Long-term survival after neck lymph node metastases from sigmoid colon cancer--a case report

We report a 73-year-old female who had been operated on for sigmoid colon cancer and neck lymph node metastases. Tumor size was controlled by systemic chemotherapy for about 3 years. During the chemotherapy, toxicity over grade 2 was not observed and good QOL was maintained on an outpatient basis. It is suggested that low-dose systemic chemotherapy may be useful for patients with poor general status.     

Successful endocrine chemotherapy in patients with multiple bone metastases of breast cancer--a case report]

A 54-year-old woman was admitted to our hospital with upper and lower back pain. She had previously developed multiple bone metastases of advanced breast cancer. Endocrine chemotherapy of tamoxifen citrate (TAM) 20 mg/day and carmofur (HCFU) 300 mg/day was started. Subsequently, medroxyprogesterone acetate (MPA) 600 mg/day and 5'-deoxy-5-fluorouridine (5'-DFUR) 600 mg/day were administered. In evaluating the treatment effect for symptomatic relief, partial response and performance status were judged to have improved from 4 to 2. At present, the patient is able to walk on her own to the hospital. She has lived 4 years with no newly developed lesions, and no adverse effects such as diarrhea or body weight gain have been observed. Substantial results can be achieved in patients with bone metastasis of breast cancer even with mild endocrine chemotherapy. A combination of radiotherapy, pain control, and orthopedic surgery suitable to each case is thought to be necessary.     

Patient survival with liver metastases from colorectal cancer--a district hospital experience

In a retrospective review of 301 newly diagnosed tumours of the colon and rectum, 61 patients (20%) presented with liver metastases. The mean survival for this group was 7.4 months. Five patients with solitary metastases were found who may have been helped by further surgery. There was a 20% operative mortality. No significant association between the grade, differentiation, lymph node status or venous invasion of the primary lesion was demonstrated. Operative palliative resection of the primary lesion did not improve survival. These results confirm the poor prognosis for patients with liver metastases, justifying all efforts into the earlier detection and prevention of colorectal carcinoma.     

Heart metastasis of gallbladder cancer--a case report

A 42-year-old man with gall bladder cancer was given a pancreatoduodenectomy. Chest-roentgenograms revealed a prominence of the left cardiac silhouette 6 months after operation. Two months later, the patient developed exertional dyspnea and chest pain. A diagnosis of heart metastasis of gall bladder cancer was established by aspiration cytology. Intravenous administration of 5-FU and cis-DDDP proved ineffective in controlling the disease. The patient died 14 months after operation. An autopsy revealed metastasis to the left ventricle of the heart. This is the 6th such case of gallbladder cancer in the literature.     

Brain metastases from colorectal carcinoma.

AIMS AND BACKGROUND: Brain metastases are an unusual finding in patients with colorectal carcinoma. We wished to determine the clinical presentation, the time interval between the diagnosis of colorectal carcinoma and the appearance of brain metastases, and the overall survival. PATIENT CHARACTERISTICS: The median age of our patients was 61 years. Brain metastases developed subsequently to the diagnosis of colorectal cancer in nine patients. All patients had neurologic symptoms. All patients had progressing systemic disease at the moment of intracranial presentation. Four patients received whole brain radiation therapy. The median survival was 11 weeks. DISCUSSION: The development of brain metastasis is a late event in the course of colorectal carcinoma and occurs most often in patients with extensive systemic disease that contraindicates surgical resection. Radiotherapy can improve the survival of this group of patients whereas the role of chemotherapy is still unclear due to the low frequency of such cases.     

Resolution of liver metastases in response to S-1 monotherapy in advanced pancreatic cancer--a case report

We report a case in a late phase II clinical study investigating the efficacy and safety of the oral fluoropyrimidine anticancer drug S-1. The drug proved effective in a patient with inoperable advanced pancreatic cancer in whom radiation therapy was not indicated. The antitumor effect after 4 courses was rated excellent, with a target site (liver) evaluation of CR and overall evaluation of PR. In particular, two liver metastases, measuring 18.7 x 15.4 mm and 16.2 x 14.6 mm, respectively, both resolved, and S-1 was found to exert a potent antitumor effect against metastases. Assessment of adverse events revealed no grade 3 or 4 adverse reactions, and other adverse events were all mild. Based on the above results, S-1 appeared to be effective against advanced pancreatic cancer and showed excellent tolerability.     

Brain metastases from apocrine carcinoma of the scalp: case report

Summary Apocrine carcinoma is an extremely rare malignant neoplasm that occurs most frequently in the axilla. Although it usually shows an indolent clinical course, it often metastasizes to regional lymph nodes and sometimes to lungs or bones. However, a literature search did not reveal any report describing the detailed clinical course of brain metastases from apocrine carcinoma. We report a case of a 54-year-old male who suffered from multiple brain metastases from apocrine carcinoma that had originated in the scalp 6 years before. The brain metastases appeared in spite of several regimens of chemotherapy for lung metastases for two years. The tumor in the right frontal lobe was successfully operated. However, the small tumor in the right occipital lobe was not cured by gamma knife surgery, and eventually required second operation. The operation had contributed to his neurologically independent life for about one year until he died for gradual progression of lung metastases. To our knowledge this is the first reported case of metastatic brain tumor from apocrine carcinoma.     

Clinical case report and literature review: metachronous colorectal splenic metastases

A 52-year-old woman with a rising carcinoembryonic antigen CEA, no clinical or radiological findings, a negative colonoscopy, and a positron emission tomography (PET) scan that revealed an isolated hypermetabolic lesion in the spleen. The patient underwent splenectomy by laparoscopic surgery. The pathological study confirmed the presence of an isolated metastasis to the spleen. This case reveals the rare occurrence of isolated splenic metastases in the context of colorectal cancer and illustrates the role of PET when a patient shows a rising CEA with negative clinicoradiological studies.     

Multidisciplinary treatment for advanced bladder cancer--a case report

The patient was a 63-year-old woman who had been diagnosed with advanced bladder cancer with renal dysfunction and bilateral bulky pulmonary metastasis. Initially, the primary lesion was resected and the implantation of an infusion catheter and port system was performed. Following surgery, she received intermittent intra-arterial (IA) low-dose CDDP chemotherapy via the infusion port and concurrent bronchial arterial infusion and radiation (40 Gy for the left lung). About 3 months later, the right and left lung metastases were reduced 63% and 91%, respectively, and a right lower lobectomy was performed. CDDP was administered through the outpatient clinic ever since. From January 2001, we began to use docetaxel (TXT) for CDDP because of continuous grade 2 nausea and appetite loss. There were no adverse effects by TXT. Repeated IA chemotherapy was discontinued from June 2001 because of neurological symptoms. In September 2001, a left skull base metastasis was detected and was treated by radiation 40 Gy. In November 2002, a left patella metastasis appeared and was treated by IA chemotherapy with angiotensin II and radiation 30 Gy. We confirmed that multidisciplinary treatment contributed to her approximately 3-year survival with good QOL. The cancers in both lungs could be kept under control until her death.     

Brain metastases in soft tissue sarcomas: case report and literature review

Background and purpose: Brain metastasis is a relatively uncommon event in the natural history of soft tissue sarcomas. The increasing use of chemotherapy may have caused a reduction in local relapses as well as distant failures leading to an improvement in survival, thereby allowing metachronous seeding of the brain, a sanctuary site. The purpose of this report is to increase awareness amongst clinicians regarding such a possibility.Patients and methods: A review of the departmental sarcoma database following the presentation of this index case in the clinic.Results and discussion: An adolescent male who had previously been treated with surgery and radiotherapy for a spindle cell sarcoma of the left thigh developed a space-occupying lesion in the brain within 6 months of treatment of the primary tumor. He subsequently underwent resection of the presumed solitary brain metastasis followed by whole brain radiotherapy. On radiation he was detected to have pulmonary metastases too, for which he was offered palliative chemotherapy. The patient died of brain metastasis within 4 months. A review of the departmental sarcoma database, restricted to soft tissue sarcomas purely, maintained prospectively from 2000 till date, could not identify any other such case.Conclusion: Brain metastases from soft tissue sarcomas are rare. Patients with neurological symptoms, however, should be appropriately investigated. Surgical resection of brain metastasis could be considered for solitary brain metastasis in non-eloquent areas. Palliative radiotherapy is appropriate for patients with multiple brain metastases or co-existing extra-cranial disease.     

Late brain metastases from colorectal cancer a case report and review of the literature

Metastatic brain tumors from colorectal cancer are relatively rare. In previous reports the incidence ranged from 1.9 to 3.5 percent of all metastatic brain tumors. In another recent article the cumulative incidence of brain metastasis was estimated at 1.2%. The prognosis for patients with even a single resectable brain metastasis is poor. This paper presents the case report of a 72-year-old woman with a solitary brain metastasis 16 years after a diagnosis of colorectal cancer. She remained asymptomatic for 16 years. The first sign of a secondary tumor was diplopia. Brain scan demonstrated a space-occupying lesion in the occipital area. A solitary tumor was removed by craniotomy. Histological examination showed that it was a metastasis from the intestinal primary tumor. The patient subsequently underwent whole brain radiotherapy for a total dose of 30 Gy in 10 fractions.     

Pheochromocytoma combined with malignant lymphoma and prostatic cancer--a case report

A rare case of pheochromocytoma associated with a malignant lymphoma and a prostatic cancer is reported. An 80-year-old male had had his terminal ileum resected one year earlier due to a malignant lymphoma. A year later, postoperative follow-up study by ultrasound revealed a solitary retroperitoneal tumor. The resected tumor was found to be a pheochromocytoma, which had provoked intraoperatively an intractable hypertension and ventricular arrhythmia. One year following this, a urinary disturbance was noted. On examination, a hard and irregular prostata was palpate and a subsequent biopsy revealed an adenocarcinoma. As far as we have been able to ascertain after a perusal of the Japanese literature, we believe that this case represents the first reported case of such a malignant lymphoma, combined with prostatic cancer and a pheochromocytoma.     

Brain metastases from adenoendocrine carcinoma of the common bile duct: a case report.

A 68-year-old man with metastatic brain tumors from adenoendocrine carcinoma of the common bile duct is reported. A common bile duct tumor and a metastatic liver tumor had been resected 6 years and 3 years prior to admission, respectively. Microscopically they showed two components; moderately differentiated tubular adenocarcinoma and neuroendocrine carcinoma. He presented with headache and vomiting and MRI revealed two metastatic brain tumors. They were successfully resected and radiotherapy was carried out. Histological diagnosis of the metastatic brain tumors was neuroendocrine carcinoma, but carbohydrate antigen (CA)-19-9 and carcinoembryonic antigen (CEA)-immunoreactive cells were observed without glandular pattern. Immunohistochemically serotonin and pancreatic polypeptide were detected, but somatostatin was not. As the endocrine cells demonstrated in the normal extrahepatic bile ducts are only somatostatin-containing D cells, these cells are considered to originate as part of a metaplastic process. To our knowledge, this represents the second case of adenoendocrine carcinoma of the common bile duct.     

Brain metastases from colorectal carcinoma: prognostic factors and outcome

Brain metastases from colorectal carcinoma (CRC) are rare. The objectives of this study are to assess the natural history, outcome, and possible prognostic factors in CRC patients with brain metastases. Between 1995 and 2008, 8,732 patients with CRC were treated at Yonsei University Health System. Brain metastases were found in 1.4% of these patients. Retrospective review and statistical analysis of these 126 patients were performed. Median time from diagnosis of metastatic CRC (mCRC) to brain metastases was 9.0 months (range 0–85 months), and 14 patients (11.1%) had brain involvement as their initial presentation. Among the 126 patients, 91.3% had other systemic metastases; the most common extracranial metastatic site was lung (72.2%). Median follow-up duration was 6.1 months (range 0.1–90.3 months), and median survival after diagnosis of brain metastases was 5.4 months [95% confidence interval (CI) 3.9–6.9 months]. Median survival time after diagnosis of brain metastases was 1.5 months for patients who received only steroids (15.9%), 4.0 months for those who received whole-brain radiation therapy (37.5%), 9.5 months for those who received gamma-knife surgery (GKS) (32.5%), and 11.5 months for those who underwent surgery (20%) (P < 0.001). On multivariate analysis, recursive partitioning analysis (RPA) class and amount of chemotherapy before brain metastasis were independent prognostic factors for survival. Overall prognosis of patients with brain metastases from CRC is poor. Nevertheless, patients with low RPA class, or those with previous less chemotherapy showed good prognosis, indicating that proper treatment may result in improved survival time.     

Low-dose CPT-11 against a recurrent rectal cancer--a case report]

We attempted a new regimen of low-dose CPT-11 on a 5-FU resistant recurrent rectal cancer patient with multiple lung metastases and a paraaortic lymph node metastasis. CPT-11 was administered at 25 mg/m2/day x 3/week by intravenous infusion. Serum CEA level decreased gradually with a half time of approximately 4 weeks. The lung metastases almost disappeared and the paraaortic lymph node was also reduced more than 50%. There were no adverse effects except slight alopetia. This treatment could be continued on an outpatient basis. These results suggest that low-dose CPT-11 may be more effective and tolerable than the conventional, CPT-11 therapy.     

Chemotherapy with gemcitabine after non-curative resection of bile duct cancer--a case report

Non-curative resection for cholangiocarcinoma usually leads to a poor prognosis. We present a case successfully treated with gemcitabine for residual tumor after extra hepatic bile duct resection with positive surgical margin. The patient was a 77-year-old male who was diagnosed as having a common bile duct cancer. Extra hepatic bile duct resection was performed, but intraoperative pathology diagnosed the surgical margin of duodenal-side bile duct was positive for cancer. Although additional resection of bile duct was done, pathological diagnosis resulted in positive margin again. We had to avoid pancreatoduodenectomy in light of the patient's wishes, so a curative resection could not be carried out. Adjuvant chemotherapy with gemcitabine(800 mg/m2 on days 1, 8 and 15 every 4 weeks)was started at the seventh postoperative day. A residual lesion was shown in the pancreas head by abdominal CT after 2 courses of chemotherapy. Follow-up CT was performed every 6 months, and the lesion gradually seemed to become unclear. Finally, CT showed disappearance of the residual lesion 28 months after surgery. The chemotherapy has been continued up to the present(3 years and 5 months after surgery). No evidence of recurrence nor adverse events of WHO grade 2 or more has been observed.     

Successfully resected an isolated extraperitoneal metastasis of sigmoid colon cancer--a case report

We herein report an extremely rare operative case of an isolated extraperitoneal metastasis of colon cancer. A female patient had undergone a sigmoidectomy for ileus due to sigmoid colon cancer when she was 40 years old. Peritoneal metastasis, 5 mm in diameter, was on the sigmoid colon mesentery and she was histologically diagnosed as Stage IV. She received fluorouracil-based adjuvant chemotherapy for 24 months. Serum CEA increased gradually from 36 months after the operation, and CT scan demonstrated bilateral ovarium tumors. Bilateral oophorectomy was performed at 44 months after the operation. Serum CEA decreased temporarily, but increased again. Serum CEA increased in spite of giving UFT/LV, so we changed to mFOLFOX6 therapy. Serum CEA decreased until it reached to a normal range after 9 courses, and stopped mFOLFOX6 therapy. Four months later, serum CEA increased again and PET-CT demonstrated a 3 cm mass with calcification in pelvic, and accumulation of FDP. Serum CEA decreased until it reached to a normal range after a resection of extraperitoneal mass. A histological examination of the tumor revealed a moderately differentiated adenocarcinoma similar to colon cancer. She has been well without recurrence 77 months after the first operation.     

Application of radiofrequency hyperthermia for treating advanced urinary bladder cancer--a case report

A patient with advanced urinary bladder cancer treated with a combination of radiation and hyperthermia, using short-wave radiofrequency (RF) and intravesical irrigation with warm water is reported. The tumor temperature was successfully maintained at 43 degrees to 44.6 degrees by external application of 13.56 MHZ RF when the bladder was irrigated with heated saline (intravesical temperature: 43 degrees) Hyperthermia was performed for 30 min immediately after each course of external bladder irradiation (Linac: 400 rad, twice a week; total 5 weeks exposure of 4000 rad). The tumor disappeared completely (CR) after the completion of the combination therapy.     

198例结直肠癌肝转移患者外科治疗的疗效分析

背景与目的:肝脏是结直肠癌常见的转移部位,35%的患者在确诊时已发生肝转移,肝转移患者的预后较差。尽管手术切除、化疗、射频消融术、介入治疗等手段应用于临床,但治疗效果不同。本研究探讨结直肠癌肝转移外科治疗的临床疗效。方法:对我院5年间经病理检查证实的198例结直肠癌肝转移患者的临床资料进行回顾性分析。根据治疗方法的不同进行分组:根治性切除组46例(23.2%)、姑息性切除组43例(21.7%)、手术探查组或最佳支持治疗组29例(14.6%)、肝动脉置泵化疗组41例(20.7%),全身化疗组39例(19.7%);对其生存期进行比较和统计学分析。结果:根治性切除组中位生存期37.1个月,5年生存率为31.2%;姑息性切除组的中位生存期14.3个月,5年生存率为0;肝动脉置泵化疗组的中位生存期21.3个月,5年生存期为7.5%;全身性化疗和探查组或最佳支持治疗组的中位生存期分别为18.7个月、6.3个月,均无5年生存者。根治性切除组与其他组比较,中位生存期有统计学意义(P<0.01)。结论:根治性切除是提高结直肠癌肝转移患者生存率的重要手段;姑息性切除治疗效果并不优于辅助性治疗,对于不能根治性切除的病例可采用肝动脉置泵化疗。     

Complete pathological response of colorectal liver metastases after chemotherapy and bevacizumab treatment: a case report

The vast majority of colorectal cancer patients who present with liver metastases are not initially candidates for hepatic resection. Although the combination of systemic chemotherapy and liver surgery can convert a significant proportion of patients from a palliative situation to a potentially curative situation, the majority of initially unresectable liver metastases do not respond sufficiently to initial chemotherapy to become resectable. More recently the addition of biologic agents (bevacizumab or cetuximab) to cytotoxic chemotherapy has increased the rate of tumor response, suggesting that the addition of these agents could improve resectability rate. Here we report the clinical case of a complete pathological response (pCR) in a 67-year-old male affected by metastatic colorectal cancer, with initially unresectable liver metastases, after treatment with chemotherapy and bevacizumab.