[A Case of Intractable Chylorrhea Following Breast Cancer Surgery with a History of Liver Cirrhosis].

We present a case of intractable chylorrhea following breast cancer surgery in a 75-year-old female. During a close examination for a mass in her left breast, which was indicated by a CT scan performed to test for nausea, cancer of the left breast and an enlarged left axillary lymph node were observed. The FNA of the axillary lymph node was unsuitable as a sample since no lymph node cell-derived components were observed. A left breast mastectomy and axillary lymph node dissection were performed for the evaluation of cT2N1M0, Stage ⅡB. On postoperative day 3, cloudy drainage was observed, leading to a diagnosis of chylorrhea. Despite management by a fat-restricted diet and peripheral infusion on postoperative day 4, chyle from the drainage remained high, with a TG of 257 mg/dL, a cell count of 525/mm3(70% lymphocytes), and a postoperative drainage volume of over 500 mL per day. On postoperative day 8, octreotide subcutaneous injection was started, and drainage could be reduced. Locally injected picibanil solution through the drain on postoperative days 12 and 17 further decreased the drainage to 20 mL/day, and the drain was removed. The patient was discharged on postoperative day 22. The occurrence of chylorrhea was a concern due to the risk of distal hepatic collateral flow, regional lymph nodes and vessels, and high hepatic flow pressure due to liver cirrhosis.

[A Case of Septic Arthritis in the Hip Joint Following a Long‒Term Chemotherapy for Breast Cancer].

A 67‒year‒old woman, who had been receiving chemotherapy for 16 years because of recurrences of breast cancer, suffered from arthrosis in the left hip joint. A total hip joint replacement was needed. The central venous catheter port was removed a month before the operation. The culture of the catheter revealed Staphylococcus aureus. During the operation, a gram‒positive coccus was detected in the synovium of the hip joint. Therefore, the replacement was terminated, and an irrigation was performed. Two months later, a replacement of the hip joint was successfully performed after an antibacterial therapy. The patient died of the cancer 1 and a half years later. Septic arthritis secondary to catheter infection is a disease to consider in patients with long‒term chemotherapy.

[One Case of Accessory Breast Cancer Complicated by Contralateral Breast Cancer].

We experienced a case of right sided accessory breast cancer complicated by contralateral breast cancer. A 50-year-old woman came to us for an examination because a tumor in her left breast was pointed out at breast cancer screening. A breast MRI confirmed a tumor in her left breast and a tumor continuing from the skin to the subcutis of the right axilla. A skin biopsy for the tumor in the right axilla and a core needle biopsy(CNB)for the tumor in the left breast were performed. The pathological result of the CNB for the left breast indicated an invasive ductal carcinoma of the tubular formative scirrhous type. Although the tumor of the right axilla was poorly differentiated adenocarcinoma demonstrating cord-like arrays, it was examined by skin biopsy and therefore no deep part of the tissue was included. We conducted immunostaining, in consideration of the possibility of metastasis from the left sided breast cancer. ER, PgR, mammaglobin, GATA 3 were positive, strongly suggesting that the tumor in the right axilla was also derived from a mammary gland. We also performed a wide local excision of the right axilla plus axillary dissection(level Ⅰ)in addition to conducting a left mastectomy plus sentinel lymph node biopsy, in consideration of the possibility of primary right sided accessory breast cancer. The pathological result following surgery confirmed a difference in the histologic features between both sides, residual normal accessory mammary glands around the tumor on the right side, and the presence of rich DCIS and a lobular replacement image, leading to a definitive diagnosis of primary invasive ductal carcinoma of the accessory breast on the right side.