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blood tests and chest wall ultrasound. In contrast, LFS requires lifetime cancer surveillance. Since the surveillance for osteosarcoma has been performed by semi-annual chest and local X-rays, we decided to introduce a surveillance program according to the Toronto protocol13), which avoids radiation exposure and follow-up drop outs. Through this case, we have just settled a system of annual whole-body magnetic resonance imaging (MRI) examinations in cooperation with the radiology department (Figure 3). In addition, we decided to Familial presentationMultiple primitive tumorsRare tumorsVery early-onset breast cancerDx, age at diagnosis; d, age at death; y, years old.Table 1　2015 version of Chompret’s criteria for Li-Fraumeni syndrome diagnosisProband with TP53 core cancer before 46 years and at least one first- or second-degree relative with a core tumor before 56 years.Proband with multiple tumors, including two TP53 core tumors, the first of which occurred before 46 years, irrespective of family history.Patient with adrenocortical carcinoma, choroid plexus carcinoma or rhabdomyosarcoma of embryonal anaplastic subtype, irrespective of family history.Breast cancer before 31 years, irrespective of family history.Figure 1　Family historyconduct colonoscopy and abdominal ultrasound every one to two years in cooperation with her family clinic (Figure 4).This case is speculated be de novo onset of LFS because there is no LFS-related family history and due to the high penetrance of the syndrome; the parents have no history of abnormal findings on annual examinations to date. The younger brother underwent carrier diagnosis and no variants were detected. Hereafter, the patient is also considering carrier diagnosis for her 5-year-old daughter, taking 407