101.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2485-2487.
[A Case of Lymph Node Recurrence with Invasion to the Trachea after the Resection of Esophageal Cancer Treated by Multidisciplinary Treatment].
[Article in Japanese]
Hayashi Y1, Motoori M, Nakatsuka R, Nishizawa Y, Komatsu H, Miyazaki S, Tomokuni A, Komori T, Iwase K, Fujitani K.
Abstract
A 78-year-old man who underwent esophagectomy for middle thoracic esophageal squamous cell carcinoma(pT1bN0M0, pStage Ⅰ)was diagnosed with lymph node recurrence 12 months after the initial surgery. He received chemoradiotherapy(5- fluorouracil plus cisplatin); however, the treatment was terminated at the middle of the treatment course because of progressive disease. He received chemotherapy(docetaxel plus 5-fluorouracil plus cisplatin)as a second-line treatment, which was also canceled due to serious adverse events. Partial response was achieved after the second therapy; therefore, surgical excision was performed. Thirteen months after the second surgery, he was diagnosed with second local recurrence with invasion to the trachea. Another course of chemotherapy(docetaxel[2-weekly]plus 5-fluorouracil plus cisplatin)was administered, which also achieved a partial response. Thus, surgical excision with partial tracheal resection and mediastinal tracheostomy was performed. He has been alive without recurrence for 6 months after the final operation. In case of postoperative solitary lymph node recurrence of esophageal cancer, long-term survival can be expected with multidisciplinary treatment.
102.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2482-2484.
[A Case of Unresectable Sigmoid Colon Cancer with Peritoneal Dissemination Treated with Chemotherapy after an Unintended Emergency Jejunostomy Formation].
[Article in Japanese]
Abstract
A 33-year-old man was diagnosed with bowel obstruction due to advanced sigmoid colon cancer and underwent an emergency laparotomy. The sigmoid colon cancer turned out to be unresectable because of firm invasion to the retroperitoneum with severe adhesions and diffuse dissemination. Therefore, unplanned jejunostomy was performed, which was complicated by high-output stoma and short bowel syndrome. His condition was stable enough to receive chemotherapy via parenteral nutrition and parenteral electrolyte solution infusion added to the diet. mFOLFOX6 plus cetuximab therapy was started 4 weeks postoperatively. Although oxaliplatin was discontinued because of worsening numbness, he was sustained without cancer progression by receiving chemotherapy for a year. Chemotherapy was interrupted by a Candida fungemia 13months postoperatively, and he died 4 months later. Patients with jejunostomy may have difficulty absorbing enough water and nutrients in the intestine; therefore, they are at risk of dehydration and electrolyte depletions due to high stomal output, and malnutrition due to the short bowel. These complications may prevent colorectal cancer patients with jejunostomy to be indicated for chemotherapy.
103.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2479-2481.
[A Case of Two Curative Resections for the Peritoneal Dissemination of Transverse Colon Cancer].
[Article in Japanese]
Kato S1, Miyake M, Uemura M, Kato T, Fujiwara A, Maeda S, Hamakawa T, Hama N, Nishikawa K, Miyazaki M, Miyamoto A, Hirao M, Takami K, Sekimoto M.
Abstract
No large clinical trials have been conducted to prove the efficacy of peritoneal dissemination resection for colorectal cancer, and no evidence has shown the usefulness of resection for metachronous peritoneal dissemination. An elderly woman in her 70s underwent a laparoscopic transverse colectomy for transverse colon cancer in 2014, which was performed by another physician. The pathological diagnosis was tub2-por>muc, pT3, ly2, v0, pN2, and pStage Ⅲb. The patient was followed up with capecitabine plus oxaliplatin(CapeOX)therapy as an adjuvant chemotherapy for 6 months. Three years postoperatively, the CEA level increased to 10 ng/mL, and CT showed a nodular shadow in front of the left prerenal fascia. After the diagnosis of peritoneal dissemination recurrence and 8 courses of capecitabine plus bevacizumab therapy, other metastases were not observed. She was referred to our hospital for surgery and underwent laparoscopic peritoneal dissection at 3 years and 6 months after the first operation. Only one apparent disseminated recurrent lesion, which was resectable, was observed. However, at 4 years and 9 months after the initial operation, CT showed a recurrence of Douglas pouch peritoneal dissemination without any other obvious metastasis. Laparoscopic low anterior resection of the rectum and hysterectomy were performed. Here, we encountered a case that could be radically resected for peritoneal dissemination twice after the colon cancer surgery.
104.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2476-2478.
[A Case of Peritoneal Recurrence of HCC Who Achieved Long-Term Survival after a Multidisciplinary Treatment].
[Article in Japanese]
Takase K1, Katsura Y, Takeda Y, Ohmura Y, Sakamoto T, Yukawa Y, Toya K, Kawai K, Naito A, Murakami K, Kagawa Y, Masuzawa T, Takeno A, Hata T, Murata K.
Abstract
The treatment for peritoneal dissemination of hepatocellular carcinoma(HCC)remains to be established. Therefore, peritoneal recurrence ofHCC has a poor prognosis. Here, we report a case ofperitoneal recurrence ofHCC after a liver resection. The patient underwent surgery for peritoneal recurrence 5 times already and had taken sorafenib for 3 years. No recurrence occurred for 55 months during the last follow-up. Therefore, multidisciplinary treatment for peritoneal recurrence of HCC, including surgical resection, may improve prognosis.
105.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2473-2475.
[A Case of Splenic Lymph Node Metastasis from the Distal Bile Duct Carcinoma Seven Years after a Curative Resection].
[Article in Japanese]
Abstract
We report a case of splenic lymph node recurrence 7 years after a distal bile duct carcinoma. A 70s man underwent pylorus ring-preserving pancreaticoduodenectomy for distal bile duct carcinoma in 20XX. The pathological diagnosis was T2N0M0, Stage Ⅱ(Japanese Classification of the Biliary Tract Cancers 5th edition). Then, S-1 was administered as an adjuvant chemo- therapy 1month later and continued for 3 years. At 7 years postoperatively, the serum CEA level was elevated(CEA 77.0 ng/ mL), and FDG-PET showed high-grade accumulation in the splenic hilum lymph node, which was diagnosed as lymph node recurrence. Because it was a solitary metastasis and had a long recurrence-free period, tumor resection was not performed, and the patient opted for a nonsurgicaltreatment. No recurrence occurred to date. Recurrent resection is rarely performed for splenic lymph node metastasis.
106.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2470-2472.
[A Rare Case of Gastric Metastasis from Cholangio Carcinoma].
[Article in Japanese]
Imamura N1, Kusashio K, Yasutomi J, Matsumoto M, Suzuki T, Iida A, Fushimi K, Furukawa A, Konishi T, Harano R, Fujita A, Furuguchi H, Ozaki D.
Abstract
An 80-year-old man was referred to our hospital because of jaundice and fatigue. Abdominal computed tomography(CT) scan revealed an extrahepatic bile duct tumor, and biliary cytology detected adenocarcinoma; therefore, subtotal stomachpreserving pancreaticoduodenectomy was performed. Histological analysis showed that the tumor was a well-differentiated adenocarcinoma without lymph node metastasis. Two years after the initial surgery, blood examination detected an elevated serum CA19-9 level and submucosal tumor which is 2.5 cm diameter with an ulcer at the gastrojejunostomy anastomosis. Tumor biopsy was performed, and histological analysis revealed a recurrent cholangiocarcinoma. The tumor directly invaded the transverse colon mesentery; therefore, distal gastrectomy and right hemicolectomy were performed. The patient survived 12 months postoperatively without recurrence. Gastric metastasis from cholangiocarcinoma rarely occurs. Intraoperative exposure of bile juice may have caused gastric metastasis in this case.
107.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2467-2469.
[Long-Term Survival of Gastric Cancer with Multiple Liver and Lymph Node Metastases-A Case Report].
[Article in Japanese]
Ami K1, Yamashita D, Yamada A, Kajiyama D, Kawaguchi M, Maeda F, Motoyama K, Amagasa H, Ganno H, Imai K, Iida S, Fukuda A, Akita H, Tei S, Andou M.
Abstract
Currently, chemotherapy against unresectable advanced gastric cancer is progressing with the development new drugs and due to results of several clinical trials. Here, we reported a case of long-term survival of gastric cancer with multiple liver and lymph node metastases. A 68-year-old man was diagnosed with gastric cancer and Virchow lymph node, para-aortic lymph node, and multiple liver metastases at another hospital. He was referred to our hospital from Yamashita Naika Syokakika. We administrated 4 courses of S-1 plus CDDP. The main tumor and all metastatic lesions were significantly reduced. Subsequently, total gastrectomy, partial liver resection, and left neck and para-aortic lymph node resection(conversion surgery)were performed. The cancer cell was remnant at the main tumor and para-gastric lymph node. No cancer cells were detected in another lesion(R0 resection). Postoperatively, only S-1 was administered. However, 28 months after undergoing gastrectomy, liver metastasis occurred. Therefore, S-1 plus oxaliplatin, paclitaxel plus ramucirumab, and CPT-11 plus CDDP were administered. Liver metastases again increased and decreased, respectively. However, 46 months after gastrectomy, liver metastasis recurred and nivolumab was administered. Subsequently, liver metastases disappeared. At 55 months after gastrectomy, rectal resection was performed against rectal cancer and partial liver resection against liver metastases. Cancer cells were not detected in the resected specimens.
108.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2464-2466.
[A Case of Pancreatic Head Cancer after Esophagectomy and Gastrectomy Treated with Pancreatoduodenectomy].
[Article in Japanese]
Sugimoto T1, Komatsu H, Nishizawa Y, Inoue A, Miyazaki Y, Komori T, Motoori M, Tomokuni A, Fujitani K, Iwase K.
Abstract
A woman in her 40s was hospitalizedfor jaundice. Six years before, she hadbeen diagnosedwith synchronous esophageal andgastric cancers andhadund ergone subtotal esophagectomy andtotal gastrectomy, accompaniedby reconstruction with the pedicled jejunum. Multimodal imaging revealed a tumor at the pancreatic head, probably pancreatic cancer, which induced severe stenosis of the intrapancreatic bile duct. Scraping cytology findings of the lesion via the percutaneous transhepatic cholangial drainage(PTCD)route strengthenedthe suspicion. In the image, although no obvious invasion of the major vessels or apparent distant metastases were detected, an abnormal shadow was found continuously lining the main tumor andpara -aortic region, which was a contraindication for curative resection. Therefore, we performed neoadjuvant chemotherapy with gemcitabine plus S-1. After 3 courses, the lesion size reduced notably, and pancreatoduodenectomy was performed. The pathological diagnosis was pancreatic cancer(ph, ypT3, ypN1a, ypM0, ypStage ⅡB). Except for pancreatic fistulas(Clavien-Dindo Ⅲa), the postoperative clinical course was uneventful, andshe was dischargedon postoperative day 27. To date, the patient is alive without recurrence and is undergoing adjuvant chemotherapy with S-1.
109.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2461-2463.
[A Case of Breast Cancer Liver Metastases with Jaundice Responding to Chemotherapy].
[Article in Japanese]
Abstract
A 50-year-old woman was referred to our hospital due to breast cancer with multiple liver metastasis diagnosed by CT scan. Laboratory findings showed liver dysfunction(T-Bil 7.6mg/dL)with marked elevation of tumor markers(CEA 727.9 ng/mL). Breast tumor biopsy showed an invasive ductal carcinoma(scirrhous type), ER(+), PgR(-), and HER2(3+). Combination therapy with docetaxel, carboplatin and, trastuzumab was administered after the end of 1 course of weekly paclitaxel plus bevacizumab regimen. The patient maintained a good condition without liver dysfunction 8 months after the first visit. Follow-up CT scan showed partial response of breast and hepatic tumors. Our case suggests that careful chemotherapy can improve the prognosis of breast cancer with liver metastasis even if a patient is in an icteric condition.
110.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2458-2460.
[A Case of Chemotherapy with Abscess Drainage for Pancreatic Cancer Detected Due to Peritonitis].
[Article in Japanese]
Takiuchi D1, Morimoto O, Eguchi S, Hokkoku D, Wada R, Ikeshima R, Munakata K, Wada N, Okura E, Azama T, Akamaru Y, Ota H, Kitada M, Shibata K, Ohashi H.
Abstract
A 69-year-old woman was admitted to our hospital because of abdominal pain. Abdominal CT revealed free air, so we performed an emergency operation. Although the perforation site could not be confirmed, pancreatic cancer invading the stomach, spleen, and transverse colon was found. As a splenic abscess and peritoneal dissemination were also found, we created a colostomy and placed drains. Although the postoperative course was good, the splenic abscess continuous with the tumor remained. We thought that early removal of the drain would be difficult, so chemotherapy was introduced while continuing drainage. Fortunately, the pancreatic cancer was controlled, and the abscess tended to shrink, so we removed the tube 137 days after the surgery. After that, we continued chemotherapy, but in the second year after the surgery, the liver metastasis acutely exacerbated and DIC also developed, resulting in cancer death. If surgical intervention is difficult, as in this case, chemotherapy may be considered as an option, keeping in mind the possibility of exacerbation of infection.
111.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2455-2457.
[A Case of Breast Cancer Complicated with Castleman's Disease].
[Article in Japanese]
Abstract
The patient was a 57-year-old woman with Castleman's disease. The follow-up CT scans obtained during the treatment of Castleman's disease, detected a 15mm nodule in the right breast AC area, and the patient was diagnosed with breast cancer. Lymphadenopathy was noted on both sides of the axilla; however, it was considered to be due to Catsleman's disease. Mastectomy and sentinel lymph node biopsy were performed with preoperative diagnosis of cT1cN0M0, cStage Ⅰ. Rapid diagnosis of the sentinel lymph node during the operation showed a metastatic tumor measuring 3mm and axillary dissection was performed. However, no metastasis was found in the dissected lymph node, which was, therefore, considered as an enlargement due to Castleman's disease.
112.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2452-2454.
[A Case of Peritoneal Metastasis Resection from GIST of the Small Intestine with Focal Resistance Against Imatinib Mesylate].
[Article in Japanese]
Ono T1, Tanaka N, Suzuki H, Imoto H, Yamamura A, Karasawa H, Kohyama A, Aoki T, Watanabe K, Ohnuma S, Musha H, Motoi F, Kamei T, Naitoh T, Unno M.
Abstract
A 69-year-old man was referred to our institute for the surgical resection of focal resistant peritoneal GIST during imatinib administration. He had been diagnosed with GIST of the small intestine with liver and peritoneal metastases, and imatinib treatment was initiated. Shortly after imatinib administration, the primary lesion perforated, and thus, partial resection of the small intestine was performed. Imatinib treatment was resumed after the first surgery, and he achieved partial response. However, computed tomography scans obtained 7 months after the first surgery showed focal progression, a peritoneal metastasis near the right kidney. Under the diagnosis of focally imatinib-resistant GIST, local resection of the metastatic tumor was performed. In this case, an exon 11 mutation of c-kit was noted initially. After the imatinib treatment, an additional point mutation was observed in exon 18 that caused resistance to imatinib. Therefore, imatinib treatment was reinitiated after the second surgery, and other metastases were well controlled. In case of GIST with multiple metastases, appropriate treatment should be selected based on the resistance of each lesion.
113.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2449-2451.
[A Case of Surgical Resection of an Esophageal Gastrointestinal Stromal Tumor after Neoadjuvant Therapy with Imatinib].
[Article in Japanese]
Nishida Y1, Takeda S, Kanekiyo S, Shindo Y, Matsukuma S, Matsui H, Tokumitsu Y, Tomochika S, Iida M, Suzuki N, Yoshino S, Hazama S, Ueno T, Nagano H.
Abstract
A 64-year-old man presented with dysphagia. Esophagogastroduodenoscopy revealed a submucosal tumor of 52mm in size at the lower thoracic esophagus. Biopsy yielded a pathological diagnosis of c-kit-positive esophageal gastrointestinal stromal tumor(GIST). We started neoadjuvant therapy with imatinib to avoid excessive surgical invasion. After 6 months of treatment, CT revealed a reduction in tumor size to 27 mm. We performed laparoscopic lower esophagectomy, proximal gastrectomy, double-tract reconstruction, and complete tumor resection. Neoadjuvant imatinib therapy was effective for the esophageal GIST.
114.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2446-2448.
[Questionnaire Survey on Adjuvant Chemotherapy for Colorectal Cancer in Yamaguchi Prefecture].
[Article in Japanese]
Abstract
A questionnaire survey on postoperative chemotherapy for colorectal cancer was conducted in 22 hospitals in Yamaguchi Prefecture. Adjuvant chemotherapy was performed in<95% of Stage Ⅲ cancer, and oxaliplatin(OX)combination therapy was selected depending on the risk of recurrence. However, the proportion of OX combination therapy was lower than that in other prefectures, which was 24% in Stage Ⅲa, 44% in Ⅲb, and 76% in Ⅲc. In addition, among the OX combination therapy regimens(FOLFOX or CAPOX), the proportion of FOLFOX administration was higher in Yamaguchi Prefecture than in other prefectures. In Stage Ⅱ, most hospitals set up high-risk factors for recurrence and underwent adjuvant chemotherapy. FU-based monotherapy was selected in 80% of hospitals. A few hospitals decided the requirement of OX combination therapy based on age alone. In Yamaguchi Prefecture, the indication of postoperative adjuvant chemotherapy for colorectal cancer was almost standard; however, the rate of administering OX combination therapy was low.
115.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2443-2445.
[A Case of Laparoscopic Abdominoperineal Resection for Rectal Cancer with Left-Sided Inferior Vena Cava].
[Article in Japanese]
Maruo K1, Iseki Y, Fukuoka T, Shibutani M, Nagahara H, Tamura T, Toyokawa T, Tanaka H, Lee S, Muguruma K, Ohira M.
Abstract
A 66-year-old-man was hospitalizedfor the treatment of rectal cancer. Preoperative contrast-enhancedcomputedtomography revealedrectal cancer, left-sided inferior vena cava, and distant metastasis. He was diagnosed with cStage Ⅳb rectal cancer. Laparoscopic abdominoperineal resection with standard lymph node dissection was performed. There have been a few reports on laparoscopic colorectal resection for patients with left-sided inferior vena cava. We report a case of laparoscopic abdominoperineal resection for a patient with left-sided inferior vena cava.
116.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2440-2442.
[A Case of Curatively Resected Locally Recurrent Rectal Mucinous Adenocarcinoma Followed by Preoperative Chemoradiotherapy].
[Article in Japanese]
Sato K1, Karasawa H, Kajiwara T, Suzuki H, Kohyama A, Watanabe K, Ohnuma S, Ishida T, Kamei T, Naitoh T, Unno M.
Abstract
A 60s man was diagnosed with rectal cancer and underwent low anterior resection of the rectum. The pathological diagnosis was mucinous adenocarcinoma, pT3(SS), pN0, pM0, pStage Ⅱ. Two years after the primary surgery, contrast-enhanced CT showed local recurrence on the oral side of the anastomosis. As the tumor had invaded the left seminal vesicle and coccygeus muscle, neoadjuvant chemoradiotherapy(NACRT)(S-1 80mg/m / 2 plus 45 Gy/25 Fr)was performed. After NACRT, abdominoperineal resection, including the left seminal vesicle, coccygeus muscle, and coccygeal bone, was performed. Pathological examination showed a histological response of Grade 2 and that R0 resection was achieved. Although the only radical treatment of locally recurrent rectal cancer is R0 resection, we performed R0 resection with Grade 2 histological response to NACRT.
117.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2437-2439.
[A Case of Long-Term Clinical Complete Response after Chemotherapy for Locally Advanced Rectal Cancer].
[Article in Japanese]
Abstract
With the advancement ofchemotherapy against colorectal cancer, clinical complete responses(cCR)are more frequently observed. We report a case oflocally advanced rectal cancer with maintained long-term cCR after chemotherapy alone. Detailed examinations ofa man in his 60s revealed that he had poorly controlled diabetes mellitus, with elevated serum CEA and CA19-9 levels. Colonoscopy revealed rectal cancer(Rba). Besides the prostate invasion observed in the CT scan, intestinal obstruction was caused by a tumor that required surgical removal. However, the tumor was unresectable due to prostate and pelvic wall metastases; therefore, only sigmoid colostomy was performed. After 6 courses of mFOLFOX6, the tumor shrunk, and prostate invasion reduced as confirmed by the CT scan. Chemotherapy was switched to sLV/5FU2 due to the occurrence of peripheral neuropathy. No tumor was found after 20 courses of treatment, and cCR was achieved after 58 courses ofcontinuous and consecutive treatment. Throughout the treatment, radical resection was proposed to the patient; however, the surgery was not performed because of his lifestyle, ie, heavy smoking, which resulted in poor blood sugar control. The patient appears to be tumor free for 7 years after the initiation of chemotherapy.
118.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2434-2436.
[A Case of Multiple Lymph Node Metastases Treated with Nivolumab after an Adrenalectomy for Solitary Adrenal Metastasis of Gastric Cancer after a Gastrectomy].
[Article in Japanese]
Nakai M1, Ichisawa A, Yamada T, Kimura T, Yonaiyama S, Jin H, Tokura T, Aoki K, Kawashima H, Toyoki Y, Endo M.
Abstract
A 69-year-old man was hospitalized for gastric cancer. He underwent total gastrectomy with distal pancreatectomy, splenectomy, and cholecystectomy. Pathological staging was pT3N3aM0 and Stage ⅢB. Adjuvant chemotherapy(S-1)was administered postoperatively. Ten months later, left adrenal metastasis was detected on computed tomography(CT)scans. He was then treated with 4 courses of chemotherapy with SOX therapy and 2 courses of PTX plus RAM therapy for the left adrenal metastasis. However, the tumor size increased. He underwent adrenalectomy with left nephrectomy and partial resection of the transverse colon for the solitary adrenal metastasis. His pathological diagnosis was metastatic carcinoma of the left adrenal gland and lymph nodes, which invaded the left renal vein and originated from gastric carcinoma. Three months after the adrenalectomy, CT scans identified paraaortic, porta hepatis, and left supraclavicular lymph node metastases. The patient was continuously treated with nivolumab, for 20 courses, and is doing well with good PS. Adrenalectomy for solitary adrenal metastasis of gastric cancer very rarely occurs. We report a case of multiple lymph node metastases treated with nivolumab after an adrenalectomy for solitary adrenal metastasis of gastric cancer after a gastrectomy.
119.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2431-2433.
[Five Cases of Ten-Year Survival after Surgical Treatment of Pancreatic Cancer in Yamaguchi Prefecture].
[Article in Japanese]
Fujiwara Y1, Matsui H, Tokumitsu Y, Shindo Y, Suto R, Kato T, Kawaoka T, Ueno T, Tanabe M, Harada E, Kaino S, Ito K, Hamano K, Sakaida I, Nagano H.
Abstract
A questionnaire survey was conducted regarding the prognosis for pancreatic cancer at 8 major hospitals in Yamaguchi Prefecture. A total of 552 patients with pancreatic cancer who underwent radical surgery between 1997 and 2016 were identified. Five of them survived for more than 10 years. Among the 5 patients, none was treated with neoadjuvant chemotherapy: 4 underwent PD and 1 underwent DP-CAR. Two of them were treated with adjuvant chemotherapy. No complications occurred during their postoperative courses. All of them had no recurrence and survived. Here, we reported the longterm postoperative survival of patients with pancreatic cancer with literature review.
120.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2428-2430.
[A Case of Mucinous Cystoadenocarcinoma with Metastatic Liver Tumor in a Young Woman Lacking Specific Findings].
[Article in Japanese]
Hamasaki T1, Tokumitsu Y, Shindo Y, Matsui H, Matsukuma S, Nakajima M, Tomochika S, Yoshida S, Iida M, Suzuki N, Takeda S, Yoshino S, Hazama S, Ueno T, Nagano H.
Abstract
The patient was a 17-year-old woman. An abnormal urinalysis was observed, and abdominal echography showed a pancreatic cystic mass. At the first examination, computed tomography(CT)and endoscopic ultrasound(EUS)showed a unilocular cystic mass of 60mm in size in the pancreatic body and tail, and no malignant findings were observed. After 14 months, CT and positron emission tomography-computed tomography(PET-CT)showed that the cystic mass had a mural nodule with FDG accumulation, and presence of a tumor in hepatic S8 with FDG accumulation. Laparoscopic distal pancreatectomy and hepatic subsegmentectomy of S8 were performed for diagnostic and therapeutic purposes. The pathological diagnosis was mucinous cystadenocarcinoma(MCC)and metastatic liver cancer in the form of MCC. S-1 was administered after surgery. Nine months after resection, multiple metastatic liver tumors were found, and GEM plus nab-PTX was administered. After 2 courses of treatment, the patient is still alive without new lesions.
121.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2425-2427.
[A Case of Borderline Resectable Pancreatic Adenosquamous Carcinoma Achieving Pathological Complete Response].
[Article in Japanese]
Chidimatsu H1, Matsui H, Tokumitsu Y, Matsukuma S, Shindo Y, Tomochika S, Yoshida S, Iida M, Suzuki N, Takeda S, Hasegawa H, Yoshino S, Hazama S, Ueno T, Nagano H.
Abstract
The patient was a 66-year-old man presenting with epigastric pain and jaundice. PET-CT demonstrated limited-accumulation on the tumor at the head of the pancreas, diagnosed as borderline resectable adenosquamous carcinoma. The patient was treated with preoperative chemoradiation therapy with 2 courses of gemcitabine followed by administration of S-1 and gemcitabine for 13 months, which reduced the tumor size. After preoperative therapy, pancreaticoduodenectomy was performed. Histopathological examination revealed that no viable tumor cells were detected in the pancreas or lymph nodes, and the patient had achieved a pathological complete response. Postoperative adjuvant chemotherapy was not performed, and the patient is still alive without recurrence for 66 months after surgery.
122.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2422-2424.
[A Case of Curative Resection of Locally Advanced Gastric Cancer after Nutrition Therapy and Chemotherapy with S-1 and Oxaliplatin Using Elemental Diet Tube].
[Article in Japanese]
Abstract
We report a case of advanced gastric cancer with stenosis under severe malnutrition, in which nutritional treatment along with chemotherapy using an elemental diet(ED)tube led to complete resection of the tumor. A 66-year-old man who presented with difficulty in dietary intake came to our hospital. He was emaciated with a body mass index(BMI)score of 13.5 and a prognostic nutritional index(PNI)score of 33.8 and was admitted to the hospital for an emergency. He was diagnosed with advanced gastric cardia cancer invading the distal pancreas, spleen, and left diaphragm(U, type 3, tub2, cT4bN3M0, cStage ⅢC, HER2 score 0). There was obstruction of the passage of food due to the tumor, we performed nutrition therapy and chemotherapy consisting of 3 courses of S-1 and oxaliplatin using an ED tube. After chemotherapy, the primary tumor and lymph nodes were reduced, and we performed total gastrectomy with D2 lymph node, distal pancreas, spleen, and left partial diaphragm dissection. Histopathological diagnosis was ypT4aN1M0, ypStage ⅢA, indicating a pathological partial response(Grade 1). Adjuvant chemotherapy was performed for 6 months, and there has been no relapse for 3 years since the operation.
123.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2419-2421.
[A Case of Remarkably Effective Chemoradiotherapy for Esophageal Cancer with Multiple Bone Metastasis].
[Article in Japanese]
Tabuchi S1, Nakagawa M, Koganezawa I, Yokozuka K, Hikita K, Kobayashi T, Sano T, Tomita K, Tsutsui R, Kuwabara H, Shigoka M, Chiba N, Hisada M, Katayanagi S, Kawachi S.
Abstract
The patient was a 56-year-oldwoman. She presentedto a nearby doctor with a chief complaint of dysphagia andwas diagnosed with esophageal cancer by upper gastrointestinal endoscopy, resulting in a referral to our hospital. Upper gastrointestinal endoscopy revealeda semicircular type 1 lesion 29 to 32 cm from the incisors, andshe was diagnosedwith squamous cell carcinoma by biopsy. Computedtomography (CT)andpositron emission tomography(PET)scans revealedthe enlargement and accumulation of lymph nodes along the lesser curvature of the stomach; thus, she was diagnosed with metastasis. In addition, multiple accumulations were found in the 7th cervical vertebrae as well as in the 1st, 3rd, 4th, and 8th thoracic vertebrae, leading to the diagnosis of bone metastasis. She was finally diagnosed with middle intrathoracic esophageal cancer T2N1M1, Stage Ⅳ; thus, we performedchemorad iotherapy(CRT)with 5-FU andCDDP (FP). The main lesion was markedly reduced in upper gastrointestinal endoscopy after CRT, and no apparent malignancy was found in endoscopic biopsy, so the diagnosis was endoscopic complete response. The CT scan also showed marked reductions in both the main lesion and the lymph nodes. As for the bone metastasis, some areas of bone consolidation remained, but they were diagnosed as partial responses since they were shrunk. Since then, FP has been continuously administeredon a regular basis andit has been about 2 years without any appearance of new lesions or re-exacerbation.
124.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2416-2418.
[A Case of a Patient with Type Ⅳ Adachi Classification Treated with Laparoscopic Ileocecal Resection].
[Article in Japanese]
Abstract
A 72-year-old woman was diagnosed with cecal cancer. Preoperative enhanced abdominal computed tomography(CT) and three-dimensional(3D)-CT angiographyrevealed a celiacomesenteric trunk(CMT). We performed a laparoscopic ileocecal resection without anyproblems owing to the obtained preoperative 3D-CT images. The postoperative course was uneventful. The celiac arteryhas manyanomalies, and 6 categories have been defined. Patients can be divided into 28 groups bycombining these anomalies with mutations in the hepatic artery, as explained byAdachi. Our case was a Type Ⅳ anomaly according to the Adachi classification, which accounts for 2.4% of all cases. We herein report this extremelyrare case.
125.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2413-2415.
[Two Cases of Goblet Cell Carcinoid of Appendix Treated with Oxaliplatin-Based Adjuvant Chemotherapy].
[Article in Japanese]
Abstract
Although there are reports of goblet cell carcinoid(GCC)treated by chemotherapy using the treatment protocol for colon cancer, the benefit of chemotherapy for GCC remains controversial and unclear. Herein we report 2 cases of patients with GCC who were successfully treated by surgical resection and oxaliplatin-based adjuvant chemotherapy, without evidence of recurrence. The first case was a 57-year-old man who underwent laparoscopic ileocecal resection after being diagnosed with adenocarcinoma of the appendix by biopsy via colonoscopy. Pathological and immunohistochemical analyses demonstrated the presence of signet-ring-like cells, chromogranin A-positive and synaptophysin-positive cells, leading to a diagnosis of GCC of the appendix. Folinic acid, fluorouracil, oxaliplatin(FOLFOX)was administered for 6 months as an adjuvant chemotherapy. The patient has shown no signs of systematic metastasis and has been alive for more than 3 years after the operation. The second case was a 41-year-old woman who presented to our hospital complaining of lower abdominal pain starting 2 months previously. A computed tomography(CT)scan indicated a pelvic tumor, and she underwent ileocecal resection and hystero-oophorectomy due to an appendix tumor and an ovarian metastatic tumor. Pathological and immunohistochemical analyses demonstrated the presence of signet-ring-like cells, chromogranin A-positive, and synaptophysin-positive cells, confirming the diagnosis of GCC of the appendix. The patient received capecitabine and oxaliplatin(CapeOX)as an adjuvant chemotherapy for 6 months. The patient has been free from recurrence for 22 months following surgery.
126.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2410-2412.
[Two Cases of Advanced Colorectal Cancer Achieving Complete Response by FOLFOXIRI plus Bevacizumab-A Case Report].
[Article in Japanese]
Nemoto T1, Endo S, Isohata N, Takayanagi D, Nemoto D, Aizawa M, Utano K, Togashi K, Oshibe I, Soeta N, Saito T.
Abstract
We report 2 cases of advanced colorectal cancer achieving complete response by FOLFOXIRI plus bevacizumab. Case 1 was a 65-year-old male diagnosed with descending colon cancer with multiple liver metastases. Six courses of FOLFOXIRI plus bevacizumab were administered after laparoscopic-assisted left hemicolectomy. Ten partial hepatectomies and 1 radiofrequency ablation were performed as the liver metastases resolved. A pathological complete response was confirmed. Adjuvant chemotherapy was not administered, and recurrence-free survival was 21 months after hepatectomy. Case 2 was a 77-yearold male diagnosed with rectal cancer invading the pelvic wall and sacral foramen with bilateral lateral lymph node metastasis. Additionally, there was a cancer embolism in the right internal iliac vein. Six courses of FOLFOXIRI plus bevacizumab were administered, and the cancer tissue was absent on subsequent CT and MRI. The cancer was scarred by colonoscopy, and the biopsy showed no malignant cells. Six courses of FOLFIRI plus panitumumab were administered as second-line chemotherapy, and the patient survived without any recurrence after 12 months from initiation of chemotherapy.
127.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2407-2409.
[Analysis of Renal Toxicity of S-1 plus CDDP Regimen with Short Hydration for Outpatients with Gastric Cancer].
[Article in Japanese]
Abstract
BACKGROUND:
Although the S-1 plus CDDP(SP)regimen is the standard treatment for advanced gastric cancer, hydration and admission have been recommended after cisplatin has been administered. In this study, short hydration(SH)method was used and SP was administered in outpatient settings. We evaluated renal toxicity of cisplatin in the SH-SP regimen at our hospital.
METHODS:
Eleven of 16 patients(5 underwent only 1 course and so were excluded)received the SH-SP regimen between January 2012 and January 2018 to present and were included. Serum creatinine(Cr)and estimated glomerular filtration rate(eGFR)were used to assess renalfunction.
RESULTS:
Median course was 5. Rate of 5-course accomplishment was 72.7%. Grade 1 Cr elevation was observed in only 3 patients and there was no severe renal disorder.
CONCLUSION:
The SHSP regimen could be administered in outpatient settings and was considered safe as it did not cause renal toxicity.
128.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2404-2406.
[Two Cases of Complete Response to Trastuzumab Combined with Chemotherapy for Recurrence of HER2-Positive Gastric Cancer].
[Article in Japanese]
Iwata M1, Tabata M, Nakamura S, Nakamura S, Segi Y, Fujimura Y, Desaki R, Kobayashi M, Ohsawa I, Kato K, Sanda T.
Abstract
Case 1: A 67-year-old male underwent distal gastrectomy for advanced gastric cancer. Postoperative histopathological examination indicated pT2a, pN2, M0, pStage ⅢA. He received 4 courses of TS-1 with paclitaxel chemotherapy and TS-1 chemotherapy for 2 years. Three years and 5 months after surgery, computed tomography suggested lymph node metastasis of the mediastinum, so TS-1 with cisplatin(CDDP)therapy was administered. Five years and 10 months after surgery, recurrence occurred and docetaxel and CPT-11 were administered with no response. Since HER2 was overexpressed in the primary tumor, he was treated with capecitabine, CDDP, and trastuzumab(XPT)therapy. After 1 year and 6 months, the patient was considered to have achieved a complete response(CR), and after further trastuzumab therapy for half a year, CR was maintained for 12 years and 3 months after surgery. Case 2: A 59-year-old female underwent total gastrectomy for advanced gastric cancer. Postoperative histopathological examination indicated pT3, pN3a, M0, pStageⅢB. She received TS-1 chemotherapy for 1 year and 8 months. Computed tomography suggested paraaortic lymph node metastasis, and XPT therapy was administered. The patients responded well, and alternate administration of XPT and capecitabine and docetaxel(XT) was performed. Three years and 5 months after surgery, recurrence of lymphadenopathy occurred and intensity-modulated radiation therapy in addition to XPT/XT alternate therapy was introduced, leading to a CR 5 years and 8months after surgery. XT therapy was continued afterward, and CR was maintained for 9 years and 2 months after surgery.
129.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2401-2403.
[Usefulness of the CONUT Score for Predicting the Risk of Surgical Site Infections].
[Article in Japanese]
Abstract
BACKGROUND:
Surgical site infections(SSIs)occur at a high frequency in patients after rectal cancer surgery and are readily aggravated. Therefore, prophylactic measures for infections based on the evaluation of the patient's perioperative risk are very important. We investigated risk factors of SSI onset in patients after rectal cancer surgery.
METHODS:
In total, 66 patients with rectal cancer who underwent resection in our department between January 2015 and December 2016 were retrospectively examined.
RESULTS:
The patients in our study included 38 men and 28 women with a median age of 66 years and a median BMI of 21.3 kg/m2. Fifteen patients underwent laparotomy and 51 underwent laparoscopy. Among 66 patients, 24 had an artificial anus. The median operative time was 367 minutes, median bleeding loss was 100 mL, and median Controlling Nutritional Status(CONUT)score was 2. Twenty patients developed SSI after rectal cancer surgery. Univariate analysis demonstrated that operative time(p=0.004, OR: 1.005, 95%CI: 1.002-1.009)and CONUT score(p=0.035, OR: 1.386, 95%CI: 1.023-1.878) were significant risk factors for SSI development. Multivariate analysis also demonstrated that operative time(p=0.003, OR: 1.006, 95%CI: 1.002-1.010)and CONUT score(p=0.025, OR: 1.508, 95%CI: 1.053-2.161)were significant risk factors for SSI development.
CONCLUSIONS:
The CONUT score was identified as a significant preoperative risk factor for SSI after rectal cancer surgery in both the univariate and multivariate analyses. Therefore, the preoperative evaluation using the CONUT score may be useful for predicting the risk of SSI in patients undergoing rectal cancer surgery.
130.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2398-2400.
[Two Cases of Intraductal Papillary Neoplasm of the Bile Duct(IPNB)Resected with Hepatectomy].
[Article in Japanese]
Ikenaga N1, Komatsu H, Nishizawa Y, Inoue A, Miyazaki Y, Komori T, Motoori M, Tomokuni A, Fushimi H, Fujitani K, Iwase K.
Abstract
Case 1: A man in his 70s was referred to our hospital for further examination of a liver tumor(S3, 3 cm)detected by ultrasonography. Multimodal image examination showed a cystic lesion with solid papillary components located in the S4 accompanied by dilatation of the surrounding intrahepatic bile duct. Although biliary cytology did not indicate confirmed malignancy, the lesion was thought to be an intraductal papillary neoplasm of bile duct(IPNB)with malignant potential, and a left lobectomy was performed. Histopathological examination revealed a papillary tumor in the intrahepatic bile duct which consisted of atypical epithelial cells of pancreatobiliary type, and the lesion was diagnosed as an IPNB with high-grade intraepithelial neoplasia. Case 2: A woman in her 70s was referred to our hospital because of a liver tumor(S4, 8 cm)detected by ultrasonography. Multimodal image examination showed a cystic lesion localized to the liver(S3, 8 cm), and endoscopic retrograde cholangiopancreatography(ERCP)showed continuity of the cyst and the intrahepatic bile duct. The biliary cytology was positive, and the lesion was thought to be a malignant IPNB. After preoperative drainage of the cystic lesion, a left lobectomy was conducted. Histopathological examination showed that the papillary tumor localized to the bile duct and atypical epithelium cells of pancreatobiliary type were infiltrating into the surrounding matrix. We diagnosed this tumor as an IPNB with an associated invasive carcinoma.
131.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2395-2397.
[Gastrectomy in Patients Aged<85 Years Who Had Gastric Cancer-A Single-Institutional Experience].
[Article in Japanese]
Kato S1, Kosuga T, Konishi T, Arita T, Konishi H, Morimura R, Murayama Y, Shiozaki A, Kuriu Y, Ikoma H, Kubota T, Nakanishi M, Okamoto K, Fujiwara H, Otsuji E.
Abstract
BACKGROUND:
This study examined the treatment outcomes of gastrectomy in patients aged<85 years who had gastric cancer(GC).
METHODS:
The postoperative short- and long-term outcomes of 27 patients aged<85 years who underwent gastrectomy for GC at our institute were retrospectively investigated.
RESULTS:
The median age was 87 years(range: 85-94 years), and 17 patients(63%)had comorbidities. Total, distal, and proximal gastrectomies were performed for 12, 14, and 1 patient, respectively. Only 13 patients(48%)underwent standard lymph lymphadenectomy(LND), while R0, R1, and R2 were performed for 23, 2, and 2 patients, respectively. The overall, surgical, and non-surgical complication rates were 59%, 26%, and 44%, respectively, even though the incidence of GradeBⅢa complications was only 4%, and there was no mortality. The 1-, 2-, and 3-year overall survival rates(OSR)were 91.7%, 79.4%, and 63.2%, respectively. The 3-year OSRs of the patients who underwent R0, R1, and R2 were 76.2%, 35.4%, and 0%, respectively. The 3-year OSR was significantly higher in the patients who underwent the standard LND(100%)than in those who underwent limited LND(36.6%).
CONCLUSION:
The standard LND and R0 might also be useful for patients aged<85 years who had GC, although care should be taken for the high incidence of complications.
132.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2392-2394.
[Two Cases of Orbital Metastasis from Breast Cancer].
[Article in Japanese]
Abstract
Orbital metastasis from breast cancer is a rare condition. Here, we describe 2 cases of orbital metastasis from breast cancer. The first patient was a 26-year-old woman diagnosed with triple-negative invasive ductal carcinoma. She underwent surgery after neoadjuvant chemotherapy. One year after surgery, she had multiple bone metastases and then multiple liver metastases developed. During chemotherapy for metastatic disease, she complained ofheadaches and visual disturbances. Findings ofa MRI scan suggested a metastatic tumor in the left orbit. A total of 30 Gy of radiation therapy was administered, but she died a month after the orbital metastasis was discovered. The second patient was a 42-year-old woman, who had advanced breast cancer with bone metastasis. Diplopia developed 8 months after initiation of chemotherapy. Meningeal dissemination was suspected because ophthalmological examination revealed swelling ofbilateral optic discs. She lost her sight within a month. She died 2 months after the diagnosis oforbital metastasis. There was no evidence ofcentral nervous system metastasis in either case. Loss ofvision severely impairs patients' quality oflif e. It is important to know that there is rarely such a rapid progression ofdisease, especially in young patients with triple-negative disease.
133.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2389-2391.
[Effects of Preoperative Immune and Nutritional Indices on the Prognosis of pStage Ⅱ and Ⅲ Colorectal Cancer].
[Article in Japanese]
Nakata Y1, Furuya S, Takiguchi K, Ashizawa N, Shimizu H, Akaike H, Hosomura N, Kawaguchi Y, Amemiya H, Sudo M, Kawaida H, Inoue S, Kono H, Ichikawa D.
Abstract
We examined the relationship between immune and nutritional indices and the outcome of colorectal cancer patients at our hospital. We retrospectively analyzed 196 patients with pStage Ⅱand Ⅲcolorectal cancer who underwent curative surgery in our institution between 2007 and 2013. The evaluation items were immune and nutritional indices, such as neutrophil/lym- phocyte ratio(NLR), platelet/lymphocyte ratio(PLR), lymphocyte/monocyte ratio(LMR), and the Onodera nutritional index (PNI). Moreover, we analyzed the relationship between immune and nutritional indices and outcome, overall survival(OS), and recurrence-free survival(RFS). Univariate and multivariate analyses showed that low LMR was significantly related to high mortality. Univariate analysis showed that high NLR, low LMR, and low PNIwere significantly related to a decrease in OS. Multivariate analysis showed that PNIwas an independent predictor of OS. LMR is suggested as a new predictor for postoperative complications. PNIis suggested as a new prognostic factor in pStageⅡand Ⅲcolorectal cancer.
134.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2386-2388.
[Consideration for Prognostic Indicators of Ovarian Metastasis of Colorectal Cancer].
[Article in Japanese]
Ueda K1, Shinji S, Yamada T, Koizumi M, Matsuda A, Ohta R, Yokoyama Y, Takahashi G, Hotta M, Takeda K, Hara K, Kuriyama S, Yoshida H.
Abstract
Ovarian metastasis of colorectal cancer is associated with poor prognosis. Recent advances in chemotherapy may improve this prognosis. In this retrospective study, we evaluated indicators of poor prognosis for ovarian metastasis of colorectal cancer. Twenty patients, who were diagnosed with ovarian metastasis of colorectal cancer from April 2000 to December 2017, were enrolled. Oophorectomy was performed in 18 of the 20 patients. Postoperative chemotherapy was provided to 13 patients, and molecular targeting agents were administered in 5 patients. Metastases to other organs besides the ovaries, premenopausal condition, undifferentiated histologic type of the primary tumor, and no resection of ovarian metastases were identified as indicators of poor prognosis. The 3-year survival rate was 15%, and the 5-year survival rate was 0%. In conclusion, oophorectomy can improve the prognosis of patients with ovarian metastasis of colorectal cancer. However, prognostic improvement due to molecular target agents was not shown.
135.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2383-2385.
[A Case of Gastrointestinal Stromal Tumor in the Rectum with Preservation of Anal Function after Neoadjuvant Chemotherapy UsingImatinib].
[Article in Japanese]
Abstract
A n 81-year-old woman was admitted to our institution. Computed tomography performed before transcatheter aortic valve implantation(TAVI)for aortic stenosis revealed a tumor in the rectum. Lower endoscopy revealed that the tumor was a 60mm submucosal tumor and located 2 cm from the anal verge. Abiopsy revealed the diagnosis to be gastrointestinal stromal tumor(GIST). Although the tumor was located near the anal verge and might have invaded the surrounding organs, neoadjuvant chemotherapy(NAC) with 400mg/day of imatinib was initiated to preserve anal function as requested by the patient and her family. After 3 months, the tumor size decreased by 36.6% and there was a decrease in rate of tumor shrinkage. We performed transanal tumor resection and temporary colostomy. After 6 months, we performed colostomy closure, and the patient has remained recurrence-free and is continuing chemotherapy.
136.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2380-2382.
[A Case of Laparoscopic Gastric Local Resection for Simultaneous Multiple Gastric GIST Discovered Owing to Gastrointestinal Bleeding].
[Article in Japanese]
Abstract
An 80-year-old woman with anemia presented to our hospital. Upper gastrointestinal endoscopy revealed a 4 cm submucosal tumor(SMT)with a delle and 2 cm SMT in the upper part of the stomach. CT revealed sustained enhancement of both tumors. The posterior tumor was an intraductal growth, and the anterior tumor was an extravascular growth. We performed a laparoscopic gastric local excision for the multiple SMTs. The anterior tumor was resected with an automatic suture instrument. However, the posterior tumor could not be identified from within the abdominal cavity because it was resected while confirming using an endoscope, and all layers were sutured. On histopathological examination, the posterior tumor was 40mm in size, with spindle-shaped atypical cells growing in the submucosal layer. Immunostaining was c-kit(+), CD34(+), S-100(-), and desmin(-). The Ki-67 level was<1%. The anterior wall tumors showed similar findings, but some showed smooth muscle differentiation. From the results, a diagnosis of simultaneous multiple gastric GIST(low risk)was made.
137.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2378-2379.
[A Resected Case of Rectal Metastasis from Gastric Cancer].
[Article in Japanese]
Watanabe Y1, Iwamoto R, Kitagawa S, Kinoshita S, Ueno M, Mineta S, Okamoto Y, Uraoka M, Kubota H, Higashida M, Okada T, Tsuruta A, Fujiwara Y, Ueno T.
Abstract
An 82-year-oldwoman previously underwent total gastrectomy for gastric cancer at the age of 75 years. After 7 years of follow-up, a colonoscopy was performedto investigate the cause of constipation, which revealedan irregularity in the rectal submucosa. A colonoscopy-guidedbiopsy showedpoorly differentiatedad enocarcinoma, andthe immunohistochemical staining pattern showedMUC2(-), MUC5AC(+), CDX2(+), andCA1 25(-). FDG-PET showedintense uptake only at the rectum. Thus, laparoscopic high anterior resection was performed. Pathological findings showed that poorly differentiated adenocarcinoma and signet-ring cell carcinoma hadd evelopedmainly in the submucosa. In comparison with the immunohistological features of the previous gastric cancer, the rectal tumor hadsimilar morphological characteristics. The definitive diagnosis was rectal metastasis from gastric cancer. She has remained recurrence-free in the 20 months since this operation.
138.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2375-2377.
[A Case of Cecal Cancer Complicated with Intussusception Treated Laparoscopically].
[Article in Japanese]
Fukata T1, Okimura S, Ito Y, Taniguchi Y, Nishida H, Shingai T, Takayama O, Yoshioka S, Hojo S, Ohigashi H, Fukuzaki T.
Abstract
A 75-year-old woman presented with the chief complaint of right lower abdominal pain. There was mild tenderness in the lower right abdomen and a mass was palpated. There were no peritoneal irritation symptoms. A CT examination was performed. The ascending colon was invaginated with a part of the cecum and ileum. Wall thickening was observed in the advanced part. Colon cancer was suspected. The preoperative diagnosis was considered to be an intussusception with cecal cancer at the advanced part. A laparoscopic ileocecal resection was performed. The intraoperative findings were as follows. The tumor was invading the ascending colon, but it was possible to restore it by pressing on the developed part with forceps. The pathological diagnosis was Type 2, muc>tub1, pT4aN0M0, pStageⅡb. The postoperative course was good. Water intake was started on the next day, meals were started from the second day, and the patient was discharged on the 9th day after the operation. Cecal cancer complicated with intussusception is a relatively rare disease. We report a case that was laparoscopically operable.
139.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2372-2374.
[Curative Resection for Liver Metastasis Ten Years after Surgery for Rectosigmoid Cancer-A Case Report].
[Article in Japanese]
Okamura S1, Fukuchi N, Minoji T, Tamai K, Kitahara T, Takabatake H, Watanabe N, Yamamura N, Ebisui C, Yokouchi H, Ohishi K, Kinuta M.
Abstract
Here, we report the case of a 73-year-oldfemale patient, who previously underwent high anterior resection for rectosigmoidcancer at the age of 63. Her scheduled5 years of follow-up after colorectal surgery hadbeen finished, but she kept undergoing endoscopic mucosal resection for colorectal polyps every 1 or 2 years since then. Blood examination 10 years 6 months after surgery for rectosigmoidcancer revealedthat the value of her serum CEA was 5.5 ng/mL, which was slightly higher than the normal range. Contrast-enhancedCT showedan irregular-shapedtumor with a diameter of 3 cm in which the contrast of the peripheral area was mainly emphasized. When combining the results of MRI and PET-CT examinations, the liver tumor was clinically diagnosed as either intrahepatic cholangiocarcinoma or metastatic liver cancer. Since the first choice of therapy was tumor resection for both diagnoses, S8 subsegmental hepatectomy was performed 10 years 8 months after surgery for rectosigmoidcancer. HE staining of the resectedspecimen showedwell or moderately differentiatedad enocarcinoma, andits immunostaining findings were as follows: CDX-2: positive, CK20: positive, CK7: negative. It was pathologically diagnosed as liver metastasis from rectal cancer. It is rare for colorectal cancer to have metachronous liver metastasis more than 10 years after surgery. However, in any case where a tumor marker for colorectal cancer increases, it is necessary to examine carefully with the possibility of any metastasis in mind.
140.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2369-2371.
[A Case with Three Resections of the Pulmonary Metastases of a Distal Bile Duct Carcinoma].
[Article in Japanese]
Ando K1, Tomimaru Y, Iwazawa T, Noguchi K, Nagase H, Ogino T, Hirota M, Oshima K, Tanida T, Noura S, Kawase T, Imamura H, Akagi K, Dono K.
Abstract
A 68-year-old man underwent a subtotal stomach-preserving pancreatoduodenectomy(SSPPD)for a distal bile duct carcinoma(BDC)pT3aN1M0, pStage ⅡB and adjuvant chemotherapy with gemcitabine. One year 7 months after the initial surgery, CT revealed a nodule with an increasing tendency in the left lung. As it was difficult to distinguish primary lung cancer from BDC lung metastasis, we performed a thoracoscopic left wedge resection. The histopathology of the resected specimen was BDC lung metastasis. In the follow-up with adjuvant chemotherapy with S-1 for 10 months, 2 nodules were found in the right lung, and we performed thoracoscopic right S6 segmentectomy. Eight months later, another nodule was found in the left lung, and we performed thoracoscopic left wedge resection. The histopathology was BDC lung metastasis for all the resected specimens. The patient is alive with no evidence of recurrence after 9 months of the latest surgery(4 years 11 months after the initial surgery). Although the standard treatment for metastatic recurrence of BDC is systemic chemotherapy, some cases treated with surgical resection had relatively good prognosis, such as the present case. Surgical resection might be feasible as a treatment option for metastatic recurrence of BDC.
141.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2366-2368.
[Advanced Gastric Cancer with Liver Metastasis and Para-Aortic Lymph Node Metastases Treated Effectively Using Neoadjuvant CapeOX Therapy].
[Article in Japanese]
Kidogami S1, Tamura S, Endo S, Imamura H, Yoneda N, Mokutani Y, Kishimoto T, Hashimoto Y, Hirose H, Ide Y, Sasaki Y.
Abstract
A 60-year-old man was diagnosed with advanced gastric cancer(cT4a, N1, M1[No. 16LYM], cStage Ⅳ). He was treated with a neoadjuvant chemotherapy of a regimen consisting of capecitabine plus oxaliplatin, followed by distal gastrectomy with D2 and No. 16lymph node dissection and partial hepatectomy of S3 and S6. He had an uncomplicated postoperative course and was discharged early from hospital. Capecitabine was started at POD 40 as an adjuvant chemotherapy. Postoperatively, the histological effect was determined to be Grade 2, and hepatic tumors and lymph nodes showed no residual cancer. He started capecitabine monotherapy as adjuvant chemotherapy. At 10 months postoperatively, the patient was alive and relapse-free.
142.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2363-2365.
[A Case of Rectal Cancer with Multiple Liver Metastases Curatively Resected after Systemic Chemotherapy].
[Article in Japanese]
Inoue T1, Tei M, Mikuriya K, Makutani Y, Ozato Y, Marukawa D, Furukawa H, Sueda T, Matsumura T, Koga C, Wakasugi M, Miyagaki H, Kawabata R, Shimizu J, Hasegawa J.
Abstract
A 61-year-old man complainingof bloody stool was diagnosed with advanced rectal cancer with multiple liver metastases (cT3[A]N1M1a[H2], cStage Ⅳ). We introduced bevacizumab combined systemic chemotherapy prior to radical surgery and confirmed tumor shrinkage in both the primary tumor and liver metastases following systemic chemotherapy. We performed laparoscopic lower-anterior resection, and then the patient underwent liver metastases resection. The histologic evaluation was Grade 2. This was a pathologically curative resection, and the patient has been disease-free since the last operation.
143.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2360-2362.
[A Case of Rupture of Esophageal Varices during a Course of CAPOX with Bevacizumab Therapy for Sigmoid Colon Cancer with Multiple Liver Metastases].
[Article in Japanese]
Lee T1, Takatsuka S, Kaizaki R, Eguchi S, Okazaki Y, Sano K, Yamaguchi S, Tsukamoto T, Nishiguchi Y.
Abstract
The patient was a 67-year-old man with multiple liver metastases from sigmoid colon cancer and had received capecitabine, oxaliplatin, and bevacizumab(CAPOX plus Bev)combination chemotherapy. After 11 courses of this therapy, he had a rupture of esophageal varices and was treated with endoscopic variceal ligation(EVL). Esophageal varices are rare during the course of oxaliplatin-based chemotherapy. More studies are necessary for early detection of esophageal varices during this therapy.
144.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2357-2359.
[A Case of Liver Metastases of Ampullary Carcinoma with Clinical Complete Response Treated with Gemcitabine plus Cisplatin].
[Article in Japanese]
Takeda Y1, Ohmura Y, Katsura Y, Sakamoto T, Haruna K, Kawai K, Murakami K, Yanagawa T, Yanai A, Kagawa Y, Masuzawa T, Takeno A, Egawa C, Hata T, Murata K.
Abstract
We report a case of liver metastases of ampullary carcinoma that achieved clinical complete response after gemcitabine plus cisplatin(GC)combination chemotherapy. A 69-year-old man with obstructive jaundice was diagnosed with ampullary carcinoma and underwent laparoscopic pancreaticoduodenectomy. Postoperative histopathological examination revealed pT3aN0M0, Stage ⅡA adenocarcinoma of the papilla of Vater. Five months after surgery, multiple liver metastases were identified by CT and MRI. The patient received GC chemotherapy intravenously at doses of 1,000 and 25mg/m2 on days 1 and 8, respectively, every 3 weeks. After 3 courses of GC chemotherapy, a CT scan revealed that the liver metastases reduced in size, and PR was achieved based on the RECIST standard. However, Grade 3 neutropenia appeared. After 7 courses, the liver metastases disappeared, and the patient had achieved CR. After 9 courses, the clinical CR continued. Approximately 14 months have passed since the recurrence, and the patient is currently alive.
145.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2354-2356.
[A Surgically Resected Case of Lung Metastases and Sister Mary Joseph's Nodule 24 Months after Operation for Pancreatic Cancer].
[Article in Japanese]
Abstract
Metastatic umbilical tumors from internal malignancy, known as Sister Mary Joseph's Nodule(SMJN), are a relatively rare prognostic sign. An 86-year-old woman with pancreatic body carcinoma underwent distal pancreatectomy for D2 lymph node removal in 20XX. No peritoneal dissemination was found at that time. Postoperative chemotherapy was not administered due to her age. Eighteen months postoperatively, tumor marker values increased and chest computed tomography(CT) revealed a single mass in the left lung. We resected the suspected lung metastasis. Positron emission tomography-CT performed 23 months postoperatively for increased tumor marker values after resection showed a 18F-fluorodeoxyglucose accumulation ofapproximately 4 cm in the umbilicus. The diagnosis by biopsy was umbilical metastasis ofthe pancreatic cancer. No recurrence or other metastases were found, so we performed an umbilical tumor resection and abdominoplasty 24 months postoperatively. No peritoneal dissemination was found in her abdomen and the ascites cytology was negative. The tumor was in the subcutaneous tissue; thus, the possibility of infiltration from the primary site or peritoneal dissemination was low. The tumor marker values decreased after the resection. She was followed-up without postoperative anticancer chemotherapy. However, the tumor marker values increased again, so chemotherapy was initiated. We report a case ofresection of pancreatic cancer and operation for lung and umbilical metastases of pancreatic cancer.
146.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2351-2353.
[A Case Report of Advanced Gastric Cancer with Synchronous Liver Metastasis Treated with Conversion Surgery after S-1 plus Oxaliplatin Chemotherapy].
[Article in Japanese]
Hokkoku D1, Akamaru Y, Wada N, Wada R, Ikeshima R, Munakata K, Takiuchi D, Morimoto O, Ota H, Shibata K, Ohash H.
Abstract
Gastroscopy ofa 79-year-old man complaining ofanemia showed a type 3 tumor at the lesser curvature ofthe gastric body. A biopsy revealed poorly differentiated HER2-negative adenocarcinoma. Abdominal CT showed the tumor at the lesser curvature ofthe gastric body, multiple lymph nodes with a maximum diameter of 25mm at the lesser curvature, and a mass measuring 50mm with ring enhancement on S6 ofthe liver. The clinical diagnosis was cT4aN2M1(Hep), cStage Ⅳ. He was treated with chemotherapy comprising 4 courses ofS -1 plus oxaliplatin. Although the tumor had shrunk remarkably, chemotherapy was discontinued because of anorexia. Therefore, we performed total gastrectomy and hepatic partial resection(S6). The final staging was ypT3N0M0, ypStage ⅡA. We achieved R0 resection, and he has shown no recurrence without adjuvant chemotherapy for 3 years.
147.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2348-2350.
[A Case of Solitary Residual Lateral Pelvic Lymph Node Metastasis Despite Complete Response of Primary Rectal Cancer Followed by Neoadjuvant Chemoradiotherapy].
[Article in Japanese]
Tayama H1, Karasawa H, Kajiwara T, Ohnuma S, Suzuki H, Kohyama A, Watanabe K, Ishida T, Kamei T, Naitoh T, Unno M.
Abstract
A 45-year-old woman was referred to our hospital complaining of diarrhea. Colonoscopy showed a rectal tumor. Histological examination showed moderately differentiated adenocarcinoma. A CT scan revealed a tumor extending from the lower rectum to the anal canal with a lateral pelvic lymph node(LPLN)swelling. We administered neoadjuvant chemoradiotherapy (45 Gy/25 Fr, S-1 80mg/m / 2/day)and the tumor and LPLN shrank remarkably, with a clinically complete response by CT and PET-CT. We then performed abdominoperineal resection with D3 lymph node and bilateral LPLN dissection. Pathological examination revealed complete disappearance of the cancer cells in the primary site, while lymph node metastasis was detected in one LPLN. We report here a rare case in which LPLN metastasis remained despite the pathological complete response of the primary tumor.
148.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2345-2347.
[A Case of Cystic Biliary Hamartoma with a Difficult Preoperative Diagnosis].
[Article in Japanese]
Ohashi T1, Sakai K, Yoshida M, Hara S, Takayama K, Yoneda K, Osawa H, Ide Y, Noro H, Hirao T, Iwasaki T, Hatanaka N, Yamasaki Y.
Abstract
Intrahepatic bile duct dilatation was detected in a 63-year-old man based on abdominal ultrasonography. The computed tomography and magnetic resonance imaging scans showed an intrahepatic cystic lesion in the hilar bile duct that led to intrahepatic bile duct dilatation. As a result, intraductal papillary neoplasm of the bile duct(IPNB)was suspected. Moreover, the intrahepatic bile duct dilatation was confirmed by endoscopic retrograde cholangiopancreatography(ERCP). Biliary and brushing cytology indicated that the cystic lesion was class Ⅱ and class Ⅲ, respectively. Radiological imaging test did not rule out the possibility of a malignant lesion. Hence, a radical left hepatectomy was performed. Histopathological examination of the resected specimen indicated that it was a non-malignant cystic biliary hamartoma. Cystic biliary hamartoma or the von Meyenburg complex is a relatively rare disease. Although this disease is categorized as benign, differential diagnosis between benign and malignant forms is difficult, and this is an important clinical issue.
149.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2342-2344.
[A Case Report of Long Survival in Pancreatic Cancer with Superior Mesenteric Arterial Invasion Following Multimodal Therapy].
[Article in Japanese]
Morimoto O1, Eguchi S, Hokkoku D, Wada R, Ikeshima R, Wada N, Munakata K, Takiuchi D, Azama T, Okura E, Akamaru Y, Ota H, Kitada M, Shibata K, Ohashi H.
Abstract
The prognosis of pancreatic cancer with superior mesenteric arterial invasion is very poor and judgment of surgical indication is very difficult. We report a case that received multimodal therapy for pancreatic cancer with superior mesenteric arterial invasion. A 43-year-old woman consulted a local doctor because of upper abdominal pain. Ultrasonography revealed a nodule in the pancreatic body and elevated CA19-9 values. She was referred to our hospital for evaluation and therapy. Computed tomography showed a low-density area in the pancreatic body and around the superior mesenteric artery. The clinical diagnosis was pancreatic cancer with superior mesenteric arterial invasion. She received chemoradiation therapy(RT, 50.4 Gy, gemcitabine[GEM]plus TS-1)followed by distal pancreatectomy. She received adjuvant chemotherapy(TS-1)for 6 months. However, follow-up CTperformed 10 months after surgery revealed local recurrence. The patient received chemotherapy( GEM)for 8 months and GEM plus nab-PTX for 22 months. She died from the cancer 50 months after the primary operation.
150.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2339-2341.
[A Case of Ductal Carcinoma In Situ(DCIS)Diagnosed by Excisional Biopsy with Benign Cytology Findings of Fine-Needle Aspiration].
[Article in Japanese]
Ishizuka M1, Yamamoto D, Shoji T, Sueoka N, Miyata M, Umezaki N, Yoshikawa K, Yoshida N, Sekimoto H.
Abstract
Nipple discharge is a common symptom and frequently results from benign tumors. However, there is a 5-30% risk of malignancy. A 65-year-old woman presented at the hospital because of bloody nipple discharge in her right breast. She had noticed an abnormal nipple discharge for several months. Mammography showed focal asymmetric densities without calcification in the middle outer quadrant of her right breast. Ultrasonography indicated a 1.5×1.1 cm sized cyst with fluid-fluid level. Breast MRI showed a simple cyst with a benign contrast enhancement pattern. No malignant cells were observed by fine-needle aspiration. Considering the low sensitivity of mammography and breast MRI to DCIS, we performed an excisional biopsy. Histological examination revealed that the lesion was DCIS. The patient underwent right total mastectomy and was diagnosed with low grade DCIS(ER-positive, PgR-positive, HER2-negative). She continues endocrine therapy with an aromatase inhibitor.
151.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2336-2338.
[A Case of Long-Term Survival of a Postoperative Recurrence of Duodenal Papilla Adenosquamous Carcinoma Associated with the Annular Pancreas].
[Article in Japanese]
Abstract
A woman in her mid-50's presented to our hospital with jaundice, fatigue, and fever. Jaundice, elevated tumor markers, and lower bile duct stricture suggested malignancy, for which subtotal stomach-preserving pancreaticoduodenectomy was performed. The patient also had annular pancreas as the second part of the duodenum was surrounded by pancreatic parenchyma. The histopathological diagnosis was adenosquamous carcinoma of the duodenal papilla associated with annular pancreas. Adjuvant chemotherapy with TS-1 was administered for 1 year. Although para-aortic lymph node metastasis was detected radiographically 3 years 9 months after surgery, the recurrence remains under control and she is alive at 5 years 9 months after surgery due to multidisciplinary therapy.
152.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2333-2335.
[Two Cases of Advanced Gastric Cancer with Simultaneous Liver Metastasis with Long-Term Recurrence-Free Survival].
[Article in Japanese]
Yamaguchi T1, Kashu N, Yasuda K, Yoshitake H, Takami T, Hatano K, Shintani H, Kataoka N, Tomita M, Shono Y, Makimoto S.
Abstract
We report 2 cases of postoperative long-term survival of gastric cancer with synchronous liver metastasis. Case 1 was a 65- year-old man. Examination for anemia revealed advanced type 5 cancer in the antrum and suspected invasion of the transverse colon. A nodule 15mm in diameter suspected to be metastasis was also found in the liver S2. As no unresectable factors were present, partial hepatectomy, partial transverse colon resection, and distal gastrectomy were performed. Postoperatively, S-1 chemotherapy was administered for 14 months. Seven years after surgery, the patient is alive without recurrence. Case 2 was a 67-year-old woman. Examination for anemia revealed advanced type 2 cancer in the lower gastric body and a nodule 12mm in diameter suspected to be liver metastasis in the liver S8. Partial resection of the liver, total gastrectomy, cholecystectomy, and splenectomy were performed because no unresectable factors were observed. Postoperatively, chemotherapy with S-1 was administered for 38 months. Six years after surgery, she is alive without recurrence. Although there is no clear evidence for radical surgery for gastric cancer with simultaneous liver metastases, these results indicate that resection may be considered in cases with small numbers of metastases.
153.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2330-2332.
[A Case of Advanced Breast Cancer with Altered Biology by Eribulin Chemotherapy].
[Article in Japanese]
Asano Y1, Kashiwagi S, Kouhashi R, Takada K, Goto W, Ishihara S, Tauchi Y, Morisaki T, Noda S, Takashima T, Onoda N, Hirakawa K, Ohira M.
Abstract
In the treatment of advanced breast cancer, onlya few drugs confer overall survival(OS)benefit. Eribulin is a drug that was shown to extend OS in an international phase Ⅲtrial; however, the underlying mechanism is thought to involve cancer microenvironment regulation. The concept of "breast cancer subtype discordance" implies the biological changes that accompany treatment. Herein, we encountered a case of advanced breast cancer in a 54-year-old woman that showed biological changes after eribulin chemotherapy. The patient noticed a lump in her left breast and visited a nearby doctor, who referred her to our hospital for close examination and treatment. Ultrasonographyrevealed a large mass at the center of the left mammarygland and axillaryly mph node swelling. Core-needle biopsyconfirmed an invasive ductal carcinoma(ER stronglypositive, PgRnegative, HER-2 negative, Ki-67 low expression). CT findings showed multiple lung metastases. Letrozole was administered for cT4N2M1, stage Ⅳ, Luminal A, which showed progression to the left side with advances in breast cancer. Six months later, the primarytumor and axillaryly mph nodes showed progression. Subsequent treatment with eribulin was started, and partial response was obtained; however, new lymph node metastasis developed in the axilla after 11 cycles. The primary tumor and axillaryly mph nodes showed stronglypositive ER expression, were PgR-negative and HER2-positive, and showed Ki-67 low expression and HER2-positive conversion.
154.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2327-2329.
[A Case of Colon Neuroendocrine Carcinoma Believed to Be a Recurrence of Appendiceal Adenocarcinoma].
[Article in Japanese]
Watanabe A1, Yamashita K, Takiguchi G, Urakawa N, Hasegawa H, Yamamoto M, Kanaji S, Matsuda Y, Matsuda T, Oshikiri T, Nakamura T, Suzuki S, Kakeji Y.
Abstract
Neuroendocrine carcinomas in the right-side colon are rare. We report a case of neuroendocrine carcinoma occurring in the anastomotic site after ileocecal resection. The patient was a 55-year-old man who underwent ileocecal resection for adenocarcinoma in his appendix. Following surgery, he was administered adjuvant chemotherapy. Two and a half years after the surgery, he was diagnosedwith left ilium bone metastasis andreceivedrad iotherapy. After the radiotherapy, an anastomotic tumor andperitoneal metastasis were found. He was administeredFOLFIRI but couldnot tolerate the therapy. After changing to FOLFOX therapy, he reportedabd ominal pain from perforation of the anastomotic tumor, which was not improvedby antibiotics. Therefore, he was referredto our hospital for surgery. The surgery includedresection of part of the anastomosis. Histopathological examination showed that the tumor at the anastomosis was not adenocarcinoma but rather neuroendocrine carcinoma. After discharge, the patient started a new chemotherapy regimen(CDDP plus VP-16). This case indicates that resection of the recurrence site may leadto new treatment, improve patient' QOL, andextendthe life prognosis.
155.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2324-2326.
[Long-Term Disease-Free Survival after Chemoradiotherapy for Postoperative Local Recurrence of Rectal Cancer-A Case Report].
[Article in Japanese]
Abstract
We report a case of a 63-year-old man with a perirectal abscess due to rectal cancer referred to us from another clinic. We performed 3 courses of preoperative chemotherapy using mFOLFOX6 and then performed a Miles operation plus D3 dissection followed by reconstruction of an artificial anus using the ileum. The pathological diagnosis was tub2, pAI(prostate), pN0 (0/12), ND(v+), and fStage Ⅲa. Dehiscence of the perineum wound area occurred 4 months after surgery, for which drainage was required. Local recurrence was then discovered by cytology. We administered mild 40 Gy radiation and chemotherapy using Bmab combined with mFOLFOX6. CT scans showed a significant reduction in the tumor and the tumor marker levels returned to within normal ranges. We then converted to Pmab plus FOLFIRI, which has been administered bimonthly for 3 years to date. The overall chemoradiotherapy duration has been about 5 years. Follow-up imaging findings continue to show sustained remission.
156.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2321-2323.
[A Case of Bladder Urothelial Carcinoma with Hepatic Metastasis Achieving Histologically Complete Response by Multimodal Treatment Including Pembrolizumab].
[Article in Japanese]
Abstract
A 70s man underwent transurethral resection of the bladder tumor(TURBT)at a previous hospital. The pathological diagnosis was urothelial carcinoma pT1. Nine months later, recurrence appeared in the bladder and he underwent repeated TURBT. The pathological diagnosis was also pT1 and he was administered 8 courses of intravesical BCG therapy. Fourteen months after the first operation, computed tomography scans showed new lesions in the liver. Therefore, he was referred to our hospital. Because biopsy from the hepatic lesion confirmed the diagnosis of metastatic urothelial carcinoma, he received 10 courses of gemcitabine plus cisplatin(GC)and radiofrequency ablation. However, daughter nodule and enlargement of the main tumor were revealed on MRI 33 months after the initial TURBT. After 5 courses of pembrolizumab that limited the potential for hepatic metastases, he had no evidence of other metastatic sites and underwent laparoscopic right hepatectomy. There was no viable carcinoma in the pathological specimens of the hepatic lesions. Six months after hepatectomy, the patient has a high quality of life without any recurrence.
157.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2318-2320.
[A Case of Gastric Cancer with Continued Progression-Free Survival Even after Total Gastrectomy and Nivolumab Therapy].
[Article in Japanese]
Fujii H1, Choda Y, Kubota T, Ishida M, Sato D, Sumitani D, Yoshimitsu M, Nakano K, Harano M, Matsukawa H, Idani H, Shiozaki S, Okajima M.
Abstract
This is a first report of gastrectomy after nivolumab immunotherapy. We describe a case in an elderly woman with gastric cancer diagnosed with cT4bN3M1(LYM), cStage ⅣB disease. Although she was administered 2 courses of SOX chemotherapy as the primary treatment, she could not continue the treatment to due to bone marrowsuppression. The second-line treatment was weekly PTX therapy, but she experienced Grade 3 neutropenia and thrombocytopenia in the first course and could not continue treatment. Nivolumab as the next treatment was effective but was discontinued for suspected druginduced pneumonia. During that time, tumor hemorrhage occurred and we performed total gastrectomy. Postoperatively, nivolumab chemotherapy was resumed. There were no adverse events and the patient has had a continued partial response for 30 courses. Gastrectomy was necessary in this case, allowing observation of the pathological findings of this highly effective case.
158.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2315-2317.
[A Case of Long Survival with Hilar Lymph Node Metastasis from Gastric Cancer Successfully Treated with Nivolumab Immunotherapy].
[Article in Japanese]
Abstract
A 74-year-old man underwent distal gastrectomy for gastric cancer(CY1, fStage Ⅳ). About 18 months after surgery, abdominal CT scans revealed multiple lymph node metastases along the portal vein. Systemic chemotherapy was administered comprising a capecitabine/oxaliplatin(CAPOX)regimen. After 4 courses of chemotherapy, an adverse reaction of Grade 2 diarrhea and peripheral neuropathy occurred, although regression of the lymph node metastasis was confirmed. Ramucirumab was administered as the second-line regimen, but CT imaging revealed lymph node progression after several courses. Although irinotecan(CPT-11)was selected as the third-line chemotherapy, the lymph node progression remained uncontrolled. Nivolumab was selected as the fourth-line chemotherapy. After 23 courses, nivolumab immunotherapy induced a partial response to the lymph node metastasis. Nivolumab immunotherapy continues to be administered until now, 5 years after the operation. We experienced a case of lymph node metastasis from gastric cancer successfully treated with nivolumab chemotherapy.
159.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2312-2314.
[A Case of Small Cell Carcinoma of the Pancreas].
[Article in Japanese]
Sannomiya H1, Okamoto T, Ryu S, Ichikawa J, Koreeda N, Shin Y, Yamana I, Sato K, Yoshida Y, Noritomi T, Yoshida T, Hirata K.
Abstract
A 55-year-old man was admitted to our hospital for jaundice. Magnetic resonance cholangiopancreatography showed a mass in the pancreatic head as well as biliary obstruction. We strongly suspected invasive ductal carcinoma of the pancreas. We performed pancreaticoduodenectomy with partial resection of the portal vein. The histopathological diagnosis was small cell carcinoma of the pancreas. We detected metastasis of the right hilar lymph node in PET-CT scan performed 2 months after the surgery and started chemotherapy with cisplatin(CDDP)plus irinotecan(CPT-11). However, we observed recurrent metastasis of the right hilar lymph node 12 months after the surgery. We started second-line chemotherapy with amrubicin( AMR)and radiotherapy. Unfortunately, the patient died from multiple metastases of the left adrenal gland and brain 26 months after the surgery. The prognosis of small cell carcinoma of the pancreas is extremely poor. Multimodal treatment such as chemotherapy, radiotherapy, and curative operation are required for long-term survival.
160.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2309-2311.
[A Vesected Case of Pancreatic Metastasis from Breast Cancer Which Recurred Six Years after Breast Surgery].
[Article in Japanese]
Nakama Y1, Maruyama Y, Hisaka T, Yasumoto M, Okabe Y, Naito Y, Yamaguchi M, Tanaka M, Tanaka H, Akagi Y, Okuda K.
Abstract
A 43-year-old woman who underwent surgical resection of invasive ductal carcinoma in the left breast at the age of 37 years old presented at our hospital for evaluation of pancreatic tumor. The original tumor was estrogen receptor(ER)progesterone receptor(PgR)and HER2 positive. At that time, she underwent radical mastectomy with no evident nodal disease. Postoperatively, the patient was placed on adjuvant tamoxifen therapy for several years. Six years following the original diagnosis of breast cancer, she was referred to the hospital for routine check-up while asymptomatic. Follow-up examination showed a solitary hypodense mass approximately 0.9 cm in size in the pancreas body on dynamic CT scan. The patient underwent a standard distal pancreatectomy with standard regional lymphadenectomy. Histopathological examination and immunohistochemical features revealed that the tumor was compatible with metastatic pancreatic adenocarcinoma from breast cancer.
161.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2306-2308.
[A Case of Resected Metachronous Pancreatic Metastasis from Rectal Carcinoma].
[Article in Japanese]
Sakai K1, Ohashi T, Shimura Y, Teranishi R, Hara S, Takayama K, Yoshida M, Yoneda K, Osawa H, Ide Y, Noro H, Hirao T, Iwasaki T, Hatanaka N, Yamasaki Y.
Abstract
A 69-year-old man underwent a Miles operation with D3 lymph node dissection for rectal cancer. The pathological diagnosis was adenocarcinoma(Rb, A, ly2, v3, N2M0P0H0, Stage Ⅲb). Adjuvant chemotherapy was added for 6 months after the rectal resection. Metastasis in the left lung was detected 1 year and 10 months after rectal resection for which large segmental resection was performed. Without the onset of any new lesions, the patient underwent subsequent follow-up examinations. Abdominal CT performed for increased tumor marker levels observed at 6 years and 8 months after rectal resection revealed a mass suggestive of pancreatic ductal adenocarcinoma for which distal pancreatectomy was performed. The pathological diagnosis was metastasis to the pancreas from the rectal cancer as the tumor cells were immunohistochemically negative for cytokeratin 7 and positive for cytokeratin 20. There has been no indication of recurrence for 13 months after the pancreatic surgery. Resectable pancreatic metastasis from colorectal cancer is rarely reported. However, pancreatic resection may result in long-term survival in some cases. Patients that tolerate pancreatectomy and have no metastasis in the other organs should be considered good candidates for pancreatic resection. We present this case with a review of the literature.
162.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2303-2305.
[A Clinical Study of Seven Cases of LECS for Gastric Submucosal Tumors].
[Article in Japanese]
Koreeda N1, Yamana I, Ryu S, Ichikawa J, Shin Y, Sannomiya H, Sato K, Okamoto T, Yoshida Y, Sakamoto Y, Fukuda Y, Noritomi T.
Abstract
Laparoscopy and endoscopy cooperative surgery(LECS)is a surgical technique to resect a tumor with minimal invasion, using both a laparoscope and endoscope. Twenty-eight surgeries for gastric submucosal tumors(SMT)were performed between 2009 and 2019. Seven of those cases were performed using LECS. Two male and 5 female patients underwent LECS; their mean age was 53 years. The tumors were located at the anterior wall of the fornix in 1 case, anterior wall of the subcardia in 2 cases, anterior wall of the upper gastric body in 3 cases, and anterior wall of the lower gastric body in 1 case. Two cases were intraductal growing types, and 5 cases were intramural growing types. No postoperative complications have occurred. The mean size of the tumors was 21.1 mm. In pathological findings, 5 cases were gastrointestinal stromal tumor (GIST); 1 case was high risk, 2 cases were low risk, and 1 case was very low risk as classified using the modified-Fletcher's classification. Imatinib was administered to the high risk case, and there have been no recurrences in any cases.
163.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2300-2302.
[A Patient with Multiple Colorectal Liver Metastases for Whom Partial Splenic Embolization Contributed Extremely to Maintain Multidisciplinary Treatment].
[Article in Japanese]
Abstract
After approximately 2.5 years of chemotherapy at the referred hospital, a 69-year-old man with double colon cancer and unresectable liver metastases(H3)sought consultation. A total of 8 liver metastases were deemed resectable; however, the disease was progressive. He received 2 courses of mFOLFOX6 plus Bmab before hepatectomy. Seven weeks after starting chemotherapy, Grade 4 thrombocytopenia occurred, which required platelet transfusion. Ten weeks after, curative parenchymal- preserving hepatectomy was performed under platelet transfusion. Hematologic examination including bone marrow aspiration showed no significant abnormalities, including normal megakaryocyte formation. Therefore, the patient was diagnosed with thrombocytopenia due to sinusoidal obstruction syndrome associated with past chemotherapy including oxaliplatin. Partial splenic embolization(PSE)was performed 8 weeks after the first hepatectomy. The infarcted splenic ratio was 79.5%, and the infarcted splenic volume was 444.3 mL. Curative resection of the primary colorectal cancer and the 2nd hepatectomy for the newly developed recurrent liver lesions was successfully performed at 2 weeks and 19 weeks after PSE, respectively. Platelet transfusion was never required in the perioperative period of the 2 operations performed after the PSE. Forty-five months after the initial treatment, the patient is alive with no recurrent tumors and normal tumor marker levels.
164.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2297-2299.
[A Resected Case of Retroperitoneal Metastasis and Small Bowel Metastasis from HCC].
[Article in Japanese]
Tsukamoto T1, Togano S, Eguchi S, Nishihara C, Tanaka H, Adachi T, Kaji M, Lee T, Kaizaki R, Takatsuka S, Nishiguchi Y, Yamaguchi S, Kurai O.
Abstract
A 71-year-old man underwent right hemi-hepatectomyfor a hepatocellular carcinoma(HCC)measuring 18 cm in diameter. The pathological diagnosis was poorlydifferentiated HCC. Ten months after the surgery, computed tomographyrevealed a nodule 12mm in diameter in the right lung as well as 2 nodules measuring 19 and 11mm in diameter in the retroperitoneum at the cranial aspect of the left kidney. Four months later, the nodule in the right lung had enlarged to 44 mm, while the 2 nodules in the retroperitoneum had enlarged to 68mm and 34 mm. These nodules were resected and histopathologicallydiagnosed as metastasis from HCC. Twenty-one months after liver resection, computed tomographyrevealed nodules 16 and 25mm in diameter in the retroperitoneum around the urinarybladder and jejunum, respectively. One month later, intussusception resulted from the jejunal tumor. Laparoscopic surgerywas performed for both tumors, which were diagnosed as metastases from HCC. Twenty-five months after liver resection, metastasis from the HCC appeared in the left adrenal grand, at the site of the jejunal anastomosis, and in the fattytissue around the right scapula. Twenty-nine months after liver resection, the patient died of respiratoryfailure from multiple metastases in the left lung.
165.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2294-2296.
[A Case of Gallbladder Metastasis from Breast Cancer with Acute Calculous Cholecystitis].
[Article in Japanese]
Nobori C1, Kodai S, Kanazawa A, Hamano G, Kinoshita M, Murata A, Shimizu S, Ikeda K, Ogawa Y, Maeda K.
Abstract
In June 2018, a 75-year-old woman was admitted for right upper quadrant pain. She had a history of radical mastectomy for left breast cancer in April 2009. The axillary lymph node, bone, gastric, and pleural metastases had been treated with hormonal therapy for 2 years from April 2016. Based on the examination findings, we diagnosed her with acute calculous cholecystitis and performed emergency percutaneous transhepatic gallbladder drainage(PTGBD). Eleven days after PTGBD, we performed laparoscopic cholecystectomy. Pathological examination revealed a metastatic tumor from breast cancer in her gallbladder. Although her postoperative course was uneventful, the patient died of progression of the other organ metastasis 7 months after cholecystectomy. Gallbladder metastasis should be considered in patients with advanced breast cancer who present symptoms of cholecystitis.
166.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2291-2293.
[Transverse Colectomy with D2 Lymph Node Dissection with a Small Incision Using Body Surface 3D-Simulation CT Colonography].
[Article in Japanese]
Narushima K1, Shuto K, Kosugi C, Mori M, Hosokawa I, Fujino M, Takahashi M, Yamazaki M, Shimizu H, Miyazawa Y, Koda K, Miyauchi H, Ohira G, Hayano K, Matsubara H.
Abstract
BACKGROUND:
Laparoscopic transverse colectomy is technically difficult. In mini-laparotomy surgery, colectomy for midtransverse colon cancer can easily be performed, but exact D2 lymph node dissection is very difficult for a variety of vessels in the transverse colon. Using 3D-CT imaging, we present a case of D2 lymph node dissection where mini-laparotomy transverse colectomy was performedby a small incision similar to that usedin laparoscopic surgery.
METHOD:
The patient was a 60-yearoldwoman with early transverse colon cancer, which was locatedin the mid-transverse colon. Surgical treatment was plannedfor pT1b(1.5mm)andpVM1 in pathological findings after EMR. Using CT colonography(CTC), the location of the primary tumor was identified. Using simulation CTC(sCTC), composedof CTC and 3D imaging of the arteries andveins, the dominant artery was identified and D2 lymph node dissection was simulated. In addition, body surface 3D imaging and permeable surface 3D imaging of the abdominal trunk were performed. Using body surface 3D-sCTC, composedof sCTC and body surface 3D imaging, the minimum incision to enable D2 lymph node dissection was simulated.
RESULT:
Using sCTC, it was identified that the dominant artery was the right branch of the middle colic artery(MCA Rt)andthe accompanying vein was branchedfrom the gastrocolic trunk(GCT). D2 lymph node dissection to separate the branching root of MCA Rt and the accompanying vein was simulated. Next, surgical incision was simulated using body surface 3D-sCTC. Because the branching roots of MCA Rt andGCT were locatedabout 5 cm cranial from the upper rim of the navel, a 7 cm upper abdominal midline incision was designed in addition to a 2 cm umbilical incision. Mini-laparotomy transverse colectomy with a 7 cm incision was performedin accordance with the simulation. The operation time was 2 hours and5 1 minutes, andbloodloss was due to occult bleeding. The patient was discharged 7 days after surgery without complications, and the final diagnosis was pT1bN0M0, StageⅠwith no recurrence for 4 years and2 months after surgery. The cranial incision from the upper rim of the navel has shrank about 3 cm, and the umbilical incision is not noticeable.
CONCLUSION:
D2 lymph node dissection of minilaparotomy transverse colectomy can be a treatment option for early transverse colon cancer through using body surface 3DsCTC.
167.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2288-2290.
[Implantation Cyst at Anastomosis after Anterior Resection of the Rectum-A Report of Five Cases].
[Article in Japanese]
Abstract
We report 5 cases of implantation cysts at anastomosis after rectal surgery. All patients underwent resection of the rectum usingthe double staplingtechnique (DST). Implantation cysts were recognized within a period of 3 months to 6 years after surgery. Abdominal CT showed cystic masses with calcification in all cases. Colonoscopy revealed submucosal tumor-like lesions in 3 cases, and serum CEA level was increased in 2 cases. In one patient with anal pain, transanal aspiration was performed; the other 4 patients are free from symptoms and are beingobserved without treatment.
168.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2285-2287.
[A Case of Early Rectal Cancer Recurring as Liver Metastasis Nine Months after ESD].
[Article in Japanese]
Shigoka M1, Koganezawa I, Yokozuka K, Miyoshi K, Tomita K, Tabuchi S, Chiba N, Katayanagi S, Nagakawa Y, Katsumata K, Tsuchida A, Kawachi S.
Abstract
A 70-year-oldwoman underwent colonoscopy as a follow-up examination for colon polyps, during which early-stage rectosigmoid cancer was detected. Endoscopic submucosal dissection(ESD)was performed to remove this lesion. Additional radical anterior resection was recommended according to the histological findings but the patient chose to undergo observation. Nine months after the ESD, the patient decided to undergo additional surgical resection: a CT scan revealed liver metastasis in S6. Laparoscopic anterior resection andpartial resection of S6 of the liver was performed. Histological analysis showed no residual cancer in the rectosigmoid, no lymph node metastasis, and liver metastasis in S6. Carcinoma cells were exposed on the radial margin of the liver. After surgery, oral UFT/LV chemotherapy was administered for 6 months. The patient remains free of recurrence 4 years and6 months after the surgery.
169.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2282-2284.
[Impact of Preoperative Comorbidities on Long-Term Prognosis in Elderly Patients with Gastric and Colorectal Cancer].
[Article in Japanese]
Abstract
BACKGROUND:
There has been an increase in the number of elderly cancer patients with preoperative comorbidities, which decrease the safety of surgical therapy. Assessment of comorbidities is useful for prediction of the outcome of treatment in these patients.
PATIENTS AND METHODS:
The Charlson comorbidity index(CCI)was determined in 83 elderly patients undergo- ing surgery for gastric and colorectal cancer. Relationships of CCI with prognosis were examined in pathological R0/R1 and R2 cases.
RESULTS:
In the R0/R1 group, CCI was significantly associated with overall survival in univariate(p=0.027)and multivariate( p=0.031)analyses. Mortality from other diseases within a year after surgery for patients with CCIB4 was significantly higher than that for those with CCIC3(11.0% vs 1.4%, p=0.028).
CONCLUSION:
CCI is an independent prognostic factor after surgery for elderly patients with gastric and colorectal cancer.
170.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2279-2281.
[Analysis of Surgical Resection for Elderly Patients with Biliary Tract Cancer].
[Article in Japanese]
Tsugawa D1, Ueno K, Akita M, Hashimoto Y, Awazu M, Mukubo H, Komatsu S, Kuramitsu K, Terai S, Tanaka M, Toyama H, Kido M, Ajiki T, Fukumoto T.
Abstract
Although surgical resection is the first-line treatment for biliary tract cancer(BTC), elderly patients often have underlying diseases and decreased cardiopulmonary function that place them at a high risk of undergoing surgery. We examined the safety and efficacy of surgical resection in elderly BTC patients. Among the BTC cases that underwent surgical resection at Kobe University Hospital from 2009 to 2015, the safety and prognosis ofthose aged 75 years or older(Group 1)were compared to those younger than 75 years(Group 2)at the time ofsurgery. Fifty-two patients with perihilar cholangiocarcinoma( Bp), 29 patients with intrahepatic cholangiocarcinoma(ICC), and 40 patients with ampulla ofVater cancer(AV) were included. There was no significant difference between the 2 groups with respect to complications of Grade Ⅲor above, while surgery-related death was more common in Bp and ICC ofGroup 1. The median survival ofGroup 1 following hepatectomy for Bp and ICC(22 months)was significantly shorter than that of Group 2(40 months)(p=0.023). There was no significant difference in overall survival of Group 1 and Group 2 patients with AV(p=0.094). Surgical resection for BP and ICC for elderly patients has a higher risk of hepatectomy; therefore, precise assessment of oncologic and patient risk factors should be performed. As we can expect to achieve similar prognoses between non-elderly and elderly patients with AV, aggressive treatments should be considered for elderly patients with AV.
171.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2276-2278.
[Analysis of Post-Recurrence Survival of Resected Lung Cancer with Brain Metastasis].
[Article in Japanese]
Abstract
METHODS:
We retrospectively evaluated the post-recurrence survival of 37 cases with brain metastases out of 439 consecutive resected cases of primary lung cancer between 2001 and 2017.
FINDINGS:
There was no difference in survival according to tumor size but survival was significantly shorter in patients with larger numbers of tumors. Patients initially treated with stereotactic radiosurgery(SRS)or surgical resection survived longer than those with whole-brain irradiation(WBI)(median survival: 23 months for SRS, 17 months for surgical resection, and 4 months for WBI: p<0.001 between SRS and WBI).
CONCLUSIONS:
As SRS is recommended for 1-4 tumors with maximum diameters ofC3 cm and surgical resection is recommended for tumors larger than 3 cm, these effective locoregional therapies should be aggressively adopted for local control of brain metastases with the aim of improved QOL and prolonged survival. Due to the deterioration of neurocognitive function, WBI should be avoided as initial treatment for brain metastases when effective locoregional therapy or systemic chemotherapy is available and reserved for leptomeningeal dissemination or miliary metastases.
172.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2273-2275.
[The Current Status of Palliative Care for Cancer on a Questionnaire Survey].
[Article in Japanese]
Abstract
We evaluated the current status of palliative care for cancer by questionnaire survey in 34 medical institutions belonging to the Hyogo Society for Oncology of the Colon and Rectum. Although 29 institutions(85%)had palliative care teams, the profiles of team members differed between the institutions. The inclusion rates of psychiatrists, nutritionists, medical social workers, clinical psychologists, and rehabilitation therapists was half or less. Ten institutions had some positive screening systems for objective patients. Consultation from a surgical or medical oncologist to a palliative care doctor was most frequently performed at the end of chemotherapy(46%)but was widely distributed from the beginning of chemotherapy to the period of best supportive care. Most institutes positively adopted surgical palliation and palliative radiotherapy as non-pharmacological options. While palliative care teams were prevalent in this survey, the systematic supply of palliative care may be under development with limited resources.
173.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2270-2272.
[A Case of Long-Term Survival after Multidisciplinary Treatment for Gastrointestinal Neuroendocrine Carcinoma].
[Article in Japanese]
Yotsumoto H1, Yamamoto N, Kamiya M, Inoue H, Washimi K, Okubo Y, Oike N, Yokose T, Rino Y, Masuda M, Morinaga S.
Abstract
A 55-year-old man was admitted to our hospital for examination and treatment of a transverse colon tumor detected at a nearby hospital. After CT, FDG-PET, and laparotomy biopsy, he was diagnosed with neuroendocrine cancer(Ki-67 index 40%)without distant metastasis. He underwent transverse colectomy. The pathological diagnosis was transverse colon neuroendocrine cancer(Ki-67 index 24.7%). Six courses of carboplatin and etoposide therapy as adjuvant chemotherapy were administered. Seven months after surgery, he developed lung metastasis that was surgically removed by partial lung resection. Eighteen months after the initial surgery, liver metastasis developed in S5 and S8. A right hepatic lobectomy was performed and there has been no recurrence after hepatectomy. The patient remains alive at 3 years and 4 months after initial treatment.
174.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2267-2269.
[A Case of Pulmonary Metastases of Colon Cancer with Submucosal Invasion].
[Article in Japanese]
Hirose H1, Yoshioka S, Mokutani Y, Takeda M, Imamura H, Yoneda N, Kidogami S, Kishimoto T, Hashimoto Y, Endo S, Tamura S, Kodama K, Sasaki Y.
Abstract
In general, distant metastasis is uncommon in colorectal submucosal(SM)invasion without lymph node metastasis. We experienced an extremely rare case of synchronous pulmonary metastases for colon cancer in SM invasion. A man in his 70s was seen at the hospital for a positive fecal occult blood test. Colonoscopy revealed 3 lesions in the sigmoid colon and endoscopic mucosalresection revealed 2,000 mm SM invasion in all 3 lesions. Computed tomography showed no signs of distant lymph node or liver metastasis but showed small nodules in both lungs. Radical treatment included laparoscopic anterior resection with lymph node dissection. Histological examination showed no residual tumor in the colon and no lymph node metastasis. Two years after surgery, the number of lung nodules gradually increased and we performed partial resection of the left lung, which was diagnosed as pulmonary metastasis from colon cancer by histological examination. Therefore, we resected the opposite-side pulmonary metastases. The patient has exhibited no other signs of recurrence in the 2 years since the last operation.
175.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2264-2266.
[A Case of Diffuse Large B-Cell Lymphoma of the Ascending Colon].
[Article in Japanese]
Abstract
A 72-year-old man presented with right lower abdominal pain. Abdominal enhanced CT showed a large tumor in the ascending colon. Colonoscopyrevealed a type 2 tumor infiltrating three-quarters of the ascending colon. The biopsyspecimen showed a malignant lymphoma. Thus, the patient underwent ileocecal resection with D3 lymph node dissection. The histopathological diagnosis was primarydiffuse large B-cell lymphoma of the ascending colon. Post-operative PET-CT showed disseminated extra-nodal involvement, Stage Ⅳ(Lugano staging system). He was administered 2 courses of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone chemotherapy. However, the patient was diagnosed with progressive disease. He received several chemotherapies and finallydied 8 months after surgery. We report our present case and literature review.
176.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2261-2263.
[A Case of Successful Surgical Treatment for Paraaortic Lymph Nodes Recurrence of Gallbladder Cancer].
[Article in Japanese]
Urahigashi A1, Fukunaga H, Sawami H, Hiraki M, Sawada G, Murakami M, Chihara Y, Yamamoto M, Kimura H, Morita S.
Abstract
Cholecystectomy with gallbladder bed resection and regional lymphadenectomy was performed in a 75-year-old man with advanced gallbladder cancer. Pathological examination revealed adenocarcinoma in the gallbladder with regional lymph node metastases. Cancer recurrence was found in paraaortic lymph nodes behind the duodenum 9 months after the surgery. Although chemotherapy using S-1 was initiated, the lymph nodes remained the same size after 2 courses without any new recurrent regions. Lymphadenectomy was then performed as a curative surgery. The patient has remained alive without recurrence for 46 months after the second surgery.
177.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2258-2260.
[A Case of Recurrent Gallbladder Carcinoma Treated with Resection and Hepatic Arterial Infusion].
[Article in Japanese]
Muroya D1, Shirahama N, Arai S, Goto Y, Sato T, Kishimoto Y, Otsuka H, Yasunaga M, Ishikawa H, Sato S, Kusano H, Tayama K, Okabe M, Okuda K, Tanaka H.
Abstract
A 69-year-old woman underwent extended cholecystectomy for gallbladder cancer[T2N0M0, fStage Ⅱ(UICC 7th edition)]. She was then administered adjuvant S-1 and was treated for drug-induced neutropenia. One year later, recurrent lesions were detected in liver S4 and S5. We treated the patient with hepatectomy and hepatic arterial infusion adjuvant chemotherapy by cisplatin, along with the systemic administration of gemcitabine for 10 months. The patient is now doing well without any sign of recurrence 29 months after the initial operation and 16 months after the secondary liver resection.
178.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2255-2257.
[A Case of Resection of Intraductal Papillary Mucinous Carcinoma Detected Due to Acute Pancreatitis].
[Article in Japanese]
Abstract
A 67-year-old man visiting our hospital with the chief complaint of sudden upper abdominal pain was diagnosed with acute pancreatitis. Based on computed tomography findings, intraductal papillary mucinous neoplasm(IPMN)was suspected as the cause of the pancreatitis and detailed examination was conducted following its alleviation. Endoscopic retrograde and magnetic resonance cholangiopancreatography showed marked dilation of the main pancreatic duct, with a mural nodule inside the main pancreatic duct at the pancreatic head. Main duct IPMN was diagnosed and pancreaticoduodenectomy was performed 3 months after the onset of acute pancreatitis. The histopathological findings showed a tumor proliferating in a mold pattern in the lumen of the dilated main pancreatic duct, resulting in a diagnosis of intraductal papillary mucinous carcinoma(IPMC). The presence of IPMN should be considered as a cause of acute pancreatitis; if findings suggestive of IPMN are found on imaging, detailed examinations and treatment are needed in consideration of the potential for malignancy following alleviation of pancreatitis.
179.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2252-2254.
[A Case of Subphrenic Lymph Node Metastasis from Gastric Cancer in Which FDG-PET/CT Was Useful for Diagnosis].
[Article in Japanese]
Nishimura T1, Muroya D, Kodama M, Ishibashi Y, Matsumura M, Taketani S, Yoshimoto Y, Morimitsu Y, Wada Y, So H, Sato H, Taniwaki S, Imamura T, Akashi H, Shimokobe T.
Abstract
A 70-year-old man was admitted for lymph node metastasis detected by FDG-PET/CT showing a mass 10mm in diameter. He had a history of a distal gastrectomy for advanced gastric cancer and was administered postoperative adjuvant chemotherapy consisting of 2 courses of TS-1 with CDDP and TS-1 only for 1 year. Lymph node recurrence was diagnosed and resected 4 years after the initial surgery. Histological examination revealed lymph node metastasis of the gastric cancer. He was administered adjuvant chemotherapy using TS-1 and has been followed-up without recurrences for 17 months after the second operation. We reported a case in which FDG-PET/CT was potentially beneficial for the diagnosis of the postoperative small lymph node metastasis.
180.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2249-2251.
[Occult Breast Carcinoma and Recurrent Tumor in the Breast 14 Years after Axillary Dissection-A Case Report].
[Article in Japanese]
Abstract
We report a patient with occult breast cancer who underwent axillary dissection as primary surgery. The patient, a 68-yearold woman, noticed a tumor measuring approximately 3 cm in diameter, in her left axilla. Biopsy of the axillary tumor revealed adenocarcinoma. Imaging studies did not detect primary lesions in the mammary gland or other organs. The patient was diagnosed with occult breast cancer and underwent axillary dissection but did not desire mastectomy or radiation therapy. The patient was closely observed thereafter. Tamoxifen was prescribed for 5 years but left breast cancer was detected 14 years after the operation. A simple mastectomy was performed. She died of respiratory failure 1 year later. Occult breast cancer may require axillary lymph node dissection and systemic therapy. Breast preservation could be an alternative treatment if followed by adequate systemic therapy and close observation.
181.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2246-2248.
[Case Report of Long-Term Clinical Efficacy of Paclitaxel plus Bevacizumab Combination Therapy for Stage Ⅳ AdvancedBreast Cancer].
[Article in Japanese]
Abstract
A 50-year-old woman had noted a mass in her right breast 2 years ago but did not consult a hospital. She consulted our hospital because the mass increased in size and also reddened. The tumor measured 10 cm in diameter and was palpable in the whole right breast. A core needle biopsy was performed, and invasive ductal carcinoma was diagnosed. CT showed multiple lung and liver metastases and bone scintigraphy showed bone metastases in a rib. Because the lung and liver metastases were life-threatening, paclitaxel(PTX)chemotherapy was administered weekly. Biomarkers analysis revealed ER(+), PgR(+), HER2(2+), HER2 FISH 1.27, Ki-67 30%, and bevacizumab (Bev) was added from 2 courses. After 4 courses of chemotherapy, the multiple lung and liver metastases were found to be significantly reduced on CT. Toxicities included alopecia, hypertension, and proteinuria. At this time, 3 years after the treatment started, PTX plus Bev combination therapy was also administered.
182.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2243-2245.
[A Case of Trousseau Syndrome Complication during Chemotherapy for Advanced Gastric Cancer].
[Article in Japanese]
Abstract
The pathological condition which causes cerebrovascular disease through hypercoagulability associated with malignant tumors is known as Trousseau syndrome. Here, we report the case of a patient with Trousseau syndrome which developed as a complication during chemotherapy for advanced gastric cancer. A 70-year-old woman with multiple lymph node metastases of gastric cancer underwent TS-1 plus CDDP chemotherapy before surgery. She had symptoms of left hemiparesis during the first course of chemotherapy. She was diagnosed with acute cerebralinfarction using brain MRI, and blood tests indicated hypercoagulability. Therefore, it was strongly suspected that she had Trousseau syndrome. A total of 2 courses of chemotherapy were administered, along with anticoagulation therapy with edoxaban. She exhibited improved paralysis and received a totalgastrectomy after chemotherapy. According to recent reports, more than 90% of patients with malignant tumors have hypercoagulability, and more than 50% of them have thromboembolisms. It is therefore essential to obtain early diagnosis and provide anticoagulation therapy for cerebral infarction, and to provide treatment against malignant diseases in patients with Trousseau syndrome.
183.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2240-2242.
[A Case of Gastrointestinal Perforation in Gastric Cancer during Chemotherapy with Paclitaxel plus Ramucirumab].
[Article in Japanese]
Abstract
A 54-year-old man underwent distal gastrectomy with D2 lymph node dissection in our institution in March 2017 due to the presence of advanced gastric cancer. The pathological diagnosis was signet ring, poorly differentiated, and moderate differentiated adenocarcinoma, which was pT4aN3aM0, pStage Ⅲc and HER2-negative. After surgery, he received adjuvant chemotherapy with S-1, however, he was diagnosed with dissemination and lymph node recurrence in June. Tumor marker, CEA level decreased after the introduction of the next treatment(capecitabine plus cisplatin), however the tumor marker level rose again in September, and the chemotherapy regimen was changed to weekly paclitaxel(PTX). Furthermore, ramucirumab was added to the weekly PTX regime in January 2018, as the tumor marker level rose again. One week after the last ramucirumab administration he visited our hospital with abdominal pain, and emergency surgery was performed after the diagnosis of a gastrointestinal perforation using CT. The surgery revealed dirty fluid and countless dissemination nodes throughout the abdominal cavity, and a small intestinal perforation on a white dissemination node was identified 70 cm proximal to the end of the ileum. We performed small bowel segmental resection and functional end-to-end anastomosis. No complications were observed, and an oral diet was able to be started after surgery; however, he was introduced to the best supportive care(BSC)as his general condition gradually deteriorated.
184.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2237-2239.
[Skin Ulcer Caused by Bevacizumab-A Case Report].
[Article in Japanese]
Abstract
A case of a skin ulcer caused by bevacizumab(Bmab)is reported here, which recurred with re-administration of bevacizumab. A 69-year-old male patient was diagnosed with cecal cancer, multiple liver metastases, multiple lung metastases, and bone metastasis. Resection of the cecal cancer was performed, and the patient was post-operatively treated with XELOX and Bmabchemotherapy. After the second cycle of chemotherapy, a skin ulcer developed. The ulcer improved after cessation of chemotherapy, debridement, and treatment with antibiotic medication. In spite of re-administration of XELOX chemotherapy, the skin ulcer healed completely, however, the dermatopathy recurred after re-administration of Bmab. Bmab chemotherapy is associated with various risks, including dermatopathy and protracted wound healing, and some cases of skin ulcers caused by Bmab have been reported. Because the skin ulcer was suspected to be cutaneous actinomycosis, Bmab chemotherapy was reintroduced while the patient was treated using antibiotic agent feeding, but the skin ulcer reoccurred. Reported cases of skin ulcers caused by Bmab in Japan show that skin ulcers often recur after re-administration of Bmab. Therefore, if skin ulcers caused by Bmab develop, re-administration of Bmabshould be considered carefully.
185.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2234-2236.
[Small Intestinal Metastasis from Lung Cancer with Infiltration into Other Organs-Review of the Literature].
[Article in Japanese]
Abstract
We report a case of metastasis to the small intestine from squamous cell carcinoma of the lung with fistula formation in the adjacent small intestine as well as an analysis of reported cases in Japan of small intestinal metastasis from lung cancer invading other organs. A 63-year-old man was diagnosed with squamous cell carcinoma of the lung as a result of pneumonia. Chemoradiotherapy was administered and sequential chemotherapy was performed, but a single brain metastasis of right parietal lobe was detected 6 months later. Tumor resection was performed. Twelve months after the lung cancer diagnosis, metastasis of the small intestine was detected. Single-incision laparoscopic surgery with partial resection of the small intestine was performed. The tumor had invaded the abdominal wall and 2 parts of the small intestine and had formed a fistula with part of the small intestine. Subsequently, peritoneal dissemination recurred and the patient received the best supportive care. There are 10 reported cases in Japan of small intestinal metastasis from lung cancer invading other organs. Analysis of the reported cases indicates a poor prognosis for patients with fistula. Resection can improve prognosis in patients with primary lung cancer and without distant metastasis. Surgical resection should be considered even if metastasis in the small intestine from lung cancer has invaded other organs.
186.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2231-2233.
[A Case of Disseminated Carcinomatosis of the Bone Marrow Developing 15 Months after Gastrectomy].
[Article in Japanese]
Abstract
The patient was a 60-year-old man who underwent distal gastrectomy for gastric cancer. The pathological diagnosis was Stage ⅡB. He received adjuvant chemotherapy(capecitabine plus oxaliplatin: CapeOX)for 6months and the postoperative course was uneventful. One year and 3 months after surgery, he visited the outpatient department for acute lower back pain. Blood tests showed elevated ALP(3,752 U/L), LDH(308 U/L), and CA19-9(69.4 U/mL)levels. Bone scintigraphy showed multiple bone metastases to the femora, ischium, iliac bone, vertebrae, sternum, costae, and scapulae in a super bone scan. The onset of disseminated intravascular coagulation(DIC)was observed later. The patient was diagnosed with disseminated carcinomatosis of the bone marrow. Radiation therapy was performed and anti-RANKL monoclonal antibody was administered for the bone metastases. Recombinant human soluble thrombomodulin was administered for DIC. He received chemotherapy( TS-1 plus cisplatin: SP)but died 4 months after the diagnosis. The prognosis of disseminated carcinomatosis of the bone marrow is extremely poor. We report this case along with a literature review.
187.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2228-2230.
[A Case of Long-Term Survival after Resection for Metachronous Liver and Lung Metastases of Rectal Cancer Associated with Familial Adenomatous Polyposis].
[Article in Japanese]
Arabiki M1, Kameyama H, Abe K, Tanaka K, Oyanagi H, Tajima Y, Nakano M, Nakano M, Shimada Y, Ichikawa H, Takizawa K, Nagahashi M, Sakata J, Kobayashi T, Wakai T.
Abstract
A 37-year-old man was admitted to our hospital for the treatment of familial adenomatous polyposis and rectal carcinoma. He underwent total colectomy with ileoanal anastomosis(pT3N1M0, pStage Ⅲa)followed by adjuvant therapy with S-1. Three months after primary surgery, CT and MRIrevealed liver metastases(S5, S6). Laparoscopic partial hepatectomy was performed. Two years after primary surgery, new liver metastases(S2, S8)were found and we performed open partial hepatectomy and administered mFOLFOX6. Three years and 5 months after primary surgery, right lung metastases(S6, S9) were detected and the patient underwent a thoracoscopic-assisted right lung wedge resection. Repeated resection of metastases might have contributed to the long-survival in our case.
188.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2225-2227.
[A Case of Pancreatic Neuroendocrine Carcinoma Presenting Multiple Liver Metastasis as an Initial Manifestation for Which Diagnosis Confirmation Was Difficult].
[Article in Japanese]
Kamiya A1, Adachi M, Sasaki M, Ogawa N, Matsunaga H, Hoshino M, Goto H, Koshiishi H, Yoshimura T, Kato H.
Abstract
A 67-year-old woman with a history of esophageal cancer(poorly-differentiated squamous cell carcinoma, pStageⅡ) was diagnosed with 2 liver tumors by regular checkup CT 10 years after her operation. We also observed elevated levels of tumor marker CEA. The tumors were suspected to be metastatic although no primary lesion was identified. We performed partial hepatectomy for diagnostic therapy. The pathological diagnosis was adenocarcinoma suggestive of metastatic tumors but the primary lesion remained unknown. Tumor marker levels were elevated 2 months after the operation and we detected a pancreatic tumor, multiple liver tumors, peritoneal dissemination, and para-aortic lymph node metastasis. Therefore, our clinical diagnosis was multiple metastases with primary pancreatic cancer and chemotherapy was performed. We conducted a thorough review of the diagnostic images and repeated the pathological analysis. Immunobiological staining showed that the tumor cells were positive for neuroendocrine markers such as chromogranin A, CD56, and Ki-67. We eventually diagnosed the liver tumors as metastasis from the pancreatic neuroendocrine carcinoma(Grade 3).
189.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2222-2224.
[A Case of Synchronous Bilateral Neuroendocrine Ductal Carcinoma In Situ].
[Article in Japanese]
Hoshi N1, Abe N, Tachibana K, Noda M, Murakami Y, Okano M, Yoshida S, Abe S, Kiko Y, Hashimoto Y, Ohtake T.
Abstract
Neuroendocrine ductal carcinoma in situ(NE-DCIS)is a unique subtype of ductal carcinoma in situ(DCIS)that is not described in the general rules for clinical and pathological recording of breast cancer. NE-DCIS is described as an unusual variant of DCIS in the 2012 World Health Organization(WHO)classification. The chief complaint in NE-DCIS is hemorrhagic nipple discharge. The histological characteristics of NE-DCIS are solid growth of cancer cells with granular and spindle-shaped nuclei. Histologically, NE-DCIS is suggestive of low malignancy but a poor prognosis of neuroendocrine carcinoma of the breast has been reported. The report by Honami et al was the only other report of synchronous bilateral neuroendocrine ductal carcinoma in situ. We report the second case of NE-DCIS diagnosed synchronously in both breasts in a patient who had visited our outpatient clinic with hemorrhagic nipple discharge.
190.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2219-2221.
[A Case of Small Cell Carcinoma of the Esophagus with Complete Response to Chemoradiotherapy in an Elderly Patient].
[Article in Japanese]
Abstract
Small cell carcinoma of the esophagus is a rare malignancy with a perceived poor prognosis. We report a case of long-term survival using chemoradiotherapy. An 80-year-old man visited our hospital complaining of hiccup. Endoscopic examination showed type 2 lesions in the lower esophagus with a pathological diagnosis of small cell carcinoma. Based on the diagnosis of cStage Ⅲ disease and the patient's age, chemoradiotherapy comprising 3 courses of CDDP and CPT-11 and 45 Gy of irradiation was administered. After treatment completion, the therapeutic effect was evaluated as a complete response through CT, PET-CT, and endoscopic examination. No recurrence has been identified more than 5 years after achieving the complete response.
191.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2216-2218.
[Anastomotic Recurrence after Curative Resection for Transverse Colon Cancer-A Case Report].
[Article in Japanese]
Yoshida Y1, Miyaso H, Yasui Y, Kitada K, Hamano R, Tokunaga N, Tsunemitsu Y, Otsuka S, Iwakawa K, Inagaki M.
Abstract
The rate of local and anastomotic recurrence after curative resection for colon cancer is quite low, at 2.1%. We describe an anastomotic recurrence that rapidly increased after transverse colon cancer resection. An 80-year-old man underwent laparoscopic- assisted transverse colon resection with D3 lymph node dissection. The pathological diagnosis was pT4aN1bM0, pStage Ⅲb. We diagnosed the patient with anastomotic recurrence and liver metastasis 4 months after the procedure based on PET-CT findings. Partial colon resection(small intestine and stomach combined)was performed at 6 months after the procedure. The patient's quality of life(QOL)was reduced by complications after the second procedure and continuing with chemotherapy became difficult. Although the prognosis of curative resection of local and anastomotic recurrence after transverse colon cancer surgery can be good, combined resection of an adjacent organ can result in a decline in patient QOL. Surgical intervention should be minimally invasive and neo-adjuvant chemotherapy might offer 1 option.
192.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2213-2215.
[A Case of an Elderly Male with Breast Cancer with Synchronous Triple Cancer of the Lung and Stomach].
[Article in Japanese]
Abstract
An 89-year-old male was diagnosed with advanced gastric cancer during an upper gastrointestinal endoscopy for gastric polyp follow-up. Positron emission tomography revealed tumors with 18F-fluorodeoxyglucose(FDG)accumulation in the right lung and right breast. Incisional biopsy of the right breast tumor was performed and the tumor was diagnosed as primary breast cancer(ER: 90%, PgR: 70%, HER2: 1+, Ki-67: 17%). Since it was difficult to distinguish whether the lung tumor was primary lung cancer or metastasis, a bronchoscopic biopsy was performed. Histopathological examination revealed that the lung tumor was primary lung cancer. Thus, this male patient had simultaneous triple gastric, breast, and lung cancer. Total mastectomy was performed for the breast cancer under local anesthesia and adjuvant endocrine therapy was started. Stereo- tactic body radiation therapy(48 Gy/4 Fr/4 days)for lung cancer and partial gastrectomy for gastric cancer were subsequently performed. Although male breast cancer itself is rare, we experienced a very rare case of male breast cancer with simultaneous lung and gastric cancer.
193.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2210-2212.
[Late Recurrence of Breast Cancer 32 Years after Surgery-A Case Report].
[Article in Japanese]
Takada K1, Kashiwagi S, Kawajiri H, Asano Y, Morisaki T, Noda S, Takashima T, Onoda N, Hirakawa K, Ohira M.
Abstract
An 86-year-old woman visited her nearby hospital for a mass on the left side of her sternum. She had undergone total mastectomy for left breast cancer 32 years prior and multiple small nodules had been found in both lungs 2 years ago. She was sent to our hospital for suspected breast cancer recurrence. Chest computed tomography showed multiple small nodules in both lungs and a mass with sternal sclerosis on the parasternal bone of her left 2-3 intercostal space. A core needle biopsy was performed on the chest wall tumor by ultrasonography. Not only pathological but also immunohistological examination findings were similar to those of the surgical specimens 32 years ago(estrogen receptor: positive, progesterone receptor: positive, HER2: negative, Ki-67 score: low). Therefore, she was diagnosed with a late recurrence of her breast cancer. She started letrozole but the disease had progressed 6 months later. We experienced a case of late breast cancer recurrence 32 years after surgery.
194.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2207-2209.
[Thyroid Metastasis of Rectal Cancer].
[Article in Japanese]
Abstract
A 65-year-old woman underwent laparoscopic low anterior resection for rectal cancer with distant metastasis to the right lobe of her liver and mediastinal and right subclavian lymph nodes. Since the postoperative chemotherapy resulted in the disappearance of the lymph node metastasis and diminished hepatic metastasis lesion, the enlarged anterior segment of the liver was performed. She was administered chemotherapy for 1 year after the second surgery. Thoracoabdominal computed tomography performed 18 months after the end of the treatment revealed swelling of the left lobe of the thyroid. Ultrasonography showed a 23mm lobulated hypoechoic tumor in the left lobe of the thyroid gland. We suspected thyroid metastasis by aspiration biopsy cytology. Left thyroid lobectomy was performed for definitive diagnosis and local control. Histological examination revealed thyroid metastasis of the rectal cancer. We experienced a rare case of thyroid metastasis from rectal cancer.
195.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2204-2206.
[A Case of Laparoscopic Gastric Local Resection for Dedifferentiated Gastric Liposarcoma].
[Article in Japanese]
Abstract
A 73 year-old-woman visited our emergency department with a sudden stomach ache. A 7 cm tumor was found on the greater curvature side of the stomach by contrast-enhanced CT, and showed mosaic pattern when visualized with a contrast agent. An esophagogastroduodenoscopy showed normal mucosal gastric surface with compression findings by the gastric submucosal tumor, and therefore she was admitted to our department for surgery. Abdominal ultrasound revealed an uneven gastric submucosal tumor containing cystic components with a clear border, and gastric GIST was suspected due to its appearance, and therefore, laparoscopic gastric local resection was performed. The gastric tumor was located on the dorsal side of the greater curvature and adhered highly to the retroperitoneum and spleen. The omental incision was conducted first, and the adhesion around the tumor was carefully detached, following which wedge resection was performed using Endo-GIA®at the base of the tumor. The pathological findings of the resected specimens were mainly spindle-shaped tumor cells rich in polymorphism with a high degree of necrosis, and did not seem to be conclusively GIST; as such, various immunological tests were performed.c -kit(-), DOG-1(-), S-100 p(-), desmin(-), a-SMA(focal+), p16(+), MDM2(+), CDK4(+) results led to the diagnosis of dedifferentiated liposarcoma. The patient is currently being followed up with and is alive without recurrence 10 months after the operation.
196.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2201-2203.
[A Case of Locally Advanced Adenosquamous Carcinoma of the Pancreas Accompanied by Hepatic Metastasis Treated by Resection of the Primary Lesion as Palliative Care].
[Article in Japanese]
Abstract
A 61-year-old man presented to our hospital with appetite loss. Gastroscopy revealed a tumor on the upper body of the stomach. Persistent bleeding was observed from the tumor; therefore, the patient was immediately hospitalized. An abdominal CT scan revealed that the tumor arose from the pancreas and invaded the spleen, stomach, and transverse colon. Furthermore, a hepatic tumor was observed at the posterior segment and blood tests showed increased CA19-9 level. Therefore, the tumor was diagnosed as pancreatic cancer with invasion of the adjacent organs and hepatic metastasis. Although the tumor was classified as unresectable for the distant metastasis, resection of the primary lesion was performed to control the bleeding and obstruction at the invasion sites. The pathological diagnosis of the tumor was adenosquamous carcinoma. The patient subsequently underwent chemotherapy and was discharged from the hospital on postoperative day 34. The patient was able to spend time at home and was treated at an outpatient clinic until postoperative day 110, when his generalcondition deteriorated. In this case, resection of the primary lesion was ineffectual for a life prognosis but was beneficial for palliative care.
197.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2198-2200.
[Adenosquamous Carcinoma in the Remnant Pancreas after Pancreatoduodenectomy for Invasive Pancreas Cancer-A Resected Case with Five-Year Relapse-Free Survival].
[Article in Japanese]
Fushimi K1, Kusashio K, Yasutomi J, Matsumoto M, Suzuki T, Iida A, Imamura N, Harano R, Kosaki R, Togasaki K, Fujita A, Udagawa I.
Abstract
A 52-year-old man underwent pancreatoduodenectomy(PD)for invasive cancer of the pancreatic head, with a histopathological diagnosis of moderately to poorly differentiated invasive ductal carcinoma. One year and 2 months after PD, follow- up CT revealed a mass 3 cm in diameter in the remnant pancreas without distant metastasis. Therefore, total remnant pancreatectomy was performed with a histopathological diagnosis of adenosquamous carcinoma. Five years after re-excision, the patient remains alive without recurrence. Although no tumor component was found at the anastomotic site of the pancreatojejunostomy, squamous metaplasia with chronic inflammation with carcinogenic potential was diffusely observed in the main pancreatic duct. Clinical cases of remnant pancreatic resection after PD for invasive cancer are relatively rare. Furthermore, this case of adenosquamous carcinoma with long-term recurrence-free survival is extremely rare.
198.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2195-2197.
[Laparoscopic Gastro-Jejunostomy Using the Overlap Method after Subtotal Gastrectomy for Upper Gastric Cancer].
[Article in Japanese]
Abstract
BACKGROUND:
Due to an aging society, patients with gastric cancer are also getting older. Although total gastrectomy should be avoided for elderly patients, laparoscopic subtotal gastrectomy(LSTG)is a technically demanding procedure. Here, we present a safe procedure of gastro-jejunostomy using the overlap method.
METHODS:
After transection of the stomach using gastroscopy, an entry hole was created at the center of the staple line of the remnant stomach. The jejunum was anastomosed to the dorsal wall of the gastric remnant with a linear stapler, and the entry hole was closed by hand-sewn sutures. Nineteen patients with gastric cancer in the upper third of the stomach underwent LSTG using this technique, and the short-term clinical outcomes were analyzed retrospectively.
RESULTS:
The median operative time was 221 minutes(143-318), and the median blood loss was 10 mL(3-100). The median postoperative hospital stay was 7 days(6-13), and there were no complications related to anastomosis.
CONCLUSIONS:
The short-term clinical outcomes of the laparoscopic gastro-jejunostomy using the overlap method after LSTG reveal that this technique is safe and feasible to use for improving patient outcomes.
199.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2192-2194.
[A Case of Esophageal Cancer Achieving a Pathological Complete Response after Preoperative Docetaxel, Cisplatin, and 5-Fluorouracil Therapy].
[Article in Japanese]
Motegi D1, Ichikawa H, Kano Y, Hanyu T, Ishikawa T, Usui K, Sakai T, Hirose Y, Miura K, Nagahashi M, Shimada Y, Sakata J, Kobayashi T, Kameyama H, Wakai T.
Abstract
A 66-year-old man with middle thoracic esophageal squamous cell carcinoma with supraclavicular lymph node metastasis visited our hospital. He underwent 3 courses of preoperative chemotherapy with docetaxel, cisplatin, and 5-FU(DCF)with a clinically-determined partial response. Minimally-invasive esophagectomy with 3-fieldlymphad enectomy was subsequently performed. Histopathologic examination revealedno viable tumor cells in the resectedesophagus andsupraclavicular lymph node. DCF is a promising preoperative chemotherapy regimen for locally advanced esophageal cancer because of its higher complete response rate comparedto that for cisplatin plus 5-FU.
200.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2189-2191.
[A Case of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus Successfully Treated by Three-Dimensional Conformal Radiotherapy].
[Article in Japanese]
Katsumori T1, Ohshima H, Hamaguchi H, Yamamoto S, Toyama E, Tsukamoto Y, Iwanaga T, Fukugawa Y, Ohkawara S.
Abstract
A man in his 50s was referred to our hospital with a liver tumor detected by ultrasonography during a medical checkup. Enhanced CT scan and MRI showed hepatocellular carcinoma(HCC)in S8 of the liver. Laparoscopic partial hepatectomy was performed. The histopathological findings showed well differentiated HCC. Two years later, his serum PIVKA-Ⅱ levels were slightly elevated. A new lesion was detected by US, CT, and MRI at S5 of the liver. A second laparoscopic partial hepatectomy was performed. The histopathological findings showed moderately differentiated HCC. After 1 year, MRI detected 2 new HCCs(S4, S8). The tumor at S8 had invaded the right branch of the portal vein. There was no indication for right hepatectomy because of liver dysfunction. Lipiodol-TACE followed by DEB-TACE was not effective on the tumor. The HCC at S8 had enlarged and formed a portal vein tumor thrombus. PIVKA- / Ⅱ levels increased to 3,596 mAU/mL. The patient was adminis- tered Three-dimensional conformal radiotherapy(45 Gy/15 Fr)and his PIVKA-Ⅱ levels decreased to the normal range. He has been followed-up without recurrences for 2 years and 9 months.
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου