A 45-year-old woman complained of a painless breast mass, sized 2.5cm in diameter. It was diagnosed as fibroadenoma of intracanalicular type or benign phyllodes tumor. About one month later, breast mass appeared again, which could not be disappeared by aspiration, and was diagnosed as late onset hematoma. Its wall was coagulated under general anesthesia. Microscopic findings of the hematoma wall showed fibrosarcoma partially including the proliferation of cartilage, and it was proved that the hematoma was malignant phyllodes tumor. She died elevent months later after mastectomy. Inappropriate high levels of serum ALP and RI accumulation (99mTcMDP) in the breast mass were present. This case suggests that ALP (isozyme 3) may be an useful marker of malignant phyllodes tumor with proliferation of cartilage.
A 41-year-old woman visited our hospital because of intrathoracic discomfort in September, 1986. A mediastinal tumor was found in X-ray films. During scintigraphy, 123I did not accumulate but in both early and delayed phases, 201Tl did. Recurrence of thyroid cancer treated 20 years before by right hemithyroidectomy and radical neck dissection was the most likely diagnosis. Digital subtraction angiography showed a stenotic change of the superior vena cava (SVC). Upon sternotomy, the mediastinal lymph nodes were seen to be enlarged into a single lump. Microscopically, the diagnosis was papillary adenocarcinoma of the thyroid.When a mediastinal tumor is diagnosed, a possibility to keep in mind is metastasis to the mediastinal lymph nodes from thyroid cancer. For the diagnosis and identification of the origin of mediastinal tumors, 201Tl scintigraphy is useful. Periodic monitoring for possible reccurrence is best. However, if this is not done and the reccurrence is found only when it is advanced, resection should be extensive, if the patient's condition permits it.
Several enzymes are closely related with the mechanism of action of fluoropyrimidine (FP). Dihydropyrimidine dehydrogenase (DPD) which catalyzes 5-fluorouracil (5-FU), thymidine phosphorylase (TP), responsible for catalyzing doxifluridine to 5-FU, and thymidylate synthase (TS) were estimated for breast cancer. TP level determined by enzyme-linked immunoabsorbant assay (ELISA), DPD level by ELISA and catalytic assay and TS level by fluorodeoxyuridine monophosphate (FdUMP) binding assay were estimated for 210 specimens from 125 consenting patients with primary or metastatic breast cancer who gave consent. TS level of T1 was higher than that of T2-4 (p < 0.05). A high positive correlation was observed between TP and DPD in the same specimen. The ratio of simultaneously resected metastasis/primary and postoperative recurrent/primary never exceeded two. Enzyme level, generally decreased with or without interventing FP therapy. Enzyme level increase was frequently observed in a series of no-drug, non-FP, and FP therapy regimens. For selection of chemotherapy or estimation of chemosensitivity, TS can be used, with either TP or DPD at first surgery, and also with intervening chemotherapy after recurrence.
