A case of esophageal cancer with excellent response to oral UFT treatment

The patient was an 83-year-old Japanese male with the chief complaint of difficulty in swallowing. On Feb. 24, 1997, he was referred to our hospital under suspicion of esophageal cancer. X-P revealed an image of a protrusion at Im-Iu having a long diameter of 6 cm. Endoscopy revealed that the esophageal lumen was nearly completely obstructed due to the presence of an irregularly-shaped tumor. The pathological finding of biopsized specimen was a squamous cell carcinoma. Thus, this case was diagnosed as esophageal cancer, but surgery was deemed inappropriate due to the patient's advanced age. Accordingly, on March 12, treatment was started with oral administration of UFT-E granules (Tegafur, 450 mg/day). Initially, the patient was unable to ingest even liquids, but beginning around May the blockage of the esophagus disappeared. Endoscopic examination performed in June revealed that the tumor had shrunk to a about 1 cm in diameter. Although tumor tissue remained, the tumor was observed to have undergone further reduction in size at 6 months after the start of chemotherapy. Moreover, the patient gained weight. This is considered to be a very rare case of an excellent response of esophageal cancer to oral administration of only UFT agents.     

A case study of alpha feto protein (AFP)-producing gastric carcinoma with multiple liver metastases, in which chemotherapy was effective enough to once save a life in rapid decline

A 57 year-old man visited our hospital with general fatigue and a sensation of abdominal fullness. He had lost 10 kg in body weight during the previous 3 months. Between admission and the time the diagnosis of AFP-producing gastric carcinoma with multiple liver metastases was made, his condition deteriorated quickly due to the rapid growth of the liver metastases. Combined chemotherapy consisting of cisplatin and 5-FU was given, and was so effective that the patient recovered well and both serum AFP level and the size of the swollen liver decreased markedly. However, about a month after being discharged, he experienced a relapse and was readmitted. After obtaining informed consent, chemotherapy consisting of methotrexate and 5-FU was started. Though the level of tumor markers and LDH decreased significantly, he died of hepatic failure. We think that this case is worthy of notice because it shows the effectiveness and limitations of chemotherapy in a situation where the condition of a patient is deteriorating quickly due to rapid extension of an AFP-producing gastric carcinoma.     

A case of colorectal cancer showing complete response to UFT

A 33-year-old male patient underwent a low anterior resection for sigmoid colon cancer. Bloody stool developed about one month after discharge and a small, circumscribed, ulcerated adenocarcinoma was found about 1 cm anal to the site of anastomosis. After oral administration of FT 0.6 g/day for 42 days, UFT 0.6 g/day was administered successively. As a result, complete tumor response was observed within about four months. UFT 0.3 approximately 0.6 g/day has been administered daily since then. The patient has been in good health without any sign of relapse for three years after achievement of the complete response.     

Response of a thymic mucoepidermoid carcinoma to combination chemotherapy with cisplatin and irinotecan: a case report

A chemotherapeutic regimen for advanced thymic carcinoma has not yet been established. We describe a patient with advanced thymic mucoepidermoid carcinoma who achieved a complete response to combination chemotherapy with cisplatin (Randa) and irinotecan hydrochloride (Campto). A 74-year-old man was admitted to our hospital because of chest pain, general fatigue, appetite loss and weight loss. Chest computed tomography examinations revealed an anterior mediastinal tumour (5.5cmx3.5cmx9.5cm) that had invaded the subcutis through the sternum. The patient was treated with three courses of cisplatin and irinotecan hydrochloride followed by radiotherapy; he has since exhibited a complete response for 3 months.     

A case of advanced gastric cancer responding to neoadjuvant TS-1/CDDP chemotherapy

The patient was a 61-year-old man who was referred to our hospital with a complaint of epigastric pain. Upper gastrointestinal endoscopy and X-ray examination of the stomach revealed type 3 cancer in the gastric antrum, extending to the middle body. It was about 9 cm in diameter, and the biopsy specimen revealed moderately differentiated tubular adenocarcinoma. Abdominal CT scan showed marked enlargement of No. 3 lymph nodes along the lesser curvature of the stomach. Examination of the blood showed a hemoglobin of 10.2 g/dl, CEA 5.8 ng/ml, CA19-9 330.5 U/ml. For this gastric cancer, clinical Stage IIIA (cT3N1HOPOMO), neoadjuvant chemotherapy with TS-1/CDDP was planned. TS-1 (120 mg/day) was orally administered for 3 weeks followed by a drug-free-2-week period as the first course, and 93 mg (60 mg/m2) of CDDP administered by intravenous drip on day 8. There were grade 2 nausea and grade 3 appetite loss by intravenous administration of CDDP in the second course. An upper GI series revealed 33% reduction of gastric cancer, and laboratory studies CEA and CA 19-9 showed normal values. One month after the second course of chemotherapy, total gastrectomy, splenectomy and lymph node dissection D2 were performed. The pathological specimens showed no cancer cells in the surgically obtained stomach and lymph nodes, so the histological effect was Grade 3. The postoperative course was satisfactory, and he now attends outpatient department without any findings of recurrence 12 months after the operation. TS-1/CDDP chemotherapy produced a high response in this case, and it may be useful as neoadjuvant chemotherapy for advanced gastric cancer.     

A case with hepatocellular carcinoma with complete remission due to gamma-IFN therapy

A 65-year-old male was admitted to our hospital with the aim of closer examination of SOL in cirrhotic liver. By abdominal echography, CT and angiography etc., he was diagnosed as LC with multiple HCC, one in S5 about 2.0 cm, another in S1 about 5.0 cm in diameter, and other four small nodules in right lobe. We treated him with recombinant gamma-IFN at dose of 1.6 X 10(7) units/day for 5 consecutive days biweekly. Although until two months the tumours were gradually enlarged in size, then they became smaller, and at five months later after the beginning of gamma-IFN therapy the tumor stains in angiogram disappeared. Then we performed the surgical treatment. Both macro and microscopical findings of tumor specimens in S5, 2. 2 X 2.0 X 1.9 cm in size, showed complete necrotic tissue. Additionally the yellowish small tumor was found on surface of S8, and it was adenomatous hyperplasia histologically.     

A case of liver metastasis of colon cancer responding remarkably to 5'-DFUR

A 65-year-old man was referred to our hospital because of diarrhea due to sigmoid colon cancer. Abdominal CT scan revealed a hepatic tumor (S8) about 2 cm in diameter. We performed a sigmoidectomy and planned to resect the liver metastasis 1 or 2 months later. Pathological findings showed moderately differentiated adenocarcinoma, s, n1. Two weeks after the surgery, 5'-DFUR was administered at 600 mg/day. An abdominal CT scan 2 months later demonstrated regression of the liver metastasis and another scan 4 months later showed the tumor had disappeared. 5'-DFUR was administered for about 2 years. Five years after the surgery, the patient is alive without recurrence and CEA level is in normal range.     

Management of diabetes and pancreatic cancer

A 54-year-old male patient named D.N. developed type 2 diabetes mellitus (T2DM) 10 months ago. At the time, he weighed 225 pounds and had a body mass index of 35.2. D.N. was started on metformin with poor control and, within two months, glimepiride was added to his regimen. Six months later, D.N.'s hemoglobin A1c (HbA1c) was still above 8% (normal is less than 6%), so his endocrinologist added exenatide. He had a fairly well controlled fasting blood glucose and HbA1c ranging from 6.5%-7.3% after exenatide was added. One month later, however, D.N. developed abdominal pain and anorexia with a 20-pound weight loss. His blood glucose became extremely labile despite his poor oral intake and good compliance with his oral hypoglycemic agents.     

A case of long-term survival of a patient with intrahepatic bile duct cancer and early nodal recurrence who responded to S-1 therapy

A 71-year-old man was referred to our hospital for further evaluation of hepatic dysfunction. A diagnostic workup revealed an intrahepatic bile duct cancer, and a right hepatic lobectomy was performed. Postoperative adjuvant chemotherapy with gemcitabine (1,000 mg/m2, given for 3 weeks, followed by a 1 week rest) was begun. Because grade 3 anorexia developed, the dose of gemcitabine was decreased to 800 mg/m2 from the third cycle of chemotherapy. Computed tomography showed nodal recurrence 6 months after surgery. One year after surgery, computed tomography revealed an extensive periaortic nodal recurrence, as well as recurrence in the remnant liver. Treatment was switched to S-1 (100 mg/ day, given for 3 weeks, followed by a 1 week rest). Grade 3 thrombocytopenia was developed during the tenth cycle of therapy. The treatment schedule was therefore changed to 3 weeks of therapy, followed by a 2 week rest. From the 36th cycle, the dose of S-1 was lowered to 80 mg/day (given for 2 weeks, followed by a 2 week rest). Nodal recurrence was resolved in 2 years after the start of treatment with S-1, and recurrence in the remnant liver nearly resolved in 4 years after starting the treatment, indicating a partial response. The carcinoembryonic antigen level fell to the normal range and the CA19-9 level remains at about 100 U/mL. Although the patient had grade 2 thrombocytopenia, he is now receiving the 43rd cycle of S-1 and remains alive for 5 years and 1 month after surgery. We believe that the continuation of chemotherapy while monitoring the patient's general condition led to an improved outcome.     

Application of Everolimus in Preoperative Neoadjuvant Therapy of Tuberous Sclerosis Complex Associated With Renal Angiomyolipoma: A Single-Center Report of 5 Cases

BackgroundThe purpose of the study was to investigate the efficacy and safety of everolimus in preoperative neoadjuvant therapy of tuberous sclerosis complex (TSC) associated with renal angiomyolipoma (RAML).Patients and MethodsThe clinical data of 5 patients with TSC associated with RAML who were admitted to our hospital from May 2014 to December 2017 were analyzed. All patients received once per day everolimus 10 mg oral treatment for 3 months, and the efficacy and safety were evaluated at 1 month and 3 months after drug treatment, respectively. All patients received partial nephrectomy (PN) 1 week after drug withdrawal.ResultsAfter 1 month of treatment with everolimus, the median greatest tumor diameter (GTD) decrease was 1.8 cm (range, 1.0-4.5 cm). After 3 months of treatment, the median GTD reduction was 2.5 cm (range, 1.0-5.0 cm). The main adverse reactions included oral mucositis in 4 cases, menstrual disorder in 2 cases, and urinary tract infection in 1 case. The median surgery time was 110 minutes (range, 80-130 minutes), the median intraoperative blood loss was 70 mL (range, 50-400 mL), and the median postoperative hospital stay was 6 days (range, 5-7 days). After a median follow-up of 24 months (range, 6-30 months), no tumor with a diameter of >4 cm was found except for 1 recurrence.ConclusionThe preservation of renal function is the most important thing for patients with TSC associated with bilateral RAML. For some patients who cannot receive PN, neoadjuvant therapy with everolimus might be considered before the surgery so as to give patients the chance of PN.     

Weekly paclitaxel therapy effective for gastric cancer with obstructive jaundice due to peritoneal dissemination--a case report

The patient was a 61-year-old man who suffered from advanced gastric cancer, and a distal gastrectomy was performed (T3N2P1CY1, Stage IV). He was treated with chemotherapy of TS-1 alone (100 mg/day, days 1-28 with two weeks rest). Six months later he complained of lumbago and appetite loss, then was admitted to the hospital with obstructive jaundice. Total bilirubin (T-Bil) was increased to 11.3 mg/dl. CT scan examination revealed peritoneal dissemination with much ascites and dilatation of intrahepatic bile ducts. Endoscopic drainage was tried, but was discontinued due to stenosis of gastroduodenal anastomosis. Ultimately, T-Bil was elevated to 25.2 mg/dl, and he could not sleep comfortably because of a severe itch and an irritating feeling. Weekly paclitaxel therapy was started (70 mg/m(2), day 1, 8, 15, once a week for 3 weeks followed by a week rest as one cycle). One month after the first infusion therapy, the obstructive jaundice was notably improved and the ascites disappeared completely, so he was discharged. For about one year, he was treated with this chemotherapy as an outpatient. The toxic events were anemia (grade 3) and alopecia (grade 1).     

Health-related quality of life in patients with locally advanced prostate cancer after 76 Gy intensity-modulated radiotherapy vs. 70 Gy conformal radiotherapy in a prospective and longitudinal study

PURPOSE: To compare quality of life (QoL) after 70 Gy conformal radiotherapy with QoL after 76 Gy intensity-modulated radiotherapy (IMRT) in patients with locally advanced prostate carcinoma. METHODS AND MATERIALS: Seventy-eight patients with locally advanced prostate cancer were treated with 70 Gy three-field conformal radiotherapy, and 92 patients received 76 Gy IMRT with fiducial markers for position verification. Quality of life was measured by RAND-36, the European Organization for Research and Treatment of Cancer core questionnaire (EORTC QLQ-C30(+3)), and the prostate-specific EORTC QLQ-PR25, before radiotherapy (baseline) and 1 month and 6 months after treatment. Quality of life changes in time (baseline vs. 1 month and baseline vs. 6 months) of > or =10 points were considered clinically relevant. RESULTS: Differences between the treatment groups for QoL changes over time occurred in several QoL domains. The 76-Gy group revealed no significant deterioration in QoL compared with the 70-Gy group. The IMRT 76-Gy group even demonstrated a significantly better change in QoL from baseline to 1 month in several domains. The conformal 70-Gy group revealed temporary deterioration in pain, role functioning, and urinary symptoms; for the IMRT 76-Gy group a better QoL in terms of change in health existed after 1 month, which persisted after 6 months. For both treatment groups temporary deterioration in physical role restriction occurred after 1 month, and an improvement in emotional role restriction occurred after 6 months. Sexual activity was reduced after treatment for both groups and remained decreased after 6 months. CONCLUSIONS: Intensity-modulated radiotherapy and accurate position verification seem to provide a possibility to increase the radiation dose for prostate cancer without deterioration in QoL.     

41例肝脏原发性恶性血管肿瘤的临床病理特点

目的 探讨肝脏原发性恶性血管肿瘤（PHMVT）的临床病理学及预后的特点。方法 回顾性分析1982年1月至2012年12月在我院手术切除并经病理组织学证实的41例PHMVT,对其临床表现、病理学特点及预后进行分析。结果 41例患者中,肝上皮样血管内皮瘤（EHE） 19例（46.3％）,平均瘤体直径为49cm（1.2～6.3cm）;肝血管肉瘤（PHA）14例（34.1％）,平均瘤体直径为8.3cm（3.0～14.0cm）;肝婴儿型血管内皮瘤（IHE）5例（12.2％）,平均瘤体直径为3.8cm（1.2～6.3cm）;肝恶性血管外皮瘤（MHP）3例（7.3％）,平均瘤体直径为7.8cm（2.1～13.0cm）。免疫组化显示41例肿瘤细胞均表达Vimentin、CD34或因子Ⅷ。EHE患者术后中位生存期为87个月,优于PHA的12个月（P＜0.05）;2例有完整随访资料的MHP患者分别于术后43个月死亡和术后84个月复发;IHE患者术后均无复发,预后良好。结论 PHMVT的病理类型与预后有关,PHMVT的恶性程度由高到低依次为PHA＞MHP＞EHE＞IHE。     

A case of AFP-producing gastric cancer patient with liver relapse occurred three months after endoscopic mucosal resection (EMR) and gastrectomy

A 60s male was admitted to our hospital for a diagnosis of gastric tumor sized 20 mm in diameter at the fornix of the stomach. Endoscopic mucosal resection (EMR) was performed, and the resected tumor was pap, m, ly0, v0, HMX, VM0, pathologically. One month after the EMR, the local recurrence was confirmed and a partial gastrectomy was performed. Pathological findings were tub1, sm2, ly1, v1, HM0, VM0. Total gastrectomy was added because of the possibility of the lymph node metastasis. Pathological findings revealed no residual cancers. The final pathological diagnosis was T1b(sm2) N0H0P0M0, Stage IA, based on the Japanese classification of gastric cancer. Three months thereafter, CT showed multiple liver metastases. Immunohistochemical study of the operated tumor revealed AFP-producing gastric cancer. Chemotherapy was performed, but he died of the gastric cancer. Endoscopic treatment is a minimally invasive therapeutic strategy, but it requires a considerable care in application.     

Malignant Rhabdoid Tumor of the Breast: A Case Report

A 66-year-old woman time of 10 days. One month after radicalmastectomy, there was local recurrence, followed by multiplepulmonary metastases, and the patient died of respiratory failure5 months after surgery. The gray-white-colored tumor measured13x12x;10 cm, and its border was well defined. The tumor wascomposed of diffusely growing round or polygonal cells withvesicular nuclei, prominent nucleoli, and ample cytoplasm containingeosinophilic inclusions. Lymph node involvement was widespread.Both vimentin and keratin were clearly demonstrated by immunohistochemicalstaining. Ultrastructural studies revealed that the MRT cellscontained cytoplasmic whorls of intermediate filaments.     

A case of locally advanced breast cancer treated with hyperthermia in combination with radiotherapy]

A 59-year-old woman was admitted to our hospital because of massive bleeding from a right breast tumor. The breast tumor had existed for ten years occupied the entire right breast (23 x 20 cm), its central part forming an ulcer 17 x 15 cm in size. Radiotherapy to the right breast and medication with tamoxifen were started, after which five courses of CMF chemotherapy were given. The tumor decreased to 16 x 14 cm, and hyperthermia to the right breast was performed for a total of 87 sessions from January 1999. The irregular protruding portion of the ulcer caused the necrosis, and was sloughed off about one month after hyperthermia. No viable tumor cells were observed in a biopsy taken at 5 months after the start of treatment (40 sessions). A total of 87 hyperthermia sessions were performed, and the ulcer disappeared. For 15 months after the end of hyperthermia, the patient showed a continuous CR. Hyperthermia in combination with radiotherapy or chemotherapy for breast cancer may produce a remarkable effect as in the present case, and may become one choice for medical treatment of locally advanced or recurrent breast cancer.     

Efficacy of combination chemotherapy for stage IV colon cancer with extensive peritoneal dissemination and multiple liver metastases: a case report

A patient was diagnosed as having subacute ileus due to advanced cancer of the descending colon with multiple liver metastases and was treated by palliative left hemicolectomy. He was considered to have Stage IV cancer based on the finding of extensive peritoneal dissemination. Histopathological examination showed that the tumor was moderately differentiated adenocarcinoma. Postoperative palliative chemotherapy was given with 5-FU and LV twice a month as 1 course, and he received a total of 3 courses. As a result, the multiple liver metastases were completely eliminated. However, his liver metastases recurred, so CPT-11 was added to 5-FU and LV for another 3 courses. When bilateral pleural effusions developed about 1 year postoperatively, CPT-11 was changed to CDGP. Jaundice and massive ascites eventually developed, and he died about 1 year and 5 months postoperatively.     

A case of unresectable cholangiocellular carcinoma treated with surgery followed by combination chemotherapy

The patient was a 44-year-old man, who was investigated for lateral abdominal pain and liver dysfunction, and subsequently referred to our department with a diagnosis of unresectable intrahepatic cholangiocellular carcinoma (CCC). Radiological examinations revealed the huge mass in the right lobe of the liver with intrahepatic metastasis in the left lobe. The main tumor was surgically removed, but the metastases were not removed. A month after the operation, a subcutaneous implant reservoir was indwelled for repeated transcatheter hepatic arterial chemo infusion therapy (5-fluorouracil 500 mg/day continuous infusion, day 1-5, and CDDP 10 mg/day, day 1) from the right femoral artery. After 15 courses of home anti-cancer chemotherapy, abdominal CT revealed that the size of intrahepatic metastasis in the left lobe of the liver had not shown growth, whereas other metastitic sites popped up in the caudate lobe, which were free of chemical agent flow. There was no major complication related to the chemotherapy throughout the post-treatment course. Although he maintained a good level of QOL, he refused further chemotherapy due to depression. He died of liver failure 7 months after the operation. In conclusion, volume reduction surgery followed by transcatheter hepatic arterial chemo infusion might be promising as an effective therapy for non resectable CCC.     

A case of breast cancer metastasizing to cervix after resection of pancreatic metastasis

A case of breast cancer that metastasized to the cervix 10 years and 8 months after mastectomy is reported. The patient had undergone pancreaticoduodenectomy due to solitary metastasis to the head of the pancreas 4 years previously. The cervical metastasis was associated with abnormal genital bleeding. After pancreaticoduodenectomy the serum levels of CEA, CA15-3 and NCC-ST-439, which are markers of breast cancer, were within normal limits, but the serum level of CA15-3 had increased month by month. The patient had abnormal genital bleeding and presented to the department of gynecology at our hospital. The tumor was in the cervix, bled easily and 2.5x2.0 cm in size on ultrasonography. It was thought to be carcinoma of the cervix, but biopsy revealed the tumor to be an adenocarcinoma pathologically and CA15-3 was immunohistochemically demonstrated in the resected specimen, similar to lobular carcinoma of the breast. Abdominal CT scan revealed involvement of the ovaries and uterus, prompting hysterectomy with bilateral oophorectomy. After discharge, she received chemoendocrine therapy. However, she subsequently died due to peritoneal carcinomatosis.     

A case of colon cancer with pulmonary metastasis treated effectively by uracil futraful

A 57-year-old female was admitted for advanced ascending colon cancer with a solitary pulmonary metastasis measuring 1.5 cm in diameter. As laparotomy revealed an absolute noncurable tumor of stage V (H0, p2, s2 n1 (+], palliative right hemicolectomy was performed. A pathological diagnosis of well differentiated adenocarcinoma was made postoperatively. A daily dose of 400 mg of UFT was given orally. After 8 months, plain chest film and tomography revealed a reduction in the size of the pulmonary metastasis to 1.0 cm in diameter. The metastatic lung tumor was controlled for a period of 1 year and 9 months. It was suggested that UFT was rather effective for pulmonary metastasis from colon cancer.