The patients with a less-invasive primary tumor may gain a survival benefit from aggressive multimodality therapeutic approaches.

These data suggest that the diagnostic values of CSLEX and Nation Cancer Center-Stomach-439 are similar in single or combined use. However, the cutoff index of serum CSLEX tended to be higher than that of Nation Cancer Center-Stomach-439, which may make CSLEX more useful for detection of breast cancer metastasis.

Follow-up of women with breast cancer to detect recurrence and distant metastases is critical because earlier detection of recurrence can result in earlier and probably more efficient treatment. 18 F-2-deoxy-2-florod-glucose (FDG) positron emission tomography (PET) provides information about the metabolic activity of tumors that can complement the anatomical information provided by other imaging modalities. Several studies have demonstrated that whole-body FDG-PET is superior to conventional imaging in detecting recurrent and metastatic disease from breast cancer (1-7). However, false positive results are sometimes encountered in FDG-PET due to interpretative pitfalls and the non-specificity of FDG. Here, we present two cases of advanced breast cancer that showed false positive results on FDG-PET due to sarcoidosis that developed during the period of follow-up of breast cancer. CASE 1A 68-year-old woman underwent left modified radical mastectomy for breast cancer and axillary node dissection in September 1984. She had been treated with tamoxifen for 2 years because the cancer was positive for estrogen receptor, and no recurrence had been detected until January 2000, when bone metastasis of the cervical spine was detected. She received radiation therapy to the metastatic bone, followed by weekly administration of paclitaxel until June 2005. Thereafter, oral administration of anastrozole was started. In May 2006, FDG-PET was performed as a follow-up examination, and intense focal FDG uptake was observed in the bilateral hilar lymph nodes (Fig. 1a). As

Bevacizumab when combined with chemotherapy exerts significant activity against many solid tumors through tumor angiogenesis inhibition; however, it can induce severe side effects. We report the rare case of a 27-year-old premenopausal woman with locally advanced breast cancer that was marked by rapid tumor necrosis followed by massive hemorrhage shortly after bevacizumab and paclitaxel administration. On the basis of histopathological examination of a biopsy specimen and computed tomography findings, she was diagnosed with stage IV estrogen and progesterone receptor-negative and human epidermal growth factor receptor type 2-positive breast cancer with multiple organ metastases when she had entered gestational week 24. Cyclophosphamide, Adriamycin®, fluorouracil therapy was initiated, but multiple liver metastases continued to progress. A healthy fetus was delivered by induced delivery and trastuzumab-based treatment was initiated. Although the multiple liver metastases were controlled successfully by trastuzumab combined with paclitaxel, the primary tumor continued to expand even after subsequent administration of three other treatment regimens including anti-human epidermal growth factor receptor type 2 agents and cytotoxic drugs. To inhibit primary tumor growth, a combination therapy with paclitaxel and bevacizumab was subsequently initiated. Following therapy initiation, however, the large tumor occupying the patient’s entire left breast became necrotic and ulcerated rapidly. Furthermore, massive hemorrhage from the tumor occurred 5 weeks after bevacizumab-based therapy initiation. Although hemostasis was achieved by manual compression, the patient required blood transfusion for the massive blood loss. She eventually succumbed to respiratory failure. This case report demonstrates that primary breast cancer lesions with skin involvement have the potential to cause massive hemorrhage after bevacizumab-based treatment.