A 46-year-old woman was diagnosed with systemic lupus erythematosus (SLE) in 2004. Increased coarse calcification was found by mammography for the last 3 years, and she was referred to our hospital. Physical examination revealed diffuse firmness in the right breast and crusting of skin at the 3 o'clock position (Figure 1). The left breast and bilateral axillary lymph nodes were normal. Mammography showed branch-like coarse calcifications in the right middle-inner breast (Figure 2). Breast ultrasonography revealed skin thickening and a diffuse hypoechoic area with calcifications in the right breast. Contrast-enhanced breast magnetic resonance imaging (MRI) showed skin thickening, atrophy, and diffuse enhancement effects of the right mammary gland without a mass. The findings were assessed as fibrous scarring and edema (Figure 3). Pathologic examination revealed a fibrous area and infiltration of inflammatory cells, mainly lymphocytes. There were no malignant findings (Figure 4). The lesion was diagnosed as lupus mastitis. Because the patient's SLE was stable, she underwent follow-up observation. Lupus panniculitis, first reported by Kaposi in 1883, is chronic subcutaneous fat inflammation caused by an autoimmunity reaction associated with SLE. It can occur in approximately 2% of patients with SLE. Lupus panniculitis most frequently affects the arms, buttocks, face, and thighs. This condition rarely occurs in the breast; this condition is called lupus mastitis, which refers to subcutaneous fat inflammation of the breast. Symptoms include breast swelling, palpation of a mass and induration, and skin abnormalities such as erythema, hyperkeratosis, and ulceration. Mammography shows coarse calcification and increased breast density. Breast ultrasonography reveals an ill-defined mass with varying echogenicity and coarse or F I G U R E 1 Physical examination revealed diffuse firmness in the right breast and skin crusting at the 3 o'clock position F I G U R E 2 Mammography showed branch-like coarse calcifications in the right middle-inner breast. A, Mediolateral oblique. B, Craniocaudal

Background The initial therapeutic strategy for hormone receptor-positive (HR+), HER2-negative (HER2-) breast cancer is based on the first metastatic site; however, little evidence is available regarding the influence of metastatic distribution patterns of first metastatic sites on prognosis. In this study, we aimed to identify the metastatic distribution patterns of first metastatic sites that significantly correlate with survival after recurrence. Methods We performed a retrospective review of records from 271 patients with recurrent metastatic HR+/HER2- breast cancer diagnosed between January 2000 and December 2015. We assessed survival after recurrence according to the metastatic distribution patterns of the first metastatic sites and identified significant prognostic factors among patients with single and multiple metastases. Results Prognosis was significantly better in patients with a single metastasis than in those with multiple metastases (median overall survival after recurrence: 5.86 years vs. 2.50 years, respectively, p < 0.001). No metastatic organ site with single metastasis was significantly associated with prognostic outcome, although single metastasis with diffuse lesions was an independent risk factor for worse prognosis (HR: 3.641; 95% CI: 1.856–7.141) and more easily progressing to multiple metastases (p = 0.002). Multiple metastases, including liver metastasis (HR: 3.145; 95% CI: 1.802–5.495) or brain metastasis (HR: 3.289; 95% CI: 1.355–7.937), were regarded as significant independent poor prognostic factors; however, multiple metastases not involving liver or brain metastasis were not significantly related to prognosis after recurrence. Conclusions Single metastases with diffuse lesions could more easily disseminate systemically and progress to multiple metastases, leading to a poor prognosis similar to multiple metastases. Our findings indicate that the reconsideration of the determinant factors of therapeutic strategies for first recurrence in HR+/HER2- breast cancer may be needed.

Background: Myeloid sarcoma (MS) is a solid tumor consisting of myeloid blasts or immature myeloid cells, which are unusual outside the bone marrow. Case presentation: We present a rare case of isolated myeloid sarcoma of the small bowel in a 54-year-old man who was admitted to our hospital with repeated symptoms of intestinal obstruction. A small bowel series via an ileus tube revealed severe jejunal obstruction. Computed tomography revealed that the obstruction was likely caused by a jejunal tumor. The patient underwent laparoscopy-assisted partial resection of the jejunum with lymphadenectomy. Histopathological examination of the surgical specimen confirmed that MS had been responsible for the obstruction. Conclusions: Patients with MS require systemic chemotherapy, as do patients with acute myeloid leukemia. Hence, an early, accurate diagnosis is imperative for treating this malignancy. It is also important to list MS in the differential diagnosis of a small bowel tumor, even in nonleukemic patients.

HighlightsSolid pseudopapillary neoplasm with marked parenchymal atrophy of the distal pancreas.No acinar cells were observed, indicating exocrine dysfunction of atrophic parenchyma.The vestige of main pancreatic duct was observed in the distal atrophic pancreas.Central pancreatectomy without anastomosis of distal side of pancreas was performed.