[A Case of Superior Vena Cava Syndrome Due to Recurrent Breast Cancer Effectively Treated by Trastuzumab Deruxtecan].

A 64-year-old female underwent Bt+Ax surgery due to ER(-), PR(-), HER2(+), ycT3N1M0, Stage ⅢA right breast cancer. After cancer recured in the chest wall, whole-breast radiation therapy was performed, followed by ddAC, and T- DM1. After 12 courses of T-DM1, CT scan and physical findings showed no evidence of metastases, so chemotherapy was suspended with strict follow-up. Seven months later, a chest wall recurrence with pleural dissemination was found and 9 courses of PER plus HER plus eribulin therapy was administered until disease progression. T-DM1 was re-administered but disease progressed after 2 courses accompanied by SVC syndrome due to 8 cm mediastinal lymph node metastasis which caused respiratory discomfort and face edema. We administered T-DXd and after the first course respiratory symptoms vanished, and after 3 courses lymph node metastasis shrunk extremely in the CT imaging. SVCS is one of the oncologic emergencies, in which palliative radiotherapy may be typically selected for the relief of symptoms, and intravascular stents are used in urgent cases. Surprisingly, we experienced a case of SVC syndrome caused by breast cancer metastasis, effectively treated by T-DXd.

[Incidence of Secondary Malignancy of Chronic Myeloid Leukemia during Treatment of Breast Cancer with Hormone Therapy].

It is expected that the number of long-term breast cancer survivors will increase owing to the improvements in chemotherapy and irradiation, while the risk of double cancers, including secondary malignancy, may become an issue. There are many unclear points in the treatment policy with regard to when a secondary malignancy occurs or the primary cancer relapses during the management of a secondary malignancy. A 54-year-old woman who was diagnosed with ER/PgR-positive HER2 negative breast cancer Stage ⅢB received neoadjuvant chemotherapy FEC and docetaxel followed by breast surgery, adjuvant hormone therapy, and radiation therapy. Chronic myeloid leukemia diagnosed by the abnormal findings of leukocytosis and bone marrow aspiration emerged after 3 years of the diagnosis of the first breast cancer. After 3 years of imatinib therapy that achieved a major molecular response(MMR)of CML, a recurrence of sacral metastasis of breast cancer was revealed by MRI. The combination of imatinib and hormone or S-1 chemotherapy could be maintained without serious adverse events after the relapse of the primary cancer.

[A Case of Ipsilateral Breast Tumor Recurrence(IBTR)after Breast-Conserving Surgery Which Successfully Resected after Chemotherapy Using Carboplatin plus Gemcitabine].

A 39-year-old woman underwent partial mastectomy with sentinel lymph node biopsy for right triple negative breast cancer(T2N0M0, Stage ⅡA). Six months later, ipsilateral breast tumor recurrence(IBTR)was observed and paclitaxel plus bevacizumab therapy was started, but anaphylactoid symptoms appeared and the patient was discontinued. Subsequently, eribulin was started, but the IBTR was increased ineffectively. At that point, IBTR had progressed, apparently unresectable, with no distant metastases. We predicted from the patient's background that the patient may be associated with BRCA1 gene mutation and was sensitive to the platinum salts. Carboplatin plus gemcitabine was selected and 6 courses were performed. After the 6 courses, the IBTR were remarkably reduced and resectable, and mastectomy with axillary lymph node dissection were performed. One year after the operation, contralateral breast cancer develop and found to be hereditary breast and ovarian cancer syndrome (HBOC) by Genetic test. About 6 years have passed since local recurrence, but no distant metastases have been observed.

Spindle and giant cell type undifferentiated carcinoma arising in the common bile duct: a case report.

We report on a 61-year-old Japanese male with a pedunculated tumor in the common bile duct. The tumor consisted of two types of neoplastic cells. The majority showed atypical spindle- and giant-shaped features and proliferated densely in an inflammatory stroma, revealing a sarcomatous pattern. They expressed vimentin, KL-1, and CAM5.2. The remaining minority showed glandular and tubular features, occupied only less than 5%, located only in the tumor surface, and expressed wide spectrum keratin, KL-1, CAM5.2, epithelial membrane antigen, AE1/AE3, and carcinoembryonic antigen. CD68-positive osteoclast-like giant cells were also observed. Therefore, the patient was diagnosed as having an undifferentiated carcinoma, spindle and giant cell type.

Pancreatic endocrine tumor with partial acinar cell differentiation.

We examined a 70-year-old woman in whom a pancreatic endocrine tumor with partial acinar cell differentiation had been diagnosed. She had neither endocrine nor exocrine symptoms. The tumor was located in the pancreatic tail and measured 12.5 x 9.5 x 8 cm. It had a capsule, was composed of multiple adhesion nodules, and was elastically soft, medullary, and yellowish white. The neoplastic cells had large, irregular, oval nuclei; prominent eosinophilic nucleoli; and abundant eosinophilic cytoplasm with many fine granules. The cells had proliferated in islet-like solid medullary, trabecular, acinar, and papillary patterns. Most neoplastic cells were strongly positive for synaptophysin. 10 to 25% of the neoplastic cells were positive for alpha1-antitrypsin. Neuroendocrine and zymogen granules were simultaneously observed in the cytoplasm of the same neoplastic cells at the ultrastructural level. The tumor may be considered an amphicrine tumor.

The specific mitochondrial DNA polymorphism found in Klinefelter's syndrome.

Hypervariable segments of mitochondrial DNA (mtDNA) (HV1 and HV2) were analyzed in Klinefelter's syndrome and compared to normal population data. One pair of samples consisting of a Japanese mother and affected son with Klinefelter's syndrome (involved in a criminal case), and seven unrelated DNA samples from Caucasian Klinefelter males (two involved in criminal cases and five diagnosed) were collected in Japan and the United States. The diagnosis of Klinefelter's syndrome was established previously by multiplex XY-STR typing detecting two X alleles and one Y allele in the samples. Haplotype analysis of the mtDNA sequence in Klinefelter males was found to be identical, unique, and specific, as it was not found in the normal population. Astonishingly, family data exhibited that the haplotype of the mtDNA in the son was apparently different from the mother's, suggesting that the mtDNA of Klinefelter male would not be inherited from mother to son. Our data indicate that possible interaction of the sex chromosome and the mtDNA exists, and suggests that the specific mtDNA haplotype could cause the abnormal cell to fertilize and reproduce itself.