A case of breast cancer diagnosed by inguinal lymph node metastasis

We describe a case of a 58-year-old woman with right inguinal lymph node swelling and a T1 tumor in the right breast. She was referred with an 18-month history of the former complaint and a six-month history of the latter. Excisional biopsy of the inguinal lymph node revealed breast cancer metastasis. Radiographical examination showed no metastases to the lungs, liver or bone. Modified radical mastectomy was performed. Histological examination revealed solid tubular carcinoma, PT2, PM (axillary lymph node metastases 4/16), stage IV. Estrogen and progesterone receptors were negative. Three cycles of postoperative cyclophosphamide, adriamycin and 5-fluorouracil (CAF) chemotherapy were given, and the right inguinal area was irradiated with 40 Gy. The patient complained of swelling in both legs three years after surgery. Computed tomography revealed marked lymph node swellings in the pelvic cavity. She died six months later. Inguinal lymph node metastasis from breast cancer is very rare, although distant lymph node metastasis in the cervix occurs frequently. This case should help clarify how breast cancer metastasizes to distant lymph nodes.     

A 6-year-survival case of esophageal adenosquamous cancer with liver metastases cured by multidisciplinary therapy

A 65-year-old man was diagnosed as esophageal cancer with multiple liver metastases (S2 10 mm, S7 10 mm, S8 15 mm). The preoperative diagnosis was stage IV (T 3 N 3 M 1 Pl 0), and he was operated palliatively by esophagocardiofundectomy and intrathoracic anastomosis for oral food intake. The postoperative histological diagnosis was adenosquamous carcinoma. One month after the operation he was administered orally UFT-E (300 mg/day) and PSK (3g/day). He was also treated by hepatic arterial infusion therapy with CDDP (10 mg/week). After 180 mg of CDDP, liver metastases were evaluated for PR. This therapy was discontinued after 410 mg of CDDP by vomiting and hypotension. 16 months after, DOC (20 mg/week) was given by arterial infusion and CR of liver metastases was achieved 18 months after. Then he was given 840 mg of DOC and oral administration of UFT-E and PSK was performed for about 5 years. He was free from the recurrence of cancer as an outpatient and had a good QOL. We think that esophageal cancer with liver metastasis should be aggressively treated surgically so as to allow oral food intake, and liver metastasis should be treated with chemotherapy because postoperative hepatic arterial infusion therapy is effective and provides a good QOL.     

A case of successfully treated lower rectal cancer with both inguinal lymph nodes by chemoradiotherapy

We report a case of successfully treated lower rectal cancer with both inguinal lymph nodes by chemoradiotherapy. A 59-year-old man presented with anal pain. A colonoscopy revealed primary rectal cancer. The histological diagnosis was well to moderately differentiated adenocarcinoma. A computed tomography showed metastases to pararectal, both inguinal lymph nodes and right external iliac. After a ileostomy construction was done, he was treated with intensity modulated radiotherapy (a total 50.4 Gy) and chemotherapy with FOLFOX. The primary tumor had completely disappeared, and metastases to lymph nodes showed a remarkable shrinkage after the chemoradiotherapy. Nine months after radiation therapy, however, multiple lung and liver metastases were observed by a computed tomography, which were treated by systemic chemotherapy with FOLFOX and bevacizumab. The primary tumor and metastases to lymph nodes are still controlled well for 2 years after the initial chemoradiotherapy.     

State III large cell carcinoma of the lung cured by radiotherapy--a case report

Presented is the case of a 61-year-old male whose chief complaints were hoarseness, cough, and bloody sputum. Chest radiography demonstrated a left hilar mass with mediastinal widening, a peripheral localized infiltrate and the elevation of the left hemidiaphragm. By means of a mediastinoscopy, a biopsy was done on the enlarged mediastinal lymph node and a histological diagnosis of a large cell carcinoma was confirmed. He was graded as in Stage III (T2N2M0) and was placed under radiotherapy with 60Co. Complete response was obtained after a total dose of 6150 cGy. Following this radiotherapy, he was given multiple courses of mild chemotherapy and the disease as of this report has been under control for 7 years. This case may be unusual, but suggests the possibility of a cure of lung cancer by irradiation under certain conditions.     

A case of advanced transvers colon cancer with inguinal lymph node metastasis

An 80-year-old woman complaining of a right inguinal induration and pain was performed an inguinal lymph node resection. Histological examination with immnohistochemistry revealed that the lymph node was metastasis of colon carcinoma. With total colonoscopy, she was diagnosed as advanced transvers colon cancer with right inguinal lymph node metastasis. She was performed a right hemi-colectomy. She was dead with peritoneal metastasis of colon cancer 2 years and 1 month later. We report this case that was diagnosed having transverse colon cancer with inguinal lymph node metastasis.     

A case of ascending colon carcinoma metastasized to an inguinal hernia sac

While inguinal hernia is one of the most common diseases, metastatic cancer of an inguinal hernia sac is rare. We report a case of ascending colon cancer metastasized to an inguinal hernia sac. A 60-year-old man, who was undergone a right hemicolectomy for an ascending colon cancer, was pointed out a palpable inguinal mass at one year and eight months after the operation. He was diagnosed as inguinal hernia, and herniorrhaphy was performed. In the operation, a tumor of the inguinal hernia sac, which invaded to spermatic cord, could be found and was removed with right testis. Bassini's method was performed after the resection of the inguinal tumor. Histological examination revealed that the tumor was metastasis of colon carcinoma. Examination of the entire body showed no other metastasis. As for the advanced colon cancer, we need to mention the possibility of metastatic saccular tumor.     

A case of docetaxel-induced acute lung injury refractory to treatment

A 59-year-old man was diagnosed with squamous cell cancer of the upper lobe of the left lung 11 months before his current admission. The clinical stage was T2N3M1(Stage IV). We started chemotherapy(carboplatin/gemcitabine), which was administered for 7 courses and discontinued 5 months before admission, but he subsequently showed a local relapse. Therefore, we restarted second-line chemotherapy(docetaxel)on admission. Only a single dose of docetaxel was administered, but the patient was diagnosed with respiratory failure 18 days afterwards. The chest roentgenogram and computed tomography showed ground-glass opacities. Bronchoalveolar lavage and blood test data showed no evidence of infection. We diagnosed the patient with acute lung injury induced by docetaxel. The patient was admitted to the intensive care unit, and therapy with steroids and sivelestat was initiated. In addition, artificial respiration, direct hemoperfusion with a polymyxin B-immobilized fiber column, etc., were performed. However, this intensive care regimen was unsuccessful, and the patient died 31 days after docetaxel administration. Docetaxel is generally used in the treatment of non-small-cell lung cancer. However, the present case showed that its use might lead to fatal drug-induced lung injury.     

Successful treatment of refractory hepatic lymphorrhea after gastrectomy for early gastric cancer,using surgical ligation and subsequent OK-432 (Picibanil) sclerotherapy

Postoperative hepatic lymphorrhea is a very rare complication after abdominal surgery. Hepatic lymphorrhea, not containing chyle, involves an internal lymph fistula between the lymphatic channels toward the cisterna chyli and the peritoneal cavity. Over the past 20 years, 17 cases have been reported in Japan. Here, we report a further case, of a patient with successfully treated intractable hepatic lymphorrhea following gastrectomy for early gastric cancer. We review 18 cases, including the present case, with respect to the management of postoperative lymphorrhea refractory to conventional medical treatment.     

Long survival of a colon cancer case with multiple liver metastases cured by multidisciplinary therapy

The patient was a 79-year-old a man who had a sigmoid colon resection for sigmoid colon carcinoma in another hospital 11 years ago. Four years later,he was noted to have multiple unresectable hepatic metastases on CT. Therefore,intrahepatic arterial and portal infusion with CDDP 10 mg + 5-FU 250 mg, respectively,were started. His CEA level decreased to the normal range,and a partial response (PR) was achieved. But two years later, the CEA level increased again,so radiofrequency ablation (RFA) therapy was given during abdominal surgery. Then, IFL, CPT-11+S-1, and FOLFOX were administered. Currently, the patient is being treated as an outpatient with CPT-11+S-1. The patient's multiple hepatic metastases were treated with multidisciplinary therapy, and the man has lived for 6 years 11 months since his first hepatic metastases were noted. The multidisciplinary therapy that was used lengthened this patient's life.     

A case of anal canal cancer with pagetoid spread and inguinal lymph node involvement

We report a rare case of pSM anal canal cancer with pagetoid spread and inguinal lymph node involvement. A 74-year- old woman was admitted to our hospital complaining of a perianal erythematous lesion. Preoperative skin biopsy revealed an infiltration of pagetoid cells and signet-ring cell carcinoma cells, which were positive for CK20 and negative for GCDFP 15 by immunohistochemical stainings. Colonoscopy demonstrated an elevated lesion located just above the dentate line. Total pelvic exenteration with lateral and inguinal lymph node dissection followed by skin reconstruction with gluteal thigh flap was performed. Histological examination of the anal tumor revealed moderately differentiated adenocarcinoma infiltrating the submucosa( pSM) with left lymph node involvement. We should note that pSM anal canal cancer with pagetoid spread might cause inguinal lymph node metastasis, even though such cases have rarely been reported in the literature.     

Targeting cancer chemotherapeutic agents by use of lipiodol contrast medium

Arterially administered Lipiodol Ultrafluid contrast medium selectively remained in various malignant solid tumors because of the difference in time required for the removal of Lipiodol contrast medium from normal capillaries and tumor neovasculature. Although blood flow was maintained in the tumor, even immediately after injection Lipiodol contrast medium remained in the neovasculature of the tumor. To target anti-cancer agents to tumors by using Lipiodol contrast medium as a carrier, the characteristics of the agents were examined. Anti-cancer agents had to be soluble in Lipiodol, be stable in it, and separate gradually from it so that the anti-cancer agents would selectively remain in the tumor. These conditions were found to be necessary on the basis of the measurement of radioactivity in VX2 tumors implanted in the liver of 16 rabbits that received arterial injections of 14C-labeled doxorubicin. Antitumor activities and side effects of arterial injections of two types of anti-cancer agents were compared in 76 rabbits with VX2 tumors. Oily anti-cancer agents that had characteristics essential for targeting were compared with simple mixtures of anti-cancer agents with Lipiodol contrast medium that did not have these essential characteristics. Groups of rabbits that received oily anti-cancer agents responded significantly better than groups that received simple mixtures, and side effects were observed more frequently in the groups that received the simple mixtures. These results suggest that targeting of the anti-cancer agent to the tumor is important for treatment of solid malignant tumors.     

A case of gastric cancer with multiple liver metastasis treated with transarterial and transportal chemoembolization of tegafur/lipiodol and epirubicin]

A 56-year-old woman was admitted for advanced gastric cancer (S3H3N3P2 Stage IV). She underwent subtotal gastrectomy, left ovariectomy, and catheterization of the hepatic artery. Pre- and postoperative adjuvant chemotherapies consisting of tegafur, epirubicin, mitomycin C and cisplatin were performed. Two months after surgery, combination of transhepatic arterial and transportal chemoembolization with tegafur 400 mg/lipiodol 3 ml and epirubicin 20 mg was especially effective for this patient. The metastatic lesions of the liver regressed by 85% on computed tomography and the CEA level in the plasma decreased from 51.3 to 5.1 ng/ml. The response was judged partial response (PR), and the patient is now in good general condition.     

免疫检查点抑制剂联合化疗治疗难治性高级别B细胞淋巴瘤非特指型1例及文献复习

目的:回顾性分析1例难治性高级别B细胞淋巴瘤非特指型老年患者应用免疫检查点抑制剂联合化疗的疗效.方法:分析该病例的治疗经过,探讨选择免疫检查点抑制剂联合化疗对难治性高级别B细胞淋巴瘤的作用,并结合相关文献资料进行复习.结果:该例高级别B细胞淋巴瘤非特指型老年患者经过多程化疗后进展,因基础疾病、合并症及化疗耐受性等因素导...     

Treatment of refractory metastatic choriocarcinoma with tandem high-dose chemotherapy supported by peripheral blood stem cell transplantation: A case report

Currently, 70% to 80% of patients with advanced germ cell tumors can be cured with cisplatin-based chemotherapy, followed by surgical resection of the residual tumor. The prognosis, however, is uniformly poor for patients who fail to respond to induction chemotherapy. In this report, we describe a patient with retroperitoneal choriocarcinoma and multiple lung metastases, who was refractory to cisplatin-based chemotherapy, but who achieved a durable marker-negative partial response after 2 cycles of high-dose chemotherapy, supported by autologous, peripheral blood stem cell transplantation. The patient is now alive and well, without recurrence, more than 24 months after this therapy.     

A case of refractory pancreatic fistula following pancreaticoduodenectomy treated successfully by intestinal decompression catheter insertion to jejunum under local anesthesia

The case was an 80-year-old woman with inferior bile duct cancer. The patient had undergone subtotal stomach-preserving pancreaticoduodenectomy with end-to-side pancreaticojejunostomy. Postoperative pancreatic fistula was observed in a short period and was treated by somatostatin analog administration and abscess drainage. Despite these conservative therapies, pancreatic fistula resulted in abdominal bleeding from the branch of dorsal pancreatic artery, which stopped by emergent transcatheter arterial embolization. Because pancreatic fistula had become refractory, the intestinal decompression catheter insertion was performed under local anesthesia to the jejunum located directly below abdominal wall. After this surgery, pancreatic fistula was resolved over a few weeks. This technique could be safely performed and avoided the injury of drainage fistula, and was considered to be an option for treating refractory pancreatic fistula.     

Superficial angiomyxoma of the right inguinal region: report of a case

We report one rare case of superficial angiomyxoma of the right inguinal region, in a 67-year-old man. The tumor, measuring 4.5 x 4.0 x 3.0 cm, had a finger-like shape, was composed of a well circumscribed conglomerate of multiple myxomatous nodules and was located partially in the dermis and partially in the subcutaneous tissue. Microscopically, in contrast to previously reported cases, the tumor was composed mainly of oval plump stromal cells with an amphophilic cytoplasm. Spindle-shaped stromal cells were scattered throughout the tumor. The tumor border was not infiltrative and was well defined by thick hyalized collagen bundles. Neither hyperchromasia nor pleomorphism was apparent. No mitotic figures were detected in the specimens prepared. Small to medium-sized blood vessels showed a scattered distribution, but large vessels, seen frequently in aggressive angiomyxoma, were absent. Moreover, no plexiform capillary pattern was evident. These findings were diagnostic of superficial angiomyxoma. Although this disease entity is considered as including cutaneous focal mucinosis, follicular fibroma, trichofolliculoma and trichogenic adnexal tumor, we propose that these tumors should be excluded.      

Carcinoma of unknown primary in the inguinal lymph node region of squamous cell origin: A case series

PurposeCancer of unknown primary (CUP) of the inguinal region is a rare clinical entity that accounts for 1%-3 % of all CUPs. Of the inguinal lymph node region CUPs, about 10%-15% are of squamous cell origin. This study presents a case series of CUP of the inguinal region of squamous cell origin treated in our institution and review of the outcome.Methods and materialsWe have identified 9 patients treated during the period of 1990-2010. All patients were treated radically with chemoradiation. Regimens used were 5-fluorouracil (5-FU)/cisplatin combination (n = 8) or 5-FU/mitomycin-C (n = 1) regimen. Tumor doses were 5400 cGy (n = 7), 5500 cGy (n = 1), and 5040 cGy (n = 1).ResultsThe median duration of follow-up was 56 months (range, 10-76 months) for the whole group. There were no deaths or local or distant recurrences reported till the last recorded date of follow-up.ConclusionsOur retrospective data showed significant long-term disease control for patients with localized inguinal region CUP of squamous cell origin who received concurrent chemoradiation.     

重组人粒细胞巨噬细胞集落刺激因子治疗羟基脲致皮肤顽固性溃疡1例报道

目的:观察重组人粒细胞巨噬细胞集落刺激因子(recombinant human granulocyte/macrophage colony-stimulating factor(rhGM-CSF))治疗慢性粒细胞白血病服羟基脲导致皮肤顽固性溃疡的疗效,探讨rhGM-CSF促进溃疡愈合的作用机制。方法:对常规治疗与在常规治疗基础上局部应用rhGM-CSF进行比较,观察溃疡愈合情况。结果:局部应用rhGM-CSF疗效明显。结论:rhGM-CSF能促进溃疡愈合。