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ABSTRACT: Granular cell tumor is a soft tissue neoplasm that originates in the nervous system and arises at virtually any body site, but is mainly found in the skin, oral cavity or digestive tract. Most are benign and reportedly malignant cases are rare, occurring in only 1% or 2% of cases. We report on our findings in six patients who developed granular cell tumor in the mammary gland, esophagus, subcutaneous tissue and muscle. Of six patients, two had granular cell tumor located in the breast, two in the submucosa of the esophagus, and the other two under the skin of the left axillary cavity and in the right latissimus dorsi muscle, respectively. One of the two patients with tumor in the submucosa of the esophagus also had esophageal cancer. Patients' age ranged from 41 to 70 years (average, 59.1 years). Two patients with tumor in the submucosa of the esophagus were men, and the others were women. All of them were given a diagnosis of granular cell tumor by tissue biopsy and examination of excised specimens, but no evidence of malignancy was found. No recurrence has been noted in the patients who underwent surgical tumor removal.
World Journal of Surgical Oncology 09/2012; 10(1):204. · 1.12 Impact Factor
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ABSTRACT: There are various methods for detecting sentinel lymph nodes in breast cancer. Sentinel lymph node biopsy (SLNB) using a vital dye is a convenient and safe, intraoperatively preparative method to assess lymph node status. However, the disadvantage of the dye method is that the success rate of sentinel lymph node detection depend on the surgeon's skills and preoperative mapping of the sentinel lymph node is not feasible. Currently, a vital dye, radioisotope, or a combination of both is used to detect sentinel nodes. Many surgeons have reported successful results using either method. In this study we have analyzed breast lymphatic drainage pathways using indocyanine green (ICG) fluorescence imaging.
We examined the lymphatic courses, or lymphatic vessels, in the breast using ICG fluorescence imaging, and applied this method to SLNB in patients who underwent their first operative treatment for breast cancer between May 2006 and April 2008. Fluorescence images were obtained using a charge coupled device camera with a cut filter used as a detector, and light emitting diodes at 760 nm as a light source. When ICG was injected into the subareola and periareola, subcutaneous lymphatic vessels from the areola to the axilla became visible by fluorescence within a few minutes. The sentinel lymph node was then dissected with the help of fluorescence imaging navigation.
The detection rate of sentinel nodes was 100%. 0 to 4 states of lymphatic drainage pathways from the areola were observed. The number of sentinel nodes was 3.41 on average.
This method using indocyanine green (ICG) fluorescence imaging may possibly improve the detection rate of sentinel lymph nodes with high sensitivity and compensates for the deficiencies of other methods. The ICG fluorescence imaging technique enables observation of breast lymph vessels running in multiple directions and easily and accurately identification of sentinel lymph nodes. Thus, this technique can be considered useful.
World Journal of Surgical Oncology 12/2011; 9:157. · 1.12 Impact Factor
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ABSTRACT: We often encounter elderly patients who are difficult to treat with standard treatment (e. g. anthracycline, taxane or operation) because of complication, age and so on, though there are no standard treatments for such elderly patients. We analyzed retrospectively the efficacy and safety of oral chemo-endocrine therapy for patients more than 65 years old who were difficult to treat with standard chemotherapy or operation because of complications and other reasons. Seventeen patients were analyzed. The response rate (RR) was 76.5%, and the clinical benefit rate (CBR) was 94.1%. The two-year survival rate from the start of treatment was 91.7%, and the median progression free survival (PFS) was 1, 230 days. Grade 1 anorexia and grade 1 Hand-Foot Syndrome were observed in only one patient, and it was remarkable that patients could continue to receive treatment for such a long time. In conclusion, oral chemo-endocrine therapy is effective for elderly patients difficult to treat with standard treatment, because it has better anti-tumor effect and tolerability.
Gan to kagaku ryoho. Cancer & chemotherapy 07/2011; 38(7):1119-22.
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ABSTRACT: A 46-year-old female patient presented with a tumor measuring 0.5 cm in diameter under the areola of the breast. Because no definite malignancy was found with inspection and palpation, imaging analysis, or with a fine-needle aspiration cytology examination, follow-up observation was recommended. When the patient visited the hospital 6 months later, the mass was 0.9 cm in diameter. The tumor was excised and histopathologically diagnosed as a leiomyosarcoma. Subsequently, the patient underwent a partial resection of the breast, including the nipple and areola. A follow-up examination revealed no evidence of distant metastasis or local recurrences 8 years 4 months after the surgery. Primary leiomyosarcoma of the breast is extremely rare. Only 33 cases, which are reviewed in the present study, have been previously reported in the literature.
Surgery Today 11/2010; 40(11):1063-7. · 1.22 Impact Factor
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ABSTRACT: Breast cancer is a heterogeneous disease. The aim of this prospective study, in which fluorescence in situ hybridization was used to determine human epidermal growth factor receptor 2 status in primary breast cancers and in the lymph node metastases, was to verify the stability of human epidermal growth factor receptor 2 status in the following steps of neoplastic progression of breast cancer, which is fundamental for an appropriate therapeutic approach.
From patients with primary breast cancer, for whom, after January 2003, surgery was performed and involved metastatic lymph nodes were found, we randomly selected four groups of 15 patients, whose human epidermal growth factor receptor 2 score by immunohistochemistry was either 0, 1+, 2+ or 3+, respectively, totaling to 60. For each of those patients, their primary tumors and all of the metastatic lymph nodes were examined. Primary tumors and metastatic lymph nodes in each patient were examined by fluorescence in situ hybridization.
Of 18 patients with fluorescence in situ hybridization-positive primary tumors, 15 (83.3%) were fluorescence in situ hybridization-positive and 2 (11.1%) were fluorescence in situ hybridization-negative in all of their metastatic lymph nodes, and 1 (5.5%) patient had mixed (fluorescence in situ hybridization-positive or -negative) metastatic lymph nodes. Of 42 patients with fluorescence in situ hybridization-negative primary tumors, 40 (95%) were fluorescence in situ hybridization-negative and 2 (5%) fluorescence in situ hybridization-positive in all of their metastatic lymph nodes.
This study revealed that fluorescence in situ hybridization resulted in a high concordance of 83.3% between the human epidermal growth factor receptor 2 manifestation (fluorescence in situ hybridization-positive status) in primary tumors and that in metastatic lymph nodes, demonstrating that it is appropriate to determine whether and how to apply treatment by trastuzumab based on the results of evaluation of human epidermal growth factor receptor 2 expression.
Japanese Journal of Clinical Oncology 03/2010; 40(7):613-9. · 1.78 Impact Factor
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ABSTRACT: 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.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2005; 32(11):1676-8.
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ABSTRACT: 異常乳頭分泌症例に対する乳管内の検索は,乳管内微小病変の存在診断や良悪性の鑑別診断,さらに,病変が乳癌の場合には癌の乳管内進展状況を把握する上で重要である.我々は1990年6月に乳管内視鏡検査を開始し,これまで異常乳頭分泌症例411例に対して乳管内の観察を行い,独自に作成した乳管内腫瘍に対する乳管内視鏡分類に基づいて乳管内腫瘍の評価を行ってきた.今回,乳管内視鏡検査で病変が捉えられ良悪性の鑑別診断を行ったのち病理組織学的な検索により確定診断の得られた乳管内腫瘍191例について,乳管内視鏡分類を用いた良悪性診断の妥当性について検証した.191例の病理組織学的診断の内訳は,乳腺症17例(8.9%),乳管内乳頭腫103例(53.9%),乳癌71例(37.2%)であった.また,乳癌71例中36例(50.7%)は非浸潤性乳管癌であった.乳管内視鏡分類では,腫瘍の形態を有茎型,広基型の2型に大きく分類し,さらに広基型については半球型,凹凸不整型,不整隆起型の3型に亜分類している.有茎型を良性,広基型を悪性として算定したnegative predictive valueおよびpositive predictive valueはおのおの90.1% (n : 121), 84.3% (n : 70)と良好であった.さらに,広基型の亜型別にpositive predictive valueをみると,半球型68.4% (n : 19),凹凸不整型91.7% (n : 12),不整隆起型89.7% (n : 39)であり,凹凸不整型と不整隆起型の診断成績は良好であったが,半球型は,31.6%が良性腫瘍であり,この型の診断精度向上が今後に残された課題であると考えられた.乳管内視鏡分類は,乳管内腫瘍の病理組織学的な増殖,進展様式の特徴を的確に反映しており,乳管内腫瘍の診断に極めて有用である.乳管内視鏡による診断は,今後,早期・微小病変をターゲットにした乳腺疾患の診断と治療にさらに大きく貢献し得るものと確信する. In examinations of intraductal abnormalities of patients presenting with abnormal nipple discharge, it is important to discover and diagnose minute lesions within the duct, to determine whether the lesion is benign or malignant, and to determine the extent of ductal spreading in the case of intraductal carcinoma. To date, ductoscopy has been conducted on 411 cases, and we have been classifying intraductal tumors based on our own mammary ductoscopic classification. In the present study, we verified the validity of the benign or malignant diagnosis of the 191 intraductal tumors observed by mammary ductoscopy that we examined histopathologically using this classification. With the mammary ductoscopic classification of intraductal breast tumors, the configuration of the tumors was classified into two major categories of pedicled type and broad-based type and the latter was further subdivided into hemispherical, uneven, and irregular-mass types. Then, the negative and positive predictive values were calculated with the pedicled type classified as benign and broad-based type as malignant with favorable results of 90.1% (n=121) and 84.3% (n=70), respectively. The mammary ductoscopic classification of intraductal breast tumors proved to accurately reflect the histopathological characteristics of proliferation and progressive configurations of intraductal tumors, making the classification useful in diagnoses of intraductal tumors.
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ABSTRACT: 乳癌に対する乳房温存療法の頻度の増加に伴い,残存乳房内への癌遺残リスクも上昇している."切除断端陽性"は,乳房温存手術後の最も重要な再発リスク因子であるため,これを回避するための術前診断が極めて重要となる.今回われわれは,最近2年間に当科で手術を施行した原発性乳癌症例300例のうち,腫瘍径3cm以下の189例(63.0%)を対象として,乳房温存手術における超音波検査を用いた乳腺切除範囲診断の意義について検討した.術前の超音波検査で,乳房温存手術の適応ありと診断した症例は189例中124例(65.6%)であり,このうち乳房温存を希望しない症例および高度のリンパ節転移を認めた20例を除く104例(189例中55.0%)に乳房温存手術を施行した.この結果,断端陽性率は104例中6例,5.8%と非常に低く,極めて良好な成績が得られた.断端陽性例のうち2例は微細石灰化を伴う非触知の非浸潤性乳管癌であり,2例は浸潤性小葉癌であった.一方,術前超音波検査で,乳頭近傍(1cm以内)への癌の広がり,あるいは多発癌を認め乳房切除術の適応であると診断された症例は189例中65例(34.4%)であり,このうち64例,98.4%で病理組織学的診断との一致が得られた.超音波検査は,乳房温存手術における適切な乳腺切除範囲の診断に極めて有用である.限界はあるものの,癌遺残を回避し局所再発リスクを軽減する上で必須の検査法であり,今後,新たな装置の開発と診断技術の向上に伴い一層重要な役割を担うものと期待される. "Surgical margin (SM) positive" is the most significant recurrence risk factor in breast conserving surgery, which makes accurate preoperative diagnosis quintessential to avoid this risk. The objective of the present study was to examine the significance of ultrasonic (US) diagnosis for the decision of the appropriate extent of resection in breast conserving surgery. Of the 300 cases of primary breast cancers for which surgery was performed in our department for the past two years, 189 cases (63%) were for tumors 3 cm or less in diameter. In the preoperative US examination of 189 cases, 124 cases were (65.6%) diagnosed as indicating breast conserving surgery, and breast conserving surgery was performed on 104 cases of those 189 cases (55%), excluding 16 cases of patients who did not want breast conserving and the 4 cases of advanced lymph node metastasis. As a result, the SM-positive ratio was low (6 of 104 cases, 5.8%), an outstanding result. US examinations are useful for determining the appropriate extent of resection in breast conserving surgery, and although there are limitations, a US examination is necessary to avoid leaving cancer cells and to reduce the risk of local recurrence.
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