[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 successful case of advanced breast cancer of the elderly treated with the only breast-hormone therapy as PST].

An 83-year-old postmenopausal woman was referred to our hospital in order to get the treatment for ER positive advanced breast cancer (T4aN2M0, stage III b). The patient was diagnosed as the dissected aortic aneurysm and the hypertension. It was decided that an operation and chemotherapy would be too difficult with high existing risks. As a result, she was treated with anastrozole of PST, a 3rd-generation aromatase inhibitor, which led to the marked regression of the left breast cancer within a month. The cancer wasn't visualized after eighteen months. With the ongoing breast-hormone Therapy, no remote metastasis has been found after thirty months to this day. The patient hasn't experienced any adverse effects with the above-mentioned therapy. We concluded that the hormone (anastrozole) therapy as PST is a useful treatment for elderly postmenopausal woman with ER positive advanced breast cancer.