若年性ホジキンリンパ腫生存者における高リスク因子を有する個別化乳房サーベイランス

Survivors of pediatric Hodgkin lymphoma have an elevated lifetime risk of secondary breast malignancy, particularly those who received chest-directed radiation before age 30. This report describes a 19-year-old female patient, three years post-therapy for stage IIB Hodgkin lymphoma treated with 30 Gy mediastinal radiation, who presented within a structured survivorship program for evaluation of a self-detected, firm, mobile, non-tender left breast mass. Physical examination confirmed a 2 cm lesion in the upper outer quadrant without overlying skin changes, nipple inversion, or lymphadenopathy. Given her therapeutic radiation exposure and significant family history of early-onset breast and ovarian cancers, targeted breast ultrasound and bilateral magnetic resonance imaging (MRI) with contrast were performed for characterization. Imaging findings were consistent with a benign fibroadenoma, and short-interval follow-up was arranged in accordance with American College of Radiology (ACR) and National Comprehensive Cancer Network (NCCN) guidance for individualized surveillance of high-risk patients. The survivorship evaluation also identified an unaddressed need for germline testing, and subsequent genetic analysis confirmed a pathogenic BRCA1 mutation. This case illustrates the importance of risk-stratified, multidisciplinary assessment of new breast findings in adolescent and young adult (AYA) cancer survivors. Individualized, radiation-sparing imaging strategies coupled with comprehensive survivorship follow-up enable early detection, genetic risk identification, and longitudinal care coordination for patients at dual risk from prior therapy and hereditary predisposition.