Surgical Treatment Using Artificial Dermis for Women with Locally Advanced Breast Cancer.

Physicians occasionally come across with patients with locally advanced breast cancer (LABC) bringing about distress, due to tumor growth, invasion to the skin, bleeding or an ill smell. Physicians often experience much difficulty in selecting and administering therapeutic option. The clinical courses of patient who had been treated with total resection of LABC and an attachment of artificial dermis (TERUDERMIS) were mentioned. Elimination of the symptoms derived from the tumors could be successfully accomplished for all of the patients. Except for one patients who initially had bone metastasis and died 13 months after operation, the other patients have been alive under preferable condition without any signs for tumor recurrence. The surgical resection and an attachment of artificial dermis is quite reliable and helpful for both patients and physicians in palliating symptoms and reducing care for infections and hemorrhage due to LABC.

Spontaneous pneumothorax associated with cavitating pulmonary metastasis from breast cancer: a case report and literature review.

We report a 69-year-old woman with spontaneous pneumothorax associated with cavitating pulmonary metastasis from breast cancer. She was treated for right breast cancer (invasive ductal carcinoma, ypT4bN1M0, stage IIIB) 2 years earlier, and was admitted for right pneumothorax and chest computed tomography, which showed multiple small cavitating lesions in bilateral lungs. The pneumothorax was treated conservatively with chest drainage, but subsequently recurred ipsilaterally. During video-assisted thoracic surgery, we detected small white nodules with visceral pleural rupture; therefore, we performed partial lung resection. The pathological findings revealed metastatic breast cancer with pleural invasion. Forty days later, ipsilateral pneumothorax recurred, and chemical pleurodesis was performed, which resolved the pneumothorax and prevented subsequent recurrence. Early diagnosis and definitive treatment, including pleurodesis, should be considered to prevent recurrence of spontaneous pneumothorax and improve patients' quality of life, even in patients with advanced malignancy.

Spindle cell carcinoma of the breast - A case report.

Spindle cell carcinoma (SpCC) of the breast is quite a rare modality classified to the metaplastic carcinoma of the breast. Regarding its biological behavior and the prognosis of the patients with this rare tumor, it has been remaining controversial. We herein report an 88 year-old woman who had a huge bleeding tumor on the right breast. She was a high-aged woman with low activities of daily life, even with some suspicion of distant organ metastasis. While the tumor proved to drastically bleed due to the tumor disintegration, a right simple mastectomy was performed. According to the histopathologic examinations, sarcomatoid spindle cells with severe atypia were observed. By an immunohistochemical examination, the tumor had proved to express neither estrogen receptor, progesterone receptor nor HER2 receptor. Moreover an immunohistochemical expression of AE1/3 and CAM5.2, defining an epithelial neoplasm were observed in addition to an expression of vimentin. From these findings, this bleeding tumor was diagnosed as spindle cell carcinoma of the breast. J. Med. Invest. 67 : 365-367, August, 2020.

New scoring system to create a prognostic criteria in colorectal carcinoma based on serum elevation of C-reactive protein and decrease in lymphocyte in peripheral blood.

BACKGROUND: Both serum elevation of C-reactive protein (CRP) and reduction of lymphocyte in the peripheral blood has been known as indicator for malignant potential of human tumors. METHODS: Whether newly devised CLS (CRP/Lymphocyte Score), based on combined data of serum elevation of CRP and of lymphocyte percentage in the peripheral blood can be an indicator for progressive potential in colorectal carcinoma was examined in 280 cases who had been surgically treated. RESULTS: Significant difference in survival was observed both between CLS 0 and 1 and between CLS 1 and 2, in both cases when analyzed among whole patients and patient who had been treated with curative resection. Multivariate analysis among patients who had been treated with curative resection demonstrated that CLS (P < 0.0001), histologic type (P = 0.0003), and tumor stage (P = 0.039) were factors independently associated with worse prognosis of the patients. CONCLUSIONS: Newly devised criteria CLS could be an independent prognostic indicator in colorectal carcinoma and would be utilized as a helpful information. J. Med. Invest. 66 : 264-268, August, 2019.

A case of adenoid cystic carcinoma of the breast.

An 85-year old woman who had a large tumor in the left breast came to our out-patient clinic. Computed tomography showed multiple lung tumors in addition to a huge tumor in the left breast. A needle biopsy brought about a histological diagnosis of ductal carcinoma. A simple mastectomy was performed and a histological examination using the resected specimen demonstrated a coexistence of an adenoid structure and a false ductal structure according the histologic characteristics of adenoid cystic carcinoma, which is quite rare among breast tumors. J. Med. Invest. 65:289-291, August, 2018.

Definition of Prognosis Based on Lymph Node Metastasis and Elevation of Serum C-Reactive Protein for Patients with Gastric Carcinoma Treated with Curative Resection.

PURPOSE: The aim of this study was to develop prognostic criteria based on the combination of nodal metastasis and preoperative elevation of serum C-reactive protein (CRP) for patients with gastric carcinoma that have been treated with curative resection. METHODS: Three hundred and twenty patients with gastric carcinoma who had been treated with curative resection were enrolled. One point was provided for each incidence of nodal metastasis and preoperative elevation of serum CRP and we examined whether this cumulative score system could provide a strict stratification of survival. RESULTS: Significant differences regarding survival were observed both between patients with scores of 0 and 1 (P < 0.0001) and between patients with scores of 1 and 2 (P < 0.0001). Multivariate analysis showed that the cumulative score (P = 0.0003) and the depth of the tumor (P = 0.016) were independent prognostic indicators. CONCLUSIONS: Criteria for the prediction of prognosis in gastric carcinoma treated with curative resection based on tumor-related and host-related factors could provide a strict stratification. J. Med. Invest. 65:191-194, August, 2018.

Recent advances in treatment for colorectal liver metastasis.

A major challenge for the management of colorectal liver metastasis (CRLM) is the multidisciplinary approach including surgery. Resection is the most important treatment strategy to prolong the survival of patients with colorectal cancer (CRC). Even when resection is not possible as a primary treatment, it may still be carried out for curative intent after effective chemotherapy. Therefore, resection should always be considered when conducting chemotherapy for CRLM. Neoadjuvant anti-epidermal growth factor receptor (EGFR) antibody has shown a high response rate for RAS wild CRC. However, whether anti-EGFR antibody is superior to antivascular endothelial growth factor antibody for all types of CRLM is yet to be determined. Recently, several randomized control trials of first-line therapy for advanced CRC have been conducted, and some of them are ongoing. The optimal chemotherapy regimen and tumor biology indicated for neoadjuvant chemotherapy as well as conversion surgery are expected to be determined in the near future.

Further evidence to demonstrate the significance of serum appearance of anti-p53 antibody as a marker for progressive potential in invasive ductal carcinoma of the breast.

BACKGROUND: Serum appearance of anti-p53 antibody (p53Ab) has been reported as an indicator for progressive potential of human tumor tumors including breast cancer. But its significance in breast cancer has not been discussed fully. METHODS: Relationship between serum appearance of p53Abs and representative data accounting for progressive potential in breast cancer, nuclear grade (NG), triple negative cancer, and the cumulative score based on these two data (TGS) was investigated among 129 women with invasive ductal carcinoma (IDC) of the breast, who had been treated with surgical resection. RESULTS: There was a significant correlation between appearance of p53Abs and recurrence of the tumors (P = 0.035). Significant correlation of serum appearance of p53Abs with negative expression of ER (P = 0.011), the proportion of TNBC (P = 0.013), NG (P = 0.017), and TGS (P = 0.0005). CONCLUSIONS: Preoperative serum appearance of p53Abs can be correlated with pathological nuclear grade, incidence of triple negative breast cancer, and TGS. These results might demonstrate more powerful significance of serum appearance of p53Abs as an indicator of progressive potential in IDC of the breast. J. Med. Invest. 64: 241-244, August, 2017.

Superficial temporal artery aneurysm associated with immunoglobulin G4-related disease.

A 68-year-old man was admitted because of a pulsatile mass and pain in the left temporal region, and computed tomography demonstrated the superficial temporal artery aneurysm. He underwent aneurysmectomy, and pathologic investigation revealed marked thickness of the adventitia with substantial plasmacyte infiltration. On immunoglobulin G4 (IgG4) immunohistochemistry, IgG4-positive lymphocytes were scattered in the adventitia, and biochemical tests revealed elevation of IgG4 (200 mg/dL). The case satisfied the criteria for both giant cell arteritis and IgG4-related disease (IgG4-RD). This case report suggested that IgG4-RD can occur in the superficial temporal artery and that IgG4-RD may partially overlap with a subtype of giant cell arteritis.

Rerupture of nonparasitic liver cyst treated with cyst fenestration: a case report.

We herein describe a case involving spontaneous rerupture of a nonparasitic liver cyst successfully treated with cyst fenestration and an omental flap. A 59-year-old Japanese woman was transferred to our hospital for evaluation of acute abdominal pain. She had a history of conservative treatment with antibiotics for spontaneous rupture of a liver cyst 1 month previously. On arrival, she exhibited abdominal tenderness and muscular defense. Enhanced computed tomography showed ascites and a large ruptured hepatic cyst (diameter of 10 cm). We diagnosed rerupture of a liver cyst and performed laparotomy for cyst fenestration and intraperitoneal drainage. During the operation, we found the perforation site on the ventral side of the cyst and brown, muddled ascitic fluid. Cholangiography showed no bile leakage on the inner wall. Pathological investigation revealed no evidence of malignancy. The patient recovered without any adverse events and was discharged on postoperative day 8. No recurrences or complications occurred for 2 years.

Glasgow Prognostic Score (GPS) can be a useful indicator to determine prognosis of patients with colorectal carcinoma.

The Glasgow Prognostic Score (GPS), an inflammation-based score, has been used to predict the biologic behavior of malignant tumors. The aim of the current study was to elucidate a further significance of GPS in colorectal carcinoma. Correlation of GPS and modified GPS (mGPS), which are composed of combined score provided for serum elevation of C-reactive protein and hypoalbuminemia examined before surgical treatment, with clinicopathologic features was investigated in 272 patients with colorectal carcinoma. Survival of GPS 1 patients was significantly worse than that of GPS 0 patients (P= 0.009), and survival of GPS 2 patients was significantly worse than that of GPS 1 patients (P < 0.0001). Similarly, survival of mGPS 1 patients was significantly worse than that of mGPS 0 patients (P = 0.009), and survival of mGPS 2 patients was significantly worse than that of mGPS 1 patients (P = 0.0006). Multivariate analysis demonstrated that GPS (P < 0.0001) as well as tumor stage (P= 0.004) and venous invasion (P = 0.011) were factors independently associated with worse prognosis. Both GPS and mGPS could classify outcome of patients with a clear stratification, and could be applied as prognostic indicators in colorectal carcinoma.

Prognostic criteria in colorectal carcinoma constructed by the combination of tumor-related and host-related factors.

BACKGROUND: The significance of prognostic criteria based on a combination of tumor-related and host-related factors for patients with colorectal carcinoma has not been appreciated fully. METHODS: Correlation of tumor-related and host-related score (TRHRS), which are constructed by the combination of serum elevation of C-reactive protein and pathologic lymph node metastasis (scores ranging 0 to 2), with clinicopathologic features including prognosis was studied in 271 patients with colorectal carcinoma who had been treated with curative resection. RESULTS: Significant difference regarding survival was observed both between TRHRS 0 and 1 (P = .028) and between TRHRS 1 and 2 (P < .0001). Multivariate analysis showed that histologic types (P = .040) and TRHRS (P < .0001) were independent prognostic indicators. CONCLUSION: Criteria for the prediction of prognosis in colorectal carcinoma treated with curative resection based on both tumor-related and host-related factors could provide a strict stratification.

New criteria to predict tumor recurrence in invasive ductal carcinoma of the breast.

Incidence of triple-negative breast cancer (TNBC), which is cancer without expression of ER, PgR, and HER2, and nuclear grade (NG) are closely correlated with malignant potential of breast cancer. However, criteria to determine aggressiveness of breast cancer based on these factors have not been elucidated. The aim of this study was to create criteria using these factors to predict tumor recurrence in invasive ductal carcinoma (IDC) of the breast. One hundred and seventy-nine patients with IDC of the breast, which had been treated by surgical resection, were included. One point was added for each factor of the two categories of TNBC and NG 3. The sum of the scores (TGS 0, 1, or 2) was calculated. Significant difference was observed between TGS and the incidence of tumor recurrence (P < 0.0001). Moreover, significant differences were observed regarding relapse-free survival (RFS) between patients with TGS 0 and TGS 1 (P < 0.0001) and patients with TGS 1 and TGS 2 (P = 0.024). TGS might contain a clinical advantage as a useful predictor for tumor recurrence of IDC of the breast and could classify prognosis of the patients with a preferable stratification.

[Combined therapy of lapatinib and capecitabine effective against local recurrence of breast cancer].

A 67-year-old woman after mastectomy was afflicted with local recurrence of left breast cancer during adjuvant trastuzumab therapy. Oral administration of lapatinib and capecitabine served to distinguish the recurrent tumor and also reduce the patient's distressing symptoms. This combined anti-cancer therapy may be available for patients with breast cancer for whom trastuzumab therapy was not adequately effective.

Five-point scoring system based on clinicopathological data: A convenient criterion to determine prognosis of patients with colorectal carcinoma.

The aim of this study was to elucidate the significance of a novel staging criterion, a five-point scoring system (FPSS), determined by five histopathological factors of colorectal carcinoma. These factors included depth of invasion, lymph node metastasis, lymphatic invasion, venous invasion and histopathological tumor type. In total, 357 patients with colorectal carcinoma who had had been treated by surgical resection were investigated. One point was assigned to each of the five aforementioned tumor-related pathological factors. The FPSS score was determined by an aggregate of the points. A significant difference was observed between the survival of patients with FPSS scores of 0 and 1, and 2 and 3 (P=0.0002); and FPSS scores of 2 and 3, and 4 and 5 (P<0.0001). We demonstrate that the FPSS is a convenient criterion for stratifying the prognosis of patients with colorectal carcinoma.

Pedunculated hamartomatous polyp of the appendix: report of a case.

We experienced a rare case of a pedunculated polyp of the appendix, which had been incidentally found by preventive appendectomy performed when providing surgical treatment for rectal carcinoma. A pathological investigation of this polypoid lesion demonstrated branches of fibro-muscular stalks connecting with the lamina muscularis covered by a hyperplastic mucosa, which proved to be consistent with the features of hamartoma. The patient had no external characteristics of Peutz-Jeghers syndrome, including mucocutaneous pigmentation and gastrointestinal polyposis, observed by endoscopy. This case is considered to be a Peutz-Jeghers type polyp of the appendix with a pedunculated form, which is very rare.

Unilateral multicentric cancer of the breast containing two different histopathological types: Case report.

Unilateral multicentric cancer of the breast containing a tumor with a specific histopathological type is comparatively rare. We, herein, report a case of an unilateral multicentric cancer of the breast containing two separate tumors diagnosed as a papillo-tubular carcinoma and an invasive lobular carcinoma. In addition to the difference in histological type, these two tumors also had different patterns of expression of hormonal receptors reflecting the cellular aggressiveness. Therfore, these tumors may be formed through multicentric tumorigenesis.

Impact of high preoperative steroid doses on postoperative complications among patients on prolonged preoperative steroid therapy.

Corticosteroids are essential to maintain the organic homeostasis. Steroid, glucocorticoid or its synthetic analog is widely used for inflammatory and autoimmune diseases. Prolonged steroid therapy is reported to cause the susceptibility to infection, impaired wound healing and psychoneurosis, however whether the quantity of taking the preoperative steroid is associated the postoperative complication is still unknown. The aim of this study was to elucidate whether the steroid dose in patients on prolonged preoperative steroid therapy is associated postoperative morbidity and mortality. Twenty-five patients taking steroid for various illnesses and underwent the surgery under general anesthesia were selected in this study. The mean +/- standard deviation and the median of the steroid dose converted into hydrocortisone (mg/day) were 39.2 +/- 31.0 and 20, respectively. Of 25 cases, postoperative complications were seen in 10 cases. The postoperative complication was severe based on the grade of Clavien and Dindo by ANOVA as the doses of taking steroid increased (p = 0.0171). The grave postoperative complication classified as Clavien and Dindo grade III occurred with 100% sensitivity and 87% specificity for the steroid dose converted into hydrocortisone > 80 mg/day. Preoperative taking the large amount of steroid (> 80 mg/day) could cause a grave complication. More careful selection of the operative procedure might improve the mobidity rate.

Simple criteria to predict prognosis in colorectal carcinoma based on lymphopenia and thrombocytosis.

The aim of the present study was to establish a series of criteria based on lymphopenia and thrombocytosis to determine prognosis for patients with colorectal carcinoma. Correlation of preoperative lymphopenia and thrombocytosis with clinicopathological characteristics was investigated in 215 patients with colorectal carcinoma who had undergone surgical treatment. Multivariate analysis showed that the presence of at least either lymphopenia or thrombocytosis (P=0.006), venous invasion (P=0.003) and the stage of tumors (P=0.019) were independent prognostic indicators. Lymphocyte percentage and platelet counts that can be determined using only data from complete blood counts may therefore serve as simple and useful tools to appropriately determine prognosis for patients with colorectal carcinoma.

Effect of prolongation of operative time on the outcome of patients with gastric carcinoma.

The aim of the present study was to analyze the effect of the prolongation of operative time (OT) on the prognosis of patients with gastric carcinoma. In total, 330 patients with gastric carcinoma were enrolled. Correlation of OT with clinicopathological features including the prognosis of the patients were analyzed. Although tumors of patients for whom the OT was longer proved to be at a significantly more advanced stage of disease and univariate analysis demonstrated that the prognosis of these patients was significantly unfavorable, tumor stage was the only factor independently associated with worse prognosis for the patients based on multivariate analysis. Duration of OT was not an independent prognostic indicator. However, OT is dependent on the surgical procedure to treat tumor progression of gastric carcinoma.