been reported. 1,2 We report a case of axillary lymph node recurrence of papillary microcarcinoma (PMC). Case ReportA 46-year-old woman was referred to our department for investigation of cervical lateral lymph node swelling. Aspiration biopsy cytology of the lymph node revealed thyroid papillary carcinoma, but the primary thyroid carcinoma was not diagnosed preoperatively. Computed tomography (CT) showed enlargement of a left cervical lateral lymph node to 5.5 cm in diameter, with a cystic lesion (Fig. 1). The left jugular vein was compressed by the cervical lymph node, and was not found on the CT scan ( Fig. 1). We performed a subtotal thyroidectomy with radical neck dissection including resection of the jugular vein and sternocleidomastoideus muscle. Pathological examination of the primary thyroid tumor revealed a papillary carcinoma, 2 mm in diameter ( Fig. 2), with two metastatic lymph nodes; one in the cervical lateral nodes and one in the submandibular nodes. There was no pathological evidence of invasion of the left jugular vein.The patient was readmitted 5 years later with a left axillary mass. However, laboratory data revealed no abnormalities. The serum thyroglobulin concentration was within the normal range (6.8 ng/ml), and the antimicrosome antibody level was within the negative range (Ͻ20 titer). Ultrasonography and mammography showed two enlarged left axillary lymph nodes, which were both 2 cm in diameter, but no lesions in the breast. Aspiration biopsy cytology of one of the axillary lymph nodes showed metastatic papillary carcinoma. The patient did not initially agree to a radical operation, and she was followed up by ultrasonography for 2 months. However, chest CT and 201 thallium imaging subsequently showed progressive metastasis in the cervical, submandibular, mediastinal, and bilateral axillary AbstractWe report a case of axillary lymph node recurrence of thyroid papillary microcarcinoma (PMC) in a 51-yearold woman who had undergone thyroidectomy with lymph node dissection 5 years earlier. We performed residual thyroid resection with cervical and bilateral axillary lymph node dissection, and pathological examination revealed well-differentiated papillary carcinoma, with partial poor differentiation. Postoperative radioiodine therapy was ineffective, and the patient died of systemic dissemination of the recurrence 8 months after her second operation. The positive cell rates of proliferating cell nuclear antigen and Ki-67 were clearly higher in the recurrent lymph nodes than in the primary thyroid tumor, suggesting increased cell proliferation in the recurrent lymph nodes. Thyroid papillary carcinoma rarely recurs in the axillary lymph nodes, but its possibility must be kept in mind, especially in patients with remarkable cervical lymph node metastasis and those who undergo extensive lymph node dissection.

All-trans retinoic acid (ATRA), a synthetic derivative of vitamin A, inhibits the growth of breast cancer cells. To elucidate the mechanism by which ATRA causes cell growth inhibition, we examined changes in cell cycle and intracellular signaling pathways, focusing on protein kinase C (PKC) and mitogen-activated protein kinase (MAPK). Using the estrogen receptor-negative, retinoid receptor-positive breast cancer cell line SKRB-3, we found that treatment with ATRA significantly decreased the expression of PKCalpha, as well as reducing ERK MAPK phosphorylation. ATRA treatment leads to dephosphorylation of Rb, and consequently to G(1) arrest. Marked changes in the expression of cyclins (particularly cyclins A and E) were observed in SKBR-3 cells treated with ATRA. Using a series of pharmacological and molecular approaches, we found evidence that ATRA-induced SKBR-3 cell growth inhibition involves the deregulation of the PKCalpha-MAPK pathway. These data suggest that retinoids interfered with signal transduction pathways that are crucial for cell cycle progression, and highlight the complexities of the biological effects of retinoid derivatives.

Protein kinase C (PKC) is a family of serine-threonine kinases that regulate many cell processes. To study the role of PKCdelta in thyroid cancer cells, we used a replication-deficient adenovirus (PKCdeltaAdV), to tightly control PKCdelta expression. In NPA cells, activation of wild-type (WT) PKCdelta with phorbol 12-myristate 13-acetate (PMA) induced an arrest in cell growth at G(1) phase, which was itself inhibited by the PKCdelta inhibitor rottlerin. Furthermore, overexpression of a dominant negative PKCdelta did not induce G(1) arrest. These findings strongly suggested that PKCdelta induced cell growth arrest in NPA cells. We investigated the mechanism of G1 arrest by examining G(1)-related proteins and mitogen-activated protein kinase (MAPK) by Western blotting. After activation of WTPKCdelta with PMA, cyclin E expression and retinoblastoma protein (Rb) phosphorylation decreased; the expression of p27(Kip1) increased and the phosphorylation of extracellular signal-regulated kinase (ERK) MAPK decreased. These results indicated that the activation of PKCdelta induced cell growth arrest in NPA cells, through an ERK MAPK-p27(Kip1)-cyclin E-pRb pathway. PKCdelta may therefore be an effective molecular target for novel therapy in thyroid cancer.

We treated a patient with a pseudoaneurysm caused by core needle biopsy (CNB), in which both the cancer and the aneurysm were excised by breast conservation therapy. A 51-year-old woman attended a local hospital because of a 25-mm mass in the upper outer quadrant of the right breast. CNB was performed, and brisk bleeding occurred at the biopsy site. Immediate hemostasis was achieved with direct manual compression. CNB detected fatty tissue, and a diagnosis could not be made. When she presented at our hospital 6 weeks later, there was a 25-mm pulsating mass at the biopsy site. Color-flow Doppler US and dynamic MRI showed a breast tumor and pseudoaneurysm formation. For the purpose of diagnosis and treatment of the breast tumor and pseudoaneurysm, lumpectomy of the right breast was performed. Histological diagnosis was papillotubular carcinoma and pseudoaneurysm. Although this condition is relatively rare, it is important to be aware of the possibility of complications, such as pseudoaneurysms, which require treatment.

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