An ectopic thymoma arising in the middle mediastinum that was difficult to distinguish from a lymph node metastasis.

BACKGROUND: Ectopic thymomas often occur in the upper mediastinum; however, they rarely arise in the middle mediastinum, especially on the dorsal side of the innominate vein and superior vena cava in the peribronchial region. CASE PRESENTATION: Six years prior, a 27-year-old female presented to our department and was diagnosed with locally advanced left breast cancer. First, we administered chemotherapy including an anti-human epidermal growth factor receptor 2 antibody. The size of the tumor was markedly reduced, and a radical operation involving mastectomy and axillary lymph node dissection was then performed. The patient underwent radiotherapy after the mastectomy, followed by trastuzumab therapy; she continued to receive endocrine therapy thereafter. She underwent computed tomography once a year after the surgery, and a nodule in the middle mediastinum on the dorsal side of the innominate vein and superior vena cava in the parabronchial region was detected at 4 years. We speculated that the nodule was a solitary mediastinal lymph node metastasis from her breast cancer; therefore, we performed thoracoscopic resection of the tumor. We diagnosed the tumor as a thymoma. Currently, the patient visits our hospital to receive continuous hormone therapy for her breast cancer, and the latest computed tomography scan demonstrated no metastases from or recurrence of her breast cancer or thymoma. CONCLUSIONS: We report a case of ectopic thymoma in the middle mediastinum. The tumor, which was detected during systemic therapy for locally advanced breast cancer, was located on the dorsal side of the innominate vein and superior vena cava in the parabronchial region and was indistinguishable from a lymph node metastasis from breast cancer.

[Bladder-Infiltrating Sigmoid Colon Cancer Successfully Treated with Neoadjuvant Chemotherapy and Radical Resection-A Case Report].

A 71-year-old man presented with the chief complaints of constipation, melena, and weight loss, and sigmoid colon cancer was suspected on lower gastrointestinal endoscopy. The cancer was diagnosed as RAS wild type adenocarcinoma(tub2)on biopsy. Abdominal contrast-enhanced CT revealed a mass with a maximum diameter of 55mm in the sigmoid colon; therefore, bladder infiltration was suspected. The Group 1 lymph nodes were bulky, with a maximum diameter of 50 mm, and No. 253 lymph node was enlarged. No fistulas were found on cystoscopy. The sigmoid colon cancer was cT4b(bladder), N3, M0, cStage Ⅲc. After performing a colostomy, neoadjuvant chemotherapy with mFOLFOX6 plus panitumumab was started. Radical surgery was performed after 3 courses of chemotherapy. The clinical treatment effect was PR, and the final histopathologi- cal examination revealed ypT3, ypN0(0/17), R0, ypStageⅡa. The therapeutic effect was Grade 2a. Postoperative adjuvant chemotherapy was performed for 6 months with mFOLFOX, and there have been no signs of cancer recurrence for 9 postoperative months. We experienced a case of colon cancer with suspected bladder infiltration, successfully treated with neoadjuvant chemotherapy and radical surgery.

[A Case of Long-Term Survival in a Patient with Advanced Gastric Cancer with Virchow's Lymph Node Metastasis Which Received Multidisciplinary Treatment].

We report a case of long-term survival in a 75-year-old male with advanced gastric cancer and Virchow's lymph node metastasis[cT3N3M1(LYM)H0P0, cStage Ⅳ]which received multidisciplinary treatment. Over 1 year and 6 months, 5 courses of S-1 plus CDDP, 14 courses of S-1 plus docetaxel, and 3 courses of S-1 plus CPT-11 were administered. Following chemotherapy, FDG-PET/CT showed FDG uptake only in the primary tumor and regional lymph nodes. Total gastrectomy and D2 dissection were performed. The pathological diagnosis was Type 5, 55×50 mm, L, Less, tub1>tub2, T3, int, INF b, ly2, v1, pPM0, pDM0, pN2(3/29), HER2(-). S-1 was used as adjuvant chemotherapy. Four years and 7 months after resection, cervical lymph node swelling was detected. The cervical lymph node was resected, followed by radiotherapy administration(56 Gy/28 Fr). No relapse occurred, and the patient has survived more than 7 years and 1 month and 8 years and 11 months after conversion surgery and diagnosis, respectively.

[A Case Report of Accessory Breast Cancer in the Right Axillary Region].

An 80-year-old woman visited a previous hospital complaining of a lump in the right axillary region. Because it was suspected of accessory breast cancer from the findings of image inspection, she was referred for surgery. Based on mammography and ultrasonography, both bilateral mammary glands were reported normal, but an irregular mass was found in the right axillary region. Resection biopsy showed adenocarcinoma like invasive ductal carcinoma. In addition, ER and PgR were positive. With a preoperative diagnosis of accessory breast cancer, she underwent wide local resection of the right axillary region with lymph-node dissection(Level Ⅰ), and local pedicle flap formation. Histopathological findings revealed that the tumor was composed of invasive ductal carcinoma. The center of tumor was consisted of ductal tissue discontinuous with normal mammary gland. So, a diagnosis of accessory breast cancer in the right axillary region was confirmed. She is currently in recurrence-free survival. Accessory breast cancer is relatively rare. We report a case of accessory breast cancer in the axillary region with some review of the literature.

[A Case Report of Long-Term Survival of Metastatic Breast Cancer Treated with Mohs Paste and Systemic Therapy].

The patient was a 75-year-old woman who had experienced left breast cancer(BT plus AX)in 1988. Local recurrences in the skin of the left chest wall appeared and were treated with operation, radiotherapy, and systemic therapy. Twenty-four years later, she developed continuous bleeding due to skin metastasis of the breast cancer and received Mohs chemosurgery and continued systemic therapy. After using Mohs paste 10 times, the skin surface healed and dried up. Improving the quality of life of patients with several symptoms such as skin cancer or metastatic skin lesions is essential in multidisciplinary therapy and Mohs paste was useful for the local control of the unresectable skin lesion.

[A Case of a Bulky Axillary Ectopic Breast Cancer Which Successfully Resected after Chemotherapy(Docetaxel)].

A 78-year-old woman presented with a right axillary mass.With an incisional biopsy a diagnosis of invasive ductal carcinoma was achieved.In the whole body search, any primary focus including the breast was unclear, advanced occult breast cancer with supraclavicular lymph node metastases was diagnosed.Administration of 3 courses of docetaxel achieved disappearance of supraclavicular lymph node and reduction of an axillary mass.Right axillary lymph node dissection could be successfully performed.Pathological report showed a right ectopic cancer with right axillary lymph node metastases.The patient has been well without any relapse for 3 years.

A case of silent perforated diverticulitis in the ascending colon combined with pylephlebitis resulting in complete occlusion of the portal trunk.

A case of silent perforated diverticulitis in the ascending colon combined with pylephlebitis, resulting in complete occlusion of the portal trunk, is presented. A 75-year-old man with no relevant medical history visited our hospital complaining of a fever, which had lasted for 2 weeks. Although his laboratory data were indicative of severe inflammation, an abdominal examination and a computed tomography (CT) scan did not produce any significant findings. On the 6th day after admission, an abdominal CT scan detected a thrombus extending from the superior mesenteric vein to the portal vein, but did not show any signs of infection. However, on the 40th day after admission, an abdominal CT scan detected an embolus in the portal vein completely occluding the main portal trunk, as well as marked edematous changes indicative of inflammation, and an abscess in the ascending colon. We performed laparotomy and iliocecal resection, during which a perforation of the ascending colon derived from diverticulitis was found. We report this rare case and a review of the literature.

The associations between RAS mutations and clinical characteristics in follicular thyroid tumors: new insights from a single center and a large patient cohort.

BACKGROUND: Many studies on thyroid follicular tumors have reported the presence of somatic mutations to three forms of RAS: HRAS, KRAS, and NRAS. However, the frequency and clinical significance of these RAS mutations remain unclear, in large part due to the different methodologies being used for mutation analysis and the limited number of cases featured in studies. To clarify the significance of RAS mutations, we examined a large number of follicular adenomas and carcinomas obtained from a single institute using established methods for the analysis of RAS. METHODS: Tumor samples from 40 follicular adenoma and 58 follicular carcinoma patients treated at the Kanagawa Cancer Center Hospital were analyzed. The three RAS mutations at codons 12 and 61 were assessed with a polymerase chain reaction-based loop-hybrid mobility shift assay followed by confirmation with direct sequencing. The relationships between mutation status and clinicopathological features at the time of the initial operation and the prognosis of the patients were also analyzed. RESULTS: Twelve out of 40 (30%) adenomas harbored RAS mutations. In contrast, 33 out of 58 (57%) follicular carcinomas harbored RAS mutations, and the mutation was predominantly found in the NRAS codon 61 (22/33, 67%, p<0.01). The rate of gene mutations was significantly higher in the carcinomas than in the adenomas (p<0.01). The NRAS codon 61 mutation in follicular carcinomas was positively associated with distant metastases through the entire clinical course of the patients (p<0.05), and RAS mutations were associated with poor overall patient survival (p<0.05). CONCLUSIONS: We investigated the frequency of RAS mutations in follicular thyroid tumors from a large number of cases obtained from a single institute. The predominance of NRAS codon 61 mutations as a feature of carcinomas indicates that the diagnosis of adenoma alongside the presence of this mutation should be made cautiously. Our study raises the possibility that follicular adenomas with the RAS mutations have an inherent malignant potential; however, the clinical significance of this finding should be further investigated in more patients and over a longer follow-up period.

[Clinical efficacy and safety of CPT-11+CDDP therapy as third-line chemotherapy for advanced and recurrent gastric cancer].

The clinical efficacy and safety of CPT-11+CDDP therapy were studied retrospectively in 34 patients with advanced and recurrent gastric cancer. The overall response rate was 5. 9%; MST was 209 days. The adverse effects observed were grade 3 in 7 patients(20. 6%). CPT-11+CDDP therapy could be useful and safe as third-line chemotherapy.

[Three cases of advanced gastric cancer successfully treated by combination therapy of biweekly S-1 and docetaxel].

We report three cases of advanced gastric cancer successfully treated by combination therapy of S-1 and docetaxel (DOC). We administered S-1 orally at 80 mg/m² on days 1 to 7 and days 15 to 21, and DOC intravenously at 40 mg/m² on day 1 and 15, and evaluation was conducted every two courses. Case 1: A 73-year-old man with gastric cancer of cT4a, accompanied with bulky N2 lymph node metastasis, was treated with two courses of S-1 and DOC. Partial response was confirmed, followed by total gastrectomy, which revealed his histological grade to be 1b. Case 2: A 65-year-old man with gastric cancer of cT4a, accompanied with bulky lymph node metastasis, was treated with two courses of S-1 and DOC. Partial response was confirmed, followed by distal gastrectomy, which revealed his histological grade to be 1b. Case 3: A 76-year-old woman with gastric cancer of cT4b (panc), was treated with four courses of S-1 and DOC. After that, the main tumor was judged to be cT4a, followed by total gastrectomy, which revealed her histological grade to be 1b. Combined S-1 and DOC chemotherapy is an effective regimen for the treatment of unresectable gastric cancer.

[A case of advanced gastric cancer successfully treated by combination therapy of S-1 and docetaxel].

A 73-year-old man with gastric cancer of Borrmann type 3 accompanied with N3 was treated by combination therapy of S-1 and docetaxel (DOC). He received DOC intravenously at 45 mg/m/2 on day 1 and 15, and S-1 orally at 120 mg/body on day 1 to 7 and day 15 to 21. This treatment was repeated every 28 days as one course. After 4 courses of treatment, a CT scan revealed partial response of the lymph node metastases, and imaging modalities showed complete response of the primary lesion. The serum CEA value normalized after 4 courses of treatment. Toxicities included leukocytopenia (grade 3-4) and neutropenia (grade 3-4). Chemotherapy in the outpatient setting was possible by reduction of dose (DOC 45-->40-->35 mg/m2). Total gastrectomy was performed after 4 courses of treatment. The histological effect of primary lesion was judged to be Grade 2.

Phase II study of weekly paclitaxel as a second-line treatment for S-1-refractory advanced gastric cancer.

BACKGROUND: We retrospectively evaluated the efficacy of weekly paclitaxel therapy as second-line treatment for patients with advanced gastric cancer that was refractory to S-1. PATIENTS AND METHODS: In total, 33 patients received intravenous paclitaxel (80 mg m(-2)) on days 1, 8 and 15 as part of a 4-week cycle. RESULTS: Eight patients showed a partial response, 11 showed stable disease and 14 showed disease progression. In total, 171 courses (mean=5.2; range=3-16) were administered. Thirteen cases subsequently underwent third-line treatment. The median survival time and time to progression from the time of second-line treatment was 8.0 months and 4.2 months, respectively. The most common haematological toxicities were leukopenia and neutropenia. Non-haematological toxicities were generally mild to moderate and controllable. CONCLUSION: This study showed favourable therapeutic outcomes for advanced gastric cancer patients. However, it will be necessary to confirm the advantages of paclitaxel treatment for S-1-refractory advanced gastric cancer in a larger population.

[A case of metastatic breast cancer with liver metastasis effectively treated with capecitabine and vinorelbine].

A 31-year-old woman with cancer of the right breast underwent surgery in 1996. Histological examination demonstrated a solid tubular carcinoma that was positive lymph node metastasis and hormonal receptor, but negative for HER2 expression. The patient underwent adjuvant therapy with CAF and tamoxifen. At the age of 40 years old, Multiple liver metastasis appeared to the patient. We treated her with paclitaxel. But multiple liver metastasis became progressive disease. Next we treated with capecitabine and vinorelbine. The liver metastasis reduced, and, in the eighth month, the liver metastasis disappeared after 9 cycles. We changed treatment to goserelin, and anastrozole. The period of complete response was 1 year 3 months.