RESUMO
BACKGROUND: Solid papillary carcinoma (SPC) of the breast is a rare breast cancer that accounts for less than 1% of all breast cancers. The optimal clinical management of SPC remains controversial. Here, we report a case of invasive SPC with neuroendocrine differentiation in addition to review of the current literature. CASE PRESENTATION: A premenopausal 46-year-old female presented with a mass in her left breast that tended to increase in size over a 10-month period. Mammography and ultrasonography revealed a mass in the left upper-inner quadrant. The resulting images suggested a category 3 breast tumor according to the Breast Imaging Reporting and Data System (BI-RADS). A core needle biopsy (CNB) was performed, and the pathological findings showed a solid papillary pattern and atypical cells suggestive of noninvasive SPC. After a left partial mastectomy and sentinel lymph node biopsy (SLNB), the specimens were sent for histopathological analysis for further investigation. Postoperative pathological findings suggested invasive SPC. Whole-breast radiation therapy and adjuvant hormonal therapy were performed as postoperative treatments. Three years after surgery, multiple lung metastases were detected, and the patient was treated with a gonadotropin-releasing hormone agonist and an aromatase inhibitor. Five months later, multiple liver metastases and bone metastases appeared, and oral 5-fluorouracil was chosen for the subsequent treatment. The patient has been treated for 5 years to date, and she is continuing to take oral 5-fluorouracil and is alive without any further disease progression. CONCLUSIONS: We report a rare case of premenopausal invasive SPC with multiple metastases. Further study is needed to clarify the molecular characteristics and clinical behaviors of SPC and to explore the optimal treatment strategy.
RESUMO
Tacrolimus is a calcineurin inhibitor that has been used to prevent allograft rejection after organ transplantation. We report the case of a living-donor liver transplant recipient with breast cancer who received adjuvant chemotherapy at an appropriate relative dose intensity in spite of a decrease in the trough blood concentration of tacrolimus. The patient was a woman in her 50s who had undergone living-donor liver transplantation because of primary biliary cirrhosis and received maintenance therapy consisting of tacrolimus. She was diagnosed as having locally advanced breast cancer(ER and HER2 positive). After surgery, we administered 4 courses of EC followed by weekly administration of paclitaxel plus trastuzumab. During chemotherapy, although the trough blood concentration of tacrolimus was slightly decreased, neither severe adverse event nor allograft rejection was observed. Recently, organ transplantation outcomes have significantly improved as a result of the progress of immunosuppressive agents. However, the development of malignancies after transplantation is a serious problem.
