Microangiopathic hemolytic anemia associated with gastric cancer

A case of advanced gastric cancer associated with metastatic carcinomatosis of the bone marrow, microangiopathic hemolytic anemia (MAHA) and disseminated intravascular coagulation (DIC) was reported. A 71-year-old woman complained of lumbago and general fatigue. At the time of admission, besides anemia, jaundice and a tendency to bleeding, the laboratory data showed, hyperbilirubinemia, elevated FDP and hemolytic anemia with fragmented red cells. The bone marrow was infiltrated by carcinoma, and an upper GI series examination showed Borrmann II type gastric cancer on the greater curvature of the antrum. After remission of both MAHA and DIC by mitomycin C, neothramycin and FOY, the patient successfully underwent subtotal gastrectomy. However, she died of cerebral hemorrhage on the 96th postoperative day.     

A case of microangiopathic hemolytic anemia associated with breast cancer: Improvement with chemoendocrine therapy

Microangiopathic hemolytic anemia (MAHA) is a term which describes the association of hemolytic anemia with red cell fragmentation caused by microangiopathy mechanically. This paper reports a 45-year-old woman with bone metastases from breast cancer. She developed MAHA and disseminated intravascular coagulation (DIC). Although the prognosis of MAHA associated with malignant tumor has been very poor, she achieved remission of the syndrome after chemoendocrine therapy.     

A case of recurrent rectal cancer with idiopathic thrombocytopenic purpura showing rapid progression, suggesting disseminated intravascular coagulopathy

A 64-year-old female with idiopathic thrombocytopenic purpura(ITP)was admitted to our hospital under the diagnosis of rectal cancer. Intersphincteric resection and splenectomy were performed after high-dose gamma globulin therapy. Thirteen months after the surgery, she suffered from a local recurrence and groin and pelvic lymph node metastases. Radiotherapy was planned before curative resection. During radiation, she complained of severe back pain and high fever with severe thrombocytopenia, and was admitted to our hospital. The examinations revealed disseminated intravascular coagulopathy(DIC), probably induced by multiple bone and hepatic metastases. Although anti-DIC therapy and chemotherapy with FOLFIRI were performed, thrombocytopenia did not improve, and she died of cancer progression about 2 months after admission. We report a case ofDIC induced by cancer progression with ITP. Since thrombocytopenia may be induced by either DIC or ITP, selecting a treatment for such a patient is difficult. We report the present case in detail and discuss findings from the literature.     

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.     

Malignant pheochromocytoma with ganglioneuroblastoma elements in a patient with von Recklinghausen's disease

A 14-year-old girl with numerous café-au-lait spots in her skin was hospitalized because of fever, weight loss, and a mass of the right upper quadrant of the abdomen. Despite intensive chemotherapy, she died 6 months after admission. The autopsy revealed a right adrenal tumor with metastases to liver, lungs, vertebrae, and lymph nodes. Histologically the tumor was a pheochromocytoma with small foci of ganglioneuroblastoma. The catecholamine contents of the tumor were markedly elevated, as confirmed by the catecholamine fluorescence technique. Electron microscopically, the tumor cells contained intracytoplasmic membrane-bound chromaffin granules of varying sizes and shapes. This may be the first report of the concomitant occurrence of malignant catecholamine-secreting pheochromocytoma with ganglioneuroblastoma elements in a patient with von Recklinghausen's disease.     

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.     

Diffuse bone metastasis with hematologic disorders from gastric cancer: clinicopathological features and prognosis

Bone metastases diffusely invading the bone marrow from gastric cancer often manifest a rapid clinical course and the prognosis is very poor due to hematologic disorders such as DIC (disseminated intravascular coagulation) and/or MAHA (microangiopathic hemolytic anemia). The objective of this study was to clarify the clinicopathological features and prognosis of patients with gastric cancer in whom diffuse bone metastasis associated with hematologic disorders were evident. Thirty-eight patients with bone metastasis from a primary gastric cancer were thus selected and placed into 2 groups consisting of 15 with diffuse bone metastasis with DIC and/or MAHA, and 23 patients who had bone metastasis without hematological disorders. We compared the clinicopathological features and prognosis between the two groups. The clinicopathological features in patients with diffuse bone metastasis accompanied by hematologic disorders were significantly related to undifferentiated adenocarcinoma, a relatively younger age, elevated levels of serum ALP-BI and LDH, and a lower frequency of extraosseous metastasis. The median survival time after manifestation was 2 and 11 months for the patients with or without hematologic disorders, respectively. The prognosis was significantly worse in cases of DIC with the median survival being only one month. Since, prognosis of diffuse bone metastasis from gastric cancer is significantly poor, close attention should be directed to the specific clinicopathologic features related to diffuse bone metastasis plus hematologic disorders. Regarding high risk patients, a regular follow-up of the serum chemistry levels and a bone scan will aid in the early detection of the disease.     

Homologous carcinosarcoma of the uterine corpus associated with tamoxifen therapy

A very rare case of homologous carcinosarcoma of the endometrium associated with long-term tamoxifen treatment for breast cancer is reported. A 70-year-old Japanese woman was admitted with atypical genital bleeding. Six years earlier, she had undergone total right mastectomy for breast cancer, and administration of tamoxifen had been started postoperatively. On admission, biopsy revealed a homologous carcinosarcoma of the endometrium with metastasis in the endocervix. The patient underwent a Wertheim's hysterectomy that revealed stage IIIc disease with pelvic lymph node metastasis. She received six courses of adjuvant chemotherapy. Histological examination showed a homologous carcinosarcoma, composed of poorly differentiated adenocarcinoma and anaplastic sarcoma. No heterologous elements; for example, malignant cartilage or rhabdomyoblasts, were seen. Tamoxifen is a possible etiologic factor in the development of endometrial carcinosarcomas. Received: July 2, 1999 / Accepted: December 22, 1999     

von Recklinghausen's disease associated with pheochromocytoma--an autopsy case report and review of 24 cases in the Japanese literature

A 56-year-old woman was admitted because of vomiting and right hypochondralgia. Since she was 25 years old, she had been sick with neurofibromatosis. Systemic neurofibromatosis with café-au-lait spots, blood hypertension and tenderness on the right hypochondrium were found. Ultrasonic examination revealed a right adrenal mass. Levels of serum catecholamines were elevated. She developed ileus and died of shock from the release of adrenal catecholamines. Postmortem examination showed right adrenal pheochromocytoma. The tumor measured 11.5 X 8 cm and weighed 25 gm. Von Recklinghausen's disease associated with pheochromocytoma is very rare, and only 24 cases have been reported in Japan. We present our case here with a review of the literature.     

A case of carcinomatous cardiac tamponade due to breast cancer treated with OK-432 and mitomycin C

The patient was a 40-year-old woman who was admitted to our hospital because of severe cough and dyspnea due to multiple lung metastases from breast cancer, who had undergone Auchincloss operation for right breast cancer about five years earlier. While systemic chemotherapy (CAF) was started after admission,she presented with cardiac tamponade. A cardiac echogram revealed marked retention of pericardial effusion. Pericardiocentesis was carried out, and the cytology of the effusion showed class V, resulting in the diagnosis of carcinomatous cardiac tamponade due to breast cancer. She was treated with intrapericardial chemotherapy using OK-432 and mitomycin C (MMC), and has not suffered from pericardial effusion after the intrapericardial chemotherapy. Intrapericardial chemotherapy using OK-432 and MMC may be very useful for malignant pericardial effusion.     

A case of asbestos exposure complicated by a malignant pheochromocytoma

Reported is a case of non-functioning malignant pheochromocytoma. The patient had an occupational history of asbestos exposure and pleural plaque was seen in the chest X-rays. The tumor appeared from right adrenal gland and its size was 12 x 15 cm, which was measured by CT scanning. This determined to be non functioning because catecholamines in the serum and VMA in the urine were within normal limits. A metastasis of this tumor was seen in the lung, the liver, and the bone. So far as is known, this is the first case of asbestos exposure complicated with malignant pheochromocytoma that has been reported in the Japanese literature.     

A case of advanced breast cancer leading to DIC after chemotherapy

We reported a case of DIC who was administered FEC90 (5-FU 1,000 mg/body, epirubicin 170 mg/body, cyclophosphamide 1,000 mg/body) for advanced breast cancer. A 55-year-old woman was referred to our hospital with lumbago. There was a huge tumor in her left breast (10x10 cm) and bone scintigraphy showed multiple bone metastasis, so she was treated with FEC90. Before the third course, DIC occurred. The patient was then treated with FOY and heparin, and the DIC was resolved. We think the DIC of this case was related with tumor lysis syndrome. Febrile neutropenia has been occasionally emphasized during chemotherapy, but due care must be taken for lymphocyte depletion during treatment.     

A histologically-verified triple cancer--report of a rare case involving a primary brain tumor

Histologically-verified triple cancers that include a malignant brain tumor are rare. According to the Japan Autopsy Annuals, only 8 cases since 1958 have been so far documented. A case combining a malignant melanoma, a medulloblastoma, and a thyroid cancer is herein presented, along with a review of the literature. In March, 1983, a 27-year-old female who, 7 years prior to admission, had had malignant melanoma on the right hand removed, complained of headaches and vertigo. A CT scan revealed a right cerebellar mass lesions, which subsequently proved to medulloblastoma. Three years later, a struma was found and subtotal thyroidectomy revealed a papillary adenocarcinoma.     

A case of malignant pericardial effusion due to breast cancer successfully controlled by intrapericardial chemotherapy using pirarubicin]

We report a case of malignant pericardial effusion due to breast cancer that was successfully controlled by intrapericardial chemotherapy using pirarubicin. A 53-year-old woman underwent breast conserving therapy for left breast cancer in 1996. She was given CAF therapy and UFT as adjuvant therapy. Three years and 10 months after operation, she had malignant pericardial and pleural effusion. Pericardiocentesis and pleurocentesis were performed immediately. Pericardial effusion relapsed after some time and she was treated with intrapericardial chemotherapy using pirarubicin. After this treatment she has not suffered from pericardial effusion for 1 year and 4 months to date. This case suggests that intrapericardial chemotherapy is effective for malignant pericardial effusion.     

A case of synchronous double cancer responding to UFT--dermoid cyst with secondary malignant transformation and uterine endometrial adenocarcinoma

We report here a case of synchronous dermoid cyst with secondary malignant tumor and uterine endometrial adenocarcinoma that responded to UFT. A 35-year-old female complained of abdominal fullness and visited our hospital. She had an abdominal mass which was newborn-head size. We performed right salpingo-oophorectomy and partial omentectomy. The pathological findings were dermoid cyst with secondary malignant transformation. After the operation she had underwent cyclic chemotherapy with CDDP, CPA, THP and 5-FU. After three cycles of chemotherapy, a uterine recurrence was suspected from her uterine endocervical smear test. Then we performed a second operation, but radical surgery was impossible due to the presence of multiple metastases to pelvic lymph nodes. The pathological findings were primary uterine endometrial adenocarcinoma, not metastasis from dermoid cyst with secondary malignant tumor. After the second operation, she was treated with oral UFT (400 mg/day), as she refused chemotherapy and radiotherapy. Two months after the start of UFT, the tumor markers were reduced remarkably, and the patient maintained good QOL throughout the treatment without serious adverse events. We conclude that UFT might be benefical in the treatment of advanced gynecologic cancer.     

A case of Stage IV non-operated advanced breast cancer with local recurrence thirteen years after initial therapy

A 73-year-old woman underwent chemotherapy, radiotherapy, and hormonal therapies for right advanced breast cancer (T4, N3, M1, Stage IV) in 1993. She obtained a complete response in pathological evaluation (pCR) in 1998. For adjuvant therapies, she had been treated with hormonal therapies for five years until 2003. After the interruption of hormonal therapies, the serum levels of tumor markers had been elevated, and she had a right axillary local recurrence and a right ovarian metastasis detected by a FDG-PET/CT in February 2006. The right axillary local recurrence lesion was then resected, and she has since been treated with hormonal therapy of aromatase inhibitor (AI). The serum levels of tumor markers have been remarkably reduced, and FDG-PET/CT has showed the disappearance of the right axillary local recurrence, and the decrease of FDG accumulation of the right ovarian metastases in February 2007. We present a case of non-operated advanced breast cancer with local recurrence surviving successfully long term when treated with AI.     

A case of recurrent breast cancer with bone marrow metastasis treated with weekly paclitaxel therapy

A 44-year-old woman with bone marrow metastasis from breast cancer was treated with weekly paclitaxel therapy. She underwent radical mastectomy for right breast cancer (T2N1M0, Stage II B) in April 2003, and was then treated with hormonal therapy (leuprorelin). In November 2005, she received radiation for bone metastasis in thoracic and lumbar vertebrae, and bisphosphonate therapy was performed. Additional hormonal therapy (tamoxifen) was administered for progressive bone metastasis. However, in September 2006, pancytopenia was recognized and bone marrow metastasis was diagnosed by bone biopsy. Disseminated intravascular coagulation (DIC) developed, so she was given weekly paclitaxel therapy with blood transfusion and G-CSF injection. Improvement of pancytopenia and tumor markers was recognized temporarily, and but 3 months later the tumor markers increased again. Four months after introduction of chemotherapy, she died of gastrointestinal hemorrhage.     

Irinotecan as second-line chemotherapy for 5-FU-resistant gastric cancer with disseminated intravascular coagulation: a case report

A 60-year-old female was diagnosed as advanced gastric cancer with multiple bone, neck and mediastinal lymph node metastases. As a primary chemotherapy, she was treated with S-1(50 m g/body, twice daily for 4 weeks, followed by a 2- week rest). After 3 courses of S-1, she developed a disease progression with pulmonary lymphangitic carcinomatosis and disseminated intravascular coagulation(DIC). Therefore, she received second-line chemotherapy of irinotecan(CPT-11 150 mg/m2, biweekly). Within 3 weeks of starting the treatment, the clinical and laboratory signs of DIC were dramatically resolved. There have been no previous reports of irinotecan alone showing such remarkable effectiveness in a patient with 5- FU-resistant gastric cancer with DIC.     

A case of triple malignant tumors consisting of esophagus, stomach and malignant lymphoma with a histopathological feature of collision between gastric cancer and malignant lymphoma--a case report

We report a rare case of a collision between a gastric cancer and a malignant lymphoma with a wide systemic metastasis, combined with esophagus cancer, stomach cancer and malignant lymphoma. A 73-year-old man complained of gross hematuria and swelling of the right testis. Magnetic resonance imaging (MRI) revealed that both testes were swollen with unequal contrast and there were numerous tumors in the retroperitoneal space and pelvis. He was diagnosed with malignant diffuse large B cell lymphoma by immunostaining from the extirpated right testis. He received six cycles of R-CHOP therapy. After the second cycle, partial remission was recognized, but the tumors spread again by the fourth cycle. Thereafter, we performed MTX-HOPE therapy as a salvage therapy for four cycles. During this chemotherapy, he felt epigastralgia; esophagus cancer (squamous cell carcinoma) and stomach cancer (highly-differentiated adenocarcinoma) were found by upper endoscopy. However, the gastrointestinal cancer was inoperable, since the malignant lymphoma was progressive. His general status had been exacerbated, and he died about one year after he was diagnosed with malignant lymphoma. Pathological examination revealed that the adenocarcinoma had partly collided with the malignant lymphoma.     

Acute aggravation of subdural fluid collection associated with dural metastasis of malignant neoplasms: case report and review of the literature

A 63-year-old woman was admitted to our hospital with serious headache and vomiting. Five months before admission, she had undergone surgery for a primary advanced gastric cancer. Neuroradiological examinations revealed subdural fluid collection. We twice performed evacuation of the subdural fluid collection. However, aggravation of her state of consciousness progressed and she passed away. Histological examinations demonstrated that the dural veins were infiltrated by numerous tumor cells that produced mucus; however, ruptured vessels were not found. Furthermore, the subdural fluid collection increased shortly after the initial operation. We infer that the cause of the collection, which was associated with the dural metastasis of malignant tumors, was not only mucin secretion by tumor cells but also a rapid increase in perfusion pressure in the vessels of the dura mater, resulting in extravasation of plasma components into the subdural space. Our case demonstrates that the pathogenetic mechanism that is specific for subdural fluid collection caused by dural metastasis of malignant tumors differs from the mechanism of production of subdural hematoma associated with dural metastasis.