[A Case of Advanced Breast Cancer Effectively Treated with Bevacizumab and Letrozole].

We report a case of primary advanced breast cancer that was locally controlled by treatment with bevacizumab. A 69-yearold woman presented at our hospital complaining of left breast hemorrhage. Her left breast had a large mass with an ulcer, and there was bleeding. Breast ultrasonography showed a large tumor that involved the whole left breast, and some swollen axillary lymph nodes. Breast MRI showed a mass of 77mm and skin invasion around the medial area of the left breast. Histopathological examination indicated invasive ductal carcinoma, ER(+), PgR(+), HER2(-), Ki-67 20%. We diagnosed left breast carcinoma, T4bN1M0, stage III B. She received paclitaxel plus bevacizumab as first-line therapy. Breast MRI showed a reduction in the primary tumor and axillary lymph node swelling. Adverse events including hypertension(Grade 3) and peripheral neuropathy(Grade 2)were observed. She received letrozole as second-line therapy. After commencing letrozole, the tumor reduced further, and the local ulcer disappeared showing only induration. Four years from the start of treatment, the woman has obtained good local control and has not developed other metastases.

[Asynchronous Bilateral Neuroendocrine Breast Carcinoma - A Case Report].

We report a case of asynchronous bilateral neuroendocrine breast carcinoma. The patient was a 49-year-old woman presenting with a bloody nipple discharge from the right breast. We suspected intraductal papilloma and performed a microdochectomy. A pathological analysis of the resected specimen confirmed the diagnosis as neuroendocrine carcinoma. The tumor was positive for estrogen receptor, progesterone receptor, chromogranin A, and synaptophysin, but negative for the HER2/neu marker. The Ki-67 labeling-index was 40%. As the tumor margin was positive, breast-conserving surgery plus level II axillary lymph node dissection was performed. After surgery, radiotherapy(total dose of 50 Gy)was administered for treating residual breast involvement. Adjuvant hormonal therapy was performed for 5 years. Ten years after surgery, ultrasonography revealed a 12mm irregular hypoechoic mass in the left breast. The mass was diagnosed as a solid tubular carcinoma based on core needle biopsy findings. Subsequently, we performed breast-conserving surgery. The pathological diagnosis was a neuroendocrine carcinoma, and the tumor was positive for estrogen receptor, progesterone receptor, chromogranin A, synaptophysin, and CD56, but negative for the HER2/neu marker. The Ki-67 labeling-index was 50%. We report our experiences with a rare case of asynchronous bilateral neuroendocrine breast carcinoma. In this case, ultrasonography was a useful modality for detecting both the lesions.

[Two Cases in Which Eribulin Mesylate Was Effective for Taxane-Resistant Advanced Breast Cancer].

We experienced 2 cases in which eribulin mesylate was effective for taxane-resistant advanced breast cancer. Case 1: A 65- year-old woman was diagnosed with advanced breast cancer(T4cN2aM0, stage III B)and treated with chemotherapy(nabpaclitaxel). Bone metastasis was observed; then, she sequentially received epirubicin and cyclophosphamide, nab-paclitaxel, and bevacizumab and paclitaxel. However, lung metastases appeared, and we changed the regimen to eribulin mesylate. We administered 11 courses of eribulin mesylate before bone marrow metastasis appeared. Eribulin mesylate was effective for more than 1 year. Case 2: A 77-year-old woman was diagnosed with advanced breast cancer(T4bN3cM1, stage IV), and liver and pleural metastasis were observed during an examination at the first visit. Four courses of nab-paclitaxel were administered, but because of the increase in pleural effusion, we changed the regimen to eribulin mesylate. Thirteen courses of eribulin mesylate were administered before the disease progressed. The progression-free survival was 9.53 months. Through the 2 cases in which eribulin mesylate was effective for taxane-resistant advanced breast cancer, the effect of eribulin mesylate compared to taxane was clinically inferred.

[Examination of the Cases Given Primary Tumor Resection after Systemic Therapy for Metastatic Breast Cancer].

We examined the records of patients with stage Ⅳ breast cancer who underwent primary tumor resection after systemic therapy. In our department, in 2013, there were 8 such cases. The average local tumor diameter was 59 mm. There was 1 case of metastases to the liver, 2 cases to the lung, 3 cases to the bone, and 1 case to the kidney. Three cases had lymph node metastases. Two cases were treated with hormonal therapy, and 6 cases received chemotherapy as preoperative systemic therapy. All cases underwent Bt plus Ax. Approximately 2 years after the surgery, 5 of the 8 patients were alive. The postoperative local control was good and we were able to continue systemic treatment for the distant metastases in all cases. We think that resection of the primary tumor improved the quality of life of the patients. However, for 1 fatal case, a brain metastasis was detected shortly after surgery. Therefore, we need to consider the patient's condition carefully before we operate.

[Long-term response to eribulin in patients with metastatic breast cancer-report of 2 cases].

Case 1: Case 1 involved a 42-year-old woman who had been diagnosed as having advanced breast cancer (Stage III B). She had previously received 6 courses of cyclophosphamide, epirubicin, and 5-fluorouracil CEF, 14 courses of weekly paclitaxel, and 2 courses of vinorelbine( VNR). After the courses of chemotherapy, she underwent modified radical mastectomy with axillary lymph node dissection. Two years after surgery, lung metastases were found, and the patient received 6 courses of weekly paclitaxel and 13 courses of nab-paclitaxel. However, the lung metastases progressed after the courses of chemotherapy, and therefore, we decided to administer eribulin as third-line chemotherapy. Eribulin was effective against the lung metastases for more than 1 year. Case 2: Case 2 involved a 52-year-old woman who had been diagnosed as having Stage IIB breast cancer. She had received 4 courses of CEF and 4 courses of docetaxel as neo-adjuvant chemotherapy. After chemotherapy, she underwent breast-conserving surgery with axillary lymph node dissection. Five years postoperatively, multiple liver metastases were found, and the patient received 3 courses. However, the liver metastases progressed after this chemotherapy. Subsequently, we administered nab-paclitaxel; however, it produced severe side effects. We then decided to administer eribulin as second-line chemotherapy. Eribulin was effective against the liver metastases for more than 1 year.

[Successful treatment of multiple breast tumors with breast-conserving surgery].

We report a case in which we were able to treat multiple tumors in the right breast with breast-conserving surgery. The patient was a 60-year-old woman in whom mammography revealed grouped round calcifications and distortion in the right breast. The tumor was not palpable. Ultrasonography revealed 3 tumors in the patient's right breast. One tumor, 14.5 mm in diameter, was located in the AC area of her right breast. Vacuum-assisted core-needle biopsy was performed on this tumor, and histopathological examination revealed invasive ductal carcinoma of the breast. The tumor was estrogen receptor (ER)-positive, progesterone receptor( PgR)-negative, and human epidermal growth factor receptor( HER)-2-positive. Another tumor, 5.5 mm in diameter, was located in the C area of the patient's right breast. This tumor was diagnosed as a satellite lesion of the tumor in the AC area. The third tumor, 19.0 mm in diameter, was located in the A area of the patient's right breast. This tumor was expected to be a fibroadenoma on the basis of the clinical findings. We performed breast-conserving surgery to remove these 3 tumors and biopsied the sentinel lymph nodes. Intra-operative rapid pathological diagnosis indicated that the surgical margins were negative and the sentinel lymph nodes were negative for metastasis. The final pathological diagnosis was the same as the preoperative diagnosis.

[Usefulness of endoscopic resection for phyllodes tumor of the breast].

We compared the surgical margins for phyllodes tumors of the breast required for endoscopic local excision and normal local excision. Over a 10-year period, we experienced 38 patients with phyllodes tumors of the breast who were treated by surgical operation. Thirty-three patients underwent local excision with a surgical margin of at least 1.0 cm, and 5 underwent endoscopic local excision with a surgical margin of at least 1.0 cm. The pathological surgical margins were negative in all patients. The surgical margins for both endoscopic local excision and normal local excision were almost identical. However, the surgical wounds caused by endoscopic local excision were smaller than those caused by normal local excision. These results suggest that endoscopic local excision is a useful method for phyllodes tumor.

[A case of bilateral multiple primary breast cancer].

A 55-year-old woman underwent segmental resection and sentinel lymph node biopsy for cancer in her left breast 2.5 years ago. The pathological findings indicated papillotubular carcinoma [estrogen receptor-positive (ER+), progesterone receptor-positive(PgR+), and human epidermal growth factor receptor 2(HER2) score 0]. After the operation, she received adjuvant radiotherapy and endocrine therapy. Two and a half years after the operation, mammography revealed amorphous calcifications in her right breast. Stereotactic directional vacuum-assisted core-needle biopsy of the calcifications led to a diagnosis of invasive ductal carcinoma (ER+, PgR+, HER2 score 0). We performed quadrantectomy and sentinel lymph node biopsy. After the second operation, she received adjuvant radiotherapy and endocrine therapy with different modalities than used previously. Since the second operation, there has been no metastasis or recurrence.

[The problems of breast-conserving surgery for calcification undetected by ultrasonography].

The patient was a 58-year-old woman. Mammography showed grouped heterogeneous calcifications in the M area of the right breast. The area of the grouped heterogeneous calcifications was 1 cm in diameter. A vacuum-assisted biopsy (VAB) of the area led to a diagnosis of invasive ductal carcinoma positive for estrogen receptor and progesterone receptor, and negative for human epidermal growth factor receptor type 2/neu protein expression. A micro mark was made by VAB enforcement in the lesion. At operation, we performed ultrasonography to detect the cancer lesion, but we could not detect the micro mark. It was difficult to determine the resection area. We detected architectural distortion after VAB and determined the resection area. Breast-conserving surgery and a sentinel lymph node biopsy was performed. Histopathologically, the surgical margins were negative and the sentinel lymph node was negative for cancer. This case suggested that it was necessary to make a new micro mark.

[Complete response of advanced breast cancer with lymph node metastases to nab-paclitaxel therapy-report of a case].

We report a case of breast cancer with lymph node metastases. A complete response was recognized in response to nab-paclitaxel as a first-line therapy after recurrence. The patient was a 50-year-old woman who had a tumor in her right breast. We palpated a mass with clear boundaries in her right breast. The tumor was 2 cm in diameter. Core-needle biopsy of the breast tumor led to a diagnosis of invasive ductal carcinoma (estrogen receptor-, progesterone receptor-, and human epidermal growth factor receptor 2-negative). She received 4 cycles of EC (E: 90 mg/m2/tri-weekly; C: 600 mg/m2 /tri-weekly) plus 4 cycles of TC(T: 75 mg/m2/tri-weekly; C: 600 mg/m2/tri-weekly)as preoperative adjuvant chemotherapy. After chemotherapy, she underwent quadrantectomy plus axillary lymph node dissection. Six months after the operation, lymph node metastases were observed in her right supraclavicular lymph nodes. She received 8 cycles of nab-paclitaxel(260 mg/m2/tri-weekly) therapy. After 8 cycles of treatment, ultrasonography and computed tomography revealed the disappearance of the metastatic lymph nodes. Therefore, a clinical complete response was observed.

[A case of combined noninvasive ductal and lobular carcinoma].

We report a case of combined noninvasive ductal and lobular carcinoma. The patient was a 54-year-old woman with a breast tumor. The tumor was a palpable movable mass measuring 1 cm in diameter in the AC region of her breast. Mammography, ultrasonography, magnetic resonance imaging, and vacuum-assisted core-needle biopsy were performed. The histopathological diagnosis was intraductal papillary cystic lesion. However, there was also a ductal lesion. We performed lumpectomy, and the diagnosis was combined noninvasive ductal and lobular carcinoma. It was difficult to determine the range of carcinoma, and thus, we performed Bt+Ax. Combined noninvasive ductal and lobular carcinoma is rare. We should study additional cases and develop more adequate treatments.