medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-9-248-257medsovet-5742Research ArticleКЛИНИЧЕСКОЕ НАБЛЮДЕНИЕCLINICAL OBSERVATIONПервично-множественный BRCA1-ассоциированный рак молочной железы и рак маточной трубы (клинический случай)Primary multiple BRCA associated breast cancer and ovarian cancer (clinical case)https://orcid.org/0000-0002-7142-2986КононенкоИ. Б.KononenkoI. B.

Кононенко Инесса Борисовна, к.м.н., старший научный сотрудник отделения «онкологический дневной стационар» (химиотерапевтического и хирургического лечения)

115478, Москва, Каширское шоссе, д. 24

Inessa B. Kononenko, Cand. of Sci. (Med.), senior researcher of the Department of Oncology day hospital (chemotherapeutic and surgical treatment)

24, Kashirskoye Shosse, Moscow, 115478

Inessa.Kononenko@mail.ruhttps://orcid.org/0000-0002-0170-5681СнеговойА. В.SnegovoyA. V.

Снеговой Антон Владимирович, д.м.н., профессор, заведующий отделением «онкологический дневной стационар» (химиотерапевтического и хирургического лечения)

115478, Москва, Каширское шоссе, д. 24 

Anton V. Snegovoy, Dr. of Sci. (Med), Professor, head of the Department of Oncology day hospital (chemotherapy and surgery)

24, Kashirskoye Shosse, Moscow, 115478 

anvs2012@gmail.comБожченкоЯ. А.BozhchenkoY. A.

Божченко Яна Анатольевна, к.м.н., врач-патологоанатом отделения патологической анатомии опухолей человека

115478, Москва, Каширское шоссе, д. 24 

Yana A. Bozhchenko, Cand. of Sci. (Med.), pathologist of the Department of pathological anatomy of human tumors

24, Kashirskoye Shosse, Moscow, 115478 

Laody.1981@mail.ruКравченкоД. Н.KravchenkoD. N.

Кравченко Дмитрий Николаевич, к.м.н., врач-онколог отделения «онкологический дневной стационар» (химиотерапевтического и хирургического лечения)

115478, Москва, Каширское шоссе, д. 24 

Dmitriy N. Kravchenko, Cand. of Sci. (Med.), clinical oncologist, of the Department of Oncology day hospital (chemotherapy and surgery)

24, Kashirskoye Shosse, Moscow, 115478 

drdimazzo@gmail.comСельчукВ. Ю.SelchukVladimir Yu.

Сельчук Владимир Юрьевич, д.м.н., профессор, заведующий кафедрой онкологии

127473, Москва, ул. Делегатская, д. 20, стр. 1

Vladimir Yu. Selchuk, Dr. of Sci. (Med), Professor, head of the Department of Oncology

20, Bldg. 1, Delegatskaya St., Moscow, 127473

https://orcid.org/0000-0001-9354-0388ПальчинскаяО. В.PalchinskaiaO. V.

Пальчинская Ольга Владимировна, клинический ординатор отделения «онкологический дневной стационар» (химиотерапевтического и хирургического лечения)

115478, Москва, Каширское шоссе, д. 24 

Olga V. Palchinskaia, resident of the Department of Oncology day hospital (chemotherapeutic and surgical treatment)

24, Kashirskoye Shosse, Moscow, 115478 

kfoli@mail.ruНациональный медицинский исследовательский центр онкологии им. Н.Н. БлохинаРоссияN.N. Blokhin National Medical Research Center of OncologyRussian FederationМосковский государственный медико-стоматологический университет им. А.И. ЕвдокимоваРоссияA.I. Yevdokimov Moscow State University of Medicine and DentistryRussian Federation20203007202009248257Copyright © Кононенко И.Б., Снеговой А.В., Божченко Я.А., Кравченко Д.Н., Сельчук В.Ю., Пальчинская О.В., 20202020Кононенко И.Б., Снеговой А.В., Божченко Я.А., Кравченко Д.Н., Сельчук В.Ю., Пальчинская О.В.Kononenko I.B., Snegovoy A.V., Bozhchenko Y.A., Kravchenko D.N., Selchuk V.Y., Palchinskaia O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5742

Введение. Изучение мутации в генах BRCA1/2 впервые было инициировано в США и в Европе, а позднее и в России. Согласно статистике, у женщин с наличием мутации BRCA1/BRCA2 риск развития рака молочной железы и/или яичников выше, чем в общей популяции. По данным разных авторов, средний кумулятивный риск среди носителей BRCA1 составляет 65% (диапазон 44–78%) для рака молочной железы и 39% (диапазон 18–54%) для рака яичников. Для носителей мутаций в гене BRCA2 риск развития РМЖ составляет 45–49%, а риск развития РЯ не превышает 11–18%. При этом у пациенток с уже диагностированным РМЖ или РЯ риск развития второй опухоли сохраняется в течение всей жизни и может оставаться высоким даже в пожилом возрасте. Лечение BRCA-ассоциированного рака молочной железы и/или рака яичников практически не отличается от лечения спорадического рака и включает хирургический, лучевой метод и лекарственную противоопухолевую терапию. Однако существуют некоторые особенности, которые необходимо учитывать в клинической практике. Клинический случай.В данной статье мы представляем клинический опыт лечения пациентки 32 лет с BRCA1-ассоциированным первично-множественным синхронным раком молочных желез и метахронным раком раком маточной трубы. В июле 2015 г. у пациентки был диагностирован синхронный рак обеих молочных желез (люминальный А рак правой молочной железы и люминальный В рак левой молочной железы). В рамках комплексного лечения и с согласия пациентки была проведена билатерильная аднексэктомия. При гистологическом исследовании операционного материала диагностирован рак маточной трубы in situ. С 16.03.2016 по настоящее время пациентка получает адъювантную эндокринотерапию без признаков прогрессирования заболевания. Заключение. Представленный клинический случай демонстрирует необходимость комплекснго подхода к лечению BRCAассоциированного рака молочных желез и яичников у молодой пациентки.

Introduction. The study of mutation in BRCA1/2 genes was first initiated in the USA and Europe, and later in Russia. Statistics indicate that women with the BRCA1/BRCA2 mutation have a higher risk of breast and/or ovarian cancer than the general population. According to different authors, the average cumulative risk among BRCA1 carriers is 65% (range 44–78%) for breast cancer and 39% (range 18–54%) for ovarian cancer. For mutation carriers in the BRCA2 gene, the risk for breast cancer is 45–49%, while the risk for RNA is 11–18%. However, in patients already diagnosed with breast cancer or ovarian cancer, the risk of a second tumor persists throughout life and may remain high even in old age. Treatment of BRCA-associated breast cancer and/or ovarian cancer is almost the same as treatment for sporadic cancer, and includes surgical, radiation, and drug anticancer therapy. However, there are some features that need to be considered in clinical practice. Clinical case. In this article we present the clinical experience of the treatment of a 32-year-old patient with BRCA1-associated primary multiple synchronous breast cancer and metachronous uterine tube cancer. In July 2015, the patient was diagnosed with synchronous cancer of both breast (Luminal A right breast cancer and Luminal B left breast cancer). As part of a treatment and with the patient’s consent, a bilateral adnexectomy was performed. In the histological examination of the operating material, the uterine tube cancer was diagnosed in situ. From 16.03.2016 to the present time the patient receives adjuvant endocrinotherapy without signs of disease progression. Conclusion. This clinical case study presents the importance of a combined approach to the treatment and prevention of BRCAassociated cancer.

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The authors declare that there are no conflicts of interest present.