[A Case Report of Multiple Endocrine Neoplasia Type 2A(MEN2A)Diagnosed with Medullary Thyroid Carcinoma].

We experienced a case of multiple endocrine neoplasia type 2A(MEN2A)diagnosed with medullary thyroid carcinoma. The patient was a 50s woman who was referred for a thyroid nodule detected in the right lobe during a carotid ultrasound examination. After undergoing a hemithyroidectomy, it was determined that the tumor was medullary carcinoma. RET gene test was performed, confirming a mutation at codon768, leading to the diagnosis of MEN2A. A completion thyroidectomy was performed to remove the remaining thyroid tissue. Postoperatively, the patient is undergoing systemic surveillance.

[A Case of Giant Phyllodes Tumor Treated with Breast Reconstruction].

A 62-year-old woman was diagnosed with right breast tumor 2 years ago, which she refused to undergo surgery. The patient experienced a rapid enlargement of the mass over the past 1 month, and visited hospital. The patient was diagnosed with a borderline phyllodes tumor by needle biopsy. Her right breast was occupied by an 18 cm mass. We conducted tumor resection and immediate reconstruction with DIEAP flap. The pathological diagnosis was a malignant phyllodes tumor, and the postoperative radiation to the chest wall was performed. During a year and a half follow up, she has no recurrence and highly satisfied with the reconstructed breast. Phyllodes tumors may recur locally regardless of whether they are benign or malignant, and we need strict follow-up.

[A Case of HER2-Positive Metastatic Breast Cancer Achieved a Complete Response to Paclitaxel and Trastuzumab in Combination with Pertuzumab in Fifth Therapy].

We report a case of HER2-positive metastatic breast cancer achieved a complete response(CR)to paclitaxel(PTX) and trastuzumab(HER) in combination with pertuzumab(PER) in 5th therapy. A 69-year-old woman was diagnosed left breast cancer and underwent mastectomy and sentinel lymph node biopsy in January 2011. Pathological examination revealed an invasive ductal carcinoma that was ER 0%, PgR 0%, HER2(3+), Ki-67 67% and node negative. Two years after the operation, she found multiple lung metastases in both lungs. She was administered drug treatment as HER2-positive metastatic breast cancer, but multiple lung metastases got worse after 4th treatment. Weekly PTX, trastuzumab and pertuzumab were administered as 5th therapy. After 2 months, lung metastases diminished significantly. After 44 courses of drug treatment, positron emission tomography computed tomography(PET-CT)scan revealed CR. She wanted to cease treatment, so she continues to get CT scan every half a year and the CR has been maintained.

Diagnostic and therapeutic role of endoscopic retrograde pancreatography and stent placement for grade IV blunt pancreatic trauma: A case report.

Pancreatic trauma involving ductal injury is rare but is associated with high morbidity and mortality. The benefit of endoscopic retrograde pancreatography and stent placement is unclear because there are only a few case reports on endoscopically treated pancreatic duct transection at the pancreatic head. We report a rare case of grade IV pancreatic trauma successfully treated with endoscopic pancreatic stent, which we believe makes significant contribution to the existing literature. A 17-year-old man with blunt pancreatic trauma was referred to our hospital and was diagnosed with grade IV pancreatic injury using endoscopic retrograde pancreatography. The patient was successfully managed with endoscopic pancreatic duct stenting. Although stent replacement was required three times and a trivial ductal stricture remained, the patient finally became stent-free without any symptoms and further adverse events. Endoscopic retrograde pancreatography is highly advantageous for early detection and evaluation of the severity of ductal injury. Subsequent stent insertion is well tolerated in hemodynamically stable patients and is especially beneficial for the treatment of pancreatic head injuries because it allows avoidance of sub-total pancreatectomy or high-risk reconstructive surgery. Nevertheless, the long-term outcomes and appropriate management of main pancreatic duct strictures due to stents remain to be determined. Accumulation of similar case experiences is essential to address these issues.

[Clinical Practice of the Efficiency and Safety of Palbociclib in Patients with Metastatic Breast Cancer].

We aimed to examine the effects of palbociclib and neutropenia in patients with metastatic breast cancer(MBC). From December 2017 to December 2019, 18 patients with estrogen receptor(ER)-positive, human epidermal growth factor receptor 2(HER2)-negative MBC were treated with palbociclib for at least 1 cycle. The most common adverse event(AE) was neutropenia, which occurred in 83% of all cases. With cessation and dose reduction, none of the patients had Grade 4 neutropenia. Palbociclib used in the first- or second-line treatment of MBC showed a higher efficacy than when used as the third-line treatment, which was observed as a longer duration to stay on treatment and higher efficacy.

[A Case of the Locally Advanced Breast Cancer with Serious Comorbidities Obtained a Good Local Control].

A 66-years-old woman was referred to our hospital with the chief complaint of a huge exposed left breast mass, associated massive exudates, bleedingand foul-smelling discharge. Invasive ductal carcinoma was diagnosed by core needle biopsy. The computed tomography showed left axillary lymph node metastases and no distant metastasis. Her performance status(PS) was Grade 3. She had serious comorbidities such as non-alcoholic steatohepatitis and liver cirrhosis, renal dysfunction. DMpC therapy and Mohs paste therapy were started since her overall status was improved. The huge left breast tumor and left axillary lymph node metastases were reduced remarkably. Total mastectomy and axillary lymph node dissection and free skin grafting was perfomed, and PS was improved to Grade 0, She received DMpC therapy for 4 months postoperatively, and radiotherapy at left chest wall and supraclavicular fossa.

A phase 1, dose-finding and pharmacokinetic study of gemcitabine with nab-paclitaxel in patients with metastatic breast cancer.

PURPOSE: Gemcitabine (Gem) with paclitaxel (Pac) is used for patients with metastatic breast cancer who require cytoreduction with manageable toxicities. Nanoparticle albumin-bound (nab)-Pac exhibits better efficacy and reduces the risk of hypersensitivity reactions associated with solvent-based Pac. Therefore, Gem plus nab-Pac (GA) therapy may be effective for metastatic breast cancer. The purpose of this study was to determine the maximum tolerated dose for GA therapy. METHODS: The subjects were patients with metastatic breast cancer with performance status 0 or 1 and normal hepatic, renal and marrow function. Leukopenia, neutropenia or thrombocytopenia of grade 4, neutropenic fever, or non-hematological toxicity of grade 3 or higher during the 1st cycle, and chemotherapy-induced peripheral neurotoxicity of grade 2 or higher at the end of the 1st cycle were defined as dose-limiting toxicities (DLTs). Gem (1250 mg/m(2)) was administered on days 1 and 8. nab-Pac was administered at a starting dose of 180 mg/m(2) (cohort 1) and escalated to 220 mg/m(2) (cohort 2) and 260 mg/m(2) (cohort 3) on day 1 of the 21-day cycle, using a 3 + 3 design. RESULTS: Nine patients (n = 3, 3, and 3 in cohorts 1, 2, and 3, respectively) were included in the study (median age 56 years; range 43-75 years). DLTs did not occur in any cohorts. CONCLUSIONS: The initial recommend dose in GA therapy is 1250 mg/m(2) Gem and 260 mg/m(2) nab-Pac. It is well known that nab-Pac has cumulative toxicities, and thus the efficacy and safety of GA therapy require validation in a phase 2 study.

[Analysis of Treatment and Outcomes in Locally Advanced Breast Cancer].

Current treatment guidelines for locally advanced breast cancers recommend multimodality therapy consisting of chemotherapy followed by local treatment(surgery and radiotherapy). We retrospectively analyzed 35 cases oflocally advanced breast cancer at our institution between January 2004 and December 2014. Nine patients(25.7%)were treated with multimodality therapy consisting ofchemotherapy, surgery, and radiotherapy. Nineteen patients(54%)had disease recurrence and 9(26%)died. Factors that were significantly associated with recurrence were premenopausal, T1-3, and 4 or more lymph node metastases, and the number oflymph node metastases remained significant in the multivariable analysis. The median relapse-free survival was 1,147 days and the 5-year relapse-free survival rate was 49.7%. Survival rates were influenced by menopausal state and the number oflymph node metastases on the univariate analysis, but not in the multivariable analysis. Our results indicate that multimodality therapy is necessary particularly for patients with 4 or more lymph node metastases.

[Assessment of traumatic rib fractures caused by traffic accident].

We reviewed 66 cases of traumatic rib fracture by traffic accident between January 2009 and December 2011. The age of patients ranged from 18 to 88 years, with an average age of 55.6, and they were predominantly male. They met with traffic accident when driving automobiles in 30 cases, driving motorcycles in 15 cases, and walking in 9 cases. The average number of fractured ribs was 4.1±3.2.Multiple rib fractures were observed in 75.8% of patients. Injuries other than rib fractures were involved in all patients who suffered over 7 rib fractures. Except one who died of pneumonia 62 days after traffic accident, 7 of 8 patients died within 48 hours:6 in a shock state and 1 in cardiac pulmonary arrest on arrival. About 80 % of the patients with rib fractures were hospitalized. As traffic accidents could cause any type of injuries including rib fractures, it is important to examine the whole body when patients were transported to a hospital.

[Two cases of dural metastasis of breast cancer].

The first case of dural metastasis occurred in a 60s years old woman, who presented with bone metastasis to the right breast. Nine months later, disorientation and left hemiplegia developed, the right coronal bone metastasis enlarged, and dural metastases were detected close to the tumor, as observed by using cranial magnetic resonance imaging (MRI). Whole brain radiation and chemotherapy(weekly paclitaxel)were administered. The right coronal bone metastasis reduced remarkably, and the dural metastases almost disappeared, as observed on a cranial MRI scan. The second case of dural metastasis occurred in a 50s years old woman who presented with multiple bone metastases. Extensive bone metastases to the skull and dural metastases to the side of the head were observed on cranial MRI scans. Subsequently, the patient experienced a severe headache, and whole brain radiation and pharmacotherapy with anastrozole and trastuzumab were administered. Cranial MRI revealed that the skull bone metastasis reduced and the dural metastases almost disappeared. We report that radiotherapy and pharmacotherapy were effective in these 2 cases of dural metastases of breast cancer.

[Two cases of recurrence of breast cancer at the chest wall wherein chest wall complications were treated by ablation].

Case 1 involves a 60-year-old woman who underwent surgery (breast total resection[Bt]plus axillary lymph node resection [Ax]) for the treatment of carcinoma of the right breast when she was 37 years of age. She underwent another surgery due to cancer recurrence in the right musculus pectoralis major when she was 50 years of age. The right fourth rib and the sternum showed high fluorodeoxyglucose (FDG) accumulation on positron electron tomography (PET)-computed tomography (CT) scans. Thus, we diagnosed the patient with recurrence of breast cancer at the chest wall. Lumpectomy was performed at the right chest wall, whereas ablation was performed for the right fourth and fifth rib and sternal complications. However, mediastinal lymph node metastasis developed 1 year and 2 months after the surgery. Subsequently, the patient developed lymphangitic carcinomatosis and died at 4 years and 2 months after the surgery. Case 2 involves an 80-year-old woman who underwent surgery (Bt+Ax) for the treatment of carcinoma of the left breast when she was 62 years of age. She had the swelling of the left chest wall in the 18th year from surgery, and was diagnosed recurrence of breast cancer at the chest wall, lumpectomy was performed at the left chest wall, whereas ablation was performed for the left third and fourth rib and sternal complications. No signs of recurrence have been observed for 1 year and 7 months after the surgery. Thus, ablation was performed for the treatment of chest wall complications and local recurrence of the breast cancer at the chest wall, and pharmacotherapy and radiotherapy were administered subsequently. We thereby report our experience with these 2 cases wherein local control was eventually achieved.

[A case of a geriatric patient with stage IV anal canal cancer showing complete response to chemoradiation therapy].

We present a case in which chemoradiation therapy was effective in a geriatric patient with Stage IV anal canal cancer. The patient is an 81-year-old woman who complained of proctorrhagia and anal pain. She was referred to us by her family doctor who suspected rectal cancer. Tumors as large as 6.5 cm in diameter mainly on the right side of the rectum as well as 2 palpable enlarged lymph nodes on the right inguinal area, were found during the initial physical examination. Squamous cell carcinoma was elevated to 16 ng/mL. A CT scan revealed that irregularly shaped masses as large as 7 cm in diameter were externally exposed on the right side of the rectum along with enlarged lymph nodes on the right inguinal area and metastasis at S7 lesion in the liver. Squamous cell carcinoma was diagnosed from biopsy results. Due to her age, the chemotherapy regimen was S-1+CDDP with radiation therapy and 4-port irradiation (50.4 Gy) of the primary tumor, interior of the pelvis, and inguinal lymph nodes. Partial response was observed upon completion of treatment, and complete response was obtained after 6 months. She is currently an outpatient taking S-1: 60 mg/day orally. There is no indication of cancer recurrence after 1 year and 3 months, and she continues to visit an outpatient clinic for regular follow-ups. These results demonstrate the effectiveness of chemoradiation therapy for geriatric patients with Stage IV anal canal cancer.

[A case of recurrent breast cancer with solitary adrenal metastasis treated with surgery and endocrine therapy].

We present a case in which a 46-year-old woman underwent mastectomy (Bt+AX) for right breast cancer (T4bN0M0, Stage IIIB) at the age of 42. A histopathological examination confirmed her cancer to be an invasive ductal carcinoma n (-),ER (+), PgR (+),HER 2 (1+). For postoperative medication therapy, she was taking goserelin plus tamoxifen for 2 years and tamoxifen thereafter. A right adrenal tumor was discovered during a follow-up CT scan and MRI after the operation. There was no indication of metastasis in any other location. A laparoscopic right adrenalectomy was performed to establish a definitive diagnosis and to cure the cancer. According to the histopathological examination, the tumor was ER (+), PgR (+), and HER2 (0) and metastasized from the breast. After this operation, the regimen was changed to high- dose toremifene as endocrine therapy. No recurrence of the cancer has been reported 2 years and 4 months after the operation. In most cases, metastasis to the adrenal gland is due to systemic metastasis as seen in the last stage of breast cancer, and a solitary adrenal gland metastasis from breast cancer is extremely rare. The combination of surgical removal and medication for solitary distant metastasis from breast cancer may be effective in improving the long-term survival rate.

[Application of collimator broad correction three dimensional ordered subsets expectation maximization for regional cerebral blood flow measurement].

Autoradiography (ARG) has been used for quantitative analysis of the cerebral blood flow using 123I-IMP, and the regional cerebral blood flow (rCBF) can be assessed more accurately with scatter and attenuation correction. Currently, the filtered back projection (FBP) method is generally used for image reconstruction. However, we anticipate obtaining more accurate rCBF by the ordered subsets expectation maximization method with collimator broad correction three dimensional ordered subsets expectation maximization (3D-OSEM). In the present study, we optimized the processing conditions to quantify rCBF using the 3D-OSEM method and compared them with the FBP method. Regarding the method, we determined the subsets and iteration, compared rCBF values using a profile curve, and compared them with the rCBF values obtained by the XeCT (Xenon-enhanced computed tomography)/CBF method. We found that in the 3D-OSEM method using 90 direction collection and 1.72 mm/pixel, the most accurate image was obtained around subset 9 and iteration 10. In addition, as compared to the profile curve and the XeCT/CBF method, the thalamus rCBF was high in the 3D-OSEM method with a good correlation with that of the XeCT/CBF. Accordingly, we concluded that the 3D-OSEM method can improve the decrease in rCBF due to blurring of the distance between the source (i.e., a structure located in the central part of the brain such as the thalamus and the collimator).

Breast cancer with cartilaginous and/or osseous metaplasia diagnosed by lymph nodal metastasis: a case report.

Breast cancer with cartilaginous and/or osseous metaplasia is a type of metaplastic carcinomas and is a rare disease. We report the case of a 49 year-old female who underwent right mastectomy for a large breast tumor. Histological examinations revealed a mixed tumor with both stromal and epithelial elements;the stroma showed poor differentiated spindle-shape and multiform cells with a massive osseous matrix, and atypical epithelial cells, which mainly existed on the surface of the cysts, showed nucleic atypia. The tumor was diagnosed as a malignant phyllodes tumor with osteosarcomatous differentiation;it was not identified as a metaplastic carcinoma because of the lack of proof of a cancerous component. Two years after a mastectomy, swelling of the axillary lymph nodes was found and a biopsy was performed. Histological findings for the lymph node indicated a metastasis of the invasive ductal carcinoma. The primary tumor was re-examined and was considered to be the origin of the lymph nodal metastasis. Lymph nodal metastasis of cancer proved that the primary tumor had cancerous potential, and the pathological diagnosis was altered to a breast cancer with cartilaginous and/or osseous metaplasia.

Relationship of hypersensitivity to anxiety and depression in children with high-functioning pervasive developmental disorders.

AIMS: Sensory-perceptual abnormalities, which include hyper- and hyposensitivity, have been identified by numerous researchers as prevalent in individuals with pervasive developmental disorders (PDD). Hypersensitivity has a greater impact on PDD patients' daily lives than hyposensitivity. The purpose of the present study was to clarify the relationship of hypersensitivity to anxiety, depression and other psychopathology in children with PDD. METHODS: Sixty-four children were divided into a hypersensitivity group (HG; n = 43) and a non-hypersensitivity group (non-HG; n = 21), and compared for anxiety, depression and other psychopathology on the Child Behavior Checklist (CBCL), State-Trait Anxiety Inventory for Children (STAIC) and Children's Depression Inventory (CDI). RESULTS: The HG group had significantly higher scores than the non-HG group in Total, Internalizing, and Somatic complaints on the CBCL. On STAIC, the mean sore of Total Score, State Score and Trait Score in the HG group tended to be higher than in the non-HG group, but the difference was not significant. The score on the CDI in the HG group was significantly higher than that in the non-HG group. CONCLUSION: PDD children with hypersensitivity have more serious psychopathologies, especially internalizing symptoms including depression.

Evaluation of attention-deficit/hyperactivity disorder symptoms in male children with high-functioning pervasive developmental disorders.

BACKGROUND: Although there are many reports of high rates of hyperactivity and attention deficits in children with Pervasive Developmental Disorders (PDD), controversy remains about the applicability of the diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) to PDD children. The present study elucidates the similarities and differences of ADHD symptoms in PDD children compared to ADHD children. METHODS: Twenty-seven male children with PDD+ADHD Combined type (ADHD-C), 17 males with ADHD-C, and 9 males with PDD without ADHD-C, were compared on measures of ADHD symptoms and related behaviors using parent ratings and teacher ratings on the ADHD Rating Scale (ADHDRS), the Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF). RESULTS: The PDD+ADHD-C and the ADHD-C groups had significantly higher ratings than the PDD only group for all the scores on both the parent-rated and the teacher-rated ADHDRS. The ADHD-C and PDD+ADHD-C groups had significantly higher scores than the PDD group on Delinquent Behavior, Aggressive Behavior, and Externalizing Behavior of the CBCL and on Delinquent Behavior of the TRF; there were no significant differences between the ADHD-C and PDD+ADHD-C groups on any scores of the CBCL and TRF. CONCLUSIONS: The PDD+ADHD-C and ADHD-C groups share a similar profile of ADHD symptoms and externalizing behaviors, and the comorbidity of ADHD and PDD should be suspected when ADHD symptoms are present in PDD children.

Abscess formation of the round ligament of the liver: report of a case.

Abscess formation of the round ligament of the liver is very rare. We report a case of a 70-year-old female with abscess of the round ligament after an endoscopic papillotomy for choledocholithiasis. On the 21st day following papillotomy, abscess formation of the round ligament was found by ultrasonographic examination. Surgical treatment was performed because conservative therapy was not effective. The purulent fluid and necrotic tissue at the round ligament were completely removed. Cultures obtained from the abscess grew Staphylococcus epidermidis, but the mechanism of abscess formation in this case remains unclear.

The outcome of gastrointestinal stromal tumors (GISTs) after a surgical resection in our institute.

PURPOSE: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract arising from Cajal's cells and expressing c-kit. In a consensus report, the clinical behavior of GISTs was categorized into risk classes according to the tumor size and mitotic count. We analyzed the risk categories based on GIST patients who underwent a surgical resection at our institute during a period of 15 years. METHODS: We evaluated the risk categories of GISTs and analyzed the outcome and risk categories retrospectively. We presented the MIB-1 score of the tumor instead of mitotic counts for the evaluation of cellular growth because of inaccuracies regarding the mitotic counts. RESULTS: Patients were classified into 4 cases of very low risk, 11 of low risk, 8 of intermediate risk, and 5 of high risk. Four high-risk patients showed recurrence as either liver metastasis or peritoneal dissemination. In addition, local recurrence occurred in one low-risk and one intermediate-risk patient each. CONCLUSION: Our cases confirmed the correlation between the risk categories and the prognosis. A complete resection with sufficient margin must be confirmed even in low-risk cases to prevent local recurrence. Since high-risk patients showed poor prognosis, the adjuvant treatment with chemotherapeutic regimens must therefore be further studied for high-risk patients.