[Recurrent Breast Cancer with Pulmonary Lymphangitis Carcinomatosis Case Responding to Trastuzumab Deruxtecan].

Pulmonary lymphangitis carcinomatosis is generally characterized by resistance to chemotherapy and is associated with a poor prognosis. Herein, we present a case of pulmonary lymphangitic carcinomatosis from recurrent breast cancer that responded well to trastuzumab deruxtecan(T-DXd). The patient was a 40-year-old woman with hormone receptor-positive, HER2-positive breast cancer. At the age of 31, she had undergone a left mastectomy with axillary lymph node dissection. She received adjuvant chemotherapy(5-fluorouracil-epirubicin-cyclophosphamide, docetaxel, and trastuzumab)followed by endocrine therapy(tamoxifen and LH-RHa). Three years after the surgery, pulmonary and bone metastases were detected and she was treated with trastuzumab, pertuzumab, and capecitabine. Liver metastases were detected, and she was treated with trastuzumab emtansine. Nine years after surgery, the patient developed dyspnea and was diagnosed with lymphangitis carcinomatosis. After initiating T-DXd, dyspnea rapidly improved, and ground glass opacity on CT scan disappeared. She responded well to the treatment, with prolonged, stable disease for 1 year and 2 months. Thus, T-DXd may be effective against pulmonary lymphangitis carcinomatosis, which is generally characterized by resistance to chemotherapy.

Treatment of patellar fractures using bioresorbable forged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide cannulated screws and nonabsorbable sutures.

BACKGROUND: Forged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide (F-u-HA/PLLA) implants are widely used in surgeries because they possess high mechanical strength, bioactivity, and radio-opacity. We previously reported that F-u-HA/PLLA implants were useful for treating lateral tibial condylar, lateral humeral condylar, and ankle fractures. The study aim was to investigate the efficacy of F-u-HA/PLLA cannulated screws and FiberLoop® for treating transverse patellar fractures. METHODS: From April 2013 to February 2019, 15 patients with transverse patellar fractures were treated with F-u-HA/PLLA cannulated screws and FiberLoop® as follows: Open reduction and internal fixation (ORIF) were performed with two F-u-HA/PLLA cannulated screws and a temporary fixation Kirshner wire (K-wire). Three No. 2 FiberLoops® were inserted into these two screw holes and the K-wire hole for temporary fixation. All patients were allowed to full weight-bearing gaits using a knee brace. Knee range of motion exercise was initiated on postoperative day 1. Knee flexion was restricted to ≤90° for 1 month postoperatively. Radiograph was performed to evaluate fracture healing, screw breakage, reduction loss, and screw radio-opacity. Clinical outcomes and postoperative complications were assessed. RESULTS: The average follow-up was 16.0 months. All fractures were successfully united. Screw breakage, reduction loss, osteolysis, and radiolucent zones around the screws were not observed at the final radiographic follow-up. All F-u-HA/PLLA screw shadows were observed during the follow-up. The average range of flexion and extension were 132.0° and -2.7°, respectively. No patients experienced deep infection episodes, late aseptic tissue reactions, or foreign body reactions postoperatively. No patients complained of pain at the final follow-up. All patients returned to their pre-injury work level and activities of daily living. CONCLUSION: Our results strongly suggest that ORIF with F-u-HA/PLLA screws and FiberLoop® could be an alternative treatment option for transverse patellar fractures.

Placement of an expandable metallic stent improves the efficacy of chemoradiotherapy for pancreatic cancer with malignant portal vein stenosis or obstruction.

BACKGROUND: Advanced or recurrent pancreatic cancer can sometimes cause obstruction or stenosis of the portal vein (PV), resulting in various symptoms of portal hypertension (PH), such as ascites, pancytopenia, hemorrhagic tendencies and liver dysfunction. We placed an expandable metallic stent into the PV to improve PH-associated complications and liver function. The placement of the PV stent was beneficial for administering chemotherapeutic agents and radiotherapy (RT) safely, and resulted in an improved response rate (RR) and survival. PATIENTS AND METHODS: In the present study, 14 patients with malignant portal obstruction due to advanced or recurrent pancreatic cancer received PV stent placement to manage their PH-associated symptoms. After a mini-laparotomy at the ileocecal region, the ileocecal vein was cut and an expandable metallic stent (6-8 mm in diameter and 6-8 cm in length) was inserted into the PV under image roentgenography. After placement of the PV stent, the patients received anti-coagulation treatment with heparin and biaspirin for 1-3 months. All patients received chemotherapy with UFT, cyclophosphamide (CPA) and gemcitabine (GEM), and 11 patients also received RT. RESULTS: The RR was 43% (3 complete (CR), 3 partial (PR), 3 stable disease (SD), and 5 progressive disease (PD)), and the mean survival times (MST) after the initiation of therapy or placement of the PV-stent were 12.6 and 9.5 months, respectively, while the 1-year survival rates were 54.5% and 35.1%, respectively. In the 3 CR patients, 2 died of carcinomatous ascites 13 and 21 months later, and 1 is still disease free. In the PR and SD patients, pain and PH-associated symptoms such as ascites and hyperglycemia were also improved. CONCLUSION: The placement of a PV stent is beneficial for improving PH-associated symptoms as well as facilitating chemo-RT and the efficacy of therapy.

High incidence of synchronous or metachronous breast cancer in patients with malignant and benign thyroid tumor or tumor-like disorders.

BACKGROUND: Although many reports indicated an association between thyroid diseases and breast cancer, such an association still remains controversial. The present study was aimed to clarify the association of thyroid diseases with the breast cancer incidence. In the patients with benign and malignant thyroid tumor or tumor-like disorders, the incidence of other malignancies was surveyed, and the frequency of thyroid cancer in patients with breast cancer was also surveyed. PATIENTS AND METHODS: Between 1982 and 2005, a total of 201 female patients received surgery for tumor or tumor-like disorders, including 65 carcinoma, 68 adenoma, 61 adenomatous goiter and 7 chronic thyroiditis cases. Their outcomes were surveyed in December 2006. Furthermore, during the same periods, 340 female patients underwent breast cancer surgery and their outcomes were also surveyed in December 2006. RESULTS: The overall incidence rate of breast cancer was 16.4% (33/201) in the patients, who received thyroid surgeries and was much higher than other malignancies: 2.0% gastric cancer, 1.0% uterine and colorectal cancer. The incidence rate of breast cancer in each disease was 13.8% for thyroid cancer, 16.2% for adenoma and 21.3% for adenomatous goiter, but no incidence for chronic thyroiditis. On the other hand, in the patients with breast cancer during the same period in our department, the frequency of thyroid cancer was only 2.1% (7/340). CONCLUSION: It appears that thyroid cancer, adenoma and adenomatous goiter were associated with the risk of breast cancer, but chronic thyroiditis was not related.

[Pancreatic acinar cell carcinoma successfully treated with combination of oral TS-1 and intra-arterial cisplatin].

Pancreatic acinar cell carcinomas are rare, and little is reported on their chemotherapy. We report a 49-year old male patient with pancreatic acinar cell carcinoma and multiple liver metastases, which responded to oral TS-1 and hepatic arterial infusion of cisplatin. The patient underwent a partial hepatectomy, MCT abrasions and excision of the pancreatic tumor. Postoperative pathological studies revealed metastases of acinar cell carcinoma to the liver and lymph nodes; the primary lesion was undetermined. After surgery, the patient was treated with hepatic arterial infusion of cisplatin and oral TS-1. Metastatic tumors completely disappeared, and serum lipase decreased to normal levels. Abdominal CT one year after surgery revealed a pancreatic body tumor, which was surgically removed. Pathological studies showed primary pancreatic acinar cell carcinoma, while previous metastases remained under control. To summarize, TS-1 and cisplatin can be effective treatments for pancreatic acinar cell carcinomas.

Phase II study on low dose gemcitabine plus oral chemotherapy with uracil-tegafur and cyclophosphamide in combination with radiotherapy against recurrent and advanced pancreatic cancer.

The present study assessed the anti-tumor effects and clinical benefits of intravenous (i.v.) or intra-arterial (i.a.) gemcitabine (GEM) at low dose plus oral chemotherapy with uracil-tegafur (UFT) and cyclophosphamide (CPA) in combination with radiotherapy (RT) against recurrent and advanced pancreatic cancers. A total of 22 patients with 15 advanced or 7 recurrent pancreatic cancer were enrolled. The target lesions included 15 primary tumors, 9 liver metastases, 3 local recurrences, 1 lung metastasis and 1 pleural effusion. The patients were each given GEM at 200-400 mg weekly or biweekly, UFT at 300 mg/day daily and CPA at 50 mg/day every other day in combination with RT at a total dose of 40-60 Gy. The primary efficacy measures were the overall response rate (RR) and survival. Furthermore, the clinical benefit response (CBR) was classified by measuring the pain intensity, analgesic consumption, Karnofsky performance status and body weight. The regimen was well tolerated, and the major side effects included anorexia, general malaise and myelo-suppression. In each case, dose reduction was effective in resolving these side effects. The dose limiting side effect was thrombocytopenia. Eleven patients received i.v. GEM alone, 6 patients received i.a. GEM alone and 5 patients received both. The objective responses were evaluated in all patients, and the overall RR was 27% (2 complete responses, 4 partial responses, 6 stable diseases and 10 progressive diseases). A CBR was experienced in 22.7% of the patients. The mean survival period was 10.6 months (2-20 months), and the 1-year survival rate was 42.2%. There were no differences in RR and survival among the different administration methods of GEM. In conclusion, i.v. or i.a. GEM at low dose, UFT and CPA in combination with RT is a well-tolerated regimen with beneficial clinical efficacy, and is worthy of further study.

Retinopathy after percutaneous transluminal coronary angioplasty and stent insertion for acute myocardial infarction.

PURPOSE: To report microvascular retinopathy after percutaneous transluminal coronary angioplasty and stent insertion for acute myocardial infarction. DESIGN: Observational case series. METHODS: Retrospective review of seven patients with a retinal microangiopathy following coronary catheterization, angioplasty, and stent placement. RESULTS: All patients had bilateral cotton-wool spots in peripapillary distribution; four also had retinal hemorrhages in both eyes. None complained of visual symptoms. Lesions resolved spontaneously within several months in six patients. CONCLUSION: Although angioplasty and stent placement are less invasive than cardiac surgery, they appear to cause a retinopathy similar to postpump retinopathy.

Problems in the N-classification of the new 1997 UICC TNM stage classification for gastric cancer: an analysis of over 10 years' outcome of Japanese patients.

BACKGROUND: One of the major changes in the new TNM classification (5th edition, 1997) for gastric cancer was made in the classification of N category: the 5th edition employs the number of involved nodes and a minimum of 15 examined nodes is required for N0 classification. The validity of the new TNM classification was assessed by comparing the survivals according to the number of nodal involvement and especially the cut-off point of number of involved nodes and the problems in N0 classification in T1 were focused. PATIENTS AND METHODS: Between 1982 and 1999, a total of 641 patients underwent gastrectomy for gastric cancer in our department. The stage and the degree of subcategories were classified according to the pathological assessment after surgery, and the survival and its correlation with clinicopathological factors were statistically analyzed. RESULTS: pT classification included 325 pT1, 103 pT2, 102 pT3 and 111 pT4 cases, while pN classification included 448 pN-classifiable cases (223 pNO, 149 pN1, 52 pN2 and 24 pN3); 193 were unclassifiable (pNx), 123 of which were classified pNx due to the examined lymph nodes being less than 15. In 448 pTNM-classifiable cases the pN2 and pN3 groups showed almost the same survivals, while the pN1 included subgroups with a significant difference in prognosis. The pN1 category should be classified into two categories: pN1a, 1-3 involved nodes and pN1b, 4-6 involved nodes. Furthermore, out of 325 pT1 cases, 151 (46.5%) were pN-unclassifiable (pNx): 123 were due to the examined number being less than 15 for pN0 classification and 28 where the number of examined nodes were not reported. Although the mean number of examined nodes in pT1 was 24.7 for pN0 and 8.3 for pNx, there were no differences in survival rates between the pT1pN0 group and the pT1pNx group. This suggests the over-requirement of the number of examined nodes for pN0 classification in pT1 cases. We propose that pN0 classification in pT1 should be required for a minimum of 6 examined nodes. CONCLUSION: The pN1 category should be subclassified into pN1a and pN1b. Furthermore, pN0 classification in pT1 should be required for a minimum of 6 examined nodes.