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English to Chinese: Case histories General field: Medical
Source text - English The patient was a 54-year-old Caucasian woman with a history of right breast carcinoma 17 years earlier, which was treated with a right mastectomy; reconstruction included bilateral silicone implants. The right silicone implant was subsequently replaced by a saline implant, and the patient remained well until 10 months before presentation, when an ultrasound performed because of gradual left breast enlargement revealed a peri-implant fluid collection. The seroma was drained, and the left silicone implant was replaced by a saline implant. At the time of implant removal and replacement, the grossly unremarkable implant capsule was examined histologically and interpreted as a chronic inflammatory infiltrate with fibrosis surrounding a pseudocystic space. Over the next 10 months, the seroma persisted despite intermittent surgical drainage.
At the time of presentation, the seroma was again aspirated, and the fluid specimen was submitted for cytological evaluation. A diagnosis of lymphoma was made, and this was followed by removal of the left saline implant and excision of the surrounding fibrous capsule. Review of the initial capsulectomy specimen from 10 months earlier revealed the presence of ALK-negative ALCL. Staging evaluation by PET-CT revealed low-level fluorodeoxyglucose (FDG) uptake within the left chest wall muscle and skin overlying the left breast, consistent with postoperative changes; no other sites of FDG avidity were identified. A bone marrow biopsy was negative for lymphoma. Ann Arbor stage was IA. The patient underwent four cycles of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) followed by involved-field radiation therapy (45 Gy). She is in complete remission without evidence of lymphoma 7 months after diagnosis.
The patient was a 45-year-old Caucasian woman with onset of left hip and leg pain 2 months before presentation. CBC showed mild anemia and a normal white blood cell count with an absolute monocytopenia of 175 cells/μL. She was treated initially with NSAIDs for presumed bursitis without relief then was given a 1-week prednisone taper and the pain completely resolved. A bone scan demonstrated three areas of abnormal uptake in the left proximal femur, and subsequent magnetic resonance imaging (MRI) confirmed three discrete areas within the left femur consistent with a marrow-infiltrating process. These findings were suggestive of metastatic carcinoma and prompted further radiologic evaluation. A mammogram showed an increased density in the upper outer quadrant of the left breast compared with a study 3 years earlier. CT scans of the chest, abdomen, and pelvis confirmed the left breast density and showed no splenomegaly or lymphadenopathy. Breast MRI confirmed a 2.5 cm left upper outer quadrant mass and also revealed a small area of enhancement in the 10 o'clock position of the right breast.
A stereotactic biopsy of the left breast revealed ductal carcinoma in situ (DCIS), while a subsequent core biopsy of the left proximal femur showed involvement by hairy cell leukemia. The patient then underwent a staging posterior iliac crest bone marrow biopsy and aspirate, which also showed involvement by hairy cell leukemia, and left breast lumpectomy and left axillary sentinel lymph node biopsy. The lumpectomy contained extensive DCIS, as well as prominent atypical lymphoid infiltrates with morphologic and immunohistochemical features of hairy cell leukemia. The sentinel lymph node was negative for metastatic carcinoma, but showed a massive atypical lymphoid infiltrate, consistent with nodal involvement by hairy cell leukemia. She was treated with a 7-day infusion of cladribine for hairy cell leukemia. A repeat posterior iliac crest bone marrow biopsy and aspirate performed posttreatment showed minimal residual involvement by hairy cell leukemia involving
Translation - Chinese 患者女、54岁、白人，病史：17年前患右侧乳腺癌，行右侧乳房切除术治疗，重建包括双侧硅胶植入。后来用盐水假体替代患者右侧硅胶假体，就诊10个月前状况良好，因左乳逐渐肿大行超声波检查发现假体周围有液体积聚。引流血清肿后，用盐水假体替代了左侧硅胶假体。假体移除替代时，假体包膜大体无显著特征，经组织学检查解释为慢性炎症浸润伴假包囊区周围纤维化。其后10个月，虽然行间歇性外科引流，血清肿一直存在。
就诊时，再次引流血清肿，并对液体样本行细胞学评价。诊断为淋巴瘤，随后移除左侧盐水假体并切除其周围纤维囊。复查10月前的首次囊切除术标本发现存在ALK阴性的ALCL。PET-CT分期评价显示覆盖左乳的左胸壁肌肉皮肤内有低水平氟脱氧葡萄糖（FDG）摄取，与术后变化一致；其它部位未检出FDG亲合力。骨髓活检为淋巴瘤阴性。Ann Arbor分期为IA。患者接受4个疗程的环磷酰胺、多柔比星、长春新碱、泼尼松联合化疗（CHOP）随后行累及野放疗（45 Gy）。于诊断7个月后患者完全缓解，无淋巴瘤证据。
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