A case of hyperosmolar nonketotic coma occurring during chemotherapy in lung cancer]

A 61-year-old woman was admitted to our hospital because of hoarseness and abnormal shadow on chest X-ray. We diagnosed this patient as large cell carcinoma of the right upper lobe of the lung; T3N3M1 Stage IV. She was treated with OK-432, CDDP and CQ. On the 6th day after 2nd cycle chemotherapy, she was confused, and we diagnosed her as a case of hyperosmolar nonketotic coma (HNC) on the 7th day. Unfortunately, she died on the 8th day, after 20 hours of treatment for HNC. She suffered from chronic dehydration due to trouble with left recurrent nerve palsy. Although continuous intravenous hyperalimentation was used, she had severe HNC. HNC might be one complication in chemotherapy for patients with malignancy.     

A case of pulmonary metastasis of ovarian leiomyosarcoma responsive to CTP therapy]

One case of pulmonary metastasis of leiomyosarcoma responsive to CTP therapy was reported. The patient was a 44-year-old woman who had undergone total simple hysterectomy for uterine myoma 6 years before. Five years after the operation she underwent ovariectomy for ovarian tumor. Based on the histopathological findings, she was diagnosed to have leiomyosarcoma. One year later the patient was referred to use because of pulmonary metastasis. After admission to our hospital CTP therapy was started. Disappearance of the metastatic lesion was demonstrated by the chest X-ray findings at the end of five courses of treatment.     

Intralobar pulmonary sequestration in an elderly adult

The case of a patient admitted to the hospital for symptoms characterized by chest pain, productive cough, fever, dyspnea resistant to antibiotic therapy is discussed. Previous plain chest X-ray performed elsewhere was suggestive of inflammotory lung consolidation. An admission chest X-ray revealed a left lower lobe density. On chest CT-angiography a lobulated mass in the posterior basal segment of the left lower lobe was visualized: the diagnosis of intralobar pulmonary sequestration (ILPS) was hypothesized.     

Primary rhabdomyosarcoma of the heart--a case report

The patient, a 33 year old male, had suffered from swelling of the chest, neck and face for 4 months; palpitation, chest and epigastrium pain, cough and yellowish sputum for 10 days before admission into our hospital. Blood routine and erythrocyte sedimentation rate were normal. By X-ray examination, the right upper mediastinum was obviously widened with the trachea displaced toward the left and pleural effusion was present on both sides. On day 5 of admission, the patient died of heart failure. The clinical diagnosis was not clear but lymphosarcoma or other malignant tumors in the mediastinum was suspected. Autopsy was performed. A large tumor 8 X 10 X 2.5 cm in size was found in the right atrium. The tumor had a short and broad pedicle (6 X 5 cm in diameter) connected with the upper part of the atrial wall. The histological diagnosis was primary rhabdomyosarcoma of the heart.     

A case of pseudomyxoma peritonei successfully treated with multidisciplinary treatment including modified FOLFOX6 regimen

We report a case of pseudomyxoma peritonei caused by carcinoma of the appendix, which was successfully treated with multidisciplinary treatment including modified FOLFOX6 regimen. A 45-year-old man was diagnosed as having peritoneal dissemination associated with cancer of the cecum or appendix. Seven cycles of mFOLFOX6 treatment resulted in a marked decrease in ascites and serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9. At laparotomy, a diagnosis of pseudomyxoma peritonei caused by cancer of the appendix was made. Intraperitoneal lavarge with 10,000 mL 5% glucose was performed after right hemicolectomy, omentectomy and removed of mucinous peritoneal nodules. Intraperitoneal chemotherapy comprised of 3000 mL low molecule dextran and 80 mg cisplatin was added on postoperative days 7 and 14. Modified FOLFOX6 regimen was started again two months postoperatively and reached 28 cycles. The patient does not show any sign of recurrence 12 months postoperatively.     

Unusual origins of Pseudomyxoma peritonei

Pseudomyxoma peritonei is a rare neoplastic condition in that gelatinous intraperitoneal fluid collections and mucinous implants on the peritoneal surfaces and omentum are found. The pathological origin is usually an adenoma or well-differentiated adenocarcinoma of the appendix. A smaller number of cases arises from ovarian tumors. We report two unusual cases of pseudomyxoma peritonei. As a child, the first patient underwent several surgical procedures of the large bowel to relieve the consequences of Hirschsprung disease that were complicated by recurrent enteric fistulae. Colonic epithelial cells, with neoplastic changes due to chronic inflammation in the presence of enteric fistulae, were probably dislocated during these episodes, causing pseudomyxoma peritonei. In the second patient, pseudomyxoma was caused by intraperitoneal seeding of a mucinous urachal adenocarcinoma. We hypothesize that seeding of mucus producing epithelial cells into the abdominal cavity may result in this rare entity called pseudomyxoma peritonei, regardless of the source.     

Pseudomyxoma peritonei due to mucinous cystadenocarcinoma in situ of the urachus presenting as an inguinal hernia

Pseudomyxoma peritonei is generally caused by appendiceal and ovarian tumors. Other primary sites have been rarely reported. We describe herein the second reported case of pseudomyxoma peritonei due to mucinous cystadenocarcinoma of the urachus. A 54-year-old man was admitted with a left inguinal hernia that had developed several months prior to his admission. During herniorrhaphy, we found a large amount of gelatinous mucinous material in the indirect-hernia sac and made a diagnosis of pseudomyxoma peritonei on cytological grounds. At re-operation, the origin of the pseudomyxoma peritonei proved to be a ruptured urachal cyst. The urachal cyst and the dome of the urinary bladder were excised. In addition, we removed as much of the gelatinous material as possible. On histological examination, a unilocular cyst was found to consist of noninvasive mucinous adenocarcinoma. We succeeded in removing the rest of the mucinous material by postoperative intraperitoneal lavage with dextran solution, and have observed no evidence of recurrence for 7 years since the operation.     

A case of drug-induced lung injury associated with chemotherapy (FOLFOX6, FOLFIRI, Bevacizumab) for an advanced colon cancer

A woman in her late sixties had an operation for ascending colon cancer 15 months before her current admission. The pathological finding was T3(mod. SE), N0, H0, P3, M0, Stage IV. She had received chemotherapy after her operation. The first-line therapy comprised 15 courses of FOLFOX6 (from 14 to 5 months before admission). Her second-line chemotherapy comprised 6 courses of FOLFOX6+bevacizumab (BV) (from 3 to 2 months before admission). The third-line chemotherapy comprised 3 courses of FOLFIRI+BV (from 40 to 11 days before admission). She developed a high fever and respiratory failure 3 days before admission. On admission to our hospital, her chest X-ray and CT showed ground-grass opacities in bilateral lung fields. Bronchoalveolar lavage showed a predominance of lymphocytes without any evidence of infection. We diagnosed the patient as a case of lung injury caused by anticancer drugs. Steroid therapy was implemented, and her fever, respiratory failure, and chest X-ray abnormalities disappeared. Steroid therapy was stopped 6 months later and subsequently lung injury did not recur. Judging by the progress seen in this case, we concluded that her lung injury was due to irinotecan. We continued the chemotherapy for her colon cancer by prescribing S-1, it proved ineffective. The patient died from the colon cancer 27 months after her operation.     

A case of duodenal perforation during mFOLFOX6 treatment for metastatic sigmoid colon cancer

We present a case of metastatic sigmoid colon cancer causing duodenal perforation during modified FOLFOX6 chemotherapy. The patient was a 68-year-old man who underwent sigmoidectomy for an advanced sigmoid cancer in September 2007. He has been received mFOLFOX6 chemotherapy for multiple liver metastases since January 2009. In March 2010, the patient complained of abdominal pain during the 24th course of chemotherapy, and was admitted to our hospital. On admission, his vital signs were normal, and abdominal findings revealed no peritonitis signs. An abdominal CT scan showed free air and fluid collection on the first day of admission. The patient was diagnosed with gastrointestinal perforation, and underwent emergency operation for abdominal drainage. The leakage of biliary fluids was recognized at the drain to the Winslow postoperatively. It ceased on the 25th admission day, and an upper gastrointestinal examination showed good passage of fluids and no leakage at the duodenum. However, the patient died 36 days after admission from remarkable pleural effusion and respiratory failure.     

Toxicity of vincristine overdose in a patient with invasive mole

A few reports have documented overdoses of vincristine sulfate. The present report describes our experience with serious complications of a vincristine overdose in an 18-year-old female who had methotrexate-resistant invasive mole. The patient received VAC therapy as the second line chemotherapy after 2 courses of MTX therapy. In the 6th course of VAC therapy, she was given 5 consecutive daily doses of VCR by mistake. On the 5th day of this VAC therapy, she showed the following toxic symptoms: abdominal pain, lumbago, insomnia, bleeding tendency, absence of motor reflex, leukopenia, and paralytic ileus. These symptoms led to realization of the VCR overdose. Leucovorin calcium administration and supportive treatment were carried out. Although it was difficult to evaluate the efficacy of leucovorin calcium on the vincristine toxic symptoms, she recovered and was discharged on the 36th hospital day.     

Acute Pheochromocytoma: A Case Report and Review of the Literature

A case of pheochromocytoma ending in fatal cardiac arrhythmiasduring conservative treatment with an -adrenergic blocker isdescribed. The patient had a pheochromocytoma of a child's headsize on the right adrenal gland which could not be removed threeyears earlier because of surgical difficulty. After a 2-yr favorableperiod maintained by oral administration of phenoxy-benzamine,she was caught in a hypertensive crisis triggered by routinehouse work. On admission as an emergency case, striking changesin the electrocardiogram such as marked prolongation of theQ-T interval and wide symmetrically inverted T-waves developedin spite of intravenous infusion of phentolamine and propranolol.Eventually, she died in an irreversible shock from ventricularfibrillation. Urinary output of adrenalin and noradrenalin onthe last day was 1,160 and 2,278 µg/day, respectively. We reviewed other cases reported in the Japanese literatureand emphasized that catecholamine-induced cardiomyopathy mayplay an important role in the catastrophic terminal events ina patient bearing pheochromocytoma.     

Syndrome of inappropriate secretion of antidiuretic hormone in a patient with myeloid antigen positive acute lymphoblastic leukemia after systemic chemotherapy including vincristine

We report a case of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) after the patient had received several anti-cancer drugs, including vincristine (VCR), in a patient with myeloid antigen positive acute lymphoblastic leukemia (My(+)-ALL). A 53-year-old woman presented at the hospital complaining of high-grade fever and general lassitude. Further examination revealed that she had My(+)-ALL. On admission, she was treated with anti-cancer drugs, including VCR. On day 24, after the first administration of VCR, a conscious disturbance suddenly occurred and she was diagnosed with SIADH. A plain head CT scan showed a low density lesion through the gray matter to the white matter in the bilateral occipital lobe, as well as diffuse swelling of the cerebrum. This was not seen on the follow up CT scan, and we concluded that it had been a transient abnormal finding due to SIADH. She achieved complete remission after induction chemotherapy and 3 added courses of consolidation chemotherapy. VCR was also administered 4 times in the second consolidation chemotherapy, but hyponatremia did not occur. This case suggests that a head CT scan is a useful procedure for the diagnosis and monitoring of SIADH, and that VCR may still be used in a patient who has suffered from VCR-induced SIADH.     

A case of spindle cell carcinoma of the breast, in which irinotecan was effective against respiratory failure due to pulmonary metastases

We present our experience with chemotherapy using irinotecan for lung metastases of spindle cell carcinoma of the breast. The patient is a 50-year-old female, who consulted our hospital due to a large breast tumor about 7 cm in diameter. Although computed tomography revealed invasion to the chest wall, no distant metastases were confirmed. Chemotherapy (FEC100 followed by paclitaxel) was not effective for down-staging. To improve her quality of life, standard radical mastectomy with combined partial resection of the chest wall was performed. The tumor was histologically diagnosed as spindle cell carcinoma. After the operation, multiple lung metastases appeared, and she had severe dyspnea. Thereafter irinotecan was administered. One week after the administration, metastatic lesions were reduced so that her dyspnea was remarkably relieved. The patient continued to receive irinotecan weekly until she died on the 49th day of treatment with irinotecan.     

Malignant Pheochromocytoma Accompanied by Microangiopathic Hemolytic Anemia: A Case Report

A 63-year-old woman was in hsopital for persistent backache.Four months prior to admission she had been pointed out as havinghypertension for the first time. On admission, she had anemia(hemoglobin 7.0 g/dl) with reticulocytosis, and a blood smearshowed fragmented erythrocytes. A bone marrow aspirate disclosederythroid hyperplasia and invasion of cancer cells. The chestroentgenogram showed a coin-lesion of the right lung and leftpleural effusion. A diagnosis of microangiopathic hemolyticanemia (MAHA) associated with carcinomatosis was made, but theprimary site of the cancer was unknown. Respiratory failuredeveloped and the patient died a month later. Surprisingly,the autopsy revealed a malignant pheochromocytoma arising fromthe right adrenal gland with massive metastases to the lungs,liver, lymph nodes and systemic bones, and also disseminatedintravascular coagulation (DIC). The DIC would probably accountfor the MAHA in this case. To our knowledge, this is the firstreported case of malignant pheochromocytoma accompanied by MAHA.     

Nasopharyngeal Foreign Body in an Young Child

A number of articles on foreign body (FB) ingestion and inhalation have been reported in the literature. Of these, reports of foreign bodies lodging in nasopharynx after inhalation/ingestion are rare. A case of FB inhalation/ingestion presented with history of respiratory distress was admitted for suspected FB bronchus and kept for observation. On examination the child was not distressed and chest examination and X-ray were normal. After 2 days, however, X-ray nasopharynx was taken for rhinorrhoea, nose block and snoring since admission. A large metal nut was found in the roof of the nasopharynx. This case is reported for its rarity, unusual presentation and misleading history.     

Leiomyosarcoma of the remnant stomach--a case report

A case of leiomyosarcoma of the remnant stomach is reported. The patient was a 57-year-old woman whose chief complaint was easy fatigability. Twenty six years earlier, she had undergone gastrectomy with the diagnosis of duodenal ulcer. By X-ray examination of the stomach, a Borrmann type I gastric cancer was suspected on admission. Endoscopic study of the stomach was performed, and a diagnosis of leiomyosarcoma was made from the biopsy specimens. Total gastrectomy was performed. On the resected specimen, a Borrmann type I like tumor measuring 4.5 X 5.5 X 3.2 cm was identified in the anterior part of the body of the remnant stomach. Histologically, the lesion was confirmed as leiomyosarcoma of the stomach.     

Pseudomyxoma peritonei of appendiceal origin. The Memorial Sloan-Kettering Cancer Center experience.

BACKGROUND. Pseudomyxoma peritonei is a rare clinical entity in which the peritoneal surfaces and omentum are involved with diffuse gelatinous mucinous implants. It originates from ruptured mucinous tumors of the appendix or ovary. METHODS. The authors examined the experience with 34 patients with pseudomyxoma peritonei seen at Memorial Sloan-Kettering Cancer Center from 1952-1989. Of these, 17 cases were identified to be of appendiceal origin. RESULTS. All patients underwent celiotomy and cytoreduction. The median survival time from diagnosis was 75 months. It was found that long-term survival can be achieved by operation alone. When conditions do recur, chemotherapy may be valuable. CONCLUSIONS. Pseudomyxoma peritonei of appendiceal origin is a rare low-grade malignancy. Initial treatment consists of cytoreduction in an attempt to render the patient locally disease-free. Long-term survival can be obtained by operation alone, even if gross disease is present at the end of the procedure. Systemic chemotherapy should be reserved for patients with proven recurrence.     

Successful treatment of pulmonary artery sarcoma by a two-drug combination chemotherapy consisting of ifosfamide and epirubicin

We describe a case of 63-year-old woman with pulmonary artery sarcoma successfully treated with chemotherapy. She developed acute shortness of breath, and left chest and shoulder pain. Although a diagnosis of acute pulmonary embolism was made at a local hospital and she received anticoagulation and thrombolysis therapy, no improvement was achieved. Thereafter, she underwent a pulmonary thromboectomy in our hospital, and the histological diagnosis was intimal sarcoma of the pulmonary artery. Since post-operative computed tomography (CT) scans of the chest showed obvious persistence of an intraluminal hypoattenuated area in the left main pulmonary artery, the patient was treated with four cycles of a doublet chemotherapy consisting of ifosfamide (2.5 g/m(2)/day) on days 1-5 and epirubicin (45 mg/m(2)/day) on days 2 and 3. CT scans of the chest after four cycles showed marked regression of the intraluminal hypoattenuated area in the left main pulmonary artery. This is the first case of pulmonary artery sarcoma responding to chemotherapy. Surgical resection is currently the most hopeful treatment for pulmonary artery sarcoma. However, intensive chemotherapy is worth trying in unresectable patients.     

Diffuse alveolar damage after ZD1839 therapy in a patient with non-small cell lung cancer

ZD1839 is an orally active inhibitor selective for the epidermal growth factor receptor tyrosine kinase and has shown promise in the treatment of non-small cell lung cancer (NSCLC). We now present a case of diffuse alveolar damage (DAD) that developed in a 67-year-old man treated with ZD1839. On day 8 of ZD1839 administration, the patient complained of dyspnea and a new-ground glass opacity was apparent on a chest X-ray and computed tomography scan. Despite high-dose steroid therapy, the patient died 13 days after the first administration of ZD1839. Postmortem analysis of lung tissue revealed a pattern of DAD. No evidence of infection or of other specific etiologies was apparent. This case is the first reported of respiratory failure after ZD1839 treatment in a patient with NSCLC. Physicians should therefore be aware of the potential pulmonary toxicity of ZD1839.     

Pneumothorax caused by metastatic carcinoma of the breast

We report a rare case of pneumothorax caused by metastatic carcinoma of the breast, in a 69-year-old woman who was admitted to our hospital with severe chest pain. Four years previously, she had undergone modified radical mastectomy for a left breast tumor. Chest X-ray examination and computed tomography (CT) scan on current admission revealed right pneumothorax and bilateral pulmonary tumors. Although operation is not usually indicated in such circumstances, the patient had persistent air leakage for 7 days, despite receiving effective closed cather drainage, making right thoracotomy necessary. During the operation, an open bronchopleural fistula in the metastatic tumor of the upper lobe, infiltrating close to the visceral pleura, was observed. Wedge resection, including the necrotic tumor, was thus performed. Microscopic examination of the resected specimen showed poorly differentiated adenocarcinoma, consistent with metastasis from breast carcinoma. This is the second reported case of pneumothorax caused by metastatic carcinoma of the breast. Received: February 17, 1999 / Accepted: October 4, 1999