A Case of Inflammatory Pseudotumor of the Breast after Augmentation Mammoplasty

Inflammatory pseudotumor is a benign reactive lesion which forms due to diverse tissue responses of inflammatory cells and mesenchymal cells. It can occur in various organs of the body but rarely in the breast. We report a case of inflammatory pseudotumor of the breast after augmentation mammoplasty. The patient was a 78-year-old woman who noticed a mass in her right breast in July 2012. She had a history of augmentation mammoplasty at age 24 years. She was referred to our hospital for thorough examination. A 3-cm immovable induration was palpated in the upper lesion of the right breast. Ultrasound examination revealed a hypoechoic mass at the same site. The mass was 2.9×1.7 cm with irregular, ill-defined borders. Mammography revealed some areas of elevated density with coarse, lucent-centered calcifications in bilateral breasts but no clear findings of malignancy. Core needle biopsy of this site revealed marked fibrous hyperplasia and proliferation of fibroblast-like spindle cells. Infiltration of neutrophils and plasma cells was observed in the stroma. There were spindle cells with no atypia and scarce mitotic figures. Thus, the patient was diagnosed with inflammatory pseudotumor. The patient received only follow-up observation without surgical resection as per the patient\u27s wishes. There has not been any change as of May 2013

Positive Therapeutic Response to Bevacizumab Plus Paclitaxel in a Patient with Advanced, Life-Threatening Breast Cancer and Carcinomatous Lymphangitis:a Subsequent Treatment Change to Hormone Therapy

We present a case of advanced, life-threatening breast cancer with carcinomatous lymphangitis treatedwith bevacizumab plus paclitaxel. A positive therapeutic response was achieved and the treatment was subsequentlychanged to hormone therapy.The patient was a 53-year-old postmenopausal woman with a non-contributory medical history. She presentedto a nearby hospital with chief complaints of continued exertional dyspnea and coughing since March2012. Physical findings included a palpable mass in the left breast, and the patient was referred and presentedto our hospital in May. Examinations at our hospital revealed left-sided breast cancer (estrogen receptorpositive, progesterone receptor positive, and no amplification of the human epidermal growth factorreceptor 2 by FISH). The patient had bone metastasis and carcinomatous lymphangitis (cT2N3cM1-stageIV). The condition was life threatening, and administration of bevacizumab plus weekly paclitaxel was initiatedwith the expectation of a high response rate. Coughing and dyspnea resolved two weeks later. CTscans were taken in August after the completion of 3 cycles and showed improvement in carcinomatouslymphangitis. No major side effects were observed due to bevacizumab plus weekly paclitaxel. When theCT scans were taken in December after the completion of 6 cycles, the primary lesion and lymph node metastaseswere reduced in size. In the lung field, there was no thickening of the interlobular septa or subpleuralinterstitium, and the findings of carcinomatous lymphangitis were improved. Thus, bevacizumab plus paclitaxelwere discontinued and the treatment was changed to oral letrozole (2.5 mg/day). The patient hasbeen followed up with no recurrence as of March 2013

CD-DST ホウ オ モチイタ ニュウガン INTRINSIC SUBTYPES ニ オケル コウガンザイ カンジュ セイ シケン ノ ケントウ

乳癌の個別化治療が進む中で,依然としてエストロゲンレセプター (ER) やHER2遺伝子の発現状況と化学療法の薬剤感受性との関係には不明な点が多い.今回我々はCollagen gel Droplet embedded culture Drug Sensitivity Test (CD-DST法) を用いた抗癌剤感受性試験を行い,乳癌のsubtypeと薬剤感受性の関係について検討を行った.対象は乳癌患者60例59検体で,5-FUは34検体,epirubicinは35検体,paclitaxelは29検体で抗癌剤感受性の評価が可能であった.5-FU,epirubicin,paclitaxelいずれの薬剤においてもHER2発現状況と抗癌剤感受性との間に有意な相関は認められなかった.ERの発現を認めるホルモン陽性乳癌ではepirubicinに対する薬剤感受性が有意に低下し,5-FU,paclitaxelに対しても感受性が低い傾向が認められた.術前化学療法施行例では抗癌剤感受性試験の評価可能率が低下する事が判明した.CD-DST法は今後の乳癌化学療法を選択する上で,有用となりうる可能性が示唆された.Breast cancer is classified into four subtypes according to estrogen receptor (ER) and human epidermal growth factor receptor 2( HER2) expression. The biological subtypes have a spectrum of clinical, pathologic, and molecular features. Here, we investigated the correlation between the breast cancer subtype and chemosensitivity using the collagen gel droplet embedded culture drug sensitivity test (CD-DST). The response to 5-fluorouracil( 5-FU) was examined in 34 specimens;the response to epirubicin, in 35; and the response to paclitaxel, in 29. HER2 overexpression was not significantly correlated to the chemotherapeutic response to 5-FU, epirubicin, or paclitaxel. ER-positive breast cancer was significantly less sensitive to epirubicin and tended to be refractory to 5-FU and paclitaxel. The evaluation rate of the anti-drug sensitivity test was significantly lower in the group that received neoadjuvant chemotherapy. CD-DST could be useful in choosing anti-cancer drug agents for breast cancer patients

Efficacy of octreotide against chylothorax following lateral neck dissection for thyroid cancer: A case report

Introduction: Postsurgical chylothorax is a rare complication of cervical dissection for thyroid cancer. We report that octreotide, a synthetic analog of somatostatin, is effective in treating chylothorax after thyroid carcinoma surgery. Presentation of case: The patient was a 48-year-old woman who presented to our institution complaining of a left anterior cervical mass. We diagnosed this as thyroid papillary carcinoma and performed a subtotal excision of the thyroid gland with left cervical lymph node dissection. The patient developed dyspnea, and a chest X-ray revealed bilateral chylothorax on Day 4 post-surgery. Octreotide was administered since bilateral chylothorax was noted. A marked decrease in chyle effusion was noted just 3 days after starting octreotide, and after a total of 9 days of treatment, there were no further signs of chylous effusion. Discussion: Octreotide is effective against postsurgical chylothorax; however, if there are no signs of improvement, we believe surgical treatment should be considered. Conclusion: Octreotide should be administered first to treat postsurgical chylothorax before surgical treatment is considered

A case of mucinous carcinoma of the breast in which needle tract seeding was diagnosed by preoperative diagnostic imaging

Herein we report a 62-year-old woman with an excisable breast tumor in whom needle tract seeding was suspected during preoperative ultrasound and magnetic resonance imaging (MRI). A tumor of the right breast was observed during initial examination, and she was referred to our hospital after fine-needle aspiration cytology led to diagnosis of breast cancer, even though core needle biopsy results were negative. Mammography showed a high-density mass with a portion of the margin exhibiting very fine serrations. Ultrasonography revealed a circular mass with a border that was indistinct in some regions, and a hypoechoic band that extended from the tumor toward the skin. A mass was observed on MRI, with a linear enhancement extending on the skin side, and needle tract seeding was suspected. Fine-needle aspiration cytology revealed malignancy, and the histological appearance was consistent with mucinous carcinoma. T1cN0M0 stage I breast cancer was diagnosed, and wide excision and sentinel lymph node biopsy were performed. The skin directly above the tumor was concurrently excised to remove the biopsy puncture site. Histopathological diagnosis confirmed mucinous carcinoma, with the tumor observed to extend linearly into the subcutaneous adipose tissue in a pattern corresponding to the biopsy puncture site. The stump of the excised breast was negative for cancer cells. The possibility of tumor seeding must be considered during fine-needle aspiration cytology and biopsy. As demonstrated in this case, diagnosis of such seeding through preoperative imaging may enable extraction of the entire lesion, including the needle tract. © 2009 The Japanese Breast Cancer Society.Link_to_subscribed_fulltex