Painless acute pancreatitis associated with sorafenib treatment: a case report

Sorafenib is a multikinase inhibitor that is used for the treatment of metastatic renal-cell carcinoma. We report the case of a patient with painless acute pancreatitis associated with sorafenib treatment. The patient was a 71-year-old man who had undergone surgery for left renal carcinoma and tumor thrombus in the inferior vena cava and right atrium (IVC-RA). After a follow-up period of 3 years, he developed right adrenal metastasis and received interferon (IFN)-alpha treatment. One year later, progression of the adrenal metastasis was observed, and he was admitted to a hospital for treatment with sorafenib, which was administered at a dose of 800 mg/day. Two weeks later, he developed painless acute pancreatitis associated with sorafenib treatment. Thereafter, sorafenib treatment was discontinued, and he was treated with conservative therapy. Three weeks later, he was discharged. Even though painless acute pancreatitis associated with sorafenib treatment is rare, the possible development of painless acute pancreatitis in patients undergoing sorafenib treatment must be kept in mind.     

Claudius Regaud (1870–1940) : relecture des archives d’un pionnier de la radiobiologie et de la radiothérapie

Born in 1870, Claudius Regaud was a pioneer of radiobiology and radiotherapy. As histologist, he developed a new staining technique that allowed him to describe in detail all the reproduction system of a number of animal models. As radiobiologist, he contradicted the interpretations of Tribondeau and Bergonié about relationships between cell proliferation and radiosensitivity. In 1908, he suggested that chromatin was the main target of radiation. As physician, he defined the first bases of anti-cancer radiation treatments and treated patients suffering from incurable cancer from 1911. As military doctor, he organized war hospitals by creating multidisciplinary teams for the surgery of hurts. Organizer, he was one of the founders of the League against Cancer. As radiotherapist and brachytherapist, he contributed to make Institut Curie an international reference center for research and teaching, with nearly a thousand treated patients. As globe-trotter, he was at the origin of the creation of numerous worldwide radiotherapy and radiobiology centers. He died in December 1940 and let an impressive but still misknown scientific heritage. A re-reading of the familial archives and the Regaud Fund of Institut Curie is the occasion to remind the contribution of Regaud.     

Unusual sites of colorectal cancer metastasis

We present 2 separate cases of adenocarcinoma of the colon with metastasis to the chin and the bladder, both of which are unusual sites of colorectal cancer metastasis. Patient 1 is a 77-year-old man who was diagnosed with adenocarcinoma of the colon, American Joint Committee on Cancer (AJCC) T4 N0 M0 (stage II), and underwent a right hemicolectomy. Fourteen months later he developed a firm 2.5-cm mass involving the chin. Excisional biopsy revealed moderately differentiated adenocarcinoma, consistent with the known colon primary tumor. Patient 2 is a 75-year-old man who was diagnosed with AJCC T3 N1 M0 (stage III) adenocarcinoma of the colon and underwent sigmoid colectomy. Ten years later, he was found to have transitional cell carcinoma involving retroperitoneal nodes with no identifiable bladder or ureteral primary, for which he received chemotherapy. Eighteen months following this diagnosis, he developed hematuria and was found to have metastatic colon adenocarcinoma involving the bladder. Details of both patient cases are presented here.     

O. Harold Warwick: Canada's first medical oncologist

O. Harold Warwick graduated in medicine from McGill University as a gold medalist and Rhodes Scholar in 1940. After World War II, he started postgraduate training in Montreal, and in 1946, he began studying the newly described drug treatment of cancer in London, England. There he carried out the first study of nitrogen mustard in a group of adult patients with a non-hematologic solid tumour, lung cancer. After a brief period of practice in Montreal, he moved in 1948 to Toronto, where he became executive director of the Canadian Cancer Society and the National Cancer Institute of Canada. Simultaneously, he joined the staff of Toronto General Hospital and its Radiotherapy Institute, where he became the first physician-oncologist to provide medical care and administer anticancer drugs in a Canadian cancer centre. In 1958, the new Princess Margaret Hospital opened in Toronto; Warwick became its first chief physician, responsible for clinical drug trials. Here he carried out his best known clinical study-the use of vinblastine sulphate in patients with Hodgkin lymphoma. From 1961 to 1971, he served as dean and then vice-president Health Sciences at the University of Western Ontario. He returned to the practice of medical oncology from 1972 to 1980 at the London Cancer Clinic, after which he had a long and productive retirement. He died in October 2009. Although the specialty was not named until the latter years of his career, Harold Warwick satisfied all the criteria for and was undoubtedly Canada's first medical oncologist.     

Pericardial synovial sarcoma

A 29-year-old young man presented with acute breathlessness. After investigative work-up he was found to have a massive pericardial tumour. Thoracotomy and near total surgical excision of the pericardial tumour was carried out. Histopathology and immunohistochemical markers study revealed it to be a synovial sarcoma arising from the left lateral pericardial surface. Postoperatively, he received external radiation and chemotherapy. Thirteen months after surgery he developed local recurrence which was unresectable.     

Léon Bouchacourt (1865–1949) : comment un obstétricien mit en évidence la radiosensibilité individuelle

Léon Bouchacourt (1865–1949) was a misknown pioneer of radiology and radiotherapy from Lyon, France. While he was resident in obstetrics in Hôpitaux de Paris from 1892 to 1898, he met Charcot, the future polar explorer, and wrote the first thesis dissertation about X-rays. He invented a new radiology technique for cavitary organs such as vagina, rectum and mouth, the endodiascopy, which permitted him to perform the first pelvimetry and dental radiographies in France. While he undertook the first trials of contact-radiotherapy, he was confronted with radiation-induced reactions. In 1911, he wrote the first paper about individual radiosensitivity. During the First World War, he commanded one of the radiology vehicles, he met Irène Curie and developed his « radiological helmet », which will hold his name and became essential for interventional radiology. After the war, with Béclère and ten others, Léon Bouchacourt funded the French Radiology Society. He ended his career by thinking about public health and the different aspects of the duties of radiologists.     

A case of effective paclitaxel therapy for gastric cancer with brain metastasis

A case of effective paclitaxel therapy for gastric cancer with brain metastasis is reported. The patient was a 76-year-old male, who underwent total gastrectomy for advanced gastric carcinoma with direct invasion of the pancreas. One year and six months later, he was resected for a right temporal-occipital brain metastatic tumor, and local cerebral irradiation at 30 Gy was performed. Four months later, new multiple brain metastases were detected in the cerebellum. We tried paclitaxel administration. It was continued on a weekly basis at 70 mg/m(2), and the brain metastases continued to diminish; in addition, gamma knife therapy led to an improvement in the quality of life. Although the patient had been told that he had only a month to live, he was improving dramatically. However, he died of sepsis due to Fournier's gangrene about 5 months later. Paclitaxel seems to have a strong antineoplastic effect by brain metastasis of gastric cancer.     

A case of gastric cancer accompanied by disseminated carcinomatosis of bone marrow with DIC, and subdural hematoma successfully treated with sequential methotrexate and 5-fluorouracil therapy

A 44-year-old man visited a nearby hospital because of severe headache. Brain MRI revealed a subdural hematoma, and he was transferred to the Department of Neurosurgery of our hospital. Burr hole surgery was performed on the second day of hospitalization because of an enlargement of the hematoma. Laboratory data on admission showed the presence of a disseminated intravascular coagulation(DIC). Bone marrow aspiration revealed metastases of signet ring cell carcinoma, and abdominalCT showed gastric cancer. He was diagnosed as having DIC with bone marrow metastases of advanced gastric cancer. Despite anti-DIC therapy and blood transfusion, his systemic bleeding tendency was not improved. The neurosurgeon therefore consulted with a palliative care team. Since the patient was still young, we considered that he should be treated with anti-cancer drugs. At first, his family did not accept chemotherapy because they were pessimistic about his prognosis. However, after he regained his consciousness, we were able to perform sequential MTX and 5-FU therapy with the consent of the patient and his family. The therapy was successful, and he recovered from DIC and was discharged on the 57th hospital day.     

Metastasis to the penis in a patient with squamous cell carcinoma of the lung with a review of reported cases

Metastasis to the penis is very rare in lung cancer. We describe a patient with squamous cell carcinoma of the lung who developed a metastatic lesion in the penis. A 75-year-old Japanese male visited a local hospital complaining cough and bloody sputum. A chest plain radiograph and computed tomographic (CT) scans of the chest demonstrated a right hilar mass. He was diagnosed with squamous cell carcinoma of the lung at stage IIIB (T4N2M0). Then he was treated with concurrent chemoradiotherapy consisting of cisplatin, docetaxel, and thoracic irradiation, and after the chemoradiotherapy, he achieved a partial response. However, 6 months later, he visited an urologist complaining of firm mass in the penis with slight pain. A biopsy of the corpus cavernosum penis was performed, which provided a histological diagnosis of squamous cell carcinoma. The histology of the specimen was consistent with that of previous lung cancer, so he was considered to have penile metastasis from squamous cell carcinoma of the lung. Radiotherapy was given to the metastatic tumor in the penis. The penile tumor was diminished and the pain was completely relieved. In addition, we review reported cases to investigate the clinical characteristics and appropriate management of this rare involvement.     

A case of a malignant melanoma with late metastases 16 years after the initial surgery

We report a case of a pulmonary metastasis 16 years after the initial surgery for a malignant melanoma. The patient was a 58-year-old Japanese man. In 1976, he had a pigmented skin lesion with a diameter of 8 mm on his right third finger. He received an amputation of the finger and a dissection of the right axillary. Histological examinations of the tumor revealed a feature of a malignant melanoma with infiltration of the papillary layers of the dermis, 1.5 mm in thickness. The histological subtype was considered to be an acral lentiginous melanoma with a mixed spindle-epithelioid cell pattern. There was no regional lymph node metastasis. In December 1992, when he was 74-years-old, a round tumor in the left lower lung was discovered by chest radiography. In February 1993, he received a left lower lobectomy of the lung. Histological examination revealed a feature of a malignant melanoma with predominantly epithelioid cells and this was considered to be a metastasis from the initial skin lesion. Five months after the lobectomy, he died from a hemorrhage of a metastatic brain tumor. This case indicated the importance of periodic, life-long follow-up in treating malignant melanomas.     

Radiation-induced glioblastoma occurring 35 years after radiation therapy for medulloblastoma: case report

A 41-year-old man was admitted in June 2007 with a 1-month history of headache and cerebellar ataxia. At the age of 5 years, in May 1971, he had presented with headache, vomiting, and gait disturbance. Cerebral angiographical study demonstrated vascular shift caused by a mass lesion in the cerebellar vermis. He had immediately undergone partial removal. Histological diagnosis was medulloblastoma (MB). Postoperatively he received a total of 40 Gy radiation to the whole brain and 30.5 Gy to the spine without chemotherapy. He was again seen 35 years later with a radiation-induced glioblastoma (GB) that arose in the region of the original MB. The tumor was surgically removed, and he received radiotherapy and chemotherapy with ACNU, procarbazine, and vincristine. Postoperative irradiation reduced the size of the second tumor.     

Remarkable pain relief in the treatment with high-dose medroxyprogesterone acetate in advanced prostatic carcinoma

A 60-year-old man was admitted to our hospital because of lumbago due to a metastatic bone tumor that originated from the prostate. Previously, he had been treated with 500 mg/kg of diethylstilbestrol diphosphate and 75 mg/day of chlormadinone acetate. At our hospital, he was given 470.1 mg/day of estramustine sodium phosphate and a bilateral orchiectomy was performed. However, he felt increased lumbago. Thus, a dose of 1200 mg/day of medroxyprogesterone acetate was started. Although the histology of his prostate and bone scintigram did not change, the patient no longer felt lumbago from about 2 weeks after the start of this treatment. Six months later, he remains free of lumbago. In this report, we describe the effect of high-dose medroxyprogesterone acetate on the clinical course, and the plasma and urine levels of the hormones.     

神经母细胞瘤细胞分化过程中细胞周期及端粒酶基因的变化

目的：观察神经母细胞瘤细胞在被维甲类化合物诱导分化过程中细胞形态、细胞周期及端粒酶基因表达方面的变化,探讨其作用机理及临床意义。方法：查耳酮酸（R9158）及丁羟胺酸（R8605）均为新一代合成维甲类化合物,采用工作浓度10^-6mol/L,加入两个神经母细胞瘤细胞系SH-SY-5Y和SK-N-SH的培养基,作为观察组;与观察组同浓度的DMSO分别加入两个细胞系的培养基,作为溶剂对照组。分别观察用药前后细胞形态学变化、流式细胞术检测细胞周期分布及凋亡、原位杂交细胞化学（ISHH）方法检测端粒酶基因（hTR )的表达。结果：1.SH-SY-5Y细胞在药物处理后第5天明显的神经突起形成,形态类似成熟神经元。SK-N-SN细胞在药物处理后7天内均无明显变化。2.流式细胞分析发现,SH-SY-5Y细胞在药物处理后第5天明显地阻滞于G1期,S期比例显著减少,G2/M期比例基本不变,并有少量细胞凋亡。SK-N-SH细胞在药物处理第3天及第5天均无明显差别,仅第5天有个别细胞凋亡。3.显微镜下观察,SH-SY-5Y细胞于药物作用5天后,hTR阳性细胞显著减少,SK-N-SH细胞则无明显变化。结论：新合成维甲类化合物R9158及R8605诱导维甲酸敏感细胞SH-SY-5Y发生形态学分化,细胞周期阻滞于G1期,端粒酶基因（hTR）表达显著减少,而维甲酸耐受细胞SK-N-SH则无此变化。端粒酶与其他基因相互关联,是维甲类化合物诱导神经母细胞瘤细胞分化过程中重要的调控靶点。     

Adult T-Cell Leukemia (ATL): Clinical, Pathological and Virological Findings in Two Cases with Unusual Features

We describe two cases of adult T-cell leukemia (ATL) in young adult males. One patient was born in the Seychelles Islands and came to live in Italy at 15 years of age; five years later, he started to experience several episodes of infestation by Strongyloides stercoralis, and opportunistic infections; at the age of 25, enlarged lymph nodes were first documented, and he died one month later, with a final diagnosis of ATL. The other patient was born in Rumania. At the age of 34 years, he presented with asthenia, liver and lymph node enlargement, lymphocytosis and cutaneous lesions, and a diagnosis of malignant lymphoma was made; despite chemotherapy, he died five months later. Serologic analyses demonstrated the presence of anti-HTLV-I antibodies in both patients, but not anti-HIV-1 antibodies. HTLV-1 nucleotide sequences were detected in the neoplastic cells of both patients.     

Extragonadal seminoma after renal transplantation and immunosuppression; treatment in the presence of renal dysfunction

A 37-yr-old man who had undergone renal transplantation for end-stage renal failure presented with a large right pelvic mass obstructing the transplanted kidney. Initially, this was diagnosed as an anaplastic tumor while he had been on immunosuppressive treatment for kidney allograft rejection after transplantation. Despite difficulties of classic histopathology to reveal the origin of his tumor, FISH analysis revealed the presence of chromosome 12p abnormalities, strongly indicative of a germ-cell tumor-more likely seminoma-with extragonadal presentation. Because of renal dysfunction, he was treated with carboplatin (dose adjusted according to renal clearance) and etoposide, and when he experienced a rather atypical progression with bone metastases, he was treated with single-agent paclitaxel, and died almost 13 mo after initial presentation. The case adds further to the existing small list of seminoma/GCTs developing in transplant recipients, points to the unusual presentation patterns and diagnostic histopathology challenges, and presents the difficulty in therapeutic options, as a result of frequent renal dysfunction and intercurrent immunosuppressive therapy. All of these issues together with an extensive literature review are discussed in detail.     

Twenty-one-year survival case of rectal GIST treated with combined therapies

A 55-year-old man underwent Miles' operation with a diagnosis of rectal leiomyosarcoma in 1990. From 1998 to 2004, he had liver and lung metastases and local site recurrent tumors which were removed surgically. Immunohistochemically the recurrent tumor was positive for c-kit and CD34, and the diagnosis of GIST was confirmed. He took an adjuvant imatinib mesylate for half a year in 2004. In July 2005, he had a recurrent tumor in upper mediastinum. We restarted an imatinib after radiation therapy, and got a clinical CR. After he had interstitial pneumonitis in 2009, he stopped taking inmatinb. Then he took sunitinb for two months after an operation for the sixth local recurrence in February 2010. But the upper mediastium recurrent tumor occurred again in November 2010. We restarted sunitinb and got a clinical PR. The patient is now alive and well for 21 years after the initial operation by combined therapies.     

Weekly paclitaxel therapy effective for gastric cancer with obstructive jaundice due to peritoneal dissemination--a case report

The patient was a 61-year-old man who suffered from advanced gastric cancer, and a distal gastrectomy was performed (T3N2P1CY1, Stage IV). He was treated with chemotherapy of TS-1 alone (100 mg/day, days 1-28 with two weeks rest). Six months later he complained of lumbago and appetite loss, then was admitted to the hospital with obstructive jaundice. Total bilirubin (T-Bil) was increased to 11.3 mg/dl. CT scan examination revealed peritoneal dissemination with much ascites and dilatation of intrahepatic bile ducts. Endoscopic drainage was tried, but was discontinued due to stenosis of gastroduodenal anastomosis. Ultimately, T-Bil was elevated to 25.2 mg/dl, and he could not sleep comfortably because of a severe itch and an irritating feeling. Weekly paclitaxel therapy was started (70 mg/m(2), day 1, 8, 15, once a week for 3 weeks followed by a week rest as one cycle). One month after the first infusion therapy, the obstructive jaundice was notably improved and the ascites disappeared completely, so he was discharged. For about one year, he was treated with this chemotherapy as an outpatient. The toxic events were anemia (grade 3) and alopecia (grade 1).     

人物专栏:彭淑牖

Professor Shu You Peng was born and raised in the city of Meizhou in Guangdong Province. He received his med- ical training at Zhejiang University in Hangzhou, where he graduated with first class honors in 1955. His surgi- cal training was at the Second A…     

A case of complete response to interferon-α and S-1 combination therapy for multiple pulmonary recurrences of hepatocellular carcinoma after hepatic resection

A 77-year-old man was diagnosed as hepatocellular carcinoma, and was referred to our hospital. After he was treated by transcatheter chemoembolization, he underwent a left hepatic lobectomy of the liver and cholecystectomy. Serum AFP and PIVKA-II remarkably elevated 7 months after surgery, and CT scan revealed multiple metastatic nodules in bilateral lungs. The nodules were diagnosed as lung metastasis of HCC. Because the lesions grew larger, S-1/IFN was administered. Diagnostic imaging and tumor markers showed a marked improvement after 4 courses of S-1/IFN therapy, and he is still alive with good condition without recurrence and progression of tumors.     

A case of low anterior resection combined with resection of the prostate seminal vesicle urethra for douglas' pouch metastasis of the colon cancer

A-71-year-old man with sigmoid colon cancer underwent sigmoidectomy in 2004. Ascites cytology was positive. He had a postoperative chemotherapy, but cancer recurred on the Douglas' pouch in the first year after the surgery. After chemoradiation, he underwent a low anterior resection with combined resection of the prostate seminal vesicle urethra in 2005. Four years after the recurrence, metastasis of the right lung S9 occurred, and he underwent right lower lobectomy. One year later, metastasis of the left lung S6 occurred, he underwent a partial resection of S6. Later a local recurrence has not been observed. Among the colon cancer recurrence, we think the surgery was effective for local recurrence disease with adequate observation.