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An 84-year-old man was diagnosed with anti-acetylcholine receptor (AChR) antibody-positive ocular myasthenia gravis (OMG) at the age of 77 and received treatment. The patient was referred to our department with swelling and pain in his right upper arm, which had spread to other limbs. His serum anti-AChR antibody and creatine kinase levels were elevated, and MRI of the limbs displayed signal changes suggesting inflammation in the several muscles. Despite showing no sign of thymoma, he was positive for serum anti-titin and anti-Kv1.4 antibodies. We performed a muscle biopsy, which led to a diagnosis of inflammatory myopathy (IM). IM associated with OMG is relatively mild. Age-related immune dysregulation may cause both OMG and IM. Evaluation of disease activity with serum anti-AChR antibody levels, and assessment of prognosis with examining anti-striational antibodies are necessary for appropriate management of IM associated with MG.

The patient was a 64-year-old woman. The patient was operated for left breast cancer(pT2N0M0, stage ⅡA, Luminal A). Eight years after surgery, CT findings revealed lung metastasis in the S8 and S9 areas of the left lung. The patient was treated with a combination of abemaciclib and letrozole, which resulted in a partial response(PR). One year after treatment, the lung metastases remained small, but multiple interstitial shadows appeared in both lower lung fields. The patient was diagnosed with drug-induced interstitial lung disease(Grade 1), and abemaciclib withdrawal and steroid therapy were initiated. After 3 months of treatment with prednisolone at 30 mg/day, the interstitial shadows tended to improve on CT, but a liver abscess was found in the S8 area of the right lobe of the liver. Prednisolone was tapered and abemaciclib was resumed at a dose of 200 mg/day, resulting in scarring of the lung injury and resolution of the liver abscess. The patient's PR was maintained for 18 months after relapse. We report a case of liver abscess during treatment of abemaciclib-induced interstitial lung disease.

For qualitative diagnosis of breast mass, core needle biopsy(CNB)and fine-needle aspiration biopsy cytology(FNAC)are widely used. Overseas, vacuum-assisted biopsy(VAB)is often the first choice for qualitative diagnosis, and its proper use has become a clinical issue. In addition, with the progress of diagnostic imaging in recent years, the chances of finding micro-lesions such as ductal carcinoma in situ(DCIS)are increasing. Since a sufficient amount of tissue sample is required for these diagnoses and abundant biopsy materials are required, tissue biopsy by VAB may be desirable. The advantage of tissue biopsy with VAB is that accurate definitive diagnosis is possible by collecting a sufficient amount of tissue to obtain pretreatment tissue information. On the other hand, there is concern that patient stress may occur, such as hematoma formation after puncture and invasion by a thick puncture needle. It is lightweight and has an ergonomic design that provides stable grip. New technological innovations in this device may contribute to the reduction of patient stress, and are expected to be used in the future. We outline the experience of using BD EleVationTM in breast suction tissue biopsy at our institution.

A 52-year-old woman experienced right breast pain and detected a mammary tumor 6 months ago. She then noticed rapid enlargement of the tumor, which was suspected to be a borderline malignant phyllodes tumor. The tumor size was approximately 15 cm and presented with skin congestion but without infiltration. The tumor showed internal heterogeneous echo and rich blood flow signals on breast ultrasonography. Ultrasonography also showed swelling of the axillary lymph node. Lymph node cytology revealed the presence of atypical cells in the lymph node, and CT scan showed lymph node metastasis in the right axilla and no distant metastases. We performed mastectomy with lymph node sampling. Pathological examination of the specimens confirmed a malignant phyllodes tumor and a metastatic lymph node. One month later, a subcutaneous mass and multiple pulmonary nodules were identified on a chest CT scan. Chest wall irradiation(45 Gy)and chemotherapy were performed, but the number of pulmonary nodules, pleural effusion, and size of the subcutaneous mass continued to increase. Although she underwent another chemotherapeutic treatment, she died 5 months after the surgery. Thus, we report a case of a malignant phyllodes tumor with an extremely rare lymph node metastasis, which rapidly progressed even though multimodal therapy was performed.

Pertuzumab plus trastuzumab plus docetaxel regimen is the first choice for the initial treatment of HER2-positive recurrent breast cancer. However, docetaxel causes many adverse events. A 48-year-old woman was admitted to our hospital for a left breast tumor and was diagnosed with left breast cancer(T1N0M0, Stage Ⅰ, Luminal A). We performed a breast-conserving surgery and sentinel lymph node biopsy, followed by irradiation of the remaining parts of the mammary gland and adjuvant therapy with tamoxifen. Three and a half years after the first surgery, she underwent local resection due to chest wall recurrence of breast cancer. The recurrent tumor was HER2-positive, and we administered fluorouracil, epirubicin, cyclophosphamide( FEC)and paclitaxel plus trastuzumab. Liver metastases were confirmed on completion of cycle 11 of trastuzumab administration, and the regimen was changed to pertuzumab plus trastuzumab plus docetaxel. A partial response was seen following this regimen. The next line of treatment was the administration of 5 cycles of T-DM1, which resulted in stabilizing the disease. The liver metastases progressed, and the regimen was changed to pertuzumab plus trastuzumab plus eribulin. Partial response was seen following this regimen for liver metastases without serious adverse events(20 cycles).

Seventy years old woman noticed a mass in her right breast before 3 years. Since she had ulcer bleeding, she visited our hospital. In physical findings, a hemorrhagic about 8 cm mass with an ulcer was found in the upper right breast. Breast ultrasonography revealed a large tumor of approximately 8 cm in the right A area, and needle biopsy revealed invasive ductal carcinoma(ER positive, PgR positive, HER2 positive, Ki-67 low expression). Right axillary lymph node metastasis was confirmed, but no clear distant metastasis was observed. Pretreatment diagnosis was right breast cancer, cT4bN1M0, Stage ⅢB, Luminal HER. Chemotherapy was started with pertuzumab, trastuzumab, and docetaxel, and the tumor was reduced after 6 cycles. Due to side effects, the drug was changed to a molecular targeted drug only and the treatment was continued. However, redness was observed in the entire right breast, and breast cancer skin metastasis was suspected. Since the dermatitis caused by metronidazole gel was also distinguished, the redness was improved when the application was stopped. When confirmed by a patch test, a reaction to metronidazole gel was observed, leading to the diagnosis of dermatitis caused by metronidazole gel.

Background: The peripheral blood neutrophil-lymphocyte ratio(NLR), platelet-lymphocyte ratio(PLR), and lymphocyte- monocyte ratio(LMR)of cancer patients have been proposed as indicators of systemic inflammatory response. Recombinant human-soluble thrombomodulin(rTM)has also been reported its efficacy in DIC associated with solid tumors. In this study, we investigated the clinical significance of inflammatory markers in rTM therapy for DIC associated with solid tumors., Patients and Method: A retrospective study of 63 patients with solid tumors with DIC was performed. We examined the correlation between NLR, LMR, PLR and DIC withdrawal rate and 28-day survival rate., Results: The DIC withdrawal rate was not correlated in LMR(p=0.655), and significantly higher in low NLR and low PLR cases(p=0.037, p=0.024). Furthermore, 28-day survival rate was not correlated in LMR(p=0.632), and significantly higher in low NLR and low PLR cases(p= 0.046, p=0.014)., Conclusions: It was suggested that NLR and PLR may be useful as predictive markers of DIC withdrawal rate and 28-day survival rate in rTM therapy for DIC associated with solid tumors.

The patient was 54 years old, female. She was aware of gradually worsening right peri-eyelid swelling 2 years before the first presentation to our dermatology department. She underwent biopsy of eyelid skin 2 times. Nevertheless, definitive diagnosis was not obtained. Two months after the initial examination, right anterior thoracic swelling appeared, and right axillary, right subclavian, and interpectoral lymphadenopathy were detected. She was referred to our department for diagnosing metastatic breast cancer. Ultrasonography showed hypoechoic lesion with distortion(largest lesion>2 cm)in right breast, which was suspected to be a breast cancer. The results of breast core needle biopsy, the third time's eyelid skin biopsy and additional imaging studies confirmed T2N3M1, Stage Ⅳ right mammary invasive lobular carcinoma with metastasis to the eyelid skin, right axillary lymph nodes, right subclavian lymph nodes and the subcutaneous tissue of the right back. Immunohistochemical studies showed ER-positive, PgR-negative, HER2-negative, and low Ki-67 expression. Endocrine therapy with letrozole was initiated, which maintained stable disease without compromising the quality of life.

A 59-year-old female was performed a left mastectomy with axillary lymph node dissection. Final diagnosis of the surgical specimen was left breast cancer pT2N1M0, Stage ⅡB, Luminal type. She was treated with adjuvant endocrine therapy, however, chest wall recurrence was identified at 1 year and 3 months after surgery, and curative resection of this tumor and radiotherapy were performed. Nine months later, she was admitted to the hospital for cervical pain and dyspnea, and magnetic resonance imaging showed bone metastasis in cervical vertebra which compressed spinal cord. Although cervical fusion therapy was performed, she died 39 days later. Metastasis spinal cord compression in breast cancer patients may result in irreversible spinal cord injury if treatment is delayed. Rapid diagnosis and systemic treatment for oncologic emergency are significant.

The anti-PD-L1 antibody atezolizumab has become the standard of immunochemotherapy with the results of the international phase Ⅲ trials in lung cancer and breast cancer. We report a case in which atezolizumab was efficiency in PD-L1 (SP142)-positive lung and breast double cancer. A 56-years-old woman. She noticed a lump in her right breast and visited a nearby doctor, who referred her to our hospital for close examination and treatment. Ultrasonography revealed about 5 cm mass on the right mammary gland and axillary lymph nodes swelling. Core-needle biopsy was confirmed invasive ductal carcinoma( ER negative, PgR negative, HER2 negative, Ki-67 high expression). CT findings showed right mammary mass, right axillary lymph nodes swelling, liver mass, and lung tumor with mediastinal lymph nodes swelling. Therefore, a bronchoscopic biopsy was performed and a diagnosis of primary lung cancer was obtained. Pretreatment diagnosis was lung adenocarcinoma, cT2a, N2/3, M1b/1c(HEP, OSS), Stage ⅢA/B or ⅣA/B(PD-L1 positive), and right breast cancer, T4b, N2, M0/1 (HEP, OSS, LYM), Stage ⅢB or Ⅳ triple-negative(PD-L1 positive)double cancer. We underwent surgery(mastectomy with axillar lymph nodes dissection), followed by immunochemotherapy(atezolizumab, carboplatin, paclitaxel)and it was efficiency.

Erdheim-Chester disease(E-CD)is a rare pathology characterized by systematic granulomatosis that occasionally involves the central nervous system. We report about a 68-year-old woman with E-CD who presented with right-side visual disturbance. Magnetic resonance imaging showed a suprasellar tumor that elevated the right optic nerve and involved the right internal carotid and right anterior choroidal arteries. The tumor was partially resected via a trans-Sylvian approach and was histologically diagnosed as a granuloma. Considering the abnormal findings of postoperative X-ray and 99 mTc bone scintigraphy of the long bones, the pathology was diagnosed as E-CD. After surgery, her right-side visual disturbances disappeared. However, 1 year later, she died of systemic infection and heart failure. Histological autopsy findings indicated numerous yellowish nodules in the heart, lung, and kidney with pericardial and pleural effusions and whole-body granulomatosis, including the brain. E-CD is a rare but critical disease. This pathological entity should be considered when encountering cases of intracranial granuloma to ensure its early diagnosis and appropriate treatment. Surgical resection of intracranial granulomas in patients with E-CD may promptly improve neurological dysfunction.

In the treatment of advanced breast cancer, onlya few drugs confer overall survival(OS)benefit. Eribulin is a drug that was shown to extend OS in an international phase Ⅲtrial; however, the underlying mechanism is thought to involve cancer microenvironment regulation. The concept of "breast cancer subtype discordance" implies the biological changes that accompany treatment. Herein, we encountered a case of advanced breast cancer in a 54-year-old woman that showed biological changes after eribulin chemotherapy. The patient noticed a lump in her left breast and visited a nearby doctor, who referred her to our hospital for close examination and treatment. Ultrasonographyrevealed a large mass at the center of the left mammarygland and axillaryly mph node swelling. Core-needle biopsyconfirmed an invasive ductal carcinoma(ER stronglypositive, PgRnegative, HER-2 negative, Ki-67 low expression). CT findings showed multiple lung metastases. Letrozole was administered for cT4N2M1, stage Ⅳ, Luminal A, which showed progression to the left side with advances in breast cancer. Six months later, the primarytumor and axillaryly mph nodes showed progression. Subsequent treatment with eribulin was started, and partial response was obtained; however, new lymph node metastasis developed in the axilla after 11 cycles. The primary tumor and axillaryly mph nodes showed stronglypositive ER expression, were PgR-negative and HER2-positive, and showed Ki-67 low expression and HER2-positive conversion.

A 68-year-old woman noticed a tumor in her left breast and visited our hospital. She was diagnosed with left breast cancer cT2N2M0, stage ⅢA, and surgery was performed after the neoadjuvant chemotherapy. Although this case was indicated for radiation therapy(PMRT)after total mastectomy, postoperative radiation was not performed due to an implantable pacemaker placed in the left anterior chest. Therefore, postoperative adjuvant therapy with endocrine therapy was started. After 3 years of treatment, her left axillary lymph node was enlarged, and needle biopsy confirmed metastasis and recurrence. When local excision was performed, postoperative irradiation was deemed necessary because residual microlesions were suspected. Irradiation planning did not deny the possibility that the pacemaker in the anterior chest indwelling could become the irradia- tion range. Therefore, a leadless pacemaker was inserted, and local irradiation(50 Gy/20 Fr)was performed without complications. The next treatment is fulvestrant, and no recurrence has been observed 6months postoperatively.

An 86-year-old woman visited her nearby hospital for a mass on the left side of her sternum. She had undergone total mastectomy for left breast cancer 32 years prior and multiple small nodules had been found in both lungs 2 years ago. She was sent to our hospital for suspected breast cancer recurrence. Chest computed tomography showed multiple small nodules in both lungs and a mass with sternal sclerosis on the parasternal bone of her left 2-3 intercostal space. A core needle biopsy was performed on the chest wall tumor by ultrasonography. Not only pathological but also immunohistological examination findings were similar to those of the surgical specimens 32 years ago(estrogen receptor: positive, progesterone receptor: positive, HER2: negative, Ki-67 score: low). Therefore, she was diagnosed with a late recurrence of her breast cancer. She started letrozole but the disease had progressed 6 months later. We experienced a case of late breast cancer recurrence 32 years after surgery.

Orbital metastasis from breast cancer is a rare condition. Here, we describe 2 cases of orbital metastasis from breast cancer. The first patient was a 26-year-old woman diagnosed with triple-negative invasive ductal carcinoma. She underwent surgery after neoadjuvant chemotherapy. One year after surgery, she had multiple bone metastases and then multiple liver metastases developed. During chemotherapy for metastatic disease, she complained ofheadaches and visual disturbances. Findings ofa MRI scan suggested a metastatic tumor in the left orbit. A total of 30 Gy of radiation therapy was administered, but she died a month after the orbital metastasis was discovered. The second patient was a 42-year-old woman, who had advanced breast cancer with bone metastasis. Diplopia developed 8 months after initiation of chemotherapy. Meningeal dissemination was suspected because ophthalmological examination revealed swelling ofbilateral optic discs. She lost her sight within a month. She died 2 months after the diagnosis oforbital metastasis. There was no evidence ofcentral nervous system metastasis in either case. Loss ofvision severely impairs patients' quality oflif e. It is important to know that there is rarely such a rapid progression ofdisease, especially in young patients with triple-negative disease.

Subcortical bleeding from brain tumors is not rare. In the majority of cases, tumors are revealed within a few months after bleeding. We herein report a relatively rare case of glioblastoma(GBM)that appeared one year after the removal of a subcortical hematoma. A 70-year-old woman suddenly began experiencing headache, vomiting, and aphasia. CT revealed a subcortical hematoma in the left superior temporal lobe and subarachnoid bleeding. Neither aneurysms nor abnormal signs suggesting a malignant tumor were noted during cerebral angiography. The hematoma was completely removed via craniotomy, and she was discharged with no neurological deficit.(MRI performed seven months after the surgery showed neither space-occupying lesions in the left temporal lobe nor brain edema. Twelve months after the initial surgery, she had aphasia again. CT and MRI revealed an enhanced mass lesion in the left temporal lobe. Positron emission tomography findings strongly indicated the presence of a malignant tumor. Histology of the tumor after removal showed GBM HDH-1 wild-type with an MIB-1 labelling index of approximately 50%. After the surgery, she underwent extensive local radiation therapy(50 Gy)with chemotherapy(temozolomide). The pathological mechanism underlying the appearance of GBM at the site where subcortical bleeding was previously observed is unclear. GBM may have caused bleeding or may have originated from the brain tissue that was damaged during the first surgery. Follow-up using neuroimaging for one year may be needed when subcortical bleeding is observed.

A 40-year-old woman underwent right partial mastectomy and axillary lymph node dissection. Pathological examination confirmed right breast cancer(T2N0M0, Stage ⅡA, mucinous, ly3, v0, weakly positive ER and PgR). After surgery, she received radiotherapy for residual mammary gland cancer and endocrine therapy as adjuvant treatment for 5 years. Seven years after the first surgery, computed tomography showed multiple lung tumors. Transbronchial lung biopsy revealed lung metastasis from breast cancer(strongly positive ER and PgR, negative HER2). She received first-line endocrine therapy, and the response was classified as stable disease(SD). Three years later, the disease control became poor. Second-line endocrine therapy was then administered, and the response was classified as partial response(PR)for 3 years. After that, we modified the regimen to monotherapy of letrozole, and she achieved PR for a further 3 years. In the treatment for patients with metastatic hormone receptor-positive breast cancer, it is important to consider the sensitivity of endocrine therapy, such as relapse-free survival or the expression of hormone receptors in metastatic tumors.

A 72-year-old woman visited our hospital with the chief complaint of a mass in the right breast. Breast ultrasonography revealed a hypoechoic area with a distinct border in the right breast. A core needle biopsy showed the proliferation of spindle cells in the stroma, and she was diagnosed with stromal sarcoma or malignant phyllodes tumor. Right lumpectomy was performed. Pathological examination revealed a malignant phyllodes tumor with a sarcomatous lesion. Although she did not receive adjuvant chemotherapy, she is alive without any recurrence 2 years after the surgery. It is difficult to distinguish phyllodes tumors from stromal sarcoma, based on core needle biopsy, and the prognosis of malignant phyllodes tumors with distant metastases is poor. Rapid surgery to determine an accurate diagnosis and careful follow-up after surgery are impor- tant.

A 73-year-old woman visited our hospital with the chief complaint of a mass in the left breast. Breast ultrasonography revealed a hypoechoic area in the left breast. A core needle biopsy showed the proliferation of solid tumor cells. Immunohistochemistry indicated strongly positive expression of E-cadherin, synaptophysin, and chromogranin A. We then diagnosed her with breast neuroendocrine carcinoma. The expression of estrogen receptor(ER)and progesterone receptor(PgR)were also strongly positive, and the expression of human epidermal growth factor receptor 2(HER2)was negative. Computed tomography( CT)and bone scintigraphy revealed no metastasis. Simple mastectomy of the left breast and sentinel lymph node biopsy were performed. Final pathological examination of the tumor also led to the diagnosis of breast neuroendocrine carcinoma(T2N0M0, StageⅡA, Luminal A-like). After surgery, endocrine therapy is planned, considering the breast cancer subtype. Breast neuroendocrine carcinoma is rare. It is important to consider the possibility of metastasis from other organs to the breast.

History of male breast cancer and pancreatic cancer are important for diagnosis of hereditary breast and ovarian cancer syndrome(HBOC), while advanced pancreatic cancer is reported to have metastasis to mammary gland tissue. A 67-year-old man visited a local hospital because fever and right hypochondrial pain. Computed tomography scan revealed pancreatic cancer with multiple liver metastasis and peritoneal metastasis. He was referred to our hospital for further evaluation and treatment. No particular family history of malignancy was formed. A palpable lump was found in his left breast. Ultrasonography revealed 2.8 cm sized mass that had heterogenous internal echo and rough border. The background mammary gland showed gynecomastia. Since it was difficult primary breast cancer with metastatic tumor originated from pancreas cancer a core needle biopsy was performed. The finding of pathological examination showed invasive carcinoma with hormonal receptor negative and HER2 negative feature. CK7 and CK19 were both positive. Although it was difficult to male differentiation whether the tumor was primary a metastatic, we diagnosed as synchronous duplicated cancer of pancreas and breast due to existence of gynecomastia. Since hepatic failure due to tumor growth advanced prior to treatment start, the treatment policy became best supportive care.

Paget's disease of the breast is usually localized in the nipple epidermis and lactiferous duct located near the nipple. Here, we report a rare case of synchronous breast carcinoma with Paget's disease and invasive ductal carcinoma. A 50-year-old woman was admitted to our hospital because of abnormalities in screening mammography findings. Ultrasonography(US) findings showed a 2.4×1.3×1.6 cm sized hypoechoic lesion in a region of the left mammary gland. Computed tomography (CT)findings did not reveal distant metastasis. Magnetic resonance imaging(MRI)revealed an approximately 2.2 cm sized irregular tumor. The pretreatment diagnosis was left non-invasive ductal carcinoma(cTisN0M0, Stage 0), and surgery was performed. The tumor was found in the range of 40.2×15.0 mm, many of which were breast ductal growth. An infiltrated image was confirmed at multiple sites, but the maximum size was 2.5×1.5 mm. Pathological findings of the main lesion revealed papillotubular carcinoma. Agglomeration of heterotypic cells with abundant cytoplasm was observed in the epidermis of the papilla. The final diagnosis was invasive breast cancer(pT1aN3M0, Stage Ⅲc, Luminal HER2)coexisting with Paget's disease.

The shape of the kinetic curve for gadobutrol is reportedly different compared with that for other conventional contrast agents. We speculate that the shape of gadobutrol kinetic curve may be influenced by different magnetic resonance imaging (MRI) protocols and evaluation methods. The purpose of our study was to assess the influence between gadobutrol and other conventional contrast agent (gadodiamide hydrate) on the kinetic curve in invasive ductal carcinoma (IDC). We assessed 139 women of IDC in this study. Gadodiamide hydrate (2 ml/s) was administered to 69 women, and gadobutrol (1 ml/s) was administrated to 70 women, both contrast agents at 0.1 mmol/kg BW. When the kinetic curves of contrast agents were evaluated between by Breast Imaging Reporting and Data System (BI-RADS) 4th edition and BI-RADS 5th edition, suggested that the analysis method of BI-RADS may affect. Patient group who were administered gadobutrol demonstrated a lower washout rate when compared with patient group who were administered gadodiamide hydrate administration (P<0.01). These results suggest that the kinetic curve characteristics of gadobutrol are an important consideration in diagnosis. Therefore, it is necessary to perform image diagnosis by considering the influence of the contrast agent and the analysis method, when image diagnostic doctor perform image diagnosis.

In the etiology of secondary osteoporosis, only primary hyperparathyroidism is the one to which osteoporosis itself is indicated for surgery. However, there are several diseases that may give bone a good environment by surgical treatment for primary diseases such as hyperthyroidism or Cushing's syndrome, and secondary osteoporosis may improve. It is important to properly conduct differential diagnosis and to discuss and determine surgical indication.

A 64-year-old woman visited hospital with a chief complaint of a nodule at the left neck skin. Skin biopsy revealed adenocarcinoma, and the diagnosis was skin metastasis of unknown primary origin. Positron emission tomography and computed tomography showed multiple bone and lymph node metastasis, left breast tumor, bladder tumor, and hydronephrosis. A needle biopsy of breast revealed invasive ductal carcinoma, and transurethral biopsy of bladder revealed adenocarcinoma. The findings were similar to those for the breast and the expression pattern of estrogen-receptor was the same. We diagnosed her with breast cancer and bladder metastasis. We administered systemic chemotherapy, however she died 10 days later. Bladder metastasis of breast cancer is rarely encountered in clinical practice and is often accompanied by life threatening symptoms. Careful histopathological examinations and rapid systemic chemotherapy are significant.

We investigated the usefulness of vacuum-assisted biopsy(VAB)using the EnCor ENSPIRE®system for initial biopsy of breast tumors. We analyzed 24 cases of VAB using the EnCor ENSPIRE®system performed for breast tumors. Of 24 mammary lesions, 12 cases(50.0%)were diagnosed as malignant. Among them, 7 cases(29.2%)were invasive ductal carcinoma(IDC) and 5 cases(20.8%)were ductal carcinoma in situ(DCIS). Six cases required tumor resection for definitive diagnosis; 1 case was diagnosed with IDC, 2 cases with DCIS, 2 cases with intraductal papilloma(IDP), and 1 case with atypical ductal hyperplasia( ADH). Moreover, EnCor ENSPIRE®system biopsy was performed in 15 cases because malignancy could not be diagnosed using core needle biopsy. There were 4 cases of IDC, 4 cases of DCIS, 2 cases of IDP, 2 cases of usual ductal hyperplasia, and 2 cases of ADH. There were no complications due to a series of procedures. We believe that the EnCor ENSPIRE®system is an effective technique having both convenience and great diagnostic accuracy.

A 67-year-old female was referred to our hospital because she was pointed out mass in her right breast by her previous doctor. Core needle biopsy examination was performed at that time which revealed invasive ductal carcinoma. There'reno palpable masses in her breast or any superficial lymph nodes on her visiting our hospital. Breast ultrasonography images showed multiple nodules in C area of right breast. Breast enhanced MRI image revealed multiple enhanced nodules which showed rapid arising and plateau or slowly decreasing pattern in time intensity curve. CT scan and bone scintigraphy revealed no distant metastasis. Based on these findings, the case was diagnosed as right breast cancer, cT1N0M0, Stage I . For this case, we performed right mastectomy and sentinel lymph node biopsy. The pathological findings was ductal carcinoma in situ (DCIS)accompanied by sclerosing adenosis. Though we didn't perform adjuvant chemotherapy, she has been alive without recurrence for 6 years. Because it's difficult to make correct diagnosis with small specimen collected by core needle biopsy, we should take DCIS in sclerosing adenosis into consideration to prevent overdiagnosis.

A 46-year-old woman visited our hospital with a chief complaint of a mass in the right breast. Breast ultrasonography revealed a hypoechoic area with an indistinct border on the right breast, and right axillary lymph node swelling. A core needle biopsy revealed invasive ductal carcinoma, and the diagnosis was right breast cancer, cT2N2M0, Stage III A, HER2-enriched type. We administered 4 courses of FEC followed by weekly paclitaxel plus trastuzumab. After the treatment, she had eruption and erythema on the face, precordium and forearm. Though dermatomyositis associated cancer was suspected, a definite diagnosis was not made. However, skin symptoms were improved significantly after mastectomy, suggesting that she had dermatomyositis. For the skin symptom during breast cancer treatment, the examination should be made with the possibility of the adverse effect of chemotherapy and dermatomyositis associated cancer.

A breast cancer with tumors smaller than or equal to 5mm in diameter is treated as a microscopic lesion and axially lymph node metastasis is considered to be rare. A 52-year-old female was found to have an abnormal shadow on mammography. An ultrasonography revealed a poorly defined and irregular shaped mass with calcification, 4mm in diameter, in the AC area of her left breast. We performed vacuum-assisted biopsy and diagnosed with invasive ductal carcinoma. Under a preoperative diagnosis of left breast cancer with cT1aN0M0, stage I , Luminal A like, we underwent partial mastectomy with sentinel lymph node biopsy. The intraoperative consultation suggested sentinel lymph node metastasis and we therefore performed level II axillary lymph node dissection. The size of the tumor was 4mm and diagnosed with pT1a breast cancer. Histopathological diagnosis was papillotubular carcinoma. Radiotherapy was performed(total: 50 Gy)followed by endocrine therapy (tamoxifen). She is alive without recurrence and metastasis 5 years after surgery.

Adenoma of the nipple is a rare benign tumor, and it is important to distinguish from Paget's disease or breast cancer. A 45- year-old woman had found induration under the right areola before 2 months and visited our hospital. Ultrasonography showed a 2.4 cm solid tumor in a cystic lesion, which had high blood flow in E area of the right mammary gland. The tumor suspected as duct papillomatosis by core needle biopsy. No metastasis lesion was found by computed tomography and bone scintigraphy. But magnetic resonance imaging showed as a marginally clear tumor with contrast enhanced findings that were relatively early reinforced and prolonged. Because there was a possibility of malignancy based on these findings, tumorectomy was done with patient consent. Histological examination revealed usual ductal hyperplasia(duct papillomatosis)and no malignancy. No recurrence was seen for a year after operation. When diagnosing a tumor under areola, be careful not to misdiagnose malignancy.

We investigated into association of quality of life(QOL)and prognosis of breast cancer patients who underwent neoadjuvant chemotherapy(NAC). We retrospectively studied 228 patients with breast cancer who were performed NAC during a period between 2007 and 2015. TheQ OL score was measured with"The QOL Questionnaire for Cancer Patients Treated with Anticancer Drugs(QOL-ACD)". We evaluate association between QOL score with antitumor effect and prognosis. Changes in the QOL score between before and after NAC were compared as well. We divided 2 groups by QOL-ACD scoreinto high and low groups. Therapeautic effect of NAC on 75 patients were pathological complete response(pCR). QOL-ACD score was not significantly associated with pCR rate in both high and low groups(p=0.199). High group was significantly associated with higher survival rate in both of disease free survival(p=0.009, logrank)and overall survival(p=0.040, logrank). QOLACD score decreased after NAC in both of pCR and non-pCR patients. In conclusion, QOL evaluation using QOL-ACD could be an indicator of breast cancer patients' prognosis who underwent NAC.

The rate of local recurrence after mastectomy is reportedly similar to that of one-stage reconstruction. Most recurrences are in the skin or chest wall, while recurrence in the reconstructed breast is rare and the causes are uncertain. We report a case of a 42-year-old female who underwent partial mastectomy for left breast cancer with cT4aN0M1(PUL), cStage IV after endocrine therapy 3 years ago. Histopathological diagnosis was solid-tubular carcinoma. She had been treated with only endocrine therapy but diagnosed with local recurrence in the left breast. She underwent total mastectomy and rectus abdominis musculocutaneous flap reconstruction. Partial flap necrosis occurred following conservative therapy. She was accordingly treated with anastrozole and GnRH agonist. A mass approximately 1.5 cm in size was palpated inside of the reconstructed breast. As such, she was diagnosed with recurrence in the reconstructed breast through ultrasound biopsy. She underwent partial resection of the left precordial tumor, and histopathological examination revealed scirrhous cancer. She is currently well without any recurrence.

A goal for treating advanced disease is prolonging survival while maintaining a good quality of life(QOL). Eribulin chemotherapy may be suitable for this purpose. We report a case of advanced breast cancer with pathological complete response (pCR)obtained by eribulin chemotherapy. The patient was a 43-year-old woman who complained of a right mammary mass. A tumor measuring approximately 3 cm was palpated, and breast cancer was detected via ultrasound examination. Core needle biopsy indicated invasive ductal carcinoma based on histopathological findings. A metastasis to the supraclavicular lymph node was observed and was found to be malignant via fine-needle aspiration cytology. The patient was diagnosed with advanced breast cancer cT2N3M0, stage III C, Luminal B like. She underwent primary systemic therapy with 6 cycles of eribulin. The patient exhibited a clinical complete response to eribulin chemotherapy. Thereafter, a right mastectomy with level 3 axillary lymph node dissection was performed. Pathological diagnosis of the surgical specimen was pCR. At present, 3 years after surgery, the patient has no recurrence.

A 70-year-old woman noticed a mass in her right breast. Breast ultrasonography showed a low echo mass with a smooth border to the greatest dimension measuring 5.4 cm. Needle biopsy showed an increase in the number of spindle-shaped cells with diffuse fascicles having nuclei with seasonal polymorphisms in the stroma, which led to the final diagnosis of spindle cell sarcoma. Immunohistochemistry analysis showed a CAM5.2-negative, AE1/AE3 partly-positive, bcl-2-positive, ER-negative, PgR-negative, SMA-positive, S-100-negative, desmin-negative, CD34-negative, and keratin 5/6-negative tumor that was suspected to be a phyllodes tumor. Differential diagnoses included sarcoma-likecance r, stromal sarcoma, and malignant phyllodes tumor. Breast mass resection was performed for a definitive diagnosis. The final pathological analysis showed a malignant phyllodes tumor. To date, we have encountered 1 case of malignant phyllodes tumor that was difficult to distinguish from a spindle cell sarcoma. Excisional biopsy is required for a definitive diagnosis.

A 52-year-old woman visited our hospital with a chief complaint of a mass in the left breast. Palpation revealed a mass approximately 3 cm in diameter located on the outer aspect of the left breast. Breast ultrasound revealed a hypoechoic area with an indistinct border, which suggested breast cancer or mastitis. A needle biopsy revealed no evidence of malignancy, and granulomatous mastitis was diagnosed. Antibiotic therapy showed no improvement; therefore, we began prednisolone treatment for the patient. The mass diameter decreased over the subsequent 5 months after initiating this treatment, and we decreased the dose of prednisolone gradually. At present, when 8 months have elapsed after the diagnosis, the patient is doing well without any aggravation of signs or symptoms. The pathological findings of an inflammatory pseudotumor and granulomatous mastitis is similar, relatively rare benign diseases. As the inflammatory pseudotumor has clinical features resembling those of breast cancer, it is an important clinical entity.

Although parathyroid surgery is not a complicated surgical procedure, enough knowledge of the surgical anatomy and accurate information for localization of involved gland are required from the fact of the variation in the number and the location of the parathyroid gland. Surgical treatment for patients with hyperparathyroidism has been in the transition state from the era of both sides exploration to minimally invasive surgery. In addition, intraoperative radio guide method, intraoperative iPTH measurement, and intraoperative neuromonitoring have been introduced for the safe and reliable operation.

Beta-cryptoxanthin [β-CRX, (3R)-β, β-caroten-3-ol] is a provitamin A and a potent antioxidant that is abundant in Satsuma mandarin orange (Citrus unshiu MARC.), which is the most popular fruit in Japan. The anti-stress effect of β-CRX on humans was evaluated in fifth-year university students during both routine daily life at the university and at pharmacy practice. The study design was a double-blind group comparison and participants (n=20; female 12, male 8) were randomly assigned to β-CRX-rich orange juice or placebo (β-CRX was removed from orange juice) groups. β-CRX or placebo juice (125 mL, once a day, after breakfast) were consumed from 10 d prior to the pharmacy practice and continued for 10 d into the practice period. To assess participants' anxiety, the state-trait anxiety inventory test was carried out before the pharmacy practice. Salivary α-amylase activity (sAA) was measured as a marker of sympathetic nervous system activity. In the placebo-group, sAA in the evening (post-practice sAA) tended to be higher than sAA in the morning (pre-practice sAA) during both routine daily life at the university and during pharmacy practice. In the β-CRX-group, the increase of post-practice sAA was suppressed in females. These results suggested that β-CRX has an anti-stress effect, at least, in females.

Spontaneous regression of any malignant tumor is a rare event, occurring in about 1 of 60,000-100,000 cases of malignant tumor. We report a case of spontaneous regression of breast cancer with multiple pulmonary metastases. The patient was a 73-year-old woman who complained of a left mammary mass. A tumor, approximately 2.2 cm in diameter, was palpated, and breast cancer was suspected based on ultrasound examination. Histopathological findings of the core needle biopsy specimen indicated invasive ductal carcinoma. The patient underwent partial mastectomy with axillary lymph node dissection. It was a stage ⅡB (pT2N1 [sn] M0) tumor. CT performed after adjuvant therapy confirmed the presence of multiple pulmonary metastases 6 years after surgery. We started anti-cancer therapy with TS-1; however, it was discontinued because an adverse event occurred. Half a year later, tumor shrinkage was confirmed after a recurrence. Four years and 6 months after the treatment was discontinued, the tumor continued to regress spontaneously.

There are only a few reports in the literature about the effect of recombinant human soluble thrombomodulin (rTM) in patients with solid carcinoma with disseminated intravascular coagulation (DIC). A retrospective study of 40 patients with solid carcinoma with DIC was performed between February 2009 and April 2013. The withdrawal rate was 32.5% (13/40 patients), and the 28-day survival rate was 40.0% (16/40 patients). Patients with successful withdrawal of DIC had significantly better outcomes (p<.001). Therapy with rTM is one of the treatment options for patients with solid carcinoma with DIC.

A 74 -year-old man was hospitalized for chest pain. Chest computed tomography showed a 4 × 8 cm-sized tumor pressing on the left pectoralis major muscle. Subsequent imaging showed progression of the tumor along with rib erosion and intrapleural invasion. The patient was admitted to our hospital for a follow-up examination of the tumor. Bronchoscopy results were normal. Ultrasound-guided percutaneous needle biopsy was performed. Histopathology indicated squamous cell carcinoma on the basis of the presence of keratin pearls. We therefore diagnosed the patient with squamous cell lung carcinoma fStage IIb (T3N0M0) and subsequently administered chemoradiotherapy owing to the inoperable status of the lesion. We report a case of squamous cell lung carcinoma that was difficult to differentiate from squamous cell carcinoma of the breast, along with a review of the literature.

We evaluated the usefulness and safety of a handheld vacuum-assisted biopsy system (VACORA®) in 253 lesions suspected to be malignant. Biopsy samples were successfully obtained from 252 lesions, and no complications occurred that required other treatments during or after the biopsy. The definitive diagnosis rate using VACORA / ®was 89.3% (226/253). For 27 lesions, biopsy using Mammotome®or open biopsy was performed because a diagnosis could not be made with the VACORA® system, despite a category 4 result on ultrasonography. The lesions that were diagnosed as benign using the VACORA® system did not manifest malignant features during the observation period (1-36 months). We considered the VACORA® biopsy system as an effective technique that has both convenience and high diagnostic accuracy.

Herein, we report a rare case of malignant melanoma metastasis to the mammary gland. A 76-year-old woman had a tumor resection performed for primary malignant melanoma of the epipharynx. The patient subsequently underwent local and lymph node recurrence, for which she received heavy ion radiotherapy and lymph node dissection, respectively. The patient was referred to our hospital for a problem with her right breast. Computed tomography and magnetic resonance imaging showed a mammary tumor and multiple subcutaneous tumors. A biopsy was performed, which proved positive for S100 and Melan A staining, and the diagnosis of malignant melanoma was confirmed. Partial mastectomy was performed; and S100, HMB45, and Melan A positivity was confirmed based on immunohistological findings. The diagnosis was malignant melanoma metastasis to the mammary gland. Malignant melanoma commonly metastasizes to the liver, mediastinum, mediastinal glands, lung, and brain; and metastasis to the mammary gland is rare. To our knowledge, only 2 cases have previously been reported in the Japanese literature.

Clinical outcomes, including adverse events, in 52 advanced breast cancer patients treated with eribulin chemotherapy after taxane treatment (TX) were analyzed to confirm the effectiveness and safety of this treatment.The objective response rate (ORR) in patients was 34.6% (TX group 31.6%, non-TX group 36.4%). There were no significant differences in overall survival, time to treatment failure, or progression-free between three TX and non-TX groups. Further, adverse events did not differ between groups expression of neutropenia of Grade 3 or more. On the other hand, the number of patients with sensory peripheral neuropathy of Grade 1 or more was significantly more in the TX group than in the non-TX group. Eribulin chemotherapy was effective for the treatment of advanced breast cancer regardless of a history of taxane treatment.In addition, sensory peripheral neuropathy is a possible complication that can occur in advanced breast cancer patients treated with eribulin chemotherapy with taxane treatment history.

Nanoparticle albumin-bound paclitaxel (nab-PTX, Abraxane®) does not require premedication, and it can be used for patients with alcohol intolerance. We administered nab-PTX to 31 patients with breast cancer between October 2010 and April 2013. Eighteen patients had progressive, recurring breast cancers and 13 patients had locally advanced operable breast cancers. The treatment schedules were 175 or 260 mg/m² every 3 weeks (q3w). No patient experienced an allergic reaction. Grade 1-3 sensory neuropathies were observed in 20 patients; however, no patient experienced grade 4 neuropathy. In patients with locally advanced, operable breast cancer, 1 patient treated with 175 mg/m² q3w had a partial response (PR), while of the patients treated with 260 mg/m² q3w, 10 patients showed a PR, and 1 patient had stable disease (SD). Of the patients with progressive, recurring breast cancer, 2 patients showed a PR and 4 patients had SD when treated with 175 mg/m² q3w, whereas 1 patient displayed a PR and 1 patient had SD when treated with 260 mg/m² q3w. Our investigation suggests that nab-PTX is well tolerated, even by patients with advanced breast cancer.

Primary malignant lymphoma of the breast (PBL) is comparatively rare in Japan.Herein, the authors present report 4 cases of PBL. All patients had the primary finding of a palpable left breast mass.Malignant lymphoma was strongly suspected by core needle biopsy, and final diagnosis was made on surgical specimens. All cases were diffuse large B-cell lymphoma and were treated with targeted chemotherapy with R-CHOP. Only 1 of the 4 patients needed multidisciplinary therapy due to advanced age.Whenever PBL is suspected, targeted therapy should be considered.

The clinical outcomes, including adverse events, in 40 advanced breast cancer patients treated with eribulin were analyzed to confirm the effectiveness and safety of this treatment. The objective response rate (ORR) in patients was 35.0%. The median overall survival and time to treatment failure (TTF) in these patients was 479 and 63 days, respectively. Cases wherein eribulin was used as early-line treatment experienced significantly longer TTF compared to the cases wherein eribulin was used as late-line treatment; however, there was no difference in this value according to the breast cancer subtype. Moreover, subtype analysis revealed no significant difference in adverse events. We observed no difference in the benefit or tolerability of eribulin treatment among different breast cancer subtypes. However, our results suggest that a significant therapeutic effect can be expected when using eribulin as early-line treatment.

Bevacizumab combination chemotherapy prolongs progression-free survival but not overall survival in patients with advanced breast cancer. Here, we report our experience with bevacizumab plus paclitaxel treatment in our department. We believe that this regimen confers some benefit to a patient's quality of life. Nineteen patients with inoperable, metastatic, or recurrent breast cancer were treated with bevacizumab plus paclitaxel. The median age was 55 years; all patients were females. Of the 19 patients, 14, 1, and 4 had luminal A, luminal B, and triple-negative type tumors, respectively. The response rate was 63%: partial response (PR) was obtained in 12 patients, stable disease (SD) in 5 patients, and progressive disease( PD) in 2 patients. Adverse events of Grade 3 or more were high blood pressure( 4 patients), peripheral neuropathy (1 patient), and neutropenia (9 patients). All side effects could be tolerated. There was a high rate of response to bevacizumab plus paclitaxel chemotherapy. We believe that this chemotherapy is useful in patients with more advanced breast cancer in whom a high response rate is required.

The patient was a 40-year-old woman who was aware of a tumor in her left breast that was gradually increasing in size. Ultrasonography revealed a hypoechoic mass with a skin cyst, approximately 3 cm in size, in the C area of the left breast. Core needle biopsy indicated estrogen receptor (ER) -negative, progesterone receptor (PR) -negative, and human epidermal growth factor receptor 2 (HER2) -negative squamous cell carcinoma. Overall examination did not indicate distant metastasis. A diagnosis of T4bN2aM0, stage IIIB triple-negative left breast cancer was made. Eribulin was administered at a dose of 1.4 mg/m2. The effect of eribulin was considered to be long-term stable disease( long-term SD). The patient did not experience severe adverse events during treatment. After 24 weeks of eribulin treatment, mastectomy of the left breast with axillary lymph node dissection was performed. At present, 1 year after surgery, the patient is alive with no recurrence. We conclude that eribulin chemotherapy is useful for the treatment of patients with squamous cell carcinoma of the breast.

A 58-year-old woman observed swelling in her left breast a few weeks prior to presentation. Rigidity in the D area, breast warmth, swelling, and a peau d'orange appearance in the whole left breast was observed. She was diagnosed with inflammatory breast cancer (luminal A type) T4dN2M0, Stage IIIB. The patient underwent primary systemic therapy with 7 courses of FEC. Following FEC treatment, the disease was stable. We subsequently administered 4 courses of bevacizumab plus paclitaxel combination therapy. The patient exhibited a partial response to FEC chemotherapy. Thereafter, a left mastectomy with level II axillary lymph node dissection was performed. At present, 1 year after surgery, the patient is alive with no recurrence. We conclude that the combination therapy of bevacizumab plus paclitaxel is a useful treatment for inflammatory breast cancer.

A 57-year-old woman was referred to another hospital with bilateral breast masses. Incisional biopsy findings indicated bilateral breast invasive lobular carcinoma, with positive estrogen receptor(ER)status and negative human epidermal growth factor receptor 2(HER2)status. Close inspection did not show the presence of distant metastasis, but lymphadenopathy was noted in the left supraclavicular region, and bilateral TxN3M0, Stage IIIC breast cancer was diagnosed. We performed a simple, double mastectomy, and endocrine therapy was initiated. Treatment with anastrozole followed by tamoxifen resulted in a temporary response. Because of progression after both treatments, chemotherapy was initiated. Complete response was observed in the left supraclavicular lymph node metastases after 4 courses of docetaxel and cyclophosphamide. Two years after treatment was discontinued, metastatic breast carcinoma in the stomach was diagnosed. Immediately after fulvestrant administration, the patient complained of neck stiffness. Several examinations revealed thickening of the cervical muscles with an abnormal signal. Core needle biopsy of the cervical muscle lesion revealed the presence of metastatic adenocarcinoma, with negative ER status and negative HER2 status. Chemotherapy with capecitabine was initiated, and this resulted in stable disease.