Abstract
A 62-year-old woman consulted our hospital because of right breast and axillary masses, both of which were approximately 10 cm in size and showed dermal invasion. On needle biopsy of the breast mass, the lesion was diagnosed as a papillotubular carcinoma, which was negative for the estrogen and progesterone receptors, but positive for human epidermal growth factor receptor 2 (HER2). Computed tomography showed 5-cm metastases in the left adrenal gland. Administration of four cycles of fluorouracil, epirubicin, and cyclophosphamide, followed by triweekly trastuzumab concomitant with weekly paclitaxel for twelve weeks, reduced the sizes of the primary lesion, axillary lymph nodes, and left adrenal gland metastases. Subsequent oral administration of four cycles of lapatinib and capecitabine also reduced their sizes. We performed modified radical mastectomy with axillary dissection. Postoperative oral administration of three cycles of lapatinib and capecitabine led to normalization of the size of the left adrenal gland, which was considered complete remission. After four additional cycles of the same chemotherapy regimen, we changed to adjuvant therapy with oral administration of letrozole, because postoperative examination of the residual tumor showed estrogen receptor positivity. Complete remission has been maintained for two and a half years since it was first achieved.
