1/17. Synchronous primary cancers of the breast and cervix: planning multidisciplinary primary treatment [clinico-pathological conference]Multiple metachronous primary malignancies are becoming increasingly frequent; however, multiple synchronous primary malignancies are still unusual. We report the case of a 61-year-old woman with synchronous stage IIIB ductal carcinoma of the left breast and FIGO stage IB2 squamous cell carcinoma of the cervix. The patient was treated initially every 4 weeks with a 24-h intravenous infusion of paclitaxel (175 mg/m2) followed by a 1-h infusion of carboplatin (area under the curve of 5 mg/ml x min) with concurrent irradiation of the pelvis. Significant toxic reactions including nausea, vomiting, and diarrhea required hospitalization or outpatient intravenous fluids and antiemetics. After four cycles of chemotherapy, the breast cancer was in complete clinical remission, and the patient underwent a modified radical mastectomy with axillary lymph node dissection. Pathologic findings revealed a few microscopic foci of residual infiltrating ductal carcinoma exhibiting a marked treatment effect; none of the 14 axillary lymph nodes removed showed evidence of metastatic tumor. A near-complete pathologic response of the breast cancer and a complete clinical response of the cervical cancer were obtained. Adjuvant chemotherapy for the breast cancer was then initiated, followed by radiation and hormonal therapy.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
2/17. Fetal cardiac effects of doxorubicin therapy for carcinoma of the breast during pregnancy: case report and review of the literature.Cardiotoxicity is a recognized complication of anthracycline drugs given as part of chemotherapy; however, the pre- and postnatal cardiac effects of in utero exposure are not well documented. In this report we present a case of gestational breast cancer with initiation of four cycles of doxorubicin/cyclophosphamide chemotherapy after modified radical mastectomy and axilla dissection during the early second trimester. Serial echocardiographic measurements of the ventricular shortening fraction and biometry of the ventricular cavities were performed. Allowing for the individual variability of these values in the fetus no myocardial dysfunction was observed. The literature was reviewed in an attempt to delineate the possible role of prenatal echocardiography in the diagnosis of doxorubicin-induced cardiotoxicity in the fetus.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
3/17. Carcinocythemia as the single extension of breast cancer: report of a case and review of the literature.Carcinocythemia (carcinoma cell leukemia) has been previously described as a rare, late and dramatic event occurring in widespread tumoral disease. We report a case of carcinocythemia occurring in a patient with a particularly indolent breast cancer. When a large amount of circulating tumor cells (CTC) appeared in the blood smears, neither visceral macrometastases nor massive bone marrow infiltration could be detected. We isolated CTC to perform cell cycle analysis and to study the expression of adhesion molecules. A fraction of the CTC was proliferating in the bloodstream but we detected no relevant anomaly of adhesion properties in the CTC. A post-mortem biopsy disclosed an exclusive sinusoidal infiltration of the liver. We propose that in this case, carcinocythemia resulted from the release of CTC from the visceral microcirculation where the proliferation occurred.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
4/17. Successful management of breast cancer with liver metastases with medroxyprogesterone acetate treatment.A 38-year-old woman with cancer in the left breast underwent standard radical mastectomy. The estrogen receptor and progesterone receptor status of the primary tumor was unknown. Ten years after the surgery, a metastatic liver tumor was detected, and chemoendocrine therapy, consisting of cyclophosphamide, epirubicin, 5-fluorouracil (CEF) and medroxyprogesterone acetate (MPA) was initiated. The metastatic liver tumor showed a partial response after 11 cycles of such chemoendocrine therapy. Subsequently, MPA alone was given daily as maintenance therapy, and the disease has remained stable for 6 years. For women with metastatic breast cancer, complete remission is uncommon, and stable disease is a reasonable goal of successful therapy. In this respect, chemoendocrine therapy with CEF and MPA, followed by MPA alone as maintenance therapy, was successful in the patient reported here. Importantly, the patient's quality of life has remained favorable for several years after the partial response was achieved.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
5/17. Metastatic breast cancer in pregnancy: first case of chemotherapy with docetaxel.The focus of this paper is a case study of a woman in the first trimester of pregnancy who presented with metastatic breast cancer. The bony spread of the metastases was rapid and it was necessary to treat the patient as soon as possible after the period of organogenesis (days 18-60 of human gestation). This stage is the phase of greatest sensitivity of teratogens and the malformations are observed most often. Yet, the choice of third-line chemotherapy was difficult because of anthracycline-resistant metastatic breast cancer. The world literature reported cytotoxic combinated regimens as the standard of care for the management of the metastases. The development of new antitumoral strategies with less toxicity and their encouraging results led us to the approval of docetaxel for the treatment of the patient even though it had never been tested in pregnancy. Docetaxel is a potent inhibitor of microtubule depolymerization and has a unique ability to alter certain classes of microtubules. The monochemotherapy was administered once every 3 weeks for a total of three cycles until 30 weeks of gestation. During the 32nd week of pregnancy the patient delivered a female infant whose birthweight and apgar score were normal. The infant did not have any anomalies. The woman finished her treatment in puerperium and she received three cycles of docetaxel. The patient has been receiving vinorelbine (one cycle every 2 weeks) for 2 years; her last follow-up was good and showed that the progression of the metastases had stopped. The daughter's psychophysical development was normal.- - - - - - - - - - ranking = 3keywords = cycle (Clic here for more details about this article) |
6/17. Uterine cervical metastasis of breast cancer: a rare complication that may be overlooked.BACKGROUND: Metastasis of distant malignancies to the cervix uteri is a rare occurrence and the frequency is approximately 4% for all tumours. However, the frequency of cervical metastasis of breast cancer is much lower and is estimated to range between 0.8 and 1.7%. With the exception of ovarian metastases, secondary tumours of the female genital tract are rather uncommon. Therefore, these conditions pose diagnostic problems for the clinician. PATIENT: A 40-year-old woman with the diagnosis of invasive ductal cell carcinoma of the right breast underwent mastectomy with dissection of axillary lymph nodes in 1998. Subsequently, the patient received 6 cycles of chemotherapy with cyclophosphamide, methotrexate and fluorouracil. The initial tumour stage was pT2, pN0 (0/13), M0, G2. The oestrogen and progesterone receptors were positive and expression of the C-erb-B2 coding oncogene was negative. Gynaecological and ultrasonographic examination revealed a normal cervix without evident lesions. Exfoliative cytology was negative. 14 months after treatment the patient presented with an axillary relapse and surgery, second-line chemotherapy with doxorubicine and radiation therapy of the chest wall and the axilla were performed. The patient developed liver metastases 14 months later and at this time ultrasonographic pelvic examination revealed a 2.2 cm tumour of the cervix with good vascularisation. The patient had no clinical symptoms, i.e. no vaginal bleeding or discharge. Sonomorphologically this tumour appeared as a leiomyoma of the cervix. Cervical biopsies and curettage, however, revealed metastatic carcinoma expressing oestrogen and progesterone receptors consistent with the primary breast cancer. Under palliative chemotherapy with docetaxel progression of liver metastases and cervical metastasis occurred and the patient died 9 months later. CONCLUSION: Metastatic involvement of the cervix should be considered in women with a history of breast cancer who present with vaginal bleeding or suspicious changes of the cervix on transvaginal ultrasound. Therefore, gynaecological and ultrasonographic examination of the pelvis represent an important part of the follow- up investigations in women with primary breast cancer.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
7/17. Dramatic response of choroidal metastases from breast cancer to a combination of trastuzumab and vinorelbine.We report the case of a 57-year-old woman with unilateral choroidal metastases from HER-2-positive breast cancer. She was given trastuzumab and vinorelbine with complete resolution of her visual defect after one cycle of treatment. This article illustrates that treatment using trastuzumab-containing chemotherapy regimens in HER-2-overexpressing breast cancer patients with choroidal metastases may be an alternative therapeutic strategy to initial orbital irradiation.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
8/17. Potential role of chemo-radiation with oral capecitabine in a breast cancer patient with central nervous system relapse.A 54-year-old woman underwent mastectomy and axillary lymph node dissection for infiltrating ductal carcinoma with multiple lymph node involvement. The patient received adriamycin 60 mg/m(2) and cyclophosphamide 600 mg/m(2) (AC) followed by weekly paclitaxel 80 mg/m(2) and external irradiation to the local lymph node regions as adjuvant treatment. After 1 year and 5 months, the patient suffered her first recurrence, developing multiple brain and meningeal metastases. CNS involvement was well controlled by oral capecitabine (2400 mg twice daily, on days 1-21 of a 28-day cycle) and external whole brain irradiation of 50 Gy with minimal toxicity. We suggest that capecitabine contributed to the favorable clinical course in this patient and believe that, as an oral agent, this drug may benefit patients with CNS metastases of breast cancer by allowing home-based therapy.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
9/17. meningeal carcinomatosis preceded by a rapid increase in serum CA19-9 levels in a patient with breast cancer.We report a patient with breast cancer who developed meningeal carcinomatosis that was preceded by a rapid increase in the serum level of carbohydrate antigen (CA) 19-9. A 60-year-old woman was admitted for primary breast cancer with multiple metastases to the vertebrae. She received cyclophosphamide 400 mg/m(2), epirubicin 40 mg/m(2), and 5-fluorouracil (5-FU) 400 mg/m(2) (CEF) chemotherapy every 3 weeks. Upon admission, her serum concentrations of carcinoembryonic antigen (CEA) and CA19-9 were 28.6 ng/ml and 99.2 U/ml, respectively. After three cycles of CEF therapy, her serum CEA decreased, and metastases to the vertebrae were attenuated. Her serum CA19-9 rapidly increased, however. A modified radical mastectomy was performed, but her serum CA19-9 levels still remained high (>500 U/ml). After four cycles of CEF therapy, she experienced headaches and vomiting due to an increase in cerebrospinal pressure, and she was diagnosed with meningeal carcinomatosis. At the time of this diagnosis, the concentration of CA19-9 in her cerebrospinal fluid was greater than 500 U/ml, and immunohistochemical examination revealed that carcinoma cells in the cerebrospinal fluid overexpressed CA19-9. To our knowledge, this is the first report of the development of meningeal carcinomatosis from CA19-9-producing breast cancer cells, showing thatCA19-9 expression was associated with breast tumor progression.- - - - - - - - - - ranking = 2keywords = cycle (Clic here for more details about this article) |
10/17. Choroidal metastasis from breast carcinoma.OBJECTIVE: To report a case of intraocular metastasis from breast carcinoma. CLINICAL PRESENTATION AND INTERVENTION: A 54-year-old woman diagnosed with multifocal ductal adenocarcinoma, grade III, of the left breast presented with blurred vision of the left eye. Funduscopy under pupil dilation in the left eye revealed a plateau-shaped, yellow choroidal focus measuring 4 optic disc diameters and located 3 optic disc diameters below the fovea. The patient was treated with two cycles of docetaxel and capecitabine. One month later the patient's visual acuity improved. Funduscopy confirmed reduction of oedema. CONCLUSION: This case shows that impaired vision can be an alarming symptom in a breast cancer patient and a description is given of the morphological features that could help in recognizing the smallest detectable breast cancer metastasis.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
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