[Two cases of interstitial pneumonia caused by cetuximab plus mFOLFOX6 therapy in metastatic colorectal cancer patients].

Case 1: A 69-year-old man was diagnosed with rectal cancer and liver metastasis. After low anterior resection, mFOLFOX6 plus cetuximab therapy was started for resection of the liver metastasis. However, he had to forgo liver resection because he developed acute exacerbation of interstitial pneumonitis (IP) after 6 courses of chemotherapy. Despite beginning the second-line treatment with mFOLFOX6 plus bevacizumab, he died in June 2012. Case 2: A 71-year-old man had undergone sigmoidectomy for sigmoid colon cancer in 2005, and right lower lobe partial resection for metastatic lung cancer in 2006. Although radiofrequency ablation or transcatheter arterial chemoembolization had been performed for multiple liver metastases several times since 2007, his multiple liver metastases were uncontrollable. Therefore, FOLFOX4 therapy was started in 2010, and mFOLFOX6 plus cetuximab therapy was substituted for FOLFOX4 therapy in 2011. The patient died in March 2012 due to the rapid development of IP, and thus, it appears that IP was the cause of death in both patients. The general condition, including pulmonary function, of patients at risk of IP must be checked before starting cetuximab therapy for metastatic colorectal cancer.

[Our experiences of XELOX + bevacizumab for two cases of metastatic sigmoid colon cancer].

XELOX for metastatic colorectal cancer has been approved last year in Japan and used to manage some cases of metastatic colorectal cancer at our hospital. We thought that this regimen has some merits in the patient's quality of life (QOL). Case 1: A 66-year-old man who had been diagnosed sigmoid colon cancer with retroperitoneal invasion. Case 2: A 67-year-old man who had been diagnosed Sigmoid colon cancer with multiple lung metastases. Therefore, both of them have been diagnosed as metastatic sigmoid colon cancer. Although two cases started with XELOX + bevacizumab, there was no toxicity of grade 3 or 4 for both, and we thought that the patients' QOL had been kept. Now, two cases are followed tightly as their chemotherapeutic response is being PR or NC.

[A case of primary retroperitoneal malignant fibrous histiocytoma].

A 68-year-old man visited our hospital due to constipation. A hard mass was palpated in the left side abdomen. Several examinations could point out a large left sided retroperitoneal tumor. Because the tumor was adherent to the descending colon, both were removed. Based on histological and immunohistochemical inspection, the tumor was diagnosed as malignant fibrous histocytoma (MFH) on retroperitoneum. No treatment was undergone as the postoperative course was good, however, computed tomography (CT) for 8 months after the surgery showed the sign of local recurrence. It has been reported that the prognosis of MFH was very poor and a surgical resection was the only treatment for MFH, or we are expecting to find an effective treatment quickly such as a new combined chemotherapy.

Assessment of rectal aberrant crypt foci by standard chromoscopy and its predictive value for colonic advanced neoplasms.

BACKGROUND AND AIMS: Aberrant crypt foci (ACF) are thought to be preneoplastic lesions and are assessed by magnifying chromoscopy with methylene blue staining. The aim of this study was to evaluate the predictive value of rectal ACF recognized by conventional chromoscopy for colonic advanced neoplasms. METHODS: Total colonoscopy, involving rectal chromoscopy using indigo carmine with standard colonoscopies, was performed on 386 patients. Patients who showed no ACF were classified as Grade 0, and those who had 1-4, 5-9, and 10+ ACF were classified as Grades 1, 2, or 3, respectively. The correlation between ACF grading and the prevalence of colonic advanced neoplasm, any adenoma>or=1 cm in size and/or with villous or tubulovillous morphology, and/or with high-grade dysplasia or invasive cancer, was assessed. RESULTS: Sixty-three patients were classified as ACF Grade 0, 119 as Grade 1, 116 as Grade 2, and 88 as Grade 3. Colonic advanced neoplasm was observed in 4 patients (6.3%) for Grade 0, 43 (36.1%) for Grade 1, 61 (52.6%) for Grade 2, and 57 (64.8%) for Grade 3. As the ACF grade increased, the chance of a patient having a colonic advanced neoplasm increased. For multivariate analyses, compared with patients with Grade 0, those with Grades 1, 2, or 3 had a greater risk of colonic advanced neoplasm (odds ratio [OR] 9.18, 95% CI 3.08-27.33, OR 20.44, 95% CI 6.81-61.42, and OR 32.94, 95% CI 10.49-103.41, respectively). CONCLUSIONS: Chromoscopic assessment of rectal ACF by conventional techniques is useful for predicting colonic advanced neoplasms.