Shigeya Kyoda

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.

HER-2 Protein Overexpression in Metastatic Breast Carcinoma Found at Autopsy

OBJECTIVE The overexpression of HER-2 protein has generally been considered to be consistent in primary and metastatic tumor tissues. We evaluated HER-2 protein overexpression levels in 31 autopsied cases. METHODS Hematoxylin-eosin staining and immunohistological staining Hercep Test II were performed on the primary tumors and the lung, liver, brain and bone metastatic tumors. RESULTS Nine (29%) of the 31 primary tumors were HER-2 score 3+ and HER-2 score 3+ cases were significantly more frequent in carcinomas of nuclear Grade 3 than in those of Grade 1 or 2. In these 31 patients, the HER-2 status in the primary tumors was consistent with the metastatic foci of the lung, liver, brain and bone in 96% (25 of 26), 91% (21 of 23), 100% (12 of 12) and 85% (11 of 13), respectively. With regard to the nine patients with HER-2 score 3+ primary tumors, the HER-2 status in the primary tumors was consistent with the metastatic foci of the lung, liver, brain and bone in 87% (seven of eight), 78% (seven of nine), 100% (only one) and 33% (one of three), respectively. In 11 (92%) of the 12 patients with brain metastasis, the HER-2 was not overexpressed. CONCLUSIONS Even in the far-advanced stages of autopsy, HER-2 status of the primary tumors appeared to be maintained especially in the foci of the lung, liver and brain metastases. As there was a high degree of agreement in HER-2 status between the primary tumors and the metastatic foci to the lung, liver and brain, it is considered to be reasonable to treat patients with such metastatic foci based on the HER-2 status of the primary tumors.

Establishment and characterization of a cell line (NABCA) derived from metastatic lymph nodes of breast scirrhous carcinoma

We successfully established a breast scirrhous carcinoma cell line (designated as NABCA) derived from metastatic tumors of the lymph node. The cells grew as multi-layered cultures without contact inhibition. The population doubling time was approximately 66 h. G-band karyotype of NABCA revealed 66% diploid, XX. Surprisingly, the cells had a number of secretory granules and straight microvilli as a brash border. In heterotransplantation, the cells produced a tumor resembling the original tumor. The NABCA is sensitive to Adriamycin (doxorubicin; KYOWA HAKKO KOGYO, Tokyo, Japan) and Taxol (paclitaxel; Bristol-Myers KK, Tokyo, Japan). This cell line is useful for studying the mechanism of lymphatic metastasis and susceptibility of anticancer drugs in human breast scirrhous cancer.