佐久間 浩¹, 藤井 祐次¹, 権藤 守男², 霞 富士雄³

Hiroshi SAKUMA¹, Yuji FUJII¹, Morio GONDOH², Fujio KASUMI³

¹財団法人癌研究会附属病院超音波室, ²財団法人癌研究会附属病院内科, ³財団法人癌研究会附属病院外科

¹Department of Ultrasound, Cancer Institute Hospital, ²Department of Internal Medicine, Cancer Institute Hospital, ³Department of Surgery, Cancer Institute Hospital

キーワード : Inflammatory breast carcinoma, Ultrasonography, Histology, Dermal lymphatic permeation

Twenty-nine cases of inflammatory breast carcinoma were admitted to Surgical Department of Cancer Institute Hospital, Tokyo, during 1982-1987. The rate among the whole 2,807 breast cancer patients during the same period was 1.0%. Dermal lymphatic permeation by cancer cells (s.l.y.) was observed in 25 cases (86.2%) and was absent in 4 (13.8%). In addition, there were 20 cases (0.7%) in which no inflammatory changes were observed despite of presence of s.l.y.
Mastectomy was done on 24 cases among 29, while 5 others were treated with irradiation and chemotherapy after tissue-sampling including the skin for histopathological evaluation, hormonereceptor assay and sensitivity test of anti-cancer drugs. The distribution of histological types was as follows; 2 papillotubular carcinomas (8.3%), one solid-tubular carcinoma (4.2%), 19 scirrhous carcinomas (79.2%) and 2 invasive lobular carcinomas (8.3%).
Ultrasonography (US) was done on 28 patients. The sensitivity rate to diagnose as inflammatory breast carcinoma had been 42% before 1983, and was raised to 94% after then. The rest were all diagnosed as malignant.
The main characteristics of US images was thickness of the skin which correlated with skin edema, and was observed in 86% of inflammatory breast carcinoma. But the degree of thickness was lower in inflammatory breast carcinoma without s.l.y.
Lowering of echo-level of the skin was frequently observed. In many cases tumor shadow was accompanied by rough borders and attenuation of posterior echoes, and in some cases, by comedo-like-pattern alone. Higher echo-levels or rough echoes in the subcutaneous fatty tissue were occasionally seen.