Ikuo Kokufu

Squamous Cell Carcinoma of the Breast: Three Case Reports.

Three cases of squamous cell carcinoma of the breast, initially diagnosed by fine needle aspiration cytology, are presented.The first case was a 49-year-old woman with a T1 tumor located in the lower outer quadrant of the left breast. Ultrasonography revealed a cystic tumor. Aspiration cytology suggested squamous cell carcinoma (SCC). Mastectomy was performed. Histological examination revealed a pure SCC. The second case was a 40-year-old woman with a T1 tumor located in the upper outer quadrant of the right breast. Ultrasonography showed a cystic tumor and aspiration cytology revealed SCC. A quadrantectomy was performed. Histological examination revealed predominant SCC with an adenocarcinoma component. Estrogen receptor (ER) was negative. The patient received postoperative radiation. Thirteen months after the first operation, a salvage mastectomy was performed because of local recurrence. The third case was a 61-year-old woman with a T1 tumor located in the upper outer quadrant of the right breast. Ultrasonography showed a solid tumor. Aspiration cytology revealed both SCC and adenocarcinoma. Wide excision was performed. Histological examination revealed predominant SCC with foci of adenocarcinoma. ER was negative. She received postoperative radiation.The three patients are alive and disease-free 10 to 54 months after operations.

Prevention of bone metastases from breast cancer by adjuvant bisphosphonate therapy.

There is increasing evidence regarding the importance of osteoclast activation in the pathogenesis of bone metastases. Cancer cells produce osteoclast-activating factors which play an important role in the development of bone metastases. Bisphosphonates are drugs that inhibit bone turnover by decreasing bone resorption. In patients with bone metastases from breast cancer, the effectiveness of bisphosphonate is well established for reducing skeletal complications, such as bone pain, pathological fracture, bone surgery and hypercalcemia. Recent attention has focused on a possible preventive effect on bisphosphonates of bone metastases. Animal models have supported the prevention of bone metastasis by bishosphonate therapy, but three major adjuvant clinical trials of the oral bisphosphonate clodronate have yielded conflicting results. However, our preliminary trial of intravenous bisphosphonate with pamidronate showed effective inhibition of bone metastases. Use of bisphosphonates as adjuvant therapy is still investigational yet promising. Several more randomized trials are underway to further investigate adjuvant therapy with bisphosphonates.

Cyst Fluid Levels of Carcinoembryonic Antigen, Carbohydrate Antigen 19-9, Squamous Cell Carcinoma Antigen, and Amylase in Thyroglossal Duct and Branchial Cleft Cysts

Abstract Cyst fluid was aspirated from five thyroglossal duct cysts (TDCs) and four branchial cleft cysts (BCCs). The cyst fluid levels of carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, squamous cell carcinoma antigen (SCC), and amylase were measured and compared between the two types of cyst. The enzyme immunoassay technique was used for CEA and CA19-9, while SCC and amylase levels were measured by the immunoradiometric assay and nitrophenol method, respectively. Immunostaining for CEA, CA19-9, and amylase was also performed. The serum levels of these markers in both groups of patients were within the normal ranges. In contrast, their cyst fluid levels were extremely high. There was no significant difference in the cyst fluid levels of CEA and SCC between the two types of cyst; however, the cyst fluid from the TDCs showed significantly higher levels of CA19-9 and significantly lower levels of amylase compared with that from the BCCs. Immunostaining revealed expression of CA19-9 in nearly half the columnar epithelial cells in the TDCs, but not in the squamous epithelial cells in the BCCs. CEA and amylase were not found in the epithelial cells of either type of cyst. These findings seem to reflect the difference in etiology between TDCs and BCCs.