title: A case of metaplastic breast cancer that showed a good response to platinum-based preoperative chemotherapy.
abstract: Patients with metaplastic breast cancer (MBC) exhibit reduced response to chemotherapy and have poor prognosis. We investigated a case of MBC that showed a positive response to preoperative chemotherapy, resulting in near pathological complete response (pCR). A 59-year-old woman complained of a lump in her right breast. Magnetic resonance imaging (MRI) showed the presence of a solid mass that was 24 mm in diameter. The pathological diagnosis was MBC with cartilaginous differentiation. The clinical stage was T2N0M0, stage IIA according to the International Union against Cancer (UICC) criteria. To observe the response to chemotherapy, we gave her preoperative chemotherapy. The patient was monitored closely, since we realized that failure of chemotherapy carries a risk of tumor progression. Evaluation was carried out using ultrasound, MRI, fluorodeoxyglucose (FDG) positron emission tomography (PET), and a Ki-67 labeling index after the first cycle of chemotherapy, and ultrasound after each additional cycle. FDG-PET showed a positive response after the first cycle of chemotherapy. The patient underwent 4 cycles of docetaxel (75 mg/m(2)) and cisplatin (75 mg/m(2)) followed by 4 cycles of cyclophosphamide (500 mg/m(2)), doxorubicin (50 mg/m(2)), and cisplatin (50 mg/m(2)). Ultrasound showed decreases in tumor size after each cycle of chemotherapy. After chemotherapy, MRI showed nearly complete regression of the tumor. Partial mastectomy was performed. Pathological examination showed few cancer cells remaining, indicating near pCR. We report a case of MBC that responded well to platinum-based preoperative chemotherapy. We propose that preoperative chemotherapy may be an option for treatment of MBC in conjunction with careful monitoring.
authors.affiliation: Department of Breast Surgery, Graduate School of Medicine, Kyoto University Hospital, 54 Shogoin kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Haruko
authors.initials: H
authors.lastname: Takuwa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ueno
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishiguro
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Mikami
authors.forename: Shotaro
authors.initials: S
authors.lastname: Kanao
authors.forename: Masahiro
authors.initials: M
authors.lastname: Takada
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Sugie
authors.forename: Masakazu
authors.initials: M
authors.lastname: Toi
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D000077143:Docetaxel; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008679:Metaplasia / Q000188:drug therapy* / Q000473:pathology; D008875:Middle Aged; D064847:Multimodal Imaging; D011300:Preoperative Care; D011379:Prognosis; D043823:Taxoids / Q000008:administration & dosage
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin