[Key Points of Examination after Breast Augmentation and Our Clinic's Algorithm of Immediate Reconstruction Using Silicone Implant for Breast Cancer Patient after Breast Augmentation].

Recently, the cases of breast augmentation for cosmetic purposes are rapidly increasing, there are more opportunities to examine for patient with breast augmentation history than before. In some cases, breast cancer screening is difficult due to the effects of breast augmentation. At our clinic, even in cases diagnosed with breast cancer after breast augmentation, we actively perform immediate breast reconstruction using silicone implant. However, it is necessary to consider the condition and type of breast augmentation at the time of diagnosis and also treatment. We will share our algorithm for immediate breast reconstruction using silicone implant for breast cancer after augmentation mammaplasty.

[Palbociclib in a Postmenopausal Metastatic Breast Cancer Patient].

The purpose of our study was to test the efficacy and toxicity of palbociclib therapy for breast cancer treatment. Ten patients diagnosed with breast carcinoma were selected for this retrospective study between 2017 and 2018. After the patients had previously been administered palbociclib, they received either capecitabine or eribulin. As a result, the median PFS of capecitabine and eribulin were 6.4 months(3-10)and 5.8 months(4-7), respectively. Therefore, the treatment administered after palbociclib therapy may be useful for breast cancer patients.

[The Treatment of Olaparib for BRCA Positive-Metastatic Breast Cancer Patient].

Breast cancer patient(invasive ductal carcinoma, ER[+], PgR[+], HER2[3+], Ki-67: 30%)had neoadjuvant chemotherapy( FEC followed by docetaxel plus trastuzumab). After surgical operation(mastectomy and Ax)was performed and she received trastuzumab plus hormone therapy. After 2 years later, she had liver metastasis that showed IDC, ER(+), PgR (+), HER2(-). In addition, BRCA positive was shown. Therefore, the patient received olaparib tablets(300 mg twice daily). After 2 months later, liver metastasis reduced dramatically.

[Radiation-Induced Breast Angiosarcoma after Conservative Surgery for Breast Cancer].

We present the case of an 88-year-old woman who had undergone breast conserving surgery for left breast cancer 8 years ago.She received postoperative radiotherapy(total dose of 60 G/30 Fr)to the residual breast together with endocrine therapy.She underwent skin biopsy after having had a red skin tumor in the left breast.Angiosarcoma was diagnosed and chemotherapy and radiotherapy were initiated.The patient is alive without recurrence 8 months after chemotherapy.

[Abnormal Nipple Discharge].

BACKGROUND: Breast carcinoma and precancer are thought to start in the lining of the milk duct or lobule. Ductography and fiberoptic ductoscopy have beenadvocated as the mainprocedures inpatien ts with nipple discharge. METHODS: We investigated the usefulness of microdochectomy(MD)by using indocyanine green(ICG)fluorescence imaging. ICG and indigo carmine were injected into the mammary duct. A periareolar incision was made, and a fluorescence image of the demarcated mammary duct segment was obtained. CONCLUSION: MD using indocyanine green fluorescence imaging is a useful procedure in guiding subsequent breast surgery in the treatment of nipple discharge.

[Local Control by Mastectomy in Advanced Breast Cancer with Liver Metastasis after Chemotherapy, Radiotherapy, and Hyperthermia - A Case Report].

Advanced breast cancer has a poor prognosis compared to early breast cancer; however, quality of life and radical operation can be improved in some case by using multidisciplinary treatment. A 54-year-old woman was examined at the hospital because of an enlarging tumor in the left breast. She was aware of a lump for 3 years. Results of the initial examination indicated invasive ductal carcinoma with liver metastasis. She first received chemotherapy(AC followed by weekly paclitaxel). After 4 courses of weekly paclitaxel, computed tomography revealed axillary lymph nodes involved in the axillary vein. Operation was difficult and conversion therapy was administered. The patient underwent radiotherapy, hyperthermia, and hormone therapy. After 1 year from the start of hormone therapy, the metastasis had disappeared and the patient underwent operation in our unit. Eight months after operation, no recurrence was observed.

[A Successful Treatment of Locally Advanced Breast Cancer with Using Mohs' Paste and Chemotherapy - A Case Report].

Foul smell and large amounts ofexudate, bleeding are the most common and serious symptoms with locally advanced breast cancer(LABC). Mohs' paste is made ofa mixture ofzinc chloride and used for treatment ofmalignant skin tumors. Recently some reports show that Mohs' paste is useful for treatment of malignant tumor including unresectable breast cancer and skin metastasis ofcancer. Mohs' paste is useful for reducing symptoms such as foul smell and exudate, Bleeding. We report a successful case of treatment for LABC with using Mohs' paste and chemotherapy and surgery.

[Radiotherapy and Eribulin Mesylate for Mediastinal Node Metastasis from Breast Cancer-A Case Report].

A69 -year-old woman was diagnosed as having local advanced breast cancer. She was treated with neoadjuvant chemotherapy( AC followed by paclitaxel)and followed up with left total mastectomy with axillary lymphadenectomy for breast cancer(pT3N1aM0, Stage ⅢA, ER positive, PgR positive, and HER2 negative). She received adjuvant therapy with chest wall irradiation and an aromatase inhibitor. Two years after the mastectomy, mediastinal lymph node and rib metastases and dissemination appeared. We changed the regimen to capecitabine. She continued the capecitabine therapy for 7 years and was found to have multiple lung metastasis. Therefore, we chose eribulin mesylate therapy. Ten days after eribulin mesylate (1.0mg/body)was first administered, she suddenly had difficulty breathing, and chest CT revealed left low lobe atelectasis. The superior mediastinal lymph node had grown rapidly and compressed the left main bronchus and superior vena cava. To reduce the lymph node size, we started radiotherapy(50 Gy/25 Fr)for the superior mediastinal area in addition to the eribulin mesylate therapy. After the radiotherapy, chest CT revealed a remarkable reduction of lymph node size and full pulmonary reexpansion. One year after the radiotherapy, she is continuing treatment without systemic progression.

[A Case of Shock Due to nabPTX Administration Successfully Treated with Cytokine Adsorption Therapy].

The patient was a 71-year-old woman with ER(+), PgR(-), HER2(3+), and Ki-674 2% breast cancer. After surgery for left breast cancer(Bt+Ax), epirubicin, cyclophosphamide therapy was administered as postoperative adjuvant chemotherapy, and nabPTX plus trastuzumab therapy was started sequentially. The patient was hospitalized due to severe neutrope- nia(neutrophils 0/mm3)from nabPTX, but her condition stabilized after admission. However, the patient suddenly went into shock after 3 days and was thus transferred to the ICU. Her general condition was rapidly improved through cytokine adsorption therapy in the ICU. After 5 days, she was extubated and wheeled back to a general ward. She was discharged without problems in the succeeding months. In this case, FN or cardiovascular diseases was ruled out, and engraftment syndrome was considered given that cytokine adsorption therapy significantly improved the patient's condition. Considering the risk for severe neutropenia in nabPTX administration, clinicians should exercise caution when administering the drug.

[Examination of Stereotactic Mammotome Biopsy for Microcalcification in Our Hospital].

We introduced stereotactic mammotome biopsy(ST-MMT)for the purpose of screening and other institutions. There are many benign cases to be diagnosed by pathological findings, so it is thought to be necessary to examine the adaptation of STMMT again. We examined the performance of ST-MMT in a case of a non-palpating calcification lesion. Between August 2013 and December 2016, ST-MMT biopsies were performed for 247 microcalcified lesions revealed by mammography(in both breasts in 9 patients; twice in the ipsilateral breast in 2 patients). The mean age of all patients was 46 years(range, 24- 89 years). We found 39 cases(15.8%)of breast cancer. A final diagnosis of breast cancer was made in 39 patients, who comprised 0% of those with Category 2, 53.8% of those with Category 3, 35.9% of those with Category 4, and 10.3% of those with Category 5. Regarding the morphology and distribution of microcalcifications, breast cancer accounted for 46.2%, 5.1%, 2.6%, 35.9%, 7.7%, and 2.6% of the cases with small round/clustered, amorphous/clustered, pleomorphic/clus- tered, pleomorphic/linear segmental, and fine linear/clustered patterns, respectively. Also, we examined each of the patients, (1) who underwent mammography for medical examinations, (2) who underwent mammography performed at other institutions, (3) who underwent follow-up for microcalcifications and postoperative follow-up mammography. The proportions of breast cancer diagnoses were (1) 11.4%, (2) 20.6%, and (3) 7.1%. Proportions of Category 3 breast cancer were (1) 10.3%, (2) 38.5%, and (3) 5.1%. Among the cases in which ST-MMT was performed in this study, Category 3 accounted for more than half. However, 10.9%(21/192 lesions)were diagnosed as malignant in Category 3. The diagnosis of breast cancer in pa- tients who underwent mammography performed at other institutions was not observed in 79.4%(104/131 lesions), and among the 104 lesions, as a result of reassessment of calcification in our hospital, Category 2 was also included. Calcification in Category 2 lesions was benign in all cases. It was suggested that the indication for ST-MMT biopsy could be further narrowed down by being careful not to over-diagnose.

[Strut Adjusted Volume Implant(SAVI) - An Interim Report of Patient Satisfaction and Outcomes].

BACKGROUND: Strut adjusted volume implant(SAVI)was approved by the Food and Drug Administration(FDA)for the treatment of breast cancer in 2006. MATERIAL AND METHODS: The phase II study was conducted to investigate the activity and safety of SAVI in breast cancer patients. Criteria for SAVI treatments were N0, T<2 cm, and age≥40. After patients underwent breast-conserving surgery, they received SAVI twice a day×5 days(34 Gy). The primary endpoint are feasibility and safety. Second endpoint are local recurrence rate and cosmesis. RESULTS: Three patients were enrolled and the median duration of administration is 18.7 days(17-20). Further, the most common treatment-related adverse events were thickening and redness of skin(grade 1/2), while there was no deformity of breast in each case. CONCLUSION: The current study demonstrated that SAVI is well tolerated treatment in breast cancer patients and may be convenient for use in patient treatment.

[Serous Carcinoma of the Peritoneum with Metastases to the Breast and Axillary Lymph Nodes].

Metastasis of peritoneal serous carcinoma to the breast and axillary lymph nodes is rare. We present a case of serous carcinoma of the peritoneum with metastases to the breast and axillary lymph nodes. A 72-year-old woman was diagnosed with Stage III peritoneal serous carcinoma in November 2009; she was treated with 6 courses of paclitaxel and carboplatin. In December 2015, she had a palpable mass(2×2 cm)and enlarged axillary lymph nodes. Mammography did not reveal any mass(C1)and ultrasonographic examination demonstrated a partially ill-defined hypoechoic mass with a diameter of 8.7× 7.1 mm. Cytological examination of the axillary lymph node revealed malignancy; breast carcinoma metastasis was suspected and the patient underwent breast-conserving surgery. Histopathological examination of the specimens(breast and axillary lymph nodes)revealed adenocarcinoma, and immunohistochemistry analysis showed that the specimens were CK7(+), CK20(-), CA125(+), PAX8(+), and GCDFP15(-). Taken together, the results indicated peritoneal serous carcinoma metastases to the breast and axillary lymph nodes. CONCLUSION: We report a case of serous carcinoma of the peritoneum with metastases to the breast and axillary lymph nodes.

[Effectiveness of Postoperative Physical Therapy for Upper-Limb Impairments after Breast Cancer Treatment].

Previous studies have reported the benefits of beginning rehabilitation immediately after breast cancer surgery for improving motor function. However, most studies have not evaluated the long-term struggles patients face after hospital discharge in resuming their previous activities and socialparticipation. Furthermore, the intervention methods and effects of rehabilitation for such activities have not been evaluated. We investigated the effectiveness of postoperative physical therapy for upperlimb impairments after breast cancer treatment. Fifty-four women in the postoperative period of surgery for breast cancer participated in the study. Range of motion in the ipsilateral shoulder was initially limited after surgery and recovered during the study period: shoulder flexion range of motion reached a mean value from 110 to 155 degrees, mean abduction was from 70 to 110 degrees, and mean externalshoul der rotation was from 69 to 85 degrees. Lymphedema was present in 5 women. In conclusion, physical functional disabilities were present in the late postoperative period for breast cancer survivors, and limited range of motion in their shoulders negatively affected their functional capacity and quality of life. Therefore, we need to increase rehabilitation care after breast cancer surgery immediately.

[A Case of Gallbladder Carcinoma and Breast Cancer Associated with Pancreaticobiliary Maljunction].

We report a case of gallbladder cancer and right breast cancer associated with pancreaticobiliary maljunction.The patient was a 74-year-old woman who presented with abdominal pain due to cholecystitis.Abdominal CT detected a gallbladder tumor and right breast tumor.Enhanced CT and MRCP examination revealed gallbladder cancer and right breast cancer associated with pancreaticobiliary maljunction.We performed a gallbladder bed resection, bile duct resection, and right total mastectomy.The histopathological diagnosis of the gallbladder was moderately tubular adenocarcinoma and that of the breast tumor was scirrhous carcinoma.The patient remains recurrence-free 8 months after surgery.

[Everolimus plus Exemestane in Postmenopausal Metastatic Breast Cancer Patients].

The purpose of our study was to test the efficacy and toxicity of everolimus plus exemestane therapy for breast cancer. Between 2014 and 2015, 20 patients diagnosed with breast carcinoma were selected for this retrospective study. Patients received everolimus plus exemestane. As a result, 4 patients showed a partial response to treatment and the median PFS was 2.5 months (range, 1-9). The most common adverse events (AEs) associated with combination therapy were stomatitis, rash, dysgeusia, and non-infectious lung disease. The AEs reported were mostly grade 1 and 2, and manageable with appropriate intervention. Therefore, everolimus plus exemestane therapy for breast cancer seems to be effective and generally tolerable.

[Local Microwave Hyperthermia for Advanced or Recurrent Breast Cancer].

The purpose of our study was to test the efficacy and toxicity of hyperthermia for treating breast cancer. Ten patients received treatment (AC, paclitaxel, S-1, and aromatase inhibitor) in combination with hyperthermia. The hyperthermia device was a microwave heating device with water loaded and water-cooled waveguides. The temperature was monitored subcutaneously in the skin under the aperture of the waveguide. Two patients had a partial response to treatment with only mild toxicity (grade 1 acute skin toxicity). Therefore, hyperthermia combined with chemotherapy for treating breast cancer seems to be effective and generally tolerable. A larger patient cohort is needed to confirm these results in the future.

[A complete response following treatment with Paclitaxel and bevacizumab for metastatic breast cancer].

A 60-year-old woman with left breast cancer underwent partial mastectomy and sentinel lymph node biopsy. Pathological examination revealed an invasive ductal carcinoma that was ER (+), PgR (-), HER2 (-), and node positive (1/1). She received adjuvant chemotherapy with doxorubicin and cyclophosphamide (AC), followed by weekly paclitaxel (PTX). After receiving radiation therapy, she was administered an aromatase inhibitor for 5 years. Six months after completion of therapy, she found a hard lymph node in the left infraclavicular area. Fine needle aspiration cytology of the lymph node indicated metastatic breast cancer. Fulvestrant was administered but disease progression was observed after 3 months. Systemic chemotherapy with PTX and bevacizumab (Bev) was begun. After 3 cycles of chemotherapy, computed tomography (CT) scan revealed a complete response (CR). After 6 cycles of chemotherapy, the CR has been maintained.

[The synergistic effect of local microwave hyperthermia and chemotherapy for advanced or recurrent breast cancer].

The purpose of our study was to test the efficacy and toxicity of hyperthermia in conjunction with chemotherapy for breast cancer. Between 2009 and 2014, 6 patients diagnosed with breast carcinoma were selected for this retrospective study. Patients received standard chemotherapy (AC followed by paclitaxel ) in combination with hyperthermia. The hyperthermia device employed microwave heating with water loaded and water-cooled waveguides. The temperature was monitored subcutaneously in the skin under the aperture of the waveguide. Following hyperthermia therapy, 4 patients had a partial response to treatment and the toxicity was mild, consisting of Grade 1 acute skin toxicity. Therefore, hyperthermia combined with chemotherapy for breast cancer seems to be effective and generally tolerable. A larger patient cohort is needed to confirm these results.

[Immediate breast reconstruction for breast cancer].

We performed immediate breast reconstruction after nipple-sparing mastectomy or skin-sparing mastectomy and evaluated the reconstruction procedure, cosmesis, and complications. Among the 30 patients included in the study, 6 received latissimus dorsi flaps, 1 received a transverse rectus abdominis myocutaneous flap, 7 received deep inferior epigastric perforator flaps, 1 received an implant, and 15 received tissue expanders. In addition, the results were excellent in 25 patients, good in 3 patients, and poor in 2 patients. As the number of patients with breast cancer is increasing, the demand for breast reconstruction will increase. Therefore, it is essential to choose an appropriate method of breast reconstruction for each case.

[Comparison of a safety evaluation between paclitaxel injection NK and Taxol®].

Paclitaxel injection NK(NK)is a generic product containing the same amount of ingredients as a Taxol®Injection. We examined the safety of NK in clinical practice compared to the original drug. Our results suggested that for the cancer patient, most safety profiles between NK and the original drug are similar. However, patients who received Taxol®Injection had significantly more grade 2 neuropathy compared to those who received NK(p<0. 01).