Retrospective analysis of palliative chemotherapy for the patients with bladder adenocarcinoma: Korean Cancer Study Group Genitourinary and Gynecology Cancer Committee

BACKGROUND/AIMS: Because of rarity, role of chemotherapy of bladder adenocarcinoma are still unidentified. Therefore, we performed a retrospective analysis of the clinical features and chemotherapy outcomes of bladder adenocarcinoma. METHODS: Eligible patients for this retrospective analysis were initially diagnosed with bladder adenocarcinoma and presented with a clinically no other primary site of origin. The collected data included age, gender, performance status, stage, hemoglobin, albumin, initial date of diagnosis, treatment modality utilized, response to treatment, presence of relapse, last status of patient, and last date of follow-up. RESULTS: We retrospectively reviewed 29 patients, who were treated with chemotherapy for bladder adenocarcinoma at 10 Korean medical institutions from 2004 to 2014. The median age of patients was 58 years (range, 17 to 78) and 51.7% of the patients were female. Urachal adenocarcinoma was identified in 15 patients. Of 27 symptomatic patients, 22 experienced gross hematuria. Twelve patients were treated with 5-f luorouracil based chemotherapy, five were gemcitabine based, three were taxane and others. Thirteen of them achieved complete response (10.3%) or partial response (34.5%). Median progression-free survival (PFS) and overall survival (OS) for all patients were 10.6 months (95% confidence interval [CI], 9.5 to 11.6) and 24.5 months (95% CI, 1.2 to 47.8), respectively. The cases of urachal adenocarcinoma exhibited worse tendency in PFS and OS (p = 0.024 and p = 0.046, respectively). CONCLUSIONS: Even though bladder adenocarcinoma had been observed moderate effectiveness to chemotherapy, bladder adenocarcinoma is a highly aggressive form of bladder cancer. PFS and OS were short especially in urachal carcinoma.

Retrospective analysis on the clinical efficacy of bevacizumab combined with FOLFOX4 in the first line treatment of metastatic colorectal cancer / 고신대학교의과대학학술지

OBJECTIVES: The addition of bevacizumab to standard chemotherapy has been improved survival outcomes in patients with metastatic colorectal cancer. However, the combination of bevacizumab with oxaliplatin-based chemotherapy as first-line treatment showed limited survival benefit. The purpose of this study was to investigate the clinical efficacy and toxicity of the combination of bevacizumab to oxaliplatin and leucovorin (FOLFOX4) in the first-line treatment of patient with metastatic colorectal cancer. METHODS: Between December 2004 and September 2009, medical records of patients who were diagnosed with metastatic colorectal cancer and received the first line chemotherapy with bevacizumab and FOLFOX4, were retrospectively reviewed. RESULTS: A total of forty patients were analyzed. The median age of the patients was 55 years (range, 33–80), and 55% was male. The patients received a total of 206 cycles of therapy (median 4 cycles per patient; range 1 – 15 cycles). Of these 40 patients, none achieved complete response (CR) and 15 achieved a partial response (PR), for the overall response rate (ORR) 37.5% (95% CI, 22.5–52.5). Median progression free survival (PFS) was 6.9 months (95% CI, 3.4–10.5) and median overall survival (OS) was 22.6 months (95% CI, 17.3–27.8The most common grade 3 or 4 hematologic toxicity and non-hematologic toxicity were neutropenia (10.0%) and diarrhea (10.0%), respectively. Two patients experienced gastrointestinal perforation. CONCLUSIONS: In this study, the combination bevacizumab with FOLFOX4 was associated with favorable OS, but did not showed favorable PFS and ORR.

Prognostic Significance of Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Diffuse Large B-Cell Lymphoma Patients Treated with R-CHOP / 고신대학교의과대학학술지

OBJECTIVES: The both values of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) were reported as indexes of systemic inflammation and readily available and inexpensive prognostic markers in patients with solid cancer. The objective of this study was to clarify whether the NLR and PLR were significant prognostic markers in Korean diffuse large B-cell lymphoma (DLBCL) patients treated with R-CHOP as a first line therapy. METHODS: We retrospectively collected the clinical data of ninety nine DLBCL patients treated with R-CHOP from 2004 to 2012 and analyzed. NLR and PLR were calculated from complete blood count (CBC) and differential leukocyte count. RESULTS: In univariate analysis, NLR was significantly associated with 5-year progression free survival(PFS) rate (P= 0.039), but not significantly associated with 5-year overal survival (OS) rate (P= 0.276). PLR was not significantly associated with 5-year PFS (P= 0.632) and OS rate (P= 0.855). In multivariate analysis, NLR was not a significant independent prognostic factor for 5-year PFS (P= 0.415) and OS rate (P= 0.991). CONCLUSION: The NLR can be considered a useful predictor of survival outcome. The PLR is not a valid predictor of survival outcome.

Intra-tumoral Metastatic Double Primary Carcinoma: Synchronous Metastatic Tumor in Lung from Breast and Thyroid Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

Cases of phenotypic heterogeneity of cells within tumors have recently been reported. Here, we report on a patient with characteristic intra-tumor double primary metastases in the lung. This patient was a 40-year-old Korean woman who had been diagnosed with breast cancer (T1N0M0, estrogen receptor/progesterone receptor/HER2 +/+/+) and papillary thyroid cancer three years prior and underwent a complete surgical resection followed by appropriate adjuvant treatment with radiation, hormone, and radioactive iodine. She was recently admitted for newly developed pulmonary nodules. Metastasectomy through video-assisted thoracoscopic surgery revealed recurrent double primary cancer with two different components (metastatic ductal carcinomas from the breast and metastatic papillary carcinomas from the thyroid gland) in each pulmonary nodule in the right upper lobe and right middle lobe. To the best of our knowledge, this is the first report of simultaneous recurrent double metastasis in one organ from different primary origins.

Successful Chemotherapy Following Autologous Stem Cell Transplantation in Multiple Myeloma and Multi-organ Dysfunction with Infiltration of Eosinophils: A Case Report / Journal of the Korean Cancer Association, 대한암학회지

Eosinophils are derived from hematopoietic stem cells. Peripheral blood eosinophilia is defined as an absolute eosinophil count of > or =0.5x10(9)/L. Eosinophilia is classified into primary or clonal eosinophilia, secondary eosinophilia, and idiopathic categories including idiopathic hypereosinophilic syndrome. Both hematopoietic and solid neoplasms may be associated with peripheral blood eosinophilia, but multiple myeloma is rarely associated with eosinophilia. We now report the case of a 31-year-old man with multiple myeloma associated with marked eosinophilia who developed multiple organ dysfunction with infiltration of eosinophils. He recovered after treatment with chemotherapy followed by autologous stem cell transplantation.

Successful Chemotherapy Following Autologous Stem Cell Transplantation in Multiple Myeloma and Multi-organ Dysfunction with Infiltration of Eosinophils: A Case Report / Journal of the Korean Cancer Association, 대한암학회지

Eosinophils are derived from hematopoietic stem cells. Peripheral blood eosinophilia is defined as an absolute eosinophil count of > or =0.5x10(9)/L. Eosinophilia is classified into primary or clonal eosinophilia, secondary eosinophilia, and idiopathic categories including idiopathic hypereosinophilic syndrome. Both hematopoietic and solid neoplasms may be associated with peripheral blood eosinophilia, but multiple myeloma is rarely associated with eosinophilia. We now report the case of a 31-year-old man with multiple myeloma associated with marked eosinophilia who developed multiple organ dysfunction with infiltration of eosinophils. He recovered after treatment with chemotherapy followed by autologous stem cell transplantation.

A case of multiple small cell carcinoma of the esophagus / 대한내과학회지

The extra-pulmonary sites of a small cell carcinoma are the salivary glands, pharynx and larynx, esophagus, stomach, pancreas, colon, rectum, skin and cervix. Primary small cell carcinoma of the esophagus is extremely rare with an incidence ranging from 0.8~2.4% of all esophageal malignancies. There have been approximately 20 cases reported in the Korean literature thus far. However, there has not been a reported case of multiple small cell carcinoma of the esophagus. We report a case of multiple small cell carcinoma of the esophagus in a 61-year-old man who presented with a 2 month-history of progressive dysphagia with a review of the relevant literature.

A case of a minute gastric carcinoid tumor with regional lymph node metastasis that was misdiagnosed as an intraabdominal mass / 대한내과학회지

Gastric carcinoid tumors have been regarded as rare neoplasms, accounting for just 0.3% of all gastric tumors and fewer than 2% of all carcinoid tumors. Recently, there has been an increase in the number of reported studies of gastric carcinoid tumors with the widespread use of gastroscopy and improvements in immunohistochemical methods. Gastric carcinoid tumors are classified into three types. For type III gastric carcinoids not associated with hypergastrinemia, which tend to be larger and demonstrate a biologically more aggressive behavior with metastasis, and also for sporadic lesions, excision with regional lymph node clearance has been recommended. Tumors that are less than 1cm in size are called minute carcinoids, which seldom give rise to regional lymph node metastasis, except in rare cases. We report here a rare case of a minute gastric carcinoid tumor with regional lymph node metastasis that was misdiagnosed as an intraabdominal mass in a 42-year-old woman. Furthermore, we review the available literature on this entity.

A Case of Carcinoid Tumors of the Stomach and Duodenum Treated by Endoscopy / 대한소화기내시경학회지

A carcinoid tumor is a slow growing, rare neoplasm arising from enterochromaffin cells with a malignant potential. A primary carcinoid tumor of the stomach and duodenum is uncommon. However, their prevalence has been increasing due to the widespread use of endoscopy. Recently, the use of endoscopic resection for the treatment of small carcinoid tumors is gradually increasing. To our knowledge, this is the first case report of synchronous carcinoid tumors in the stomach and duodenum. We report a case of small, multiple carcinoid tumors of the stomach and duodenum in a 58-year-old man that was endoscopically removed with a snare.

Histological comparison of endoscopic forceps biopsy with endoscopic mucosal resection in the gastric lesions / 대한내과학회지

BACKGROUND: The correct histological diagnosis of a gastric adenoma is important, because an adenoma has been reported to be a precancerous lesion and is associated with focal gastric carcinoma. However, there is some discrepancy between the histology of a forceps biopsy and that of the endoscopic mucosal resection. This study compared the histological findings of a gastric mucosal lesion in the specimens of a forceps biopsy and an endoscopic mucosal resection. METHODS: 88 cases of gastric mucosal lesions, which had been removed by the endoscopic mucosal resection, were reviewed retrospectively. All the patients had undergone a forceps biopsy before the endoscopic mucosal resection. The histological findings of the specimens by a forceps biopsy were compared with those by resection. RESULTS: The histological findings were accordant at 52 of the 88 cases (59.1%). Among the 71 cases with adenoma or gastritis in the biopsied specimens, 13 cases (18.3%) were finally diagnosed with gastric cancer in the resected specimens. Among all the gastritis and adenomas determined by the forceps biopsy, the high-risk groups for adenocarcinomas were characterized by the following endoscopic findings: red-colored and depressed lesions. CONCLUSIONS: Biopsy specimens may not be representative of the entire lesion. Therefore, an endoscopic resection of a gastric mucosal lesion is needed for making an accurate histological diagnosis and treatment if adenomas such as red-colored or depressed lesions are suspected.