A 69-year old woman was admitted to our hospital because of
dyspnea and
pain in her left breast. Computed tomography revealed a massive quantity of left
pleural effusion, a
tumor in the left breast(5 cm in diameter), left cervical and supraclavicular
lymph node metastasis, and a large left axillary metastatic mass. Based on a core needle biopsy, her
breast tumor was diagnosed pathologically as
scirrhous carcinoma, which was positive for
estrogen receptor/
progesterone receptor and negative for HER2 using the FISH assay, and left pleural
metastasis was diagnosed cytologically. The carcinomatous
pleural effusion was successfully controlled using pleural instillations of
pirarubicin HCl and
OK-432 after pleural drainage. A near clinical complete response was achieved by EC systemic
chemotherapy(6 months)followed by endocrine
therapy(
letrozole), but 3 months later she was diagnosed cytologically with carcinomatous
cardiac tamponade. After operative pericardial drainage, intrapericardial instillations of
cisplatin and
OK-432 successfully prevented re-accumulation of
pericardial effusion. Systemic
chemotherapy(weekly
paclitaxel)for 11 months and endocrine
therapy(
letrozole)resulted in a clinical complete response. One year and 10 months after pericardial drainage, she underwent surgery(
mastectomy and axillary
lymph node dissection level II)because of two small
tumors in the left breast which were found to be malignant using PET-CT. One
tumor(diameter 1.6 cm)was found pathologically to consist of degenerated
cancer cells, and another
tumor(diameter 2 cm)was diagnosed as recurrent
cancer. There was no
lymph node metastasis in the axilla except for a single mass(1.4×0.7×0.3 cm), which was composed of extremely degenerative and necrotic non-lymphoid cancerous tissue. Since having the surgery, she has not experienced recurrence on
hormone therapy with
fulvestrant, and to date she is still alive, 3 years and 5 months since the left pleural
metastasis episode.