Adrenalectomy for solitary adrenal metastasis from colorectal cancer

A 77-year-old man had sigmoidectomy for sigmoid colon cancer. Two years later, a right hepatectomy for a liver metastasis was performed. Two years thereafter, abdominal computed tomography scanning and FDG-PET showed the right adrenal mass. Right adrenalectomy was performed with a diagnosis of solitary adrenal metastasis from sigmoid colon cancer. On pathology, adrenal metastasis was confirmed. The patient underwent adjuvant chemotherapy (IRIS). There have been no signs of recurrence for 6 months after the operation. We conclude that patients with solitary adrenal metastasis from colorectal cancer may benefit from surgical resection.     

21例乳腺癌术后孤立性肺转移的临床分析及预后

目的:探讨乳腺癌术后孤立肺转移的临床病理特点、治疗方法及预后因素。方法:自1999年1 月～2009年1 月,中国医学科学院肿瘤医院对35例乳腺癌术后孤立肺结节患者进行了手术治疗,对上述患者的临床特点、治疗方式、生存期及预后因素进行了单因素和多因素的分析。结果:乳腺癌手术至发现肺结节的时间为6～177 个月,中位时间48个月。经病理证实,乳腺癌肺转移21例（60.0%）,原发性肺癌8 例（22.9%）,良性病变6 例（17.1%）。 乳腺癌肺转移患者中,术后2、3、5 年的生存率分别为95.2%（20/21）、71.4%（15/21）、19.0%（4/21）。 从肺转移切除术至再次出现病情进展的中位时间（PFS）为32个月（3～73个月）;全组患者生存期为12～103 个月,中位时间43个月。经过单因素分析,影响乳腺癌肺转移术后至病情再次进展（PFS）的因素包括乳腺癌原发肿瘤大小、有无脉管瘤栓以及肺转移术后是否接受化疗（P<0.05）;而原发肿瘤至肺转移的时间（无瘤生存期,DFS）以及肺转移术后是否化疗与肺转移术后生存期（OS）有关（P<0.05）。 但经过多因素分析,上述因素对PFS 无显著关系。结论:乳腺癌术后孤立肺结节的外科治疗具有诊断和治疗的作用,术后全身治疗对提高无进展生存及总生存可能有一定的积极意义。      

Two cases with long-term disease-free survival after resection and radiotherapy for solitary brain metastasis from breast cancer with extensive nodal metastases

Two rare cases, each with a solitary brain metastasis from breast cancer with extensive nodal metastases as the first site of distant metastasis, were locally treated with surgery and irradiation. The outcome of the two treated cases indicated an excellent and non-recurrent post-therapeutic survival period of more than 3 and 8 years, respectively. In a 50-year-old woman (Case 1), a solitary brain metastasis was found to have developed after standard radical mastectomy and adjuvant chemotherapy with doxorubicin and tegafur-uracil (UFT) and hormonal therapy with tamoxifen for left breast cancer. The brain metastasis was treated twice surgically followed by radiotherapy. One year and 6 months later, local recurrence of the brain metastasis appeared and was treated surgically again. No other treatment was done thereafter. Since then, no other distant or lymph node metastasis occurred, and to date her outcome has been non-eventful for 8 years and 5 months. In a 63-year-old woman (Case 2), a solitary brain metastasis was found to have developed after standard radical mastectomy and adjuvant chemotherapy with cyclophosphamide, epirubicin and fluorouracil (CEF) for right breast cancer. The brain metastasis was treated locally with surgery and irradiation of 50 Gy. She thereafter received no further treatments. Since then neither distant metastases nor local recurrence have developed, and to date the post-treatment outcome has been uneventful for 37 months. Our findings suggest that patients who developed a solitary brain metastasis as the first site of distant metastasis from breast cancer have a chance of achieving long-term disease-free survival when treated with aggressive local therapy, even in the presence of extensive lymph node metastases at the primary surgery site for breast cancer.     

Two cases of radiofrequency ablation (RFA) therapy for control of liver metastases from breast cancer

We present two cases of liver metastases from breast cancer treated by radiofrequency ablation (RFA) for elongation of life. Case 1: A 50-year-old woman was treated by left mastectomy (stage IIIa) in December 2002. In April 2004, she was treated with a combination therapy of weekly paclitaxel and trastuzumab for multiple liver metastases, left supraclavicular lymph node metastases, and multiple bone metastases. After 16 courses of weekly paclitaxel and trastuzumab, liver metastases decreased significantly in size. Because liver metastases recurred during a continuation of weekly paclitaxel and trastuzumab, we performed RFA and chemotherapy using a hepatic artery infusion of docetaxel for liver metastasis. The aggravation spread to the liver lesion and she died after 20 months from liver metastases. Case 2: A 65-year-old woman was treated by left mastectomy (stage IIA) in 1984, and the distant metastasis was not found through the course after an operation. She was noted with a liver function aberration in another hospital in March 2005. We scanned it, and it was diagnosed as multiple liver and bone metastases from breast cancer. Because she did not hope for an anticancer drug treatment for multiple liver metastases, we performed RFA in May 2005. After the second RFA was performed, she does not show any new lesion to the liver for 10 months.     

Sustained complete response in lung metastasis of breast cancer by goserelin--report of two cases

We report two patients with lung metastasis of breast cancer who had durable complete responses (CR) with goserelin. The first patient was a 48-year-old woman diagnosed with left breast cancer (T1N0M0, Stage I) at the age of 40, for which she underwent mastectomy. The tumor was estrogen receptor (ER) and progesterone receptor (PgR) positive. She received tamoxifen for 2 years as adjuvant therapy. After 8 years and 7 months, a lung metastasis was found by chest X-p, and treatment with goserelin was started. After 11 months of this treatment a CR was achieved, and the response lasted 3 years and 5 months. The second patient was a 38-year-old woman with a diagnosis of lung metastasis. She underwent right mastectomy at the age of 29 for breast cancer (T2N1M0, Stage IIB), and the tumor was ER and PgR positive. She received tamoxifen and doxifluridine for 2 years as adjuvant therapy. Eight years and 6 months after the mastectomy, a lung metastasis was found by chest X-p, and goserelin treatment was started. After 8 months of this treatment, chest X-p and CT revealed a complete regression of the lung metastasis, and response lasted 1 years and 7 months. Serum estradiol levels were suppressed below 10 pg/ml during the treatment in both patients. These results indicate the usefulness of LH-RH agonist in the treatment of recurrent breast cancer.     

A case of multiple liver metastases from breast cancer in which we confirmed disappearance of cancer cells after hepatic resection following hepatic arterial infusion chemotherapy

A 46-year-old woman underwent right mastectomy for stage IIA breast cancer in 1993. Six years and 8 months after this operation, she was diagnosed as having multiple liver metastasis form the breast cancer. An intra-arterial catheter was inserted percutaneously into the hepatic artery and she was given hepatic arterial infusion chemotherapy and general chemoendocrine therapy. The metastatic liver tumors were gradually reduced in size and tumor markers returned to the normal range. However, tumor size was unchanged after February 2001. After obtaining her informed consent from the patient, we performed hepatic resection in December 2001. Histopathologically, three scars were observed and no tumor cell was found. She has been free from recurrence to date. This case suggests that chemoendocrine therapy including hepatic arterial infusion chemotherapy is effective for breast cancer patients with liver metastasis.     

Two patients of recurrent breast cancer with carcinomatous pleurisy well controlled pleural effusion

We report two patients of recurrent breast cancer with carcinomatous pleurisy well controlled pleural effusion. One patient is a 49-year-old woman. She underwent radical mastectomy for right breast cancer in September 1993. She suffered from multiple liver metastases in June 2000, so CEF therapy contained hepatic arterial infusion chemotherapy and extended right lobectomy of the liver were performed in December 2001. Right pleural effusion was detected in December 2003, then, pleurodesis was carried out with OK-432 after thoracic drainage. After pleurodesis, a weekly paclitaxel therapy was started and she was taking the regimen continuously. Another patient is a 55-year-old woman. She underwent radical mastectomy for left breast cancer in September 1999. Local recurrent lesions on the left chest and left pleural effusion were found in May 2003. After thoracic drainage, infectious pleurisy was complicated, so the drainage tube was removed after the therapy for preventing infection. After pleurodesis, CE therapy followed by peroral chemo-endocrine therapy was performed. Both of the two patients are receiving outpatient treatment without recurrent pleural effusion as of July 2005.     

Radiofrequency ablation of liver metastasis from breast cancer

As the hepatic metastasis from breast cancer has a tendency to have an extrahepatic lesion, systemic therapy therefore becomes acclimatization. However, local therapy is regarded as one of the choices if there is no extrahepatic lesion. We present three cases of liver metastasis from the breast treated by radiofrequency ablation (RFA). Case 1: A 65-year-old woman was treated by left mastectomy in 1997. Radiation exposure was performed for lung metastasis, and a weekly paclitaxel therapy was administered in 2001. We performed RFA percutaneously for liver metastasis of 2.8 cm in 2002. The aggravation spread to the lung lesion and she died after RFA within one year. The liver metastasis finally enlarged to 4 cm in size. Case 2: A 36-year-old woman was treated by left mastectomy (Stage IIIa), and was followed by chemotherapy in 2000. We performed RFA for metastasis of 2 cm of liver (S7) percutaneously in 2001, and didn't recognize a recurrence to date for 3 years and 8 months. Case 3: A 43-year-old woman was treated by left mastectomy (Stage IIIa), and followed by chemotherapy in 2003. We performed RFA for a liver metastasis of 3.5 x 4 cm under laparotomy in 2004. She has been disease free for 15 months.     

Two cases of recurrent breast cancer with regional lymph node metastases showing a complete response to trastuzumab and paclitaxel treatment

We report two cases of recurrent breast cancer with regional lymph node metastases that responded completely to treatment with trastuzumab and paclitaxel. Case 1: A 52-year-old woman, who presented with left breast cancer, underwent mastectomy and axillary lymph node dissection in July 2002. Pathological findings were as follows: invasive ductal carcinoma (scirrhous type), 2.2 cm in size, histological grade 3, positive invasion to the lymphatic and blood vessels, negative nodal status (0/11), negative ER/PgR status, and overexpression of HER 2/neu. Left axillary lymph node metastasis was noted after five months, ie, in December 2002. Four cycles of chemotherapy with doxorubicin and cyclophosphamide were administered from January 2003; however, they were not effective. The patient showed a complete response after three months of chemotherapy with trastuzumab and paclitaxel. This treatment was stopped in September 2003. She has maintained a complete response for two and a half years and was not administered any further treatment as of February 2006. Case 2: A 59-year-old woman, who presented with right breast cancer, underwent mastectomy and axillary lymph node dissection in May 2002. Pathological findings were as follows: invasive ductal carcinoma (scirrhous type), 1.8 cm in size, histological grade 2, positive invasion to the lymphatic and blood vessels, negative nodal status (0/5), positive ER and uncertain PgR status, and overexpression of HER 2/neu. She had received adjuvant hormonal therapy with tamoxifen; however, a right supraclavicular lymph node metastasis was noted in October 2004. Treatment with exemestane was not effective. However, a complete response was observed with trastuzumab and paclitaxel for four months. She has maintained a complete response for six months and was not administered any further treatment as of February 2006.     

Surgical treatment of hepatic metastases from breast cancer

We have performed a retrospective study to evaluate whether surgical treatment is beneficial in patients with hepatic metastases from breast cancer. Between September 1985 and September 1998, 25 patients with hepatic metastases (14 solitary and 11 multiple), eight of whom had extrahepatic metastases, underwent hepatectomy. All of the detectable liver metastasis were resected in all of the cases. There were no severe postoperative complications. All but one of the patients received adjunctive polychemotherapy after the hepatectomy. After the hepatectomy, recurrent tumors were detected in 18 of the patients, being located in the liver in 12 (67%) of them. Overall, however, hepatectomy ensured that the liver was clinically recurrence-free for a median of 24 months (range 2–132 months). Eleven patients died of recurrent tumors, two died of other causes and the remaining 12 are currently alive. The 2- and 5-year cumulative survival rates after hepatectomy were 71% and 27%, respectively, and the median survival duration was 34.3±3.2 months, much better than the period of 8.5 months for another series of patients treated with standard or non-surgical therapies at our institution. The number and the size of hepatic metastases, the interval between treatment of the primary lesion and hepatectomy, and the existence of extrahepatic metastasis were not adverse prognostic factors. In conclusion, our data, although limited and highly selective, suggest that surgical treatment of hepatic metastases from breast cancer may prolong survival in certain subgroups of patients to a greater extent than standard or non-surgical therapies.     

Three cases with liver metastasis from gastric or colon cancer successfully treated with S-1 combined with CPT- 11

We report three cases with liver metastasis from gastric or colon cancer successfully treated with S-1 with CPT-11. Case 1: A total gastrectomy was performed for a gastric cancer located in the lower to upper body of the stomach(T3 (SE), N2, H0, P0, por 2, stage III B). Abdominal computed-tomography(CT)revealed a solitary liver metastasis in the S8 subsegment of the liver. We treated the patient with S-1 combined with CPT-11. Abdominal CT revealed a complete response(CR)after 5 courses. Case 2: Sigmoidectomy and partial resection of small intestine and abdominal wall were performed for sigmoid colon cancer. The intraoperative findings revealed liver metastases in left lobe of the liver(Si, N1, H1, P0, M0, tub 1, stage IV). After surgery, the patient was treated with S-1 combined with CPT-11. Abdominal CT demonstrated CR after 5 courses. Case 3: Laparoscopic right hemicolectomy was performed for ascending colon cancer( SE, N1, H0, P0, M0, tub 1, stage III a). Abdominal CT showed a solitary liver metastasis in the S6 subsegment of the liver 3 months after surgery. We treated the patient with S-1 combined with CPT-11. Abdominal CT revealed CR after 3 courses. The three cases are alive without any signs of recurrence.     

Metastasis of breast cancer to a uterine leiomyoma

Metastasis of breast cancer to a uterine leiomyoma is rare. We review the clinicopathological features of breast cancer metastasis to a uterine leiomyoma and discuss possible effective treatment. We describe a case of a woman who presented with abdominal discomfort after undergoing mastectomy for breast cancer. At the time of mastectomy, imaging showed osseous metastases involvement to the right kidney. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Microscopic examination disclosed carcinoma of breast origin localized within the leiomyoma. To date, the patient is alive and asymptomatic after treatment with anastozole and capecitabine for 11 months. Per reports in the literature, abnormal uterine bleeding or a rapidly growing leiomyoma may be symptomatic of breast cancer metastasis to a uterine leiomyoma, especially if a patient has a previous diagnosis of invasive ductal carcinoma of the breast. Palliative hysterectomy can potentially improve prognosis in patients whose cancer is restricted to a uterine leiomyoma with or without involvement of lymph nodes, and may offer relief of genital tract symptoms in patients who have widespread involvement of non-life-threatening metastases.     

A case of local recurrent breast cancer with complete response to combination of systemic chemotherapy and topical use of adriamycin ointment

A Case of local recurrent breast cancer in a 45-year-old female with complete response to Combination of chemotherapy and topical administration of Adriamycin is reported. The patient had left mastectomy for breast cancer in 1978, and then right mastectomy for breast cancer in 1987. Two years later, she was readmitted to our hospital with right neck lymph node metastasis and local recurrence at right chest wall. Neck lymph node metastasis was treated with irradiation with good response. On the other hand, Adriamycin ointment was applied to recurrent cancer on the right chest. The cancer was gradually diminished in size. Seventy-eight days after treatment, the local chest wall with cancer was resected. Histologically, the entire resected tissue showed no viable cancer cells and Adriamycin concentration in the tissue was extraordinary high (ten to forty fold over on systemic chemotherapy). Adriamycin ointment may be an alternative treatment of choice for local recurrent breast cancer.     

Two cases of choroidal metastasis from breast cancer

We report two cases of choroidal metastasis from breast cancer. The first case was a 41-year-old woman with loss of her right upper visual area in whom right breast cancer accompained by lung and choroidal metastases were detected simultaneousyl. She died without having received radiation therapy for the affected eye 6 months after mastectomy and oophorectomy. The second case was a 34-year-old woman in whom choroidal metastasis causing right visual disturbance was diagnosed 3 years after mastectomy for breast cancer. She received radiation therapy following oophorectomy and her visual acuity completely recovered. She dies 7 months later. Radiation therapy improved her quality of life despite her short survival, because her visual acuity was maintained until death. In general, the life span of patients with choroidal metastases is short because of multiple organ metastases, but to obtain a better quality of life, active treatment of the affected eye is necessary.     

Clinicopathological features of gastric metastasis from breast cancer in three cases

The common sites for metastases from breast cancer are lymph nodes, bone, lung, liver, and brain. Gastrointestinal (GI) metastasis is rarely found or diagnosed in patients with breast cancer. This report presents three cases of gastric metastasis from breast cancer. Case 1 was a 42-year-old female diagnosed with gastric metastasis after mastectomy with axillary lymph node dissection for invasive lobular carcinoma of the left breast. Case 2 was a 54-year-old female who was diagnosed to have invasive lobular carcinoma of the left breast with systemic bone and gastric metastasis. Case 3 was a 54-year-old female who was diagnosed to have bilateral invasive ductal carcinoma of the breast with simultaneous bone and gastric metastasis. The immunohistochemical statuses for estrogen receptor, progesterone receptor, mammaglobin, and gross cystic disease fluid protein-15 (GCDFP-15) between the primary and gastric metastatic lesions were all well matched. All three cases were treated with systemic chemotherapy, hormone therapy or both, without surgical intervention for gastric lesions. Two patients with disseminated disease died 27 and 58 months after diagnosis of gastric metastasis, while one patient without organ metastasis is still alive at 56 months after diagnosis. It is important to make a correct diagnosis by distinguishing gastric metastasis from breast cancer in order to select the optimal initial treatment for systemic disease of breast cancer.     

Hepatic infusion of docetaxel using PEIT for a patient with stage IV breast cancer]

Hepatic infusion of docetaxel using PEIT was performed for a patient with stage IV breast cancer. Docetaxel was effective to a solitary liver metastatic lesion. A 64-year-old woman was admitted to our hospital because of a left breast mass that was bleeding. She was diagnosed with stage IV breast cancer. Surgery was performed on February 16th. The pathological diagnosis was invasive ductal carcinoma, and hormone receptors were negative. Two weeks after operation, monthly docetaxel injections were given together with doxifluidine 400 mg/day p.o., cyclophosphamide 50 mg/day p.o., and fadrozole hydrochloride hydrate 2 mg/day p.o. After two courses, hepatic infusion of docetaxel was performed using PEIT after informed consent. The patient's high serum CEA and CA15-3 level returned to the normal range. A metastatic lesion on CT changed to a cystic pattern. These results suggest that PEIT is worth trying in patients with solitary liver metastasis from breast cancer.     

Metachronous secondary primary occult breast cancer initially presenting with metastases to the contralateral axillary lymph nodes: report of a case

We report a rare case of a 64-year-old female with metachronous secondary primary left occult breast cancer initially presenting right axillary lymph node metastases. The patient, who had received breast-conserving therapy for left breast cancer at another hospital about 4.5 years ago, came to our hospital complaining of right axillary node swelling. After both breast and systemic examination, she received complete right axillary lymph node dissection. Just after the operation, she was diagnosed with right occult breast cancer by a review of the right axillary lymph nodes and previous left breast cancer. She was followed by radiation and systemic chemoendocrine therapies. One year after axillary lymph node dissection, mammography and ultrasonography showed a new lesion in her left breast. Core needle biopsy revealed similar findings to right axillary lymph node metastasis. After salvage surgery, the diagnosis was revised. We recommend that patients without clinical findings except for axillary lymph node metastasis, especially post-breast-conserving surgery followed by radiation therapy, should be considered not only as having ipsilateral but also contralateral occult breast cancer. If there is no evidence of a primary lesion, axillary lymph node dissection needs to be carried out, and the patient should be offered the choice of radiation therapy or mastectomy followed by proper systemic therapy.     

A case report of intrahepatic cholangiocarcinoma diagnosed as lung cancer with liver metastasis treated with radiofrequency ablation

In December 2008, a 43-year-old male who had been pointed out a nodular shadow in the right upper field on a chest radiography was admitted to hospital. A 35 mm mass infiltrating to superior vena cava in the right upper lobe of the lung, and 32 mm mass in the liver at S7 were detected by CT. Pathological diagnosis of the liver tumor was adenocarcinoma. Under the diagnosis of lung carcinoma and liver metastasis, systemic chemotherapy was started from January 2009. Radiofrequency ablation (RFA) therapy was added for liver S7 mass in February, and radiation therapy was performed for lung mass in December. The lung lesion has markedly reduced, but the liver lesion recurred in October 2009, which continued to grow up to 80 mm until August 2010. He presented to our hospital with the diagnosis of liver metastasis of controlled primary lung cancer. In October, we performed right hepatectomy with diaphragma and right lung resection. The pathological diagnosis was intrahepatic cholangiocarcinoma. Multiple recurrences in remnant liver, lung and peritoneal metastasis were detected in January 2011. For intrahepatic cholangiocarcinoma, hepatectomy is the only established treatment, and RFA treatment remains controversial. Clinical diagnosis of multiple cancers should be decided with caution.     

A case of breast cancer diagnosed by inguinal lymph node metastasis

We describe a case of a 58-year-old woman with right inguinal lymph node swelling and a T1 tumor in the right breast. She was referred with an 18-month history of the former complaint and a six-month history of the latter. Excisional biopsy of the inguinal lymph node revealed breast cancer metastasis. Radiographical examination showed no metastases to the lungs, liver or bone. Modified radical mastectomy was performed. Histological examination revealed solid tubular carcinoma, PT2, PM (axillary lymph node metastases 4/16), stage IV. Estrogen and progesterone receptors were negative. Three cycles of postoperative cyclophosphamide, adriamycin and 5-fluorouracil (CAF) chemotherapy were given, and the right inguinal area was irradiated with 40 Gy. The patient complained of swelling in both legs three years after surgery. Computed tomography revealed marked lymph node swellings in the pelvic cavity. She died six months later. Inguinal lymph node metastasis from breast cancer is very rare, although distant lymph node metastasis in the cervix occurs frequently. This case should help clarify how breast cancer metastasizes to distant lymph nodes.