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男性乳癌は全乳癌の1％以下であり，さらに男性乳房Paget病は全乳癌の約0.5％ときわめてまれな疾患である1)．また近年センチネルリンパ節生検が一般臨床に急速に普及してきた．今回われわれは男性乳房Paget病の症例に対して，センチネルリンパ節生検により腋窩リンパ節郭清を省略しえた症例を経験したので，若干の文献的考察を含めて報告する．

We applied quantitative parameters in three-dimensional ultrasonic images to distinguish benign from malignant breast tumors in 29 benign cases including 8 cysts and 21 fibroadenomas, and 32 malignant cases including 23 ductal carcinomas, 2 special types of carcinoma, 1 malignant lymphoma and 6 others. This procedure involved simultaneously acquiring video data from real-time ultrasonic images and recording the original position and orientation of the probe. Both sets of data were fed directly into a desktop computer. Fuzzy reasoning and relaxation techniques were use to automatedly extract the shape of the tumor and render it in three dimensions. We then evaluated three parameters: 2D-D/W, the so-called depth-width ratio measured in B-mode images: 3D-D/W; and the S/V index ([surface area](3)/36π [volume](2)) calculated from the three-dimensional volume extracted with this system. All three parameters were significantly higher in the malignant group (averages: 0.81, 0.64, and 11.3, respectively) than in the benign group (averages: 0.62, 0.47, and 3.78, respectively). All three parameters were thus found to be useful in differentiating the two groups.

Background. Anastrozole, a new aromatase inhibitor, has been used to treat postmenopausal metastatic breast cancer, and several clinical trials of adjuvant treatment using this agent are ongoing. However, the effects of anastrozole on lipid metabolism are unknown. The aim of this study was to evaluate the effect of anastrozole on lipid metabolism, especially lipoprotein lipase (LPL) activity, compared with tamoxifen in rats. Methods. Ovariectomized female rats were divided into six groups: C, controls; T, tamoxifen treatment; A, anastrozole treatment; CAT, combined anastrozole/tamoxifen treatment; NAT, no treatment after tamoxifen; and AAT, anastrozole treatment after tamoxifen. The agents were orally administered for 3 weeks. Serum total cholesterol, triglycerides, and LPL activity in postheparin plasma were measured at the end of the experiment. Results. Serum cholesterol levels were significantly lower in the T and CAT groups than in controls (P < 0.001). Serum triglyceride levels were significantly higher in the T group than in the other groups (P < 0.001). LPL activity was significantly lower in T and AAT groups (P < 0.01). There was no significant difference in any parameters in group A. Conclusions. Anastrozole does not affect lipid metabolism including LPL activity. There was little effect on lipid profiles during combination treatment or following treatment with tamoxifen. In a clinical setting, therefore, anastrozole might be safe for patients with abnormal triglyceride profiles during tamoxifen treatment.

We are developing a new method of breast cancer screening that we call Automated Breast Cancer Diagnosis (ABCD). This system uses computerized three-dimensional (3D) imaging techniques and statistical analysis to base diagnosis on data obtained from ultrasound images. Here we use this system to investigate ten parameters and their effectiveness in determining the malignancy of tumors. Twenty-nine benign tumors and 32 malignant tumors were studied. The benign tumors comprised 8 cysts and 21 fibroadenomas; the malignant tumors were 23 ductal carcinomas, 2 special carcinomas, 1 malignant lymphoma, and 6 other types of lesions. The procedure requires the simultaneous acquisition of both the ultrasonic image data and the position and orientation of the probe for each slice. This data is transferred to a computer, where the tumor surface is determined using fuzzy reasoning and relaxation techniques. The extracted tumor image is then rendered in 3D, allowing interactive manipulation and observation. A significant distinction between benign (0.57±0.25, 2.08±0.12, 0.76±0.25) and malignant tumors (0.78±0.33, 2.22±0.16, 0.58±0.29) was obtained for all three parameters (Sz/Sxy, M-D, and Vei/V). A malignancy probability expression is calculated using multivariate logistic regression analysis in combination with the five parameters (Sz/Sxy, M-D, Vei/V, 3D-D/W, and S/Vindex). Satisfactiorily results were obtained when this method was applied to newly prepared external data that consist of three benign and two malignant tumors additional tumors.

Objectives Previous reports have indicated that small breast cancers without lymph node metastasis present a favorable prognosis. However, 10–20% of patients with T1 N0 invasive ductal carcinoma experience recurrence and have a poor prognosis. The objective of this study was to examine whether certain metastasis-related factors are prognostic of cancer recurrence in such patients at risk for relapse. Methods Nineteen patients with the carcinoma who had recurrence 1–15 years after margin-free resection were examined. The control group consisted of 20 patients with pT1 pN0 invasive ductal carcinoma who had no recurrence for ≥10 years after radical surgery. The two groups were compared with respect to clinical profiles, conventional neoplastic features, and immunohistochemical expressions of 16 metastasis-related factors. Results No significant difference was found between the two groups in clinical profiles and conventional neoplastic features. However, six factors (MMP-2, MT1-MMP, T1MP-2, VEGF, cMET, and PCNA) were significantly expressed in the recurrence group against the control group. MMP-9 was significantly less expressed in the recurrence group. Of these factors, MMP-2, MT1-MMP, and VEGF showed the highest adjusted odds ratios. Conclusion MMP family and growth factors may be promising predictors of recurrence risk of early stage breast cancer. J. Surg. Oncol. 2007;96:46–53. © 2007 Wiley-Liss, Inc.

The purpose of our study was to verify in animals the possibility of using albumin-enhanced ultrasonography as a modality for sentinel node detection. The nine pigs were injected subcutaneously in the neck with albumin, five with 5% solution and four with 25% solution, and then the regional lymph nodes were observed over time. It was found that, where the 5% solution had been injected, the lymph nodes showed no change, but where the 25% solution had been used, a high echo 1 to 5 mm in size was seen at the hilus of the nearest lymph node. Examination of the excised pathologic specimens of lymph nodes demonstrated that this echo was due to albumin accumulated in the efferent lymphatics. This finding suggested that this technique of ultrasonography using albumin as a contrast agent was an effective new method of identifying sentinel nodes.

Isoflavones are known to exert anticancer effects. These effects were examined using two isoflavones, biochanin A and daidzein, in a mouse mammary tumor virus (MMTV)-induced spontaneous breast cancer model. Emphasis was placed on isoflavone metabolism by the intestinal microflora and changes in estrogen levels. Germ-free (Gf) mice and their conventionalized (Cv) counterparts were assigned to three diet groups: (1) control diet, (2) biochanin A and (3) daidzein. In all groups, urine was collected from virgin female mice to analyze isoflavone metabolism by high performance liquid chromatography. These studies revealed changes of biochanin A into genistein, and of daidzein into equol, which were accelerated in the Cv animals. However, the Gf mice could not transform biochanin A into genistein, or daidzein into equol. Estrogen levels in the control and daidzein diet groups were lower in the Gf mice than in the Cv mice. The biochanin A group showed no differences in estrogen levels between the Cv and Gf animals. Four-week-old male and female animals were paired in the Gf and Cv groups. The female animals delivered and lactated repeatedly and were observed for the development of mammary cancer by palpation, twice weekly, until 15 months of age. The Cv mice showed a significantly lower incidence of breast cancer in the biochanin A diet group than in the control or daidzein groups (p < 0.05). These results suggest that the anticarcinogenic effects in this system might be produced not by daidzein or equol, but by biochanin A and/or genistein. In the Gf animals, the incidence of breast cancer was significantly higher in the biochanin A group than in the control group (p < 0.05), probably due to the increased level of estradiol in the former group. The biochanin A group tended to have a higher incidence of breast cancer than the daidzein group in the Gf group, although no significant differences were noted. Thus, no anticarcinogenic effect was produced by biochanin A alone in the Gf mice. In view of the results presented, genistein derived from biochanin A following metabolic processes in the intestinal microflora most likely acts as an inhibitor in breast carcinogenesis; biochanin A is most likely a precursor of genistein.

This is a report of a unilateral loop-forming duplicate recurrent laryngeal nerve and its clinical relevance. A 72-year-old woman with a giant goiter underwent a total thyroidectomy. At operation we identified two recurrent laryngeal nerves on the right side and one on the left side. The nerve on the right was smaller and displaced laterally by the. goiter, whereas the other was adjacent to the trachea and behind the goiter, and it was accidentally divided. Both nerves were united before innervating the larynx. The divided nerve was microsurgically reanastomosed but a postoperative assessment revealed hoarseness. This case report of an anomalous loop-forming duplicate recurrent laryngeal nerve indicates that it may not be sufficient to identify a single recurrent laryngeal nerve on one side during thyroid surgery especially when the observed recurrent nerve is relatively smaller than usual.