受化學治療。2003年9月在本院發現另一個甲狀腺乳頭狀癌，而接受全甲狀腺摘除，目前持續治療及追蹤中。我們以此病例，提醒基層醫師對癌症病人的追蹤及照顧，應注意二重甚至三重原發性癌症的可能性。

Cancer was one of the three major lethal diseases of the twentieth century. Advances in medical science have increased treatment and survival rates. However, post-treatment surveillance of an initial malignancy alone is not adequate. Attention must also be paid to the possibility of a metastatic lesion, a second or even third primary tumor. The case presented in this paper is that of a 61-year-old female who was diagnosed with malignant melanoma in the right axilla in 1990. She underwent wide excision and split thickness skin grafting at Mackay Memorial Hospital. Subsequently in 1994, she was diagnosed with infiltrating ductal carcinoma in the right breast. She was treated with a modified radical mastectomy followed by chemo- and radiotherapy. She was followed regularly thereafter for 5 years. However, in September 2002, she presented to another hospital complaining of shoulder and back pain. She was found to have multiple bone metastasis. A year later, she was also diagnosed with thyroid cancer and underwent total thyroidectomy. This case serves as a reminder of the importance of diligent follow-up of patients treated for malignancy, not only for recurrence or metastases, but also for development of further primary tumors.