目的:探讨胃癌乳腺转移的临床特征及治疗方案.方法:对1例以乳腺转移包块为首发症状的晚期胃癌病例进行临床影像学特征、病理学特征的观察,探讨外周血化疗疗效相关基因检测与个体化化疗方案疗效的关系,并结合临床资料、随访结果观察治疗效果、复习国内外相关文献.结果:该患者以乳腺包块就诊,乳腺包块穿刺活检病理及胃镜病理结合免疫组化确诊为胃癌转移.经外周血基因指导下的个体化化疗联合腹腔灌注化疗后达到病理完全缓解,无进展生存期已达一年以上.结论:胃癌乳腺转移非常罕见,其生存时间短、预后差,需与原发性乳腺癌相鉴别.根据患者化疗疗效相关基因表达选择个体化化疗可获得病理完全缓解并延长无进展生存期,成为晚期胃癌的一种有效治疗手段.%Objective:To investigate the clinical characteristic and treatment of breast metastasis of gastric adenocarcinoma.Methods:To report one case of breast metastasis lump as the initial symptom of gastric carcinoma.Its clinical imaging and pathological features,immunological phenotypes were observed.The association of BRCA1 mRNA expression level and the sensitivity to chemotherapy drugs was discussed.The clinical feature was analyzed,the therapeutic effects were followed up,and the relevant literatures were reviewed.Results:Breast metastasis lump was the initial symptom of the 23-year-old female.The diagnosis of breast metastasis of gastric cancer was confirmed by pathological biopsy of the breast lump and stomach with histology and immunohistochemical staining.The patient received personalized systemic chemotherapy and intraperitoneal perfusion chemotherapy based on the BRCA1 mRNA expression level.After the chemotherapy,the patient achieved a pathological complete response with progress free survival for more than one year.Conclusion:Metastasis of gastric adenocarcinoma to the breast is very rare,which has a short survival time and poor prognosis.Primary breast cancer must be considered in the differential diagnosis.There was no generally accepted standard treatment.Pathological complete response with progress free survival for more than one year was achieved,which indicating that personalized systemic chemotherapy and intraperitoneal perfusion chemotherapy,based on the BRCA1 mRNA expression level may be a feasible palliative therapy for advanced gastric cancer.
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