[A Case of Lobular Carcinoma In Situ Occurring in a Fibroadenoma of the Breast].

The patient was a 43-year-old premenopausal woman with a 14×11 mm tumor in upper outer quadrant of the left breast, diagnosed as a fibroepithelial lesion using core needle biopsy. Resection was performed. Histopathologically, the resected specimen was diagnosed as a fibroadenoma with lobular carcinoma in situ(LCIS). Tamoxifen was administered as endocrine therapy to reduce recurrence risk. We report a case of LCIS accidentally discovered by surgical resection of a benign tumor.

[A Case of Advanced Breast Cancer with Hypercalcemia and No Bone Metastasis Treated with Multidisciplinary Therapy].

A 37-year-old woman presented with general malaise, anorexia, and nausea. She was hypercalcemic and had an 8-cm- diameter mass in her left breast. Histopathological diagnosis was invasive breast cancer(T3N0M1). She had multiple lung metastases and pleural dissemination, but she did not have bone metastasis. Serum parathyroid hormone-related protein level was elevated. Therefore, it was thought that hypercalcemia was induced by advanced breast cancer. High-volume fluid therapy and bisphosphonate were administered, and electrolyte correction was performed. Her general condition improved after these measures. Although chemotherapy(epirubicin with 5-fluorouracil and cyclophosphamide)was performed twice, breast cancer progressed; therefore, the chemotherapy regimen was changed to nab-paclitaxel, following which the progression of breast cancer was delayed. Left mastectomy was performed to control local tumor enlargement, following which hypercalcemia did not relapse. Hormone therapy showed long-term effectiveness; however, humoral hypercalcemia induced by the malignancy suggested that it was a poor prognosis factor. Aggressive multimodal treatment was important to control tumor growth.

Eribulin, trastuzumab, and pertuzumab as first-line therapy for patients with HER2-positive metastatic breast cancer: a phase II, multicenter, collaborative, open-label, single-arm clinical trial.

Purpose To examine the efficacy and safety of triple therapy with eribulin, trastuzumab, and pertuzumab in patients with HER2-positive metastatic breast cancer (MBC) who never received any prior therapy in the first-line metastatic/advanced setting. Methods Eribulin 1.4 mg/m2 (days 1 and 8), trastuzumab 8 mg/kg over 90 min and 6 mg/kg over 30 min, and pertuzumab 840 mg/body over 60 min and 420 mg/body over 30 min were administered intravenously in 21-day cycles. Results 25 women (median age, 57 years [range, 41-75 years]) received a median of 10 cycles (range, 0-34 cycles); 24 had performance status (PS) 0, 1 PS 1, 8 stage IV breast cancer, and 17 recurrence. Lung and liver metastases occurred in 9 and 9 patients, respectively. Median time to treatment failure with eribulin was 9.1 months (95% confidence interval [CI], 4.3-13.9 months), and median progression-free survival was 23.1 months (95% CI, 14.4-31.8 months). The overall response rate (complete response [CR] + partial response [PR]) was 80.0% (95% CI, 59.3-93.2%), and the clinical benefit rate (CR + PR + stable disease ≥24 weeks) was 84.0% (95% CI, 63.9-95.5%). The most common treatment-emergent adverse events (TEAEs) were alopecia (92.0%), fatigue (68.0%), and sensory peripheral neuropathy (60.0%). Grade 3/4 TEAEs occurred in 11 patients (44.0%). The only grade 4 TEAE was neutrophil count decreased (16.0%). Neither grade 4 peripheral neuropathy nor febrile neutropenia occurred. Conclusions ETP therapy showed acceptable efficacy and safety and is a potential first-line therapy for patients with HER2-positive MBC.

Correction to: Eribulin, trastuzumab, and pertuzumab as first-line therapy for patients with HER2-positive metastatic breast cancer: a phase II, multicenter, collaborative, open-label, single-arm clinical trial.

The authors would like to note the replacement of Fig. 2b, for which Fig. 2a was placed erringly, with appropriate Fig. 2b.

[A Case of Recurrent Breast Cancer with Contralateral Axillary Node Recurrence Cured after Mastectomy for Ipsilateral Breast Tumor Recurrence].

A 65-year-old woman was treated with breast-conserving therapy for dissection of the left breast and axillary lymph nodes. Histopathological diagnosis was invasive breast cancer(scirrhous), T1cN2M0, stageⅡB, ER+/PgR+/HER2-. Approximately 4 years later, a mass found in her left breast was confirmed to be ipsilateral breast tumor recurrence(IBTR). Left mastectomy was performed because no clear metastasis was found on whole-body examination. Histopathological diagnosis was invasive breast cancer(solid-tubular), ER-/PgR-/HER2-. IBTR was of a different type, compared to the primary breast cancer. In the follow-up period, multiple axillary lymph node metastases were found in the right axilla. Histopathologically, 20 lymph node metastases were found, and ER-/PgR-/HER2-breast cancer-related lymph node recurrence was diagnosed. Postoperative adjuvant chemotherapy(PTX, TS-1)was administered. In the 10 years following IBTR, there has been no recurrence, and it is thought to be completely cured. Usually, contralateral axillary lymph node recurrence is treated the same way as distant metastases because they are extra-regional lymph nodes; however, this strategy is not applicable to IBTR. When surgery is performed for IBTR, the contralateral axillary lymph node may become a new sentinel lymph node, and thus, sufficient examination and accurate risk assessment may be necessary before surgery for local control.

[A Long-Surviving Case of HER2-Positive Breast Cancer with Brain Metastasis Treated through Multidisciplinary Therapy].

We present a case of a 48-year-old woman who visited our hospital due to a lump in her left breast. She was diagnosed with HER2-positive, hormone-positive stage III A breast cancer. The patient underwent trastuzumab-based neoadjuvant chemotherapy and surgery(Bt+Ax). The pathological effect of neoadjuvant chemotherapy was Grade 1b. The patient underwent radiotherapy and was administered hormone therapy and adjuvant trastuzumab. Seven months postsurgery, the patient was taken to the hospital for loss of consciousness. Single brain metastasis with a diameter of 3 cm was found in the right frontal lobe with edema. She underwent surgery and was administered chemotherapy with lapatinib and capecitabine. Because of relapse of brain metastasis, she underwent 4 surgeries and 5 sessions of gamma-knife radiosurgery. She died 7 years after the detection of brain metastasis. The prolonged survival of this breast cancer patient with brain metastasis seems to be a result of multidisciplinary therapy, local therapy(surgery and radiation), and systemic therapy(chemotherapy). Cooperation between the radiation therapy department and the neurosurgery department was thought to be important for the treatment of the metastatic brain tumor.

[A Study of Patients Who Underwent Breast-Conserving Surgery and Developed Cryptogenic Organizing Pneumonia(COP)].

Of the 210 patients who underwent breast-conserving surgery for breast cancer and received radiation therapy for 3 years from April 2012 to March 2015 at the Department of Therapeutic Radiology of our hospital, 6 were diagnosed with cryptogenic organizing pneumonia(COP)-like pneumonia and treated as reported. The mean age of the patients was 51years(40- 65 years), and the pathological subtypes were the luminal type(5 cases)and HER2 type(1case ), all of which were treated with radiation therapy for breast conservation. Postoperative systemic therapy included hormonal therapy with anastrozole in 2 cases, tamoxifen plus LH-RH agonist in 3 cases, and chemotherapy in 1case. The mean onset time of COP was 4.2 months after the completion of irradiation therapy, and all of the 5 patients who received endocrine therapy received it concurrently with radiation therapy. The major symptoms were fever(4 cases)and cough(6 cases). Chest radiography showed an infiltrative shadow consistent with pneumonia. Steroid therapy was effective in all cases while antibiotics were not. It was inferred that COP should be regarded as one of the complications of radiation therapy after breast-conserving surgery.

[The case of a giant malignant phyllodes tumor of the breast].

A 75-year-old female patient complained of a mass in her left breast 2 years ago. The patient experienced a rapid enlargement of the mass 2 months later and visited our hospital. A computed tomography (CT) scan indicated a 25-cm tumor with infiltration of the left breast skin. Pectoral muscle invasion was considered. Swelling of the axillary lymph node and remote metastases were not found. A needle biopsy indicated a phyllodes tumor. A pectoral muscle-preserving mastectomy was undertaken. The tumor weighed 7.1 kg. Pathological examination indicated hyperplasia of the stroma and part of the epithelium, which had invaded the skin layer and fatty tissue. The pathological diagnosis was a malignant phyllodes tumor. This paper reports the case of a giant malignant phyllodes tumor.

[A case of locally advanced breast cancer successfully treated with Mohs paste].

We report a case of primary advanced breast cancer that was locally controlled by treatment with Mohs paste. A 57- year-old woman presented with right locally advanced breast cancer with massive exudate and oozing blood. Histopathological examination indicated an invasive ductal carcinoma. Moreover, the patient had lung, liver, and bone metastases. She received chemotherapy, following which the breast tumor was treated using Mohs paste and dissected. The bleeding and exudate stopped almost completely, and the breast tumor became flat. Therefore, it is suggested that locally advanced breast cancer could be controlled by treatment with Mohs paste.

[A case of squamous cell cancer of the breast in which effective hemostasis was obtained by preoperative emergency radiation].

A case was a 40-year-old woman. Her right breast was presented with massive bleeding ulcer and fixed with a pectoral muscle. Diagnosis of Stage IIIb breast cancer( T4b, N1, M0) showed a high inflammatory response and severe anemia. Palliative surgery was difficult because of hemostasis, and her general health also was in poor condition. The pathological diagnosis was squamous cell cancer. We underwent a total of 30 Gy radiation emergency hemostasisose. After radiation and chemotherapy, the lesion was undergone a radical surgery, and was reduced in size significantly. It was diagnosed as squamous cell cancer, which was more sensitive to general radiation so neoadjuvant chemoradiation therapy was effective.

[A case of bilateral breast cancer and metastatic gastric cancer with peritonitis carcinomatosa successfully treated with a combination therapy of S-1 and paclitaxel].

A 46-year-old woman was diagnosed with complaints of bilateral breast tumor with massive ascites retention. The patient was examined as scirrhous carcinoma by lacteal gland inspection and dysplastic cell by ascites cytotechnology. We diagnosed her case to be bilateral breast cancer with peritonitis carcinomatosa, lymph node metastases and bony metastases. In addition to that, gastric metastasis was diagnosed by the result of widespread irregular gastric mucosa, which was inspected through upper gastrointestinal endoscope. The patient was treated with S-1 and paclitaxel and has achieved a remarkable response. The patient's tumor, gastric metastasis, and ascites were disappeared almost completely.

[Palliative home care for advanced and recurrence breast cancer--a six-case report].

Two years of palliative home care for advanced and recurrent breast cancer of six patients was performed since January 2007. The reasons to provide palliative home care include an administration of skin infiltrative tumor, pain, home oxygen therapy (HOT), and chemotherapy. Most important part of home palliative care is to prepare any physical and psychosocial problems among any types of occupation.

[A case of stage IV breast cancer in which a long-term no change state (NC) was attained by a combination of S-1 and TAM following AC-T as a primary systemic therapy (PST)].

We here describe a case of advanced breast cancer (Stage IV) in which an oral S-1+TAM therapy following a primary systemic chemo-radiotherapy has been effective in maintaining the patient's QOL. A 40-year-old woman visited our hospital because of her left breast tumor. On physical examination, the tumor had invaded to the skin adjacent to the nipple forming a skin ulcer and marked deformity of the entire breast. Also noted were swollen lymph nodes in the left armpit. Subsequently, radiographic imaging tests revealed that the tumor had metastasized to the liver and lungs, as well as the skull. Accordingly, a primary systemic chemotherapy (4 series of AC/T) was started and followed by local radiation therapy (60 Gys) immediately after completing the chemotherapy. The metastasizing lesions in the liver, lungs, and skull had markedly reduced in the size and number, and the skin ulceration had healed up by these treatments. Afterwards, she has been given TAM daily and S-1 for 4 weeks with a 2-week interval. She has been quite well without any adverse effects by S-1 and TAM, and the primary as well as metastasizing lesions remain stable with normalized tumor marker levels (NC) for nearly 3 years.

Effect of Different Breast Densities and Average Glandular Dose on Contrast to Noise Ratios in Full-Field Digital Mammography: Simulation and Phantom Study.

We aimed to investigate the effects of mammary gland density and average glandular dose (AGD) on contrast-to-noise ratio (CNR) of breast-equivalent phantoms with different mammary gland/fat tissue ratios. Full-field digital-mammography breast X-rays were performed on breast-equivalent phantoms with three different mammary gland/fat tissue ratios (Phantom A [30/70], Phantom B [50/50], and Phantom C [70/30]) and seven thicknesses ranging from 10 mm to 70 mm. The prediction formula for the CNR was calculated by multivariate analysis and the effects of the various parameters on CNR were evaluated using a multiple regression analysis model. Higher CNR values were obtained with lower mammary gland/fat tissue ratios and lower phantom thicknesses. Variation in CNR among the three breast models was low (coefficient of variation, 3.4-8.7%) at lower phantom thicknesses (10-30 mm) and high (coefficient of variation, 10.5-16.8%) at higher phantom thickness (50-70 mm). CNR showed a strong negative correlation (r = -0.8989) with AGD across all three mammary gland ratios. A predictive formula for CNR using AGD and mammary gland density was developed. CNR can be predicted with high precision using AGD and mammary gland density. The predicted CNR could be used to measure the diagnostic reliability of mammography in breast cancer.