Akio Hirano

Primary small-cell neuroendocrine carcinoma of the breast: Report of a case

Primary small-cell neuroendocrine carcinoma of the breast is a rare and aggressive neoplasm without an established treatment protocol because so few cases have been described. We report a case of primary smallcell neuroendocrine carcinoma in a 31-year-old woman. The patient came to our hospital 10 days after consulting another clinic, where a diagnosis of locally advanced breast cancer suitable for neoadjuvant chemotherapy had been made. Core needle biopsy under ultrasonographic guidance revealed invasive carcinoma. The doubling time of the tumor progression was calculated as 12 days based on ultrasonographic measurement. After three cycles of chemotherapeutic regimens consisting of adriamycin plus docetaxel, the disease was judged to be progressive and the patient underwent surgery. Definitive histopathological examination revealed primary small-cell neuroendocrine carcinoma. Local and mediastinal recurrence with multiple liver metastases developed only 5 weeks after surgery. Cisplatin plus irinotecan combination chemotherapy was started; however, the patient died of aggressive recurrent tumor progression 6 months after surgery, in spite of the transient tumor regression achieved by chemotherapy. This case reinforces the importance of an early correct diagnosis and the standardization of a treatment regimen for this very rare tumor.

Retrospective Comparison of Non-Skin-Sparing Mastectomy and Skin-Sparing Mastectomy with Immediate Breast Reconstruction

Background. We compared Skin-sparing mastectomy (SSM) with immediate breast reconstruction and Non-skin-sparing mastectomy (NSSM), various types of incision in SSM. Method. Records of 202 consecutive breast cancer patients were reviewed retrospectively. Also in the SSM, three types of skin incision were used. Type A was a periareolar incision with a lateral extension, type B was a periareolar incision and axillary incision, and type C included straight incisions, a small elliptical incision (base line of nipple) within areolar complex and axillary incision. Results. Seventy-three SSMs and 129 NSSMs were performed. The mean follow-up was 30.0 (SSM) and 41.1 (NSSM) months. Respective values for the two groups were: mean age 47.0 and 57; seven-year cumulative local disease-free survival 92.1% and 95.2%; post operative skin necrosis 4.1% and 3.1%. In the SSM, average areolar diameter in type A & B was 35.4 mm, 43.0 mm in type C and postoperative nipple-areolar plasty was performed 61% in type A & B, 17% in type C, respectively. Conclusion. SSM for early breast cancer is associated with low morbidity and oncological safety that are as good as those of NSSM. Also in SSM, Type C is far superior as regards cost and cosmetic outcomes.

Successful Combination Therapy with Trastuzumab and Paclitaxel for Adriamycin- and Docetaxel-Resistant Inflammatory Breast Cancer

We present a case of adriamycin-and docetaxel-resistant inflammatory breast cancer (IBC) in which partial response was achieved with combination therapy using trastuzumab and paclitaxel. A 48-year old woman noticed a lump in her right breast. She was diagnosed with IBC and the disease was staged as T4d N1 M0, stage IIIB. The patient was started on neoadjuvant chemotherapy with adriamycin (50 mg/m2) and docetaxel (60 mg/m2) administered every three weeks. Six courses were performed and the response was evaluated as no change. After one month, contralateral breast swelling indicated bilateral IBC. Bilateral mastectomy using the Halsted method was performed. The immunohistochemical results of the Hercep Test™ was strongly positive (3+). After the mastectomy, right pleural effusion appeared, and cytological examination revealed the cells to be class V (adenocarcinoma).To treat the clinically advanced breast cancer, combination therapy with trastuzumab (initially 4 mg/kg followed by two or more cycles of 2 mg/kg) and paclitaxel (80 mg/m2) were given intravenously every week for eight cycles and then every two weeks thereafter. A total of 32 courses of therapy were performed, the pleural effusion completely disappeared and partial response was maintained for a duration of 482 days. The adverse reactions were mild, and it was possible for her to be treated as an outpatient with high quality of life. This report suggests that weekly combination therapy of trastuzumab and paclitaxel was useful for treatment of adriamycin-and docetaxel-resistant metastatic breast cancer.

Initial experience with contrast-enhanced ultrasonography in follow up assessment of small breast cancer treated by cryoablation

Background Cryoablation (CA) is a nonsurgical focal therapy for small tumours. To detect residual or relapsed tumour after CA of renal cancer, contrast-enhanced imaging is generally used to identify tumour blood flow, but no definitive criteria are established for such follow-up after CA of breast cancer. Aims The aim of this study was to compare the usefulness of contrast-enhanced ultrasonography (CEUS) and magnetic resonance (MR) imaging for assessing residual tumours and local relapse following CA of small breast cancers. Methods We enrolled 4 patients treated by CA at our institution between January 2015 and December 2016 for luminal A breast cancer with maximum tumour size of 1.5cm and neither distant metastasis nor metastatic findings in sentinel lymph node biopsy, who underwent CEUS and MR imaging before CA. In addition to our standard postoperative follow-up for breast cancer, these patients underwent CEUS every 3 months and MR imaging every 6 months after CA. Results Six months after CA, no patient showed enhancement at the lesion site on MR imaging, but there were two with continued enhancement on CEUS. They underwent vacuumassisted breast biopsy under US guidance followed by histopathological examination of tissue that identified no malignancy. Conclusion Our findings of focal enhancement within ablated breast tissue in CEUS after CA is likely attributable to the much higher sensitivity of CEUS to that of other modalities to even slight vascularization. Further investigation in more patients is needed to clarify the utility of CEUS to detect residual or relapsed tumour after CA of small breast cancer.

Clinicopathological Assessment of Patients with Locally Advanced Breast Cancer with 10 or More Lymph Node Metastases

Background and Objective: Prognosis is generally very poor in patients with breast cancer with 10 or more axillary node metastases, but long-term recurrence-free survival is observed. We assess the clinicopathological features of these patients with and without recurrent disease and review the literature. Patients and Methods: We retrospectively examined the background, clinicopathological features, and prognoses of 29 patients who underwent surgery at our hospital for primary breast cancer with 10 or more axillary lymph node metastases between April 2003 and March 2015 and compared findings between those with and without disease recurrence. Metastases were identified based on hematoxylin and eosin staining. Results: The mean number of lymph node metastases was 19 and of dissected lymph nodes, 26. The cumulative disease-free survival plateaued at 59% 3 years after treatment, and the cumulative overall survival rate was 68.4% at 5 years and plateaued at 61% at 6 years. The mean disease-free survival was significantly shorter in those whose disease recurred (13.6 months) than those without recurrence (62.2 months). The expression of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) differed significantly between the 2 groups. Conclusion: Prognosis is generally very poor in patients with breast cancer with 10 or more axillary node metastases if tumors recur within 3 years. Furthermore, findings of all five patients with recurrent disease demonstrating a triple-negative subtype and all 14 patients without recurrence demonstrating luminal A intrinsic subtype suggest the use of these subtypes as prognostic factors.