病例报告：罕见的三联肿瘤：导航同步副乳腺癌症、甲状腺乳头状癌和炎性鼻乳头状瘤
Case Report: A rare triad of neoplasms: navigating synchronous accessory breast cancer, papillary thyroid carcinoma, and inflammatory nasal papilloma.
摘要(中文译文)
女性乳腺影像学检查正常而表现为孤立性腋窝肿块的鉴别诊断是一项重大临床挑战，其中副乳腺癌是一种关键但常被忽视的病变。多原发肿瘤的同期管理进一步增加了治疗决策的复杂性。患者为60岁女性，表现为左腋窝无痛性增大肿块1年。初始影像学检查显示左腋窝BI-RADS 5类病变伴可疑淋巴结，但乳腺未见原发异常；随后乳腺MRI证实无原位原发灶。空芯针活检证实为乳腺来源的II级浸润性导管癌。后续评估中偶然发现Bethesda V类甲状腺结节及良性鼻腔乳头状瘤。接受六个周期新辅助TAC化疗后，患者依次接受了以下手术：预防性同侧保留乳头的皮下乳房切除术加腋窝淋巴结清扫术、内镜下鼻腔肿瘤切除术，以及甲状腺全切除术加中央区淋巴结清扫术。最终病理证实为原发性副乳腺癌（ypT3N2，Luminal B型）、甲状腺乳头状癌（pT1aN1a）及鼻腔鳞状上皮乳头状瘤。辅助治疗包括局部区域放疗、内分泌治疗（来曲唑联合阿贝西利）及放射性碘消融。本病例强调，在标准乳腺影像学检查阴性的孤立性腋窝肿块鉴别诊断中，原发性副乳腺癌必须作为首要考虑。本病例还展示了一种务实的多学科策略，以肿瘤学优先级原则和序贯干预为指导，实现同期多原发肿瘤的综合管理。
Abstract
The differential diagnosis of an isolated axillary mass in a woman with normal breast imaging presents a significant clinical challenge, with accessory breast carcinoma being a critical yet often overlooked entity. The concurrent management of multiple primary tumors further complicates therapeutic decision-making. A 60-year-old woman presented with a 1-year history of a painless, enlarging left axillary mass. Initial imaging revealed a BI-RADS 5 lesion in the left axilla with suspicious lymph nodes, but no primary breast abnormality; subsequent breast MRI confirmed the absence of an orthotopic primary. Core needle biopsy confirmed grade II invasive ductal carcinoma of mammary origin. Subsequent evaluations incidentally identified a Bethesda V thyroid nodule and a benign nasal papilloma. Following six cycles of neoadjuvant TAC chemotherapy, she underwent sequential surgeries: prophylactic ipsilateral nipple-sparing subcutaneous mastectomy with axillary lymph node dissection, endoscopic nasal tumor resection, and total thyroidectomy with central compartment dissection. Final pathology confirmed primary accessory breast carcinoma (ypT3N2, Luminal B), papillary thyroid carcinoma (pT1aN1a), and squamous epithelial papilloma of the nasal cavity. Adjuvant treatment included locoregional radiotherapy, endocrine therapy (letrozole plus abemaciclib), and radioiodine ablation. This case underscores that primary accessory breast cancer must be a leading consideration in the differential diagnosis of an isolated axillary mass with negative standard breast imaging. It also illustrates a pragmatic, multidisciplinary strategy for the integrated management of synchronous primary tumors, guided by the principles of oncologic prioritization and sequenced intervention.
如何引用
AMA
Xiangning Zeng, Huang Huang, Yuzhong Hong, Qin Meng, Kaihua Ye, Lian Zhou, et al. Case Report: A rare triad of neoplasms: navigating synchronous accessory breast cancer, papillary thyroid carcinoma, and inflammatory nasal papilloma.. Frontiers in medicine. 2026; doi:10.3389/fmed.2026.1841765.
APA
Xiangning Zeng, Huang Huang, Yuzhong Hong, Qin Meng, Kaihua Ye, Lian Zhou, et al (2026). Case Report: A rare triad of neoplasms: navigating synchronous accessory breast cancer, papillary thyroid carcinoma, and inflammatory nasal papilloma.. Frontiers in medicine. https://doi.org/10.3389/fmed.2026.1841765
GB/T 7714
Xiangning Zeng, Huang Huang, Yuzhong Hong, Qin Meng, Kaihua Ye, Lian Zhou, et al. Case Report: A rare triad of neoplasms: navigating synchronous accessory breast cancer, papillary thyroid carcinoma, and inflammatory nasal papilloma.[J]. Frontiers in medicine, 2026 doi:10.3389/fmed.2026.1841765.
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