[A Case of Pharyngolaryngitis Requiring Hospitalization during Chemotherapy for Breast Cancer].

A 45-year-old woman underwent primary systemic therapy for left breast cancer(cT1N1M0, cStage ⅡA, Luminal B [HER2-positive]). She received EC therapy(epirubicin 90mg/m2, and cyclophosphamide 900mg/m2). On the 4th and 5th day of the third EC cycle, she developed sore throat and a fever of over 38℃, and was not able to consume anything orally. She visited our hospital and underwent a laryngeal endoscopy on the 8th day of the third EC cycle, which revealed severe inflammation of her pharynx and larynx. Viral pharyngolaryngitis was suspected and hence, she was admitted to our hospital. She developed laryngeal edema after hospitalization, for which hydrocortisone was administered. She was discharged from the hospital when her symptoms improved.

＜Editors' Choice＞ Practice management for elderly patients with breast cancer; Findings from a survey by the Japan Breast Cancer Study Group.

Information on patterns of clinical care for elderly breast cancer patients is lacking. The aims of this study are two-fold, firstly, to clarify daily practice treatments for elderly breast cancer patients in Japan, and secondly, to plan a prospective clinical trial to address unresolved clinical questions. We investigated practice care of elderly breast cancer patients in 38 institutions of the Japan Clinical Oncology Group (JCOG). Questionnaires asked: (1) definition of "elderly" for each treatment, (2) clinical standard anti-HER2 therapy in each age-group, (3) recommended docetaxel dose in each age-group, (4) considerations for future clinical trials, and (5) other information about geriatric oncology concerning breast cancer. The upper age-limit for surgery and irradiation therapy was generally 80 years, while many physicians considered anti-cytotoxic adjuvant therapy unsuitable for patients >70-75 years. For HER2-positive metastatic breast cancer, 82% of physicians recommended docetaxel (DTX) plus trastuzumab plus pertuzumab (DTP) as standard care for patients aged 65-70, although 54% of physicians avoided DTP for those aged 71-75 as first-line standard preference. Most physicians recommended 75 mg/m2 DTX for both 65-70 (63%) and 70-75 (52%) age-groups, but not for those over 75. Many physicians (73%) recommended 60 mg/m2 DTX first. Most (97%) agree that the vulnerability of each elderly patient in a clinical trial should be assessed by comprehensive geriatric assessment. This is the first questionnaire study of care patterns for elderly breast cancer patients. Physicians considered different drug regimens and dosages according to patients' fragility.

A case of Miller Fisher syndrome during preoperative chemotherapy for breast cancer.

A 53-year-old woman with breast cancer received FEC treatment (5FU: 500 mg/m(2), epirubicin: 100 mg/m(2), and cyclophosphamide: 500 mg/m(2)) every 3 weeks as preoperative chemotherapy. Fifteen days after her third cycle of FEC, she developed a cold. Diplopia occurred 4 days after developing the cold, and progressive paresthesia of the hands and weakness of the limbs occurred. She had ophthalmoplegia, ataxia, and are flexia and was diagnosed with Miller Fisher Syndrome (MFS). The cause of MFS during chemotherapy is believed to be caused by an immunological response to infection, or drug neurotoxicity. In our case, since the patient underwent an antecedent upper respiratory infection in the period of myelosuppression, her MFS was probably induced by the immunoreaction associated with this infection. Our patient underwent intravenous immunoglobulin therapy. After initiation of the treatment, her neurological symptoms improved, then, she received a fourth cycle of FEC and her remaining neurological symptoms did not worsen. Thus, we report a rare case of MFS developed in immunosuppression by chemotherapy and remind physicians of the alarming triad of MFS symptoms.

Single-cell time-of-flight secondary ion mass spectrometry reveals that human breast cancer stem cells have significantly lower content of palmitoleic acid compared to their counterpart non-stem cancer cells.

Lipids comprise the primary component of cell membranes. Imaging mass spectrometry is increasingly being used to visualize membranous lipids in clinical specimens, and it has revealed that abnormal lipid metabolism is related to the development of diseases. To characterize cell populations which are rare and sparsely localized in tissues, we conducted time-of-flight secondary ion mass spectrometry (TOF-SIMS) analyses of individual cells sorted by fluorescence activated cell sorting (FACS) and applied the method to analyze breast cancer stem cells (CSCs). TOF-SIMS analyses visualized phosphoric acids and four fatty acid (FA) species in the sorted CD45(-)/CD44(+)/CD24(-) CSCs, and these ions are suspected to have originated from membranous phospholipids as they were uniformly detected from the locus where the cells attached. Integrated ion intensity of palmitoleic acids [FA(16:1)] normalized by phosphoric acid signals were decreased significantly in CSCs as compared to that of CD45(-)/CD44(-)/CD24(+) non-stem cancer cells (NSCCs). This finding was supported by liquid chromatography coupled electrospray ionization-tandem mass spectrometry analysis, which revealed phosphatidylcholine (PC)(16:0/16:1) to be less abundant and PC(16:0/16:0) to be more abundant in CSCs as compared to NSCCs. Therefore, our novel method successfully provided lipid composition analysis of individual cells classified by the expression of a complex combination of cell-surface markers. The lipid compositions of CSCs originating from the heterogeneous cellular populations of clinical specimens were successfully characterized by this method.