Carcinoma of the Breast

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Abstract
IT HAS been advocated that adjuvant cytotoxic chemotherapy with melphalan after mastectomy may be the preferred form of management of primary carcinoma of the breast with pathologically positive axillary nodes.1We report two patients treated with melphalan in whom carcinoma of the breast subsequently developed. Report of Cases Case 1.— A 68-year-old woman had back pain in January 1974. A diagnosis of multiple myeloma was made based on a monoclonal peak on serum protein electrophoresis, a total protein value of 11.3 gm/100 ml, and a bone marrow aspirate that showed 60% plasma cells. The patient was treated with intermittent doses of melphalan and prednisolone.2 In April 1975, obstructive jaundice developed. A liver biopsy specimen showed evidence of extrahepatic biliary obstruction. A percutaneous transhepatic cholangiogram showed dilated hepatic ducts, with complete obstruction in the common bile duct. At laparotomy, a carcinoma of the head of the pancreas was found;

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