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Spindle cell carcinoma (SpCC) of the breast is quite a rare modality classified to the metaplastic carcinoma of the breast. Regarding its biological behavior and the prognosis of the patients with this rare tumor, it has been remaining controversial. We herein report an 88 year-old woman who had a huge bleeding tumor on the right breast. She was a high-aged woman with low activities of daily life, even with some suspicion of distant organ metastasis. While the tumor proved to drastically bleed due to the tumor disintegration, a right simple mastectomy was performed. According to the histopathologic examinations, sarcomatoid spindle cells with severe atypia were observed. By an immunohistochemical examination, the tumor had proved to express neither estrogen receptor, progesterone receptor nor HER2 receptor. Moreover an immunohistochemical expression of AE1/3 and CAM5.2, defining an epithelial neoplasm were observed in addition to an expression of vimentin. From these findings, this bleeding tumor was diagnosed as spindle cell carcinoma of the breast.

An 85-year old woman who had a large tumor in the left breast came to our out-patient clinic. Computed tomography showed multiple lung tumors in addition to a huge tumor in the left breast. A needle biopsy brought about a histological diagnosis of ductal carcinoma. A simple mastectomy was performed and a histological examination using the resected specimen demonstrated a coexistence of an adenoid structure and a false ductal structure according the histologic characteristics of adenoid cystic carcinoma, which is quite rare among breast tumors.

Corticosteroids are essential to maintain the organic homeostasis. Steroid, glucocorticoid or its synthetic analog is widely used for inflammatory and autoimmune diseases. Prolonged steroid therapy is reported to cause the susceptibility to infection, impaired wound healing and psychoneurosis, however whether the quantity of taking the preoperative steroid is associated the postoperative complication is still unknown. The aim of this study was to elucidate whether the steroid dose in patients on prolonged preoperative steroid therapy is associated postoperative morbidity and mortality. Twenty-five patients taking steroid for various illnesses and underwent the surgery under general anesthesia were selected in this study. The mean ± standard deviation and the median of the steroid dose converted into hydrocortisone (mg/day) were 39.2 ± 31.0 and 20, respectively. Of 25 cases, postoperative complications were seen in 10 cases. The postoperative complication was severe based on the grade of Clavien and Dindo by ANOVA as the doses of taking steroid increased (p = 0.0171). The grave postoperative complication classified as Clavien and Dindo grade III occurred with 100% sensitivity and 87% specificity for the steroid dose converted into hydrocortisone > 80mg/day. Preoperative taking the large amount of steroid (> 80mg/day) could cause a grave complication. More careful selection of the operative procedure might improve the mobidity rate., コルチコステロイドは生体の恒常性を維持するのに必須なホルモンである．グルココルチコイドやその合成アナログであるステロイドは炎症性疾患や自己免疫性疾患に対して広く使用されている．長期間のステロイド治療により易感染，創傷治癒遷延，精神症状を引き起こすと報告されているが，術前のステロイド内服量と術後合併症との関連については言及されていない．種々の疾患に対し長期間ステロイド治療が行われ，全身麻酔下に外科手術を施行された25例を対象とした．ヒドロコルチゾンに換算したステロイド内服量(mg/day)の平均±標準偏差および中央値はそれぞれ39.2 ± 31.0，20であった．25例中10例に術後合併症を認めた．ステロイド内服量とClavien-Dindo分類による術後合併症の重症度は有意に正の相関を示した(p=0.0171)．ヒドロコルチゾンに換算したステロイド内服量のcut-off値を80mg/day以上とした場合のClavien-Dindo分類III度の合併症の発生は感度100%，特異度87%であった．術前ステロイド内服量が80mg/day以上の患者では，術後重篤な合併症を引き起こしうる．より慎重な術式の選択などの工夫が肝要である．

The results and outcomes of surgical resection for esophageal carcinoma have improved remarkably in recent years; however, recurrence still frequently develops, even after complete resection. The purpose of this study is to clarify the characteristics of recurrence in this patient population. Among 208 patients, who underwent R0 resection for esophageal carcinoma, recurrence developed in 61. Clinical data were available for 56 of these patients, who were the subjects of this study. We evaluated the time, patterns, and treatment of recurrence in these patients. Recurrence developed within 1 and 2 years after esophagectomy in 71 and 84% of the patients, respectively, and was classified as loco-regional (54%), hematogenous (36%), or mixed type (10%). The prognosis of patients with loco-regional recurrence tended to be better than that of those with distant metastasis, although the difference was not significant (P = 0.088). Patients with recurrence treated by chemotherapy alone or multimodal therapy, such as radiation or surgery combined with systemic chemotherapy, survived significantly longer than those with untreatable recurrence (P = 0.016). These findings reinforce the importance of careful follow-up for both loco-regional and hematogenous recurrence after esophagectomy, particularly during the first 2 years.