A case with lung metastasis of osteosarcoma occurred 21 years after the operation of osteosarcoma on left tibia

The patient was a 38-years-old woman. A chest X-ray film demonstrated the presence of an abnormal lesion. Her past history included osteosarcoma on the left tibia for which she received amputation of the left inferior limb at 17 years of age without any relapse thereafter. Considering that the patient might have lung metastasis of osteosarcoma on the basis of lung biopsy performed under CT guide, and then a tumor was removed under the thoracoscope. The tumor, 2.8 x 2.2 x 2.1 cm in size, was located right under the pleura at left S10 with its inside being filled up with fragile necrotic tissues. When compared pathohistologically with the primary lesion of osteosarcoma which had occurred 21 years before, the lung tumor was almost identical in terms of the tumor cell morphology but had a higher cell density without evidence of osteoid formation. The diagnosis of lung metastasis of osteosarcoma was established on the basis of the clinical course and the immunohistochemical staining. It is extremely rare case that osteosarcoma recurs in the form of lung metastasis 21 years after the operation of primary lesion. We report this case as a valuable one to identify the prognosis of osteosarcoma and the development mechanism of lung metastasis.     

New pelvic sonoangiography for detection of endometrial carcinoma: a preliminary report.

Pelvic sonoangiography (PSAG) using transvaginal color Doppler was done on 16 postmenopausal patients with abnormal uterine bleeding. Seven women had no endometrial carcinoma and nine had carcinoma. No flow was detected around and within the endometrium in noncancer patients. PSAG showed a feeder artery (blood flow with pulsation that runs into and clings to the tumor) in all patients with endometrial carcinoma, and intratumor blood flow (a mixture of pulsating and constant flow within the tumor) was evident in 7 of 9 patients with endometrial carcinoma. These findings were confirmed by conventional pelvic angiography. In the diagnostic evaluation of PSAG for endometrial carcinoma, both sensitivity and specificity were 100%. We conclude that PSAG with transvaginal color Doppler can be used to detect endometrial carcinoma in postmenopausal women with abnormal uterine bleeding and that this method might be applicable to selecting patients who really require diagnostic surgery for endometrial cancer.     

Magnetic resonance imaging of the fetus: initial experience

Magnetic resonance imaging (MRI) examinations were made on 9 high-risk fetuses (poor fetal growth, 3; maternal manic-depressive psychosis, 1; maternal systemic lupus erythematosus, 1; habitual intrauterine fetal death, 1; twin pregnancy with 1 fetus in distress, 1; fetal hydrocephalus, 1), ranging from 29 to 36 weeks of gestation. T1 weighting sequences were better than T2 weighting sequences for in utero fetal imaging. Fetal movement significantly degraded the imaging quality. In all fetuses, cerebrum, cerebellum, heart, lung, liver, stomach, bladder and extremities were identified and in 1 fetus, even the cochlea was seen. In 2, the four-chamber view of the heart was evident. The signal intensity of the lung was lower than that of the liver in T1 weighting imaging. In the case of maternal lupus erythematosus, a cavum veli interpositi was noted. In the fetus with hydrocephalus, clear images of the intracranial structure were obtained. Similarly, location of the placenta was clearly depicted. MRI is currently less than satisfactory to determine the fetal anatomy, however, it does provide unique and characteristic information that complements the superior anatomic imaging by ultrasonography.     

Adenocarcinoma in situ coexisting with carcinoma in situ of the cervix during pregnancy

Case report We report a pregnant patient with adenocarcinoma in situ (AIS) coexisting with carcinoma in situ (CIS) of the cervix diagnosed by conization at 16 weeks' gestation. Apoptotic activity was higher in the CIS lesion than in the AIS lesion in the cone biopsy specimen. Postpartum evaluation confirmed the disappearance of CIS lesion with positive cone margins, however, multifocal AIS with negative cone margins was found. Conclusion Clinical course and biological features of AIS associated with pregnancy may be different from those of CIS.     

A resected case under thoracoscopic surgery of bilateral pulmonary metastases of renal cell carcinoma ten years after radical nephrectomy]

A 68-year-old male had received a left nephrectomy for renal cell carcinoma of the clear cell type in October, 1987. He had been given Interferon alpha (IFN alpha) for one year since then. He was referred to our hospital for bilateral abnormal shadows on the chest roentgenogram in December, 1997. He underwent a video-assisted thoracoscopic biopsy of bilateral lung in January, 1998, 11 years after his nephrectomy. The resected specimens contained a coin lesions measuring approximately 2 cm in diameter, and the lesions were microscopically diagnosed as a renal cell carcinoma of the clear cell type metastatic to the lung. The patient is doing well with no signs of re-recurrence five months after the resection of the metastatic lesion.     

Minimum detectable change in reaction time to the Posner task due to change in sustained attention

[Purpose] Spatial attention evaluations are beneficial for patients with unilateral spatial neglect or dementia. Thus, such evaluations are crucial among these patients for determining functional disorder extents. The study aimed to determine minimal detectable changes in reaction time to the Posner task among healthy young participants for establishing spatial attention evaluation protocols. [Participants and Methods] The study recruited 10 healthy young adults (five males and five females; mean age: 28.9 ± 4.0 years). Each participant completed two sessions of the Posner task with 160 trials per session. The reaction time for each trial was measured. Data obtained by the two blocks were analyzed by Bland–Altman analysis, and intraclass correlation coefficient case 1 and minimal detectable changes at the 95% confidence interval were calculated. [Results] Bland–Altman analysis indicated no systematic bias. The intraclass correlation coefficient case 1 exceeded 0.80 under all conditions of the Posner task, whereas the minimal detectable changes at the 95% confidence interval spanned 23–34 ms. [Conclusion] The results exhibited high reliability for reaction time to the Posner task. The minimal detectable changes as the 95% confidence interval values determined in this study based on reaction time can be applied to establish spatial attention evaluation protocols.     

Impact of prior bevacizumab therapy on the incidence of ramucirumab-induced proteinuria in colorectal cancer: a multi-institutional cohort study

Background

The association between prior bevacizumab (BEV) therapy and ramucirumab (RAM)-induced proteinuria is not known. We aimed to investigate this association in patients with metastatic colorectal cancer (mCRC).

Methods

mCRC patients who received folinic acid, fluorouracil, and irinotecan (FOLFIRI) plus RAM were divided into with and without prior BEV treatment groups. The cumulative incidence of grade 2–3 proteinuria and rate of RAM discontinuation within 6 months (6M) after RAM initiation were compared between the two groups.

Results

We evaluated 245 patients. In the Fine-Gray subdistribution hazard model including prior BEV, age, sex, comorbidities, eGFR, proteinuria ≥ 2 + at baseline, and later line of RAM, prior BEV treatment contributed to proteinuria onset (P < 0.01). A shorter interval between final BEV and initial RAM increased the proteinuria risk; the adjusted odds ratios (95% confidence intervals) for the intervals of < 28 days, 28–55 days, and > 55 days (referring to prior BEV absence) were 2.60 (1.23–5.51), 1.51 (1.01–2.27), and 1.04 (0.76–1.44), respectively. The rate of RAM discontinuation for ≤ 6M due to anti-VEGF toxicities was significantly higher in the prior BEV treatment group compared with that in the no prior BEV treatment group (18% vs. 6%, P = 0.02). Second-line RAM discontinuation for ≤ 6M without progression resulted in shorter overall survival of 132 patients with prior BEV treatment (P < 0.01).

Conclusion

Sequential FOLFIRI plus RAM after BEV failure, especially within 55 days, may exacerbate proteinuria. Its escalated anti-VEGF toxicity may negatively impact the overall survival.

     

Pharmacokinetic and dose-finding study of osimertinib in patients with impaired renal function and low body weight

The safety of osimertinib is limited in patients with severe or moderate renal impairment, or low body weight. This study aimed to investigate the safety, pharmacokinetics (PK) and recommended dose (RD) of osimertinib in patients with epidermal growth factor receptor (EGFR)-mutated non–small cell lung cancer (NSCLC) with impaired renal function and low body weight. Thirty-one eligible patients were enrolled and allocated into four cohorts: A, normal renal function (estimated glomerular filtration rate [eGFR] ≥ 50 mL/min/1.73 m²) and normal body weight (≥45 kg); B, moderate renal impairment (eGFR = 30-50 mL/min/1.73 m²); C, low body weight (<45 kg); and D, severe renal impairment (eGFR <30 mL/min/1.73 m² or undergoing dialysis). PK parameters and safety were evaluated with a starting dose of 80 mg osimertinib administered orally once daily in cohorts A, B, and C and 40 mg once daily in cohort D. The PK parameters in cohorts A, B, and C were found to be similar. No dose-limiting toxicity was observed, and the RD was determined to be 80 mg once daily in patients with moderate renal function and low body weight. Four serious adverse events, acneiform rash, diarrhea, QTc prolongation, and interstitial lung disease, were noted. Although the PK parameters of osimertinib were similar across all cohorts, toxicity occurred more frequently in patients with impaired renal function and low body weight. Clinicians should prescribe osimertinib with caution in NSCLC patients with impaired renal function and low body weight.