[A case of local-recurring breast cancer under long term-treatment by capecitabine].

A 57-year-old woman had undergone a modified radical mastectomy at another medical institute. Six years after the resection, a tumor was confirmed and diagnosed as a recurrent metastasis in the right margin of the breastbone. The patient underwent chemoradiation therapy at the other medical institute and was then transferred to our institute, where treatment was continued. Four years after the recurrence, chemotherapy with capecitabine was started. Over the past 6 years, the capecitabine dose has not been changed and no signs of local recurrence have been seen. The values of biomarkers are normal. No adverse events, such as hand-foot syndrome, have occurred. Early during the capecitabine treatment, grade 2 elevations in the patient's GOT and GPT values were observed. However, these values recovered immediately without supportive therapy. At present, this patient is continuing to receive capecitabine treatment without experiencing any serious adverse events.

[A case of possible retroperitoneal metastasis of breast cancer successfully treated with oral S-1 and cyclophosphamide therapy after TC therapy].

We report a case of possible retroperitoneal metastasis of breast cancer successfully treated with oral S-1 and cyclophosphamide therapy after docetaxel and cyclophosphamide (TC) therapy. A 57-year-old woman with a history of bilateral breast cancer showed an increase in tumor markers during treatment with oral anastrozole as postoperative adjuvant therapy 4 years after her second cancer surgery. After careful examination, the patient was diagnosed as having multiple bone metastases and her medication was changed to oral letrozole. After 3 months, the patient developed left back pain and was referred to our hospital. CT scanning showed an enhanced mass in the region from the left perirenal and posterior pararenal spaces to the left psoas major muscle and the anterior aspect of the left iliacus muscle, suggesting retroperitoneal metastasis. TC therapy was performed and, as a result, tumor markers decreased and the mass disappeared on CT imaging. After discontinuation of TC therapy, the tumor markers increased again, following which oral S-1 and cyclophosphamide therapy were administered, and the tumor markers decreased. At the time of this writing, the patient is still undergoing therapy, and no recurrence has been observed. We concluded that oral S-1 and cyclophosphamide therapy were useful in the present case and were associated with few adverse effects.

Antitumor effect of combination of S-1 and docetaxel on the human breast cancer xenograft transplanted into SCID mice.

In vivo experiments were performed on breast cancer xenografts to examine whether the combination therapy with S-1, an oral dihydrouracil dehydrogenase (DPD) inhibitory fluoropyrimidine, plus docetaxel functions as an additive/synergistic modulator in tumor growth. The human breast cancer xenograft, MDA-MB-435SHM, was inoculated into SCID female mice. The tumor growth and thymidylate synthase (TS)/DPD activity of tumors treated with the agents were investigated. The T/C value (relative mean tumor weight of the treated group/relative tumor weight of the control group) of the group treated with docetaxel, S-1 and combination therapy were 45.3, 63.1 and 29.8%, respectively; suggesting the positive antitumor effects of the combination therapy in particular. In addition, significant down-regulation of DPD activity was also observed in the tumors treated with S-1, docetaxel and their combination. Down-regulation of the DPD activity of the tumors is also considered to be correlated with the antitumor effect of the treated groups, suggesting its influence on the synergistic effect of the combination therapy.

Fine-needle aspiration cytology of breast lesions: a review of cytological analysis using smooth muscle actin (SMA) immunostaining.

We reviewed fine-needle aspiration (FNA) cytology cases for breast lesions in order to improve the reliability of cytological diagnoses. We analyzed the results of 1,019 FNA cytology cases of patients with breast lesions for five years in our hospital. One hundred and ninety-seven (19.3%) of the 1,019 cases were examined using histological sections, in addition to cytological specimens, and included 27 cytologically suspicious cases. Of the 1,019 cytology cases, 606 (59.5%) were benign, 41 (4.0%) suspicious, 149 (14.6%) malignant and 223 (21.9%) inadequate/nondiagnostic. We also performed immunostaining against smooth muscle actin (SMA), using 19 cytological specimens and 88 histological specimens. We observed myoepithelial cells positive for SMA, which were valuable for cytological or histological diagnosis. To improve the reliability of cytological diagnoses and decrease the false-positive and false-negative cases, it is very important to obtain sufficient aspirates and to understand the cytological characteristics of various benign and malignant breast lesions.

Decreased nm23 expression, but not Ki-67 labeling index, is significantly correlated with lymph node metastasis of breast invasive ductal carcinoma.

The nm23 gene was originally identified by differential hybridization of metastatic murine melanoma cell lines. Some experimental studies demonstrated a significantly reduced metastatic potential of melanoma cell lines transfected with the nm23 gene. In this study, we clarified the relationship between lymph node status and nm23 immunoreactivity, as well as Ki-67 labeling index (LI), of human breast cancer. Of the 44 breast invasive ductal carcinomas, nm23-diffusely positive expression [nm23(+)] was detected in 17 (38.6%), and focally positive/negative expression [nm23(+/-/-)] in 27 (61.4%) cases. Lymph node metastasis was found at a significantly higher incidence in the nm23(+/-/-) cases (18/27, 66.7%) than in the nm23(+) cases (4/17, 23.5%) (p>0.001). In the lymph node metastasis-positive cases, mean LI of Ki-67 cells was 20.9% at the center of the tumors and 24.0% at the advanced margins. In the lymph node metastasis-negative cases, mean LI of Ki-67 cells was 12.4% at the center of the tumors and 27.2% at the advanced margins. Decrease of nm23 expression, but not Ki-67 LI, was significantly correlated with lymph node metastasis of breast invasive ductal carcinoma.