Granulomatous mastitis (GM) is a rare chronic inflammatory breast condition with unknown etiology. There is still no generally accepted optimal treatment for GM. Corticosteroid treatment and/or wide excision is most commonly reported in the literature. Incision and drainage or limited excision alone has little benefit because of a strong tendency of recurrence. Corticosteroids also have a high failure rate and possible side effects. In the current series, we treated GM patients without corticosteroids, except for one patient. We also devised multidirectional deep drainage for advanced and complicated abscesses, which are characteristic of GM. This retrospective study included 13 women who met the required histologic criteria of GM. The mean age of the patients was 41 years. All of the patients were premenopausal. Six patients had breast-fed in the last 5 years. Five patients were under medication with antidepressants. A total of 11 patients developed abscesses during the clinical course, and the abscesses penetrated the retromammary space in 4 patients. We treated 2 of these 4 patients with multidirectional deep drainage and obtained complete remission in 5 and 6.5 months, respectively. These times were much shorter than those in the other 2 patients. The time to resolution in 11 patients was 4 to 28 months. This overall outcome was comparable with that of corticosteroid treatment reported in the literature. Because the natural history of GM is thought to be self-limiting, close observation and minimally required drainage of abscesses without corticosteroid administration remain the treatment modality of choice.

Metastasis from mammary phyllodes tumor is rare; only five cases of phyllodes tumor metastasizing to the pancreas have been documented in the literature. Our patient developed acute retroperitoneal hemorrhage due to pancreatic metastasis from malignant phyllodes tumor of the breast, as the first presentation of metastasis. We successfully used catheter intervention to avoid urgent explorative laparotomy, and eventually found another metastasis in a short period. Systemic ifosfamide-doxorubicin combination chemotherapy was employed. The regression of metastases was partial and a new lesion appeared at the same time. This case is extremely rare. However, we should be careful about the symptoms indicating the sign of bleeding during the follow-up of patients with fast-progressing metastatic phyllodes tumor.

The O6-methylguanine-DNA methyltransferase (MGMT) protein protects cells from alkylating agents by removing alkyl groups from the O6-position of guanine. However, its effect on DNA damage induced by cyclophosphamide (CPM) is unclear. The present study investigated whether MGMT expression was correlated with prognosis in patients with breast cancer that was managed according to a common therapeutic protocol or treated with CPM-based chemotherapy. The intrinsic subtypes and MGMT protein expression levels were assessed in 635 consecutive patients with breast cancer using immunohistochemistry. In total, 425 (67%) luminal A, 95 (15%) luminal B, 47 (7%) human epidermal growth factor receptor-2+/estrogen receptor− (HER2+/ER−) and 48 (8%) basal-like subtypes were identified. Of these, MGMT positivity was identified in 398 (63%) of 635 breast cancers; 68% of luminal A, 67% of luminal B, 30% of HER2+/ER− and 46% of basal-like subtypes were positive. The overall survival (OS) and disease-free survival (DFS) rates did not significantly differ according to the MGMT status among patients with luminal A, luminal B or HER2+/ER− subtypes, and patients with MGMT-negative basal-like cancers tended to have a longer DFS, but not a significantly longer OS time. CPM-containing chemotherapy was administered to 26%, 40%, 47% and 31% of patients with luminal A, luminal B, HER2+/ER− and basal-like tumors, respectively. Although the MGMT status and clinical outcomes of patients with the luminal A, luminal B or HER2+/ER− subtypes treated with CPM were not significantly correlated, the patients with MGMT-negative basal-like tumors who received CPM exhibited significantly improved DFS and OS compared with the CPM-treated patients with MGMT-positive tumors. MGMT may be a useful prognostic and predictive marker for CPM-containing chemotherapy in basal-like breast cancer.

A 71-year-old female presented to our hospital with recent increase in diarrhea and body weight loss. Radiologic and endoscopic examinations revealed rectal adenocarcinoma with synchronous multiple liver metastases accompanied by widespread intrabiliary tumor thrombi. After primary tumor resection, systemic treatment using 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX), 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI), and panitumumab was given. The disease responded well to treatment and about two years after rectal surgery she underwent left hemihepatectomy with removal of tumor thrombi. Histological examination showed that intrahepatic bile dusts were filled with tumor thrombi indicative of a tubular adenocarcinoma resembling rectal adenocarcinoma. No tumor invasion was observed on the surgical margins. She received 5-fluorouracil and leucovorin as adjuvant treatment for six months, and she has not shown any evidence of recurrence for one year after hepatectomy.