Three long surviving patients with gastric cancer metastasizing to the liver under interdisciplinary therapy

In 30 patients with gastric cancer metastasizing to the liver over the past 15 years at our hospital the primary foci in the stomach could be resected in a curative manner. The authors report herein three long surviving patients in this series. [Case 1] A 49-year-old male. Distal gastrectomy was performed in November 1984. Metastasis to the liver occurred in June 1986. The right lobe of the liver was resected in November 1987 after transcatheter arterial embolization (TAE). Although hepatic arterial infusion chemotherapy was conducted, the cancer metastasized to the whole body, and the patient died in December 1991. [Case 2] A 65-year-old female. Distal gastrectomy was performed in July 1994. The left hepatic lobe and segment 5 in the right lobe were resected in June 1995. Although TAE was performed six times starting in December 1996, the patient died of hepatic failure in July 1999. [Case 3] A 73-year-old male. This patient simultaneously received distal gastrectomy and extended resection of the posterior hepatic segments in September 1997. Cancer recurred in the remaining liver in July 1998. Although microwave coagulation therapy (MCT) and TAE were performed, the patient died of hepatic failure in January 2000. In these patients who survived for a long period, the primary focus was well-differentiated adenocarcinoma under sufficient local control with metastasis limited to the nearest regional lymph nodes (group 1 lymph nodes). The patients could undergo interdisciplinary therapy, including hepatectomy, MCT, TAE, and hepatic arterial infusion chemotherapy.     

A case of biliary tract obstruction due to metastatic hepatic cancer, in which topical injection of CDDP and ADM into PTCD with concomitant use of UFT resulting in partial reopening of biliary tract

One year after total gastrectomy due to gastric cancer, the 50-year-old male patient underwent lateral segmentectomy, since metastatic foci occurred in the outer region of the liver. Three months thereafter, metastatic foci occurred in the right anterior lobe of the liver, causing obstructive jaundice. PTCD was performed, and after repeated anticancer doses of 10 mg of Cis-diamminedichloroplatinum (CDDP) plus 10 mg of adriamycin (ADM) in the tubing, partial opening of the obstructive bile duct was achieved.     

A case of hepatocellular carcinoma with extrahepatic portal vein obstruction due to tumor invasion, responsive to oral administration of UFT

A 38-year-old male was admitted to Ikeda Municipal Hospital because of thrombocytopenic purpura and abnormal liver function. Computed tomography and ultrasonography of the liver showed a 5 by 5 cm mass in the right lobe of the liver. Hepatic angiography revealed a hypervascular tumor in the right lobe of the liver and extrahepatic portal venous obstruction. A diagnosis of hepatocellular carcinoma with extrahepatic portal venous obstruction due to tumor invasion was made. Endoscopic examination showed marked esophageal varices with red color sign. Oral administration of UFT at a daily dose of 400 mg was started. Though ascites and frequent hemorrhage from esophageal varices were observed, these symptoms disappeared completely after 8 months administration of UFT. Endoscopic examination revealed disappearance of the esophageal varices, and recanalization of the extrahepatic portal vein was confirmed by the second hepatic angiography. Computed tomography showed no growth of the liver tumor. These data suggest that UFT was effective in this case.     

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.     

Asymmetric calf hypertrophy of neurogenic origin

A 47-year-old male presented with painful swelling of the right calf. His medical history was negative, except for a herniation of disc LIV-V 5 years before. Physical examination revealed unilateral calf hypertrophy with moderate weakness of plantarflexion, mild paresis of dorsiflexion. Electromyography showed a peripheral neurogenic lesion in the right anterior tibial muscle, but normal findings were obtained from the unaffected quadriceps muscle. Histological examination of the right gastrocnemic muscle showed neurogenic changes with typical targetoid fibers, but no pathological changes were present in the quadriceps muscle. Chronic asymmetric spinal muscular atrophy is an infrequent neuromuscular disease and because of asymmetric appearance, it might be difficult to distinguish from other, acquired neurogenic muscle diseases such as radiculopathy caused by intervertebral disc herniation. Our case confirms that muscular hypertrophy can follow partial denervation in humans.     

Extended sleeve pulmonary resection in a patient with synchronous triple bronchogenic squamous cell carcinoma

A 58-year-old male was admitted to our hospital for evaluation of bloody sputum. He was diagnosed as having synchronous triple bronchogenic squamous cell carcinomas in the right upper lobe, from the right B(6) segmental bronchus to the intermediate trunk and the middle lobar bronchus, and in the spur of the left B(1+2)/B(3) segmental bronchus. He underwent sleeve resection of the right upper lobe, right middle lobe, and right S(6) segment, with an anastomosis between the right main and right basal bronchi. This was followed by YAG-laser treatment and external irradiation for the left tumour and the residual right tumour. Postoperatively, chest X-ray revealed adequate expansion of the right basal segment, and pulmonary function testing showed satisfactory results. Recurrence was not detected during an initial 6-month period, however careful follow-up is required.     

Tissue platinum distribution and the effect following intra-arterial injection of cisplatin to metastatic liver cancer--a case report

A 63-year-old male with advanced esophageal cancer was admitted to our hospital. He received neoadjuvant chemotherapy with intravenous cisplatin and fluorouracil (5-FU), and underwent resection of the esophagus and placement of a gastric tube. Two months later, multiple metastases appeared in the right lobe of the liver. Intermittent arterial infusion chemotherapy with cisplatin and 5-FU were performed. To selectively infuse the drugs into the right hepatic artery, the left hepatic artery was embolized. Treatment had a marked effect in the right lobe, but new lesions were subsequently discovered in the left lobe. The patient died of pleuritis 27 days after the end of cisplatin infusion and 12 months after surgery. In total, 465 mg of cisplatin and 20 mg of nedaplatin were administered. At autopsy, tissue samples were collected to measure the platinum concentration. The result showed the highest value to be in the right lobe, 4.8 times as high as that in the left lobe. It is suggested that the concentration of platinum in tissue is correlated with the anticancer effect of cisplatin to the tissue, despite of the traditional view that the tissue concentration and the effect are not related.     

Budd-Chiari syndrome complicating lung carcinoma of the right inferior lobe: a case report.

A case of bronchogenic carcinoma involving the base of the right inferior lobe and causing Budd-Chiari syndrome in a 66-year-old woman is reported. It appears to be the second case in the literature with a similar clinical manifestation.     

A Case of Pulmonary Infiltrates in a Patient with Colon Carcinoma

A 31-year-old white male with a known history of colon carcinoma was referred to the Interventional Pulmonary service for right lower lobe infiltrates and mucous plugging on computed tomography with concern for pneumonia. Bronchoscopy was performed revealing a broad based mass completely obstructing the bronchus intermedius. It was possible to pass a probe into the right lower lobe, and subsequent photoablation and mechanical debulking revealed that the mass was arising near the origin of the superior basal segment of the right lower lobe (RB6) and could be resected. Pathology confirmed this was consistent with the patient''s known primary colon carcinoma. The potential for endobronchial metastasis in patients with colorectal carcinoma should be investigated in those patients with new or worsening pulmonary symptoms and signs.Key words: Pulmonary infiltrates, Colon carcinoma, Endoluminal metastasis, Endobronchial colon cancer, Bronchoscopy, Interventional pulmonology     

A hepatocellular carcinoma (HCC) with intrahepatic bile duct dilatation and right lobe atrophy following percutaneous ethanol injection therapy

Reported is the case of a 67-year-old man with an HCC who was being treated by percutaneous ethanol injection therapy (PEIT). After a year, CT and ultrasonography demonstrated the dilatation of the intrahepatic bile duct and the atrophy of the right lobe. Endoscopic cholangiography also showed stenosis of the right hepatic duct. This severe complication and injury to the hepatic duct and portal vein was determined as having occurred because of treatment by PEIT.     

A case of bilateral 3-lung lesion (metastatic and primary tumour, tumourlet) resected simultaneously

A 70-year-old male patient underwent right nephrectomy for renal clear cell carcinoma. After 8 years an X-ray showed a nodule on the left lung, and CT scan detected it to be a 15 × 12 mm mass in S1+2 segment of the left lung. CT also detected another 15 × 7 mm mass in the right S3 segment. These lesions had a high FDG accumulation. Pre-operative diagnosis is bilateral pulmonary metastases from renal cell carcinoma, and bilateral lung segmentectomy was performed. Left S1+2 resected tumor was histologically clear cell carcinoma by intra-operative examination, then right S3 segmentectomy was done. And that time, small tumor was found in the middle lung lobe, and a wedge resection was performed. These specimens revealed a primary lung carcinoma of right S3, and tumourlet of middle lobe. It is very rare that three different histlogical types of lung tumor were found.     

A Case of Bronchial Fibroma Associated with Subsegmental Atelectasis

A case of polypoid endobronchial fibroma which led to subsegmentalatelectasis in a 45-year-old male is reported. The diagnosiswas made pre-operatively by roentgenographic examination, bronchoscopyand biopsy. A lobectomy of the right middle lobe was performed.The polypoid tumor occupied the lumen of the subsegmental bronchusof the right middle lobe and had a stalk. Histologically, thetumor was composed mostly of collagen bundles with scant spindle-shapedfibroblastic cells and a myxomatous component. There was neithercellular atypia nor mitotic figures nor infiltration of smallround cells. The diagnosis was pulmonary fibroma of the endobronchialtype. To date, 66 cases of pulmonary fibroma have been reportedin the English literature since 1880; 21 of these were polypoidendobronchial fibroma. Only five cases of polypoid endobronchialfibroma including this case have been reported in the Japaneseliterature.     

Gemcitabine-induced radiation recall dermatitis: case report

A 65-year-old male with lung adenocarcinoma received radiotherapy to the mediastinum and right upper lobe, followed by chemotherapy with gemcitabine. Radiation recall dermatitis developed in the area corresponding to the radiotherapy portal. This is one of just a few cases reported recently concerning radiation recall dermatitis stemming from gemcitabine.     

Primary Leptomeningeal Sarcomatosis; A Pathology Proven Case with Challenging MRI and Clinical Findings

A 20-year-old male patient admitted with intractable seizures and progressive dementia is presented. Magnetic resonance imaging (MRI) examinations revealed diffuse leptomeningeal thickening, enhancement especially in the basal cisterns and multiple cystic formations in the brain stem, temporal lobes and basal ganglia. The pathologic examination from the right temporal lobe was consistent with leptomeningeal sarcoma. Marked regression of the symptoms and MRI lesions were detected following radiotherapy.     

Complete remission of locally advanced squamous cell lung cancer induced by chemotherapy with cisplatin and docetaxel

The patient was a 70-year-old man with c-T2N3M0 stage IIIB squamous cell lung cancer in the upper lobe of his left lung. Two cycles of chemotherapy of docetaxel with cisplatin induced complete response. Sequential radiotherapy was performed for the mediastinum. One year after treatment, he underwent a lung resection for a second lung cancer, poorly differentiated adenocarcinoma, in the upper lobe of his right lung. Resected mediastinal lymph nodes showed no cancer cells of the first lung cancer. Now, more than 3 years after the first examination, he maintains complete remission without evidence of recurrence.     

A cellular variant of supratentorial hemangioblastoma

Supratentorial hemangioblastomas are rarely seen, especially in children and adolescents. We report the case of a 17-year-old male with supratentorial hemangioblastoma. Neuroimaging demonstrated a cystic lesion within the right parietal lobe. Systemic examination revealed no abnormality. The lesion was not attached to the dura and was not associated with von Hippel-Lindau disease. It was very difficult to confirm the final diagnosis of this case, in spite of extensive examination by light microscopy, immunohistochemical studies, and electron microscopy.     

Multicentric papillary and follicular carcinomas of the thyroid

A 63-year-old female, complaining of a swelling in the neck, was diagnosed as having a thyroid carcinoma. Thus, a subtotal thyroidectomy was performed, leaving a part of the right lobe. Two thyroid carcinomas were found in the left lobe, and one carcinoma in the right lobe with a right cervical lymph nodal involvement. Each carcinoma was small and encapsulated by thick fibrous tissue, but there was no continuity among them. The three carcinomas were regarded as being multicentric in origin, and not an intraglandular metastasis.     

ALPPS术在尾状叶肝癌中的应用(附1例报道)

目的:报道ALPPS成功治疗尾状叶肝癌1例,分析ALPPS对于尾状叶肝癌的可行性及安全性。方法:患者,男,58岁,66 kg,因“体检发现肝占位20天”入院,肝脏超声示肝右叶占位性病变,初步诊断:尾状叶肝癌。患者尾状叶肝癌累及门静脉右支、肝中静脉、肝右静脉、下腔静脉肝后段,需行右半肝及尾状叶切除。经术前评估患者剩余肝脏体积不能满足切除要求,遂行ALPPS手术。结果:第一步手术时间210 min,术中出血量200 ml,术中未输血,术后无严重并发症。术后第7天左半肝体积增长至547 ml,占标准肝脏体积的46.3%,术后第14天行第二步手术。第二步手术时间180 min,术中出血量400 ml,输注红细胞3 U,血浆800 ml。Clavien-Dino并发症分级Ⅱ级,主要并发症为胆漏,予以充分引流后好转。患者术后康复良好,随访13个月,肿瘤无复发。结论:ALPPS为尾状叶肝癌患者提供了新的手术方案参考。     

Successful video-assisted thoracoscopic lobectomy in a pregnant woman with lung cancer

A 38-year-old non-smoking female patient was evaluated at our hospital for an increasing mass in the right lower lung field at 24 weeks of gestation. Computed tomography revealed an approximately 7.5-cm diameter mass in the right lower lung lobe. After assessing the benefits to the patient and risks to the fetus, we performed a lobectomy with mediastinal lymph node dissection using video-assisted thoracoscopy. Three months postoperatively, the patient delivered a healthy male baby. The patient is alive 10 months following the lobectomy, and no evidence of recurrence and distant metastasis is noted. The 6-month-old infant is also doing well postpartum.     

Endobronchial metastasis of testicular embryonal cell carcinoma--a case report

Four cases of endobronchial metastasis in testicular embryonal cell carcinoma have been reported in the literature. We now present a new case, a 39-year-old male who underwent right orchiectomy for testicular embryonal cell carcinoma. Ten months later, tumor like shadows were identified in the left upper lobe on a follow up chest X-ray. Bronchoscopy revealed an endobronchial tumor mimicking a bronchogenic carcinoma in the left superior posterior bronchus. A metastatic embryonal cell carcinoma of the testis was histologically diagnosed. Left upper lobectomy was performed, and the patient is still alive 11 months thereafter.