Bilateral Primary Breast Research Articles

Synchronous Bilateral Primary Breast Lymphoma: MRI and Pathologic Findings

Synchronous Bilateral Primary Breast Lymphoma: MRI and Pathologic Findings

US findings of bilateral primary breast cancer: retrospective study

<h3>Background</h3> For women with breast cancer, the contralateral breast is at high risk. The bilateral cancers may be synchronous or metachronous. If the bilateral breast cancers have similar ultrasonography (US) appearances, the US findings of the first breast cancer (index cancer) might lead to early detection of the contralateral cancer. The purpose of this study was to identify the US characteristics of bilateral breast cancer and to determine whether bilateral breast cancers have similar US appearances and whether the US findings for one breast cancer might be predictive of the contralateral breast cancer. <h3>Methods</h3> We retrospectively reviewed the US manifestations of 58 patients with surgically proven bilateral primary breast cancer and compared the contralateral cancer with the index cancer by evaluation the margin, shape, inside echoes, posterior attenuation, calcification, and color flow signals of 58 lesion pairs to investigate whether the bilateral breast cancers have similar US appearances. <h3>Results</h3> Bilateral primary breast cancers were more located in upper outer quadrant, frequently spiculation, taller than wide shape, with irregular margin, heterogeneous internal echo, and acoustic shadowing, containing microcalcification and abundant color flow signals. The most common US appearances were taller than wide shape (75.0%, 87/116), irregular margins (79.3%, 92/116), and heterogeneous internal echo (86.2%, 100/116). Of the total 58 lesion pairs, 18 pairs (31.0%) had similar US characteristics, whereas 40 pairs (69.0%) had different US characteristics. <h3>Conclusions</h3> US signs of the index cancer do not indicate the most likely appearance of the second cancer in the contralateral breast. Evaluation of the contralateral cancer should be performed without regard for the US findings for the index cancer.

Development in research on molecular pathogenesis of bilateral primary breast cancer

原发性双侧乳腺癌是乳腺癌中的一种特殊类型,DNA突变分析和基因组学研究认为,部分原癌基因、抑癌基因如p53、ATM、c-erb-B2和RAD51中的特异性点突变、错配修复基因变异导致的高度微卫星序列不稳定特别是BAT-26位点微卫星序列的复制错误、CHEK2基因的多态性表达与双侧乳腺癌的发生有密切关系.虽然双侧乳腺癌发病的分子一致性已有研究初步证明,但要将这些分子水平的研究结果应用于临床仍需有更多的实验证实。

US findings of bilateral primary breast cancer: Retrospective study

For women with breast cancer, the contralateral breast is at high risk. The bilateral cancers may be synchronous or metachronous. If the bilateral breast cancers have similar ultrasonography (US) appearances, the US findings of the first breast cancer (index cancer) might lead to early detection of the contralateral cancer. The purpose of this study was to identify the US characteristics of bilateral breast cancer and to determine whether bilateral breast cancers have similar US appearances and whether the US findings for one breast cancer might be predictive of the contralateral breast cancer. We retrospectively reviewed the US manifestations of 58 patients with surgically proven bilateral primary breast cancer and compared the contralateral cancer with the index cancer by evaluation the margin, shape, inside echoes, posterior attenuation, calcification and color flow signals of 58 lesion pairs to investigate whether the bilateral breast cancers have similar US appearances. Bilateral primary breast cancers were more located in upper outer quadrant, frequently spiculation, taller than wide shape, with irregular margin, heterogeneous internal echo and acoustic shadowing, containing microcalcification and abundant color flow signals. The most common US appearances were taller than wide shape (75.0%, 87/116), irregular margins (79.3%, 92/116) and heterogeneous internal echo (86.2%, 100/116). Of the total 58 lesion pairs, 18 (31.0%) pairs had similar US characteristics, whereas 40 (69.0%) pairs had different US characteristics. US signs of the index cancer do not indicate the most likely appearance of the second cancer in the contralateral breast. Evaluation of the contralateral cancer should be performed without regard for the US findings for the index cancer.

Balanced t(11;15)(q23;q15) in a TP53+/+ breast cancer patient from a Li–Fraumeni syndrome family

Li-Fraumeni Syndrome (LFS) is characterized by early-onset carcinogenesis involving multiple tumor types and shows autosomal dominant inheritance. Approximately 70% of LFS cases are due to germline mutations in the TP53 gene on chromosome 17p13.1. Mutations have also been found in the CHEK2 gene on chromosome 22q11, and others have been mapped to chromosome 11q23. While characterizing an LFS family with a documented defect in TP53, we found one family member who developed bilateral breast cancer at age 37 yet was homozygous for wild-type TP53. Her mother also developed early-onset primary bilateral breast cancer, and a sister had unilateral breast cancer and a soft tissue sarcoma. Cytogenetic analysis using fluorescence in situ hybridization of a primary skin fibroblast cell line revealed that the patient had a novel balanced reciprocal translocation between the long arms of chromosomes 11 and 15: t(11;15)(q23;q15). This translocation was not present in a primary skin fibroblast cell line from a brother with neuroblastoma, who was heterozygous for the TP53 mutation. There was no evidence of acute lymphoblastic leukemia in either the patient or her mother, although a nephew did develop leukemia and died in childhood. These data may implicate the region at breakpoint 11q23 and/or 15q15 as playing a significant role in predisposition to breast cancer development.

Bilateral primary breast cancer: a prospective study of disease incidence.

A prospective study was carried out, between January 1980 and March 1982, of all women who presented to the Breast Cancer Unit, Guy's Hospital, with a second primary breast cancer. The percentage of new simultaneous tumours detected clinically or by mammography was approximately 3 per cent. Routine mammographic screening of the contralateral breasts of patients with unilateral disease increased the rate of detection, fivefold, of simultaneous bilateral cancers. The incidence of nonsimultaneous bilateral disease was 7.6 second cancers per thousand patients at risk per year. The annual rate of occurrence of second primary cancers was a constant event and showed no trend either to increase or to decrease with follow-up. However, the risk of a nonsimultaneous second cancer was strongly correlated with age at first primary. Women who developed their first breast cancers under the age of 40 years had three times the risk of developing a second breast cancer compared with those who developed their first cancer after the age of 40. The risk of a second nonsimultaneous primary was 5.9 times that of the risk of occurrence of cancer in the first breast in the general female population.

258 ORAL Utilisation of microarray technology to refine molecular classes and improve clinical management of breast cancer

In metastatic breast cancer, nab-paclitaxel has been shown to significantly increase progression-free survival compared with solvent-based paclitaxel. The GeparSepto (GBG 69) trial assessed whether weekly nab-paclitaxel could increase the proportion of patients achieving pathological complete response compared with weekly solvent-based paclitaxel, both followed by epirubicin plus cyclophosphamide as neoadjuvant treatment.In a phase 3 randomised trial, we enrolled patients with previously untreated unilateral or bilateral primary invasive breast cancer and randomly assigned them in a 1:1 ratio using dynamic allocation and Pocock minimisation by breast cancer subtype, Ki67 and SPARC expression. Patients were treated for 12 weeks with either intravenous nab-paclitaxel 150 mg/m2 (after study amendment, 125 mg/m2) on days 1, 8, and 15 for four 3-week cycles, or solvent-based intravenous paclitaxel 80 mg/m2 on days 1, 8, and 15 for four 3-week cycles. Taxane treatment was followed in both groups by intravenous epirubicin 90 mg/m2 plus intravenous cyclophosphamide 600 mg/m2 on day 1 for four 3-week cycles. Patients with HER2-positive tumours received concurrent trastuzumab 6 mg/kg (loading dose 8 mg/kg) and pertuzumab 420 mg (loading dose 840 mg) on day 1 of every 3-week cycle. Trastuzumab and pertuzumab were given every 3 weeks concomitantly with chemotherapy for all cycles. This report is the final analysis of the primary endpoint, pathological complete response (ypT0 ypN0), analysed for all patients who started treatment (modified intention to treat). We used a closed test procedure to test for non-inferiority, with the nab-paclitaxel group calculated as non-inferior to the solvent-based paclitaxel group if the lower 95% CI for the OR was above 0·858 (OR equivalent to pathological complete response [33%] minus a 10% non-inferiority margin [3·3%]; 29·7%). We planned to test for superiority only in case of a positive non-inferiority test, using an α of 0·05. Safety was assessed in all patients who received study drug. The trial is registered with ClinicalTrials.gov, number NCT01583426.Between July 30, 2012, and Dec 23, 2013, we randomly assigned 1229 women, of whom 1206 started treatment (606 with nab-paclitaxel and 600 with solvent-based paclitaxel). The nab-paclitaxel dose was reduced after enrolment of 464 participants to 125 mg/m2 due to increased treatment discontinuation and sensory neuropathy in this group. Pathological complete response occurred more frequently in the nab-paclitaxel group (233 [38%, 95% CI 35–42] patients) than in the solvent-based paclitaxel group (174 [29%, 25–33] patients; OR 1·53, 95% CI 1·20–1·95; unadjusted p=0·00065). The incidence of grade 3–4 anaemia (13 [2%] of 605 patients in the nab-paclitaxel group vs four [1%] of patients in the solvent-based paclitaxel group; p=0·048) and peripheral sensory neuropathy grade 3–4 (63 [10%] patients receiving any nab-paclitaxel dose; 31 [8%] of patients starting with 125 mg/m2 and 32 [15%] of patients starting with 150 mg/m2; vs 16 [3%] in the solvent-based paclitaxel group, p<0·001) was significantly higher for nab-paclitaxel than for solvent-based paclitaxel. Overall, 283 (23%) patients were noted to have at least one serious adverse event (based on study drug received), 156 (26%) in the nab-paclitaxel group and 127 (21%) in the solvent-based paclitaxel group (p=0·057). There were three deaths (during epirubicin plus cyclophosphamide treatment) in the nab-paclitaxel group (due to sepsis, diarrhoea, and accident unrelated to the trial) versus one in the solvent-based paclitaxel group (during paclitaxel treatment; cardiac failure).Substituting solvent-based paclitaxel with nab-paclitaxel significantly increases the proportion of patients achieving a pathological complete response rate after anthracycline-based chemotherapy. These results might lead to an exchange of the preferred taxane, solvent-based paclitaxel, for nab-paclitaxel in therapy for primary breast cancer.Celgene, Roche.

Primary breast lymphoma: A pooled analysis of prognostic factors and survival in 93 cases

BACKGROUNDPrimary breast lymphoma is a rare disease. The small number of patients and the paucity of data make large-series studies difficult. We conducted a pooled analysis to evaluate the treatment outcome and prognostic factors in patients with primary breast lymphoma.METHODSIn a search of PUBMED and MEDLINE we found 7 observational studies with 93 patients that were eligible for inclusion. Treatments included single therapy or combined surgery, chemotherapy and radiotherapy. We analyzed the correlation between treatment protocols, tumor relapse and survival. Histopathology and cancer stage were analyzed to evaluate their significance in treatment outcome.RESULTSAll 93 patients were female, with a mean age of 57 years. The histopathology of 63 patients (68%) was diffuse large cell lymphoma. According to Ann Arbor classification, 57% were stage I, 23% were stage II, 4% were stage III, and 16% were stage IV. Thirteen percent received surgery alone, 27% received chemotherapy alone, 7% received radiotherapy alone, 10% received surgery and chemotherapy, 10% received surgery and radiotherapy, 22% received chemotherapy and radiotherapy, and 11% received surgery combined with chemotherapy and radiotherapy. With a median follow-up duration of 34 months (mean, 53 months), 48% had relapse of disease, 50% had no relapse, while 2% had disease progression. The mean time to first tumor relapse after treatment was 20 months. The 3-year and 5-year overall survival rates were 70% and 56%, respectively. Radiotherapy was a significant prognostic factor predicting tumor relapse (P=0.044). Tumor stage was a significant prognostic factor affecting overall survival, disease-free survival and disease-specific survival (P=0.0231, 0.0015, 0.0124, respectively).CONCLUSIONWith a 3-year overall survival rate of 70%, the high relapse rate of 48% is a cause for concern. Patients who received chemotherapy and radiotherapy had better survival outcome and a lower relapse rate. We suggest that chemotherapy and radiotherapy be the initial treatment for patients with primary breast lymphoma.

Metachronous Bilateral Primary Breast Cancer Associated with Dermatomyositis

The Breast JournalVolume 11, Issue 3 p. 225-226 Metachronous Bilateral Primary Breast Cancer Associated with Dermatomyositis Takehiro Sakai MD, Takehiro Sakai MD Department of Surgery, Aomori Rosai Hospital, Hachinohe, JapanSearch for more papers by this authorYuta Ogura MD, Yuta Ogura MD Department of Surgery, Aomori Rosai Hospital, Hachinohe, JapanSearch for more papers by this authorJunichi Narita MD, Junichi Narita MD Department of Surgery, Aomori Rosai Hospital, Hachinohe, JapanSearch for more papers by this authorDaisuke Kimura MD, Daisuke Kimura MD Department of Surgery, Aomori Rosai Hospital, Hachinohe, JapanSearch for more papers by this authorTakemichi Suto MD, Takemichi Suto MD Department of Surgery, Aomori Rosai Hospital, Hachinohe, JapanSearch for more papers by this authorSusumu Ainai MD, Susumu Ainai MD Department of Surgery, Aomori Rosai Hospital, Hachinohe, JapanSearch for more papers by this authorHajime Fujita MD, Hajime Fujita MD Department of Surgery, Aomori Rosai Hospital, Hachinohe, JapanSearch for more papers by this authorYoshimasa Kamata MD, Yoshimasa Kamata MD Hospital Pathology Center, Hirosaki University School of Medicine, Hirosaki, JapanSearch for more papers by this author Takehiro Sakai MD, Takehiro Sakai MD Department of Surgery, Aomori Rosai Hospital, Hachinohe, JapanSearch for more papers by this authorYuta Ogura MD, Yuta Ogura MD Department of Surgery, Aomori Rosai Hospital, Hachinohe, JapanSearch for more papers by this authorJunichi Narita MD, Junichi Narita MD Department of Surgery, Aomori Rosai Hospital, Hachinohe, JapanSearch for more papers by this authorDaisuke Kimura MD, Daisuke Kimura MD Department of Surgery, Aomori Rosai Hospital, Hachinohe, JapanSearch for more papers by this authorTakemichi Suto MD, Takemichi Suto MD Department of Surgery, Aomori Rosai Hospital, Hachinohe, JapanSearch for more papers by this authorSusumu Ainai MD, Susumu Ainai MD Department of Surgery, Aomori Rosai Hospital, Hachinohe, JapanSearch for more papers by this authorHajime Fujita MD, Hajime Fujita MD Department of Surgery, Aomori Rosai Hospital, Hachinohe, JapanSearch for more papers by this authorYoshimasa Kamata MD, Yoshimasa Kamata MD Hospital Pathology Center, Hirosaki University School of Medicine, Hirosaki, JapanSearch for more papers by this author First published: 03 May 2005 https://doi.org/10.1111/j.1075-122X.2005.21661.xCitations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume11, Issue3May 2005Pages 225-226 RelatedInformation

Morphologically Similar Epithelial and Stromal Cells in Primary Bilateral Breast Tumors Display Different Genetic Profiles

The morphologic features of primary bilateral breast carcinoma have been well elucidated, but it is not known whether tumors at two sides share a common genetic profile and undergo the same clinical course. To address this issue, morphologically comparable epithelial and stromal cells in 18 paired primary bilateral breast tumors were microdissected and subjected to comparisons for the frequency and pattern of loss of heterozygosity (LOH) and microsatellite instability (MI), as well as the profiles of comparative genomic hybridization. Of 18 paired bilateral epithelial samples assessed with 10 DNA markers at five chromosomes, 78 altered loci were found; of these, 23 (29.5%) displayed concurrent and 55 (70.5%) showed independent LOH, MI, or both. Of 18 paired bilateral stromal samples assessed with the same markers, 70 altered loci were seen; of these, 9 (12.9%) displayed concurrent and 61 (87.1%) showed independent LOH, MI, or both. Collectively, all the markers and 30 (83.3%) of 36 paired bilateral epithelial and stromal cells displayed significantly more (P < 0.01) independent than concurrent LOH, MI, or both. In contrast, the epithelial cells of a pulmonary small cell carcinoma metastasized to both breasts displayed concurrent LOH at each of the four altered loci. Of seven selected cases for comparative genomic hybridization, six (86%) displayed chromosomal changes, but none showed an identical pattern and frequency of changes in both breasts. The significantly higher rate of independent genetic alterations in morphologically comparable cells of paired bilateral primary breast tumors supports the notion that the development and clinical course of tumors in two sides differ substantially; consequently, different interventions might be needed for the optimal management of bilateral breast tumors.

Synchronous Primary Bilateral Breast Lymphoma

Synchronous Primary Bilateral Breast Lymphoma

BRCA1 and BRCA2 mutations as prognostic factors in bilateral breast cancer patients

Incidence of primary bilateral breast cancer (BC) is rare and does not exceed 5%. BRCA1/2 mutation carriers diagnosed with breast cancer have a strong life time risk of developing contralateral breast cancer (53% versus 2%). A group of 108 patients with bilateral breast cancer, who reported at our Cancer Centres from 2000 to 2002, were subjected to genetic testing. Similarities and differences between BRCA1/2 carriers and non-carriers were analysed in terms of family history, pathology of tumour, age of diagnosis, developing contralateral BC and second primary cancer. BRCA1/2 mutations were detected in 32 of 108 patients. Family history of BC was identified in 46.9% of these patients compared with 22.4% of non-carriers (P <0.05). Synchronous BC was diagnosed significantly rarer [4 of 32 (12.5%)] in BRCA1/2 carriers than in the non-carrier group [26 of 76 (34.2%)]. In addition, patients with BRCA mutations were younger when they were diagnosed than non-carriers. BRCA1/2 carriers had a significantly higher incidence of medullary BC (13.6% versus 1.7%) and developed ovarian cancer significantly more frequently than non-carriers (12 of 32 and 1 of 72 patients, respectively). Patients with bilateral BC having BRCA mutations are significantly younger than non-carriers. They also have a significantly higher family history of BC and an increased risk of developing ovarian cancer. The differences in clinical aspects of BRCA carriers with bilateral BC should be considered in clinical management.

Bilateral Primary Breast Lymphoma: A Case of Local Recurrence

Bilateral Primary Breast Lymphoma: A Case of Local Recurrence

Bilateral Primary Breast Lymphoma

A primary breast lymphoma developed in a patient. After 139 months. she was diagnosed with a new primary breast lymphoma in the contralateral breast. The pathologic diagnosis in each tumor was non-Hodgkin's lymphoma, B-cell, diffuse large cell. Radiation therapy was effective in securing a clinical remission for both tumors.

Primary bilateral mucosa-associated lymphoid tissue lymphoma of the breast with atypical ductal hyperplasia and localized amyloidosis. A case report and review of the literature.

c Primary non-Hodgkin lymphoma of the breast is a rare disease. Primary mucosa-associated lymphoid tissue lymphoma is even rarer, and bilateral involvement is exceptional. We describe a case of primary bilateral breast mucosa-associated lymphoid tissue lymphoma with bilateral atypical ductal hyperplasia and bilateral localized amyloidosis in a 64-year-old woman with a history of arthritis and systemic lupus erythematosus and its clinical, histologic, and immunohistochemical features. Microscopic examination of the breast lesion showed dense periductal and perilobular small and plasmacytoid lymphocytes with eosinophilic amyloid in the vessels and the stroma. Bilateral single foci of atypical ductal hyperplasia were also noted. Fine needle aspiration showed small and large lymphocytes and plasma cells. Molecular analysis demonstrated a heavy chain immunoglobulin H gene rearrangement. Flow cytometry studies showed an abnormal B-cell population. The combined histologic, paraffin immunohistochemistry, flow cytometry, and molecular results were considered diagnostic for low-grade mucosa-associated lymphoid tissue lymphoma. The patient underwent bilateral local breast radiation without other organ or site involvement. (Arch Pathol Lab Med. 2000;124:1233‐1236)

CLINICOPATHOLOGICAL STUDY OF PRIMARY BILATERAL BREAST CANCER

In a series of 709 patients with breast cancer operated on at the department in a recent three decades from 1968 to 1998, there were 33(4.7%) patients with primary bilateral breast cancer. Eleven patients(1.6%) had synchronous and 22 patients(3.1%) had metachronous bilateral breast cancers. These 33 patients were clinicopathologically compared with those having unilateral breast cancer. Average age at operation for the first cancer in metachronous patients was 42.9 years, that was significant younger than others. Patients with bilateral breast cancer had history of familial cancer or other multiple primary cancers in a high frequency. In metachronous patients 80% of them found the second cancer by themselves, which 27% of synchronous patients found it by themselves, with a significant difference. The 5-year survival rates were 86.9%, 88.9% and 76.7% in unilateral cases, synchronous cases and metachronous cases, respectively. Therefore, we have recognized the importance of early discovery and treatment of contralateral breast cancer.

P53 mutations in bilateral breast carcinoma. Correlation with Ki-67 expression and the mean nuclear volume

Most investigators agree that the most common antecedent of cancer in a breast is cancer in the opposite site. Thus, the present study focused on investigating the incidence of p53 gene abnormality in bilateral breast cancer and its correlation with proliferative activity and nuclear cytomorphology to demonstrate its significance in biological behavior and predicting the relatively small percentage of second tumors in the contralateral breast. Paraffin embedded tissue specimens obtained from 18 patients with bilateral primary breast cancer were studied. Ki-67 expression, a marker of tumor cell proliferation, was scored and p53 gene abnormalities were detected by avidin-biotin-peroxidase immunostaining. The mean nuclear volume of the tumor cells was assessed by a stereologic method. p53 gene abnormalities were detected in eight cases (44.4%). Seven cases (38.8%) exhibited strong Ki-67 immunopositivity, 10 cases (55.5%) exhibited weak Ki-67 immunopositivity and one case (5.5%) exhibited negative immunostaining. The mean nuclear volume was found to be 315.9 +/- 94.3 microm3 overall. The correlation between p53 mutations and the Ki-67 expression was statistically significant (P = 0.017, chi2-test), whereas the assessment of the mean nuclear volume also indicated significant correlation with p53 (P = 0.024, independent-samples t-test). However, we did not find any correlation between p53 mutation and either hormone receptor status or histological grade (P = 0.52, Fisher's test and P = 0.72, chi2-test, respectively). We have concluded that p53 gene abnormalities are detected in almost half of the bilateral breast cancers and are associated with high proliferative activity and mean nuclear volume. Although so far the number of patients is too small and the follow-up too short to determine the definitive prognostic value of p53 mutation, our preliminary results have indicated that it might be an indicator of a worse prognosis in bilateral breast cancer and a predictor of cancer in the contralateral breast.

原発性両側性乳癌の臨床的特徴

原発性両側性乳癌の臨床的特徴

Mammographic appearance of cancer in the opposite breast: comparison with the first cancer.

Patients who have had cancer in one breast are at high risk for cancer in the contralateral breast. These bilateral cancers may be synchronous or metachronous. If the manifestations on mammography were similar in both breasts, an aggressive search for the mammographic findings of the first breast cancer might lead to early detection of the contralateral cancer. The purpose of this study was to evaluate mammograms for patients with bilateral cancers to determine whether the mammographic appearance of the contralateral cancer is likely to be the same as that of the first cancer. We retrospectively reviewed the pathologic and mammographic records of 69 patients with surgically proven bilateral primary breast cancer. Thirty four of 69 (49%) had synchronous cancer, and 35 (51%) had metachronous cancer. Mammographic appearances were classified as microcalcifications, spiculated mass, nonspiculated mass (whether circumscribed or poorly defined), asymmetric or developing density, architectural distortion, and normal. Multiple findings were subclassified as major and minor findings. All findings were compared between both breast cancers, and statistical significance was determined by the two-sample Z test. Forty six (67%) of 69 patients had different major mammographic findings in the contralateral cancer. Of 30 patients whose first cancers had microcalcifications, 20 (67%) had microcalcifications in the contralateral cancer. Of 39 patients whose first cancers lacked microcalcifications, 17 (44%) had microcalcifications in the contralateral cancer. This difference was statistically significant (p = .02). Of 26 patients whose first cancers had spiculated masses, 9 (35%) had a contralateral spiculated mass. Of 43 patients whose first cancers lacked spiculated masses, 12 (28%) had a contralateral spiculated mass. This difference was not statistically significant (p = .22). Our results show that contralateral tumors usually have major mammographic findings different from those of the first cancer, and the mammographic signs of the first cancer do not indicate the most likely appearance of cancer in the contralateral breast. Evaluation of a contralateral mammogram should be performed without regard for the mammographic findings for the first cancer.

RECTAL AND GASTRIC CANCERS FOLLOWING OPERATIONS FOR HETEROCHRONOUS BILATERAL BREST CANCERS -A CASE OF MULTIPLE CANCER OF FOUR ORGANS-

We experienced a case of multiple cancer in which rectal and gastric cancers developed after operations for heterochronous primary bilateral breast cancers. The case involved a 51-year-old woman. The first cancer was detected in the right breast and a radical mastectomy was performed in March, 1984. In July, 1986, a modified radical mastectomy was performed for a left breast cancer, and the patient was diagnosed as having heterochronous primary bilateral breast cancers. After the second operation, there had been no sign of recurrence until February, 1994 when abdominal pain and anal bleeding appeared. With close examinations a diagnosis of synchronous double cancer of the rectum and stomach was made. Super low anterior resection of the rectum and subtotal gastrectomy were carried out on May 13. The rectum and subtotal gastrectomy were carried out on May 13. The postoperative course was uneventful and the patient was discharged from the hospital on July 4, 1994. Except necropsy cases, multiple cancer of four organs has been reported in only 21 cases including this case in Japan so far. Among of them no such case involving bilateral breast cancers has been in the literature and there are few cases in which radical operation could be performed for all four lesions. We think that our case is so rare.