Prevention of New Metastatic Lesions by Eribulin Monotherapy Is Associated with Better Prognosis in Patients with Metastatic Breast Cancer.

BACKGROUND: Eribulin therapy has been reported to prolong overall survival (OS) but not progression-free survival, probably because it prevents the development of metastatic lesions; however, this effect has not yet been confirmed. METHODS: We reviewed the medical charts of 50 patients with metastatic breast cancer who underwent eribulin monotherapy at our hospital between 2014 and 2019. Patients were divided into two groups, namely, those who discontinued eribulin because of disease progression due to development of new lesions (NL group) and those who discontinued eribulin for other reasons, such as lesion growth and unacceptable side effects (non-NL group). Survival times were estimated for both groups and we investigated if eribulin-mediated suppression of new metastasis increased OS. RESULTS: Median OS for all patients, from eribulin initiation, was 14.4 months (range 1.2-60.1), whereas it was 4.6 months (range 1.7-24.7) in the NL group and 16.8 months (range 1.2-60.1) in the non-NL group. OS was significantly poorer in the NL group than in the non-NL group (p < 0.05). CONCLUSION: Eribulin monotherapy-mediated suppression of new metastatic lesions results in a better prognosis in patients with metastatic breast cancer.

Survival With Surgery Is Superior to Survival Without Surgery in Breast Cancer Patients Aged 85 years or Older: A Retrospective Study.

BACKGROUND: Surgical treatment of breast cancer patients aged 85 years or older is still controversial. METHODS: A series of surgically treated breast cancer patients aged 85 years or older was evaluated. The clinicopathological features and outcomes of these patients were compared with the features and outcomes of breast cancer patients in the same age group who were managed without surgery. RESULTS: A total of 45 patients (75%) received surgical treatment, and 15 patients (25%) were managed without surgery. Significantly more patients treated by surgery underwent systemic treatment than patients managed without surgery (P = .003). The 5-year disease-free survival rate of patients treated by surgery was 80.7% (95% confidence interval: 66.2-98.5%), which was significantly higher than that of the patients managed without surgery (P = .001). CONCLUSIONS: The surgical treatment of breast cancer patients aged 85 years or older is warranted. This outcome was achieved with the use of hormonal therapy.

[Usefulness of Automated Breast Ultrasound for Deciding on a Surgical Approach in a Patient with Breast Cancer- A Case Report].

Since breast reconstruction has been covered by health insurance, we can choose a procedure that combines the cosmetic satisfaction of patients with curability. We report about a patient with breast cancer that who underwent nipple-sparing mastectomy after evaluating the intraductal spread by automated breast ultrasound system(ABUS), while hand held ultrasound( HHUS)showed only limited information on the intraductal spread of the lesion. A 52-year old woman with an abnormal screening finding was referred to our hospital. HHUS showed an irregular and poorly defined hypoechoic mass lesion with a lactiferous duct extending to directly under the nipple. A core needle biopsy revealed invasive ductal carcinoma. We performed ABUS to assess the intraductal spread in the lesion because the patient requested breast reconstruction. The coronal section of the breast in the ABUS did not showintraductal spread. We, therefore, decided to perform a nipple-sparing mastectomy and sentinel lymph node biopsy. Intraoperative evaluation by frozen and permanent sections showed negative margins. The ABUS findings helped in the evaluation of the intraductal spread of the lesion and in the choice of the optimal procedure for the patient.

[Usefulness of Breast Ultrasound in Follow-Up of Post-Operative Metachronous Contralateral Breast Cancer-A Case Report].

Mammography is the standard screening toolfor post-operative breast cancer, with annualcheck -ups recommended; however, it misses some cancers. We report a case a metachronous contralateral breast cancer detected by breast ultrasound 8 years and 6 months after operation. A 72-year-old women visited our hospital for follow-up 8 years and 6 months after the operation. She was diagnosed with right breast cancer at 63 years of age and underwent partial mastectomy with axially lymph node dissection. The pathological diagnose was scirrhous carcinoma. After chemotherapy and radiation therapy, she underwent screening with annual examinations. The mammography finding was normal, but an ultrasound showed a mass lesion in the contralateral breast. The pathological diagnosis of the biopsy specimen was mucinous carcinoma. A history of breast cancer is known to suggest an increased risk of metachronous contralateral breast cancer. Therefore, regular follow-up with breast ultrasound, not only mammography, is recommended.

[A Case of Giant Parathyroid Adenoma].

A 79-year-old man presenting with general fatigue was admitted to our department. Preoperative laboratory examination indicated primary hyperparathyroidism as the cause of his symptoms, with elevated parathormone and serum calcium levels. Ultrasound and 99mTc-MIBI of the cervical region revealed a giant parathyroid adenoma, sized 4×2.5 cm, located in the right thyroid lobe. Despite its size, the gland was successfully removed by performing minimally invasive parathyroidectomy. His postoperative course was uneventful, and he was discharged the next day. This report describes the case of an unusually large adenoma of the parathyroid, detected based on high serum calcium levels.

[Study of the Therapeutic Effect and Neutrophil Lymphocyte Ratio in Breast Cancer Patients Who Received Eribulin].

BACKGROUND: The neutrophil lymphocyte ratio is reported to be a poor prognostic factor in each carcinoma, and the possibility of predicting the therapeutic effect of chemotherapy, for example, is being studied. In this study, we measured the NLR before and after administration of eribulin and the NLR before and after the final administration in breast cancer patients and examined the relationship with the therapeutic effect. METHODS: Eleven primary breast cancer patients were examined after eribulin was administered; PD was confirmed eventually, and administration was discontinued. The NLR was determined before the first administration of eribulin and 7 days after the administration; the NLR before the final administration and after the last administration were each tested with p<0.05 as the significance level and using the t test. RESULTS: The average value of NLR before initial administration was 4.07±2.11, and the average value after 7 days of administration was 2.47±1.97. The NLR before initial administration tended to be higher, and a significant difference was observed(p<0.05). The average NLR value before the final administration was 4.02±2.04, and the average value of the NLR after the final administration was 3.19 ±1.76, showing no significant difference(p=0.27, NS).

[Treatment Experience of Palbociclib as a New Checkpoint Inhibitor].

We encountered a case of multiple metastases from breast cancer. The patient was administered palbociclib, which was a new checkpoint inhibitor. The patient received various chemotherapies and endocrine therapies. We observed episode of care, a harm phenomenon, and tolerability. We did not recognize adverse events more severe than Grade 3 during the 6 weeks after initiating palbociclib therapy. Diagnostic imaging showed that the metastatic lesions maintained stable disease during the 6 weeks after initiating palbociclib therapy. This case suggested that palbociclib therapy is useful for patients with metastatic breast cancer.

[Indoleamine 2,3-Dioxygenase Activity during Long-Term Letrozole Therapy for Hormone Receptor-Positive Breast Cancer].

Endocrine therapy is effective for elderly patients who are diagnosed with estrogen receptor-positive breast cancer and cannot receive surgical treatment or chemotherapy because of advanced age. The duration of response in patients receiving letrozole is approximately 10.3 months. There are few cases with more than 3 years of response. We evaluated the significance of indoleamine 2,3-dioxygenase(IDO)during letrozole therapy in long-term response. We measured IDO activity based on the tryptophan(Trp)/kynurenine(Kyn)ratio. Trp and Kyn levels were measured using high-performance liquid chromatography(HPLC). The Trp/Kyn ratio decreased along with tumor reduction after letrozole therapy. These results suggest that measuring the Trp/Kyn ratio may be useful for evaluating immunological status during endocrine therapy in elderly patients with locally advanced breast cancer.

[Successful Breast Conserving Surgery for Simultaneous and Ipsilateral Multiple Breast Carcinomas of Young Patient - A Case Report].

We report a case of a simultaneous and ipsilateral multiple breast carcinoma.The patient was 35-year-old woman.She was noticed a breast lump on her right breast, and visited our hospital.Mammography showed a tumor accompanied by spiculation on her right breast.Ultrasonography revealed 2 tumors with irregular margins, 23mm in diameter and 12mm in diameter, and were observed on C area of her right breast.The continuity of the 2 tumors was not clear.Core needle biopsies for each breast tumors led to a diagnosis.The pathological diagnosis was invasive ductal carcinoma.We checked up whole body. There was no metastatic lesion.We performed breast conserving surgery and sentinel node biopsy.The pathological diagnosis was invasive ductal carcinoma, positive for estrogen receptor and progesterone receptor, negative for HER2/neu.The Ki-67 positive cell index was 30%.The surgical margin was negative.We diagnosed T2N0M0=Stage II A.She was started the endocrine therapy by LH-RH agonist and tamoxifen.Four years after surgery, she was well without 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.

[Diagnosis of a Non-Invasive Ductal Carcinoma, Assisted by Long-Term Follow-Up of Spontaneous Nipple Discharge - A Case Report].

We report a case of a non-invasive ductal carcinoma revealed on long-term follow-up of spontaneous nipple discharge. The patient, a 36-year-old woman, had noticed spontaneous nipple discharge from both breasts over a 3-year period. Mammography and ultrasonography did not reveal any lesions in the breasts. The nipple discharge from her left breast stopped 36 months after initial clinical assessment. However, the nipple discharges from her right breast transformed into a bloody discharge from a single duct. Ultrasonography showed a tumor, 6mm in diameter, in the upper-outer quadrant of her right breast. A core needle biopsy for breast tumor led to a pathological diagnosis of non-invasive ductal carcinoma. We conducted a whole-body clinical examination but no metastatic lesions were detected. Subsequently, we performed breastconserving surgery and sentinel lymph node biopsy. The pathological diagnosis was non-invasive ductal carcinoma in situ. The tumor was positive for estrogen and progesterone receptors, but negative for HER2/neu. The Ki-67 labeling index was 5%. The surgical margin was negative. We diagnosed the tumor as TisN0M0=Stage 0. Endocrine therapy comprising tamoxifen (20mg/day)was initiated. Four years after surgery, she was well without any metastases.

[A Case of Sjögren's Syndrome Associated with Thyroid Cancer].

A 42-year-old woman who had a history of Sjögren's syndrome was admitted to our hospital because of a mass lesion in the left cervical region. A hard tumor in the left lobe and a smaller mass in the central area was detected by ultrasonography and computed tomography. Subtotal thyroidectomy with lymph node dissection was performed. The central mass was minimal thyroid carcinoma. The minimal thyroid carcinoma was discovered accidentally during therapy for Sjögren's syndrome. Because the symptoms decreased, surgery of the thyroid carcinoma could be performed. When it was aggravated, it was thought to be diagnosed carefully.

[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.

[Synchronous and Unilateral Breast Cancers(Invasive Lobular Carcinoma and Non-Invasive Ductal Carcinoma) - A Case Report].

We report a case of synchronous and unilateral breast cancers in a 51-year-old female.A focal asymmetric right breast density was detected on breast cancer screening mammography.Ultrasonography showed a low echoic mass, 9mm in diameter, in the B area, and a second low echoic mass in the CD area of her right breast.A core needle biopsy of the B area mass led to a diagnosis of an invasive lobular carcinoma, positive for estrogen receptor(ER)and progesterone receptor(PgR), and negative for HER2/neu.One -percent of the tumor cells were Ki-67 positive.Her preoperative diagnosis was Stage I (T1N0M0).She underwent muscle-preserving mastectomy plus sentinel lymph node biopsy.The pathological diagnosis from the resected surgical specimen was invasive lobular carcinoma(B area), positive for ER, and negative for PgR and HER2/neu protein expression.From this, she was additionally diagnosed with non-invasive ductal carcinoma(CD area)that was posi- tive for ER, and negative for PgR and HER2/neu protein expression.The surgical margins were negative, and there were no sentinel lymph node metastases.These tumors were independent.She was given adjuvant endocrine therapy.Two years and 6 months after surgery, the patient was doing well and without metastases.

[Long-Term Effect of Fulvestrant for Locally Advanced Breast Cancer in an Elderly Patient - A Case Report].

We report an elderly patient with locally advanced breast cancer who received long-term fulvestrant therapy.The patient was a 75-year-old woman who presented with a right breast lump.She noticed the tumor 4 years and 6 months ago, but she had not visited any hospital.However, her daughter brought her to our hospital.The tumor was 73mm in diameter.A core needle biopsy for breast tumor led to a diagnosis of an invasive ductal carcinoma, positive for estrogen receptor(ER)and progesterone receptor(PgR), and negative for HER2/neu.The Ki-67 positive cell index was 20%.We performed a whole- body checkup, and confirmed the diagnosis as T4cN1M0, Stage III B.She initiated endocrine therapy by letrozole(2.5 mg/ day).After 1 year and 6months, tumor marker levels increased.We changed the endocrine therapy to fulvestrant(500mg/ month).For the next 2 years and 6 months, this therapy was effective.Her axillary lymph node metastases disappeared and tumor size decreased(60%).She underwent muscle-preserving mastectomy plus axillary lymph node dissection.The pathological diagnosis from the resected surgical specimen was confirmed as invasive ductal carcinoma, positive for ER and PgR, and negative for HER2/neu protein expression.The surgical margins were negative, and there was no metastasis in the lymph nodes.She was administered adjuvant endocrine therapy.Four years after surgery, she was well without metastasis.

[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.

[A Case of Advanced Breast Cancer with Liver Metastasis Successfully Treated with Multi-Disciplinary].

We report a case of advanced breast cancer with liver metastasis(T2N1M1, Stage IV )achieving a significant improvement of QOL by multi-disciplinary therapy. The patient was 37-year-old woman who had breast lump and axillary lymph nodes swelling with liver metastasis. A core needle biopsy for breast tumor led to a diagnosis of an invasive ductal carcinoma, negative for estrogen receptor and progesterone receptor, and positive for HER2/neu protein expression. The Ki-67 positive cell index was 40%. She received 16 courses of DOC plus HER plus PER(docetaxel 75mg/m / 2, trastuzumab 6 mg/kg, pertu- zumab 450mg/body, and received 4 courses of EC(epirubicin 90mg/m / 2, cyclophosphamide 600 mg/m2). The breast lesion and liver metastatic lesion disappeared after chemotherapy. We checked up whole body. There was no metastatic lesion. Therefore, we diagnosed a clinical complete response. We performed muscle preserving mastectomy and axillary lymph nodes dissection. The pathological diagnosis from resected specimens were pathological complete response. The surgical margin was negative. She was started the endocrine therapy by tamoxifen(20mg/day). Three years after surgery, she was well without metastases. Multi-disciplinary therapy can improve patient QOL and the clinical outcomes in Stage IV advanced breast cancer.

[A Case of Neuroendocrine Carcinoma with Long-Term Abnormal Nipple Discharge].

We diagnosed invasive breast ductal cancer in a 42-year-old woman. About 10 years previously, she noticed an abnormal nipple discharge, and core needle biopsy indicated intraductal papilloma of the breast. However, the secretion continued, and we performed core needle biopsy again, which suggested invasive breast ductal cancer. Ultrasonography showed a hypoechoic tumor and an irregular low echo area. Breast MRI showed cystography tuberculum in the whole left breast. Pathological findings indicated solid papillary carcinoma with neuroendocrine differentiation, T2N0M0, stage ⅡA, ER(+), PgR(+), HER2 0. In this case, although needle biopsy was performed, the patient's long-term course provided key insights into the diagnosis. Moreover, the long-term bloody discharge from the nipple was a pathognomonic finding of intraneural secretory breast cancer, and it seemed important to take this morbus into consideration and follow-up on it.

[Indoleamine 2,3-Dioxygenase Activity during Letrozol Therapy for an Elderly Breast Cancer Patient].

We evaluated the clinical significance of indoleamine 2,3-dioxygenase(IDO)during letrozol therapy for an elderly patient with locally advanced breast cancer. IDO activity was measured by the tryptophan(Trp)/kynurenine(Kyn)ratio. Trp and Kyn levels were measured using high performance liquid chromatography(HPLC). Serum Trp/Kyn levels of the patient before endocrine therapy were lower than those after endocrine therapy. IDO activity decreased after endocrine therapy and correlat- ed with the number of metastatic lymph node lesions during letrozol therapy. These results suggest that measuring the Trp/ Kyn ratio may be useful for evaluating immunological metastatic status during endocrine therapy in elderly patients with locally advanced breast cancer.