[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.

[Long-Term Capecitabine Therapy Was Successful for Locally Advanced Breast Cancer Patient - Report of a Case].

For the treatment of locally advanced breast cancer, chemotherapy involving anthracycline and/or taxane-containg regimens is generally performed. However, some patients have difficult reasons for administering these intravenous chemotherapeutic agents. We experienced a case of locally advanced breast cancer patient who received long-term capecitabine therapy. This therapy was effective for this patient. A 72 year-old woman presented with a lump in her right breast. The tumor had been increasing for 15 years. The tumor had spread from the right breast to the axilla and the lateral chest, accompanied with ulceration. A core needle biopsy was performed and the pathological diagnosis was papillotubular carcinoma. We checked up her body, and there was no distant metastasis. We diagnosed the clinical stage as T4cN3aM0, stage III C. She was concerned about the side effect of depilation and did not wish the standard chemotherapy. We chose capecitabine therapy. She continued capecitabine therapy and endocrine therapy. The tumor and tumor markers were decreased. The tumor size has not increased and metastatic lesions have not appeared for 5 years and a half.

[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.

[A Case of Neuroendocrine Ductal Carcinoma In Situ of the Breast Detected as an Intra-Cystic Tumor Using Ultrasonography].

We report a case of neuroendocrine ductal carcinoma in situ of the breast. The tumor was shown to be an intra-cystic tumor on performing ultrasonography. The patient was a 40-year-old woman. Amorphous calcifications were detected on her right breast on performing mammography during breast cancer screening. Ultrasonography indicated that the tumor was 9mm in diameter, and displayed features of an intra-cystic tumor. A vacuum-assisted core needle biopsy for breast tumor led to a diagnosis. The pathological diagnosis was mastopathy. We could not rule out malignancy of the tumor. Subsequently, we performed surgical resection with 5mm margins. The pathological diagnosis was intra-cystic neuroendocrine carcinoma in situ, positive for estrogen receptor and progesterone receptor, and negative for HER2/neu. The Ki-67 positive cell index was 5%. The surgical margin was negative. We performed a whole-body checkup, and confirmed a diagnosis of TisN0M0, Stage 0. She was initiated endocrine therapy with tamoxifen(20mg/day). Four years after surgery, she was well without metastases.

[Breast Cancer Occurring in the Axillary Area - A Case Report].

A 50-year-old woman aware a lump in the right axillary area 5 years ago.She noticed that the lump gradually became bigger, accompanied by redness and gathering of the skin; therefore, she consulted a dermatologist.On receiving the result of skin biopsy, she was referred for a suspected metastatic lesion from breast cancer.The mass was 20mm in diameter, was palpable in the right axillary area, and accompanied by redness of the skin.Ultrasonography revealed 2 irregular-shaped masses in the right axillary area.An FDG/PET study showed some abnormal uptake in the right axillary area, but there were no other primary lesions in any other organs.We performed tumorectomy, and the axillary tumors was histopathologically diagnosed as invasive ductal carcinoma.This case was comprehensively presumed to be accessory breast cancer.In the case of malignant tumor in the axillary area, differential diagnoses are axillary lymph node metastasis of latent breast cancer, ectopic breast cancer, accessory breast cancer, and malignant tumors of skin and its appendages.We presented here a case of carcinoma that was estimated as accessory breast cancer considering clinical, radiological and pathological findings in an integrating manner.

[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.

Application of extraction chromatography to the separation of thorium and uranium dissolved in a solution of high salt concentration.

Extraction chromatography with commercially available UTEVA resin (for uranium and tetravalent actinide) was applied for the separation of Th and U from control solutions prepared from a multi-element control solution and from sample solutions of solidified simulated waste. Thorium and U in control solutions with 1-5mol/dm(3) HNO(3) were extracted with UTEVA resin and recovered with a solution containing 0.1mol/dm(3) HNO(3) and 0.05mol/dm(3) oxalic acid to be separated from the other metallic elements. Extraction behavior of U in the sample solutions was similar to that in the control solutions, but extraction of Th was dependent on the concentration of HNO(3). Thorium was extracted from 5mol/dm(3) HNO(3) sample solutions but not from 1mol/dm(3) HNO(3) sample solutions. We conjecture that thorium fluoride formation interferes with extraction of Th. Addition of Al(NO(3))(3) and Fe(NO(3))(3), which have higher stability constant with fluoride ion than Th, does improve extractability of Th from 1mol/dm(3) HNO(3) sample solution.

Influence of hydrofluoric acid on extraction of thorium using a commercially available extraction chromatographic resin.

The dependence of Th recovery on hydrofluoric acid (HF) concentration in nitric acid (HNO(3)) solutions (1-5 mol/dm(3)) containing 1x10(-6) mol/dm(3) of Th and various concentrations of HF and the elution behavior were studied using a commercially available UTEVA (for uranium and tetravalent actinide) resin column. Thorium recovery decreased with an increase in HF concentration in the sample solutions. The concentration of HF at which Th recovery started to decrease was approximately 1x10(-4) mol/dm(3) in 1 mol/dm(3) HNO(3) solution, approximately 1x10(-3) mol/dm(3) in 3 mol/dm(3) HNO(3) solution, and approximately 1x10(-2) mol/dm(3) in 5 mol/dm(3) HNO(3) solution. When Al(NO(3))(3) (0.2 mol/dm(3)) or Fe(NO(3))(3) (0.6 mol/dm(3)) was added as a masking agent for F(-) to the Th solution containing 1x10(-1) mol/dm(3) HF and 1 mol/dm(3) HNO(3), Th recovery improved from 1.4+/-0.3% to 95+/-5% or 93+/-3%. Effective extraction of Th using UTEVA resin was achieved by selecting the concentration of HNO(3) and/or adding masking agents such as Al(NO(3))(3) according to the concentration of HF in the sample solution.