[Clinicopathological evaluation of preoperative chemotherapy with doxorubicin plus cyclophosphamide followed by paclitaxel for locally advanced breast cancer].

While the optimum regimen and therapeutic duration of preoperative chemotherapy have not been established for advanced breast cancer, the combination regimen of anthracycline series and taxane series, which has been well received as a postoperative chemotherapy, is also recommended for preoperative chemotherapy. We here present a clinicopathological evaluation of the safety and efficacy of the regimen and the predictors of the effectiveness of preoperative chemotherapy conducted retrospectively in patients with advanced breast cancer who were treated preoperatively with the combination of doxorubicin and cyclophosphamide followed by sequential weekly paclitaxel during the period between January 2004 and June 2007 at Yamada Red Cross Hospital. Eleven patients were treated preoperatively with the regimen during the study period. Tumors shrank in all patients following the preoperative chemotherapy with a mean reduction rate of 64.1%. Adverse reactions to the preoperative chemotherapy included leukopenia; grade 3 in 1 patient and grade 2 or less in the remaining patients. Response rates evaluated in the primary tumors and lymph nodes were high. As for the predictors of the effectiveness of the regimen as preoperative chemotherapy, estrogen receptor(ER)and the presence of HER2 were investigated, and antitumor effects were high in patients with negative ER and positive HRE2.

Factor Analysis Influencing Postoperative Hospital Stay and Medical Costs for Patients with Definite, Suspected, or Unmatched Diagnosis of Acute Cholecystitis according to the Tokyo Guidelines 2013.

Purpose. To identify significant independent preoperative factors influencing postoperative hospital stay (PHS) and medical costs (MC) in 171 patients who underwent cholecystectomy for benign gallbladder diseases and had definite, suspected, or unmatched acute cholecystitis (AC) diagnosis according to the Tokyo Guidelines 2013 (TG13). Methods. The 171 patients were classified according to the combination of diagnostic criteria including local signs of inflammation (A), systemic signs of inflammation (B), and imaging findings (C): A+ B+ C (definite diagnosis, n = 84), A+ B (suspected diagnosis, n = 25), (A or B) + C (n = 10), A (n = 41), and B (n = 11). Results. The A+ B + C and (A or B) + C groups had equivalent PHS and MC, suggesting that imaging findings were essential for AC diagnosis. PHS and MC were significantly increased in the order of severity grades based on TG13. Performance status (PS), white blood cell count, and severity grade were identified as preoperative factors influencing PHS by multivariate analysis, and significant independent preoperative factors influencing MC were age, PS, preoperative biliary drainage, hospital stay before surgery, albumin, and severity grade. Conclusion. PS and severity grade significantly influenced prolonged PHS and increased MC.

A Case of Burkitt's Lymphoma Involving Both Breasts.

Primary malignant lymphoma of the breast is rare, and Burkitt's lymphoma is especially rare. We report the case of a 44-year-old woman in whom Burkitt's lymphoma involving both breasts was diagnosed. The patient was referred to our hospital because of a diffuse, firm swelling, like a bulky ball, in both breasts. Fine-needle aspiration cytology (FNAC) of both breast masses revealed malignant lymphoma(ML), and diffuse large B-cell lymphoma was diagnosed based on the results of immunohistochemical studies of a core needle biopsy specimen. The gallium scan revealed very hot lesions in both breasts, but there was no evidence of disseminated disease. We instituted initial therapy, with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus intrathecal chemotherapy without performing a chromosome analysis, because the clinical course was very aggressive. A CR was achieved, but after eight cycles of CHOP therapy, the ML relapsed. We then resected the mass in the left breast, and when examination of the surgical specimen revealed relapse of ML and t (8;11) (q24;q32) translocation, Burkitt's lymphoma was diagnosed. High-dose chemotherapy followed by peripheral-blood stem cell transplantation was performed, but the patient died 10 months after her initial presentation at our hospital.