Idiopathic granulomatous mastitis: case report and review of the literature.

We report a case of idiopathic granulomatous mastitis in a 35-year-old Japanese woman, who came to our hospital complaining of a tender mass in her right breast. Because the results of initial aspiration cytology were considered highly suspicious for carcinoma, modified radical mastectomy was performed. However, the final histological diagnosis was granulomatous lobular mastitis with no evidence of malignancy. Idiopathic granulomatous mastitis is a rare inflammatory breast disease of unknown etiology. Since the clinical manifestations are similar to those of mammary carcinoma, this condition has been misdiagnosed as carcinoma and treated as such. A review of the literature revealed that idiopathic granulomatous mastitis has tended to occur in young patients with a history of childbirth or oral contraceptive usage. Clinical or imaging diagnosis has often been difficult. Complete resection or corticosteroid therapy can be recommended as the optimal treatment. Since 38% of patients experience recurrence, long-term follow-up is indicated.

Endoscopic laser coagulation through an optical laser balloon.

An endoscope was equipped with a saline-filled latex rubber balloon at its tip to displace contaminating blood, bile, or gastric contents during operative portoscopy, biliary endoscopy, or upper gastrointestinal endoscopy. A fiber with its tip inside the balloon transmitted energy from an Nd:YAG laser for coagulation of tumors in one bile duct cancer, in six portal vein growths from primary liver cancers, and in a superficially growing stomach cancer. The balloon increased the precision of irradiation by making lesions easier to identify through displacement of bile or blood and by keeping the fiber tip at a fixed position relative to the lesion. The technique, basic experimental studies, and clinical experiences are reported.

[Two cases of thymic carcinoid].

Two cases of thymic carcinoid tumor were reported. Case 1 was 64-year-old male who was admitted to our hospital with a complaint of dyspnea. He was proved to have a huge anterior mediastinal tumor by chest X-ray and chest CT. After radiation therapy, the tumor was resected on February 5, 1981. Pericardium was partially resected and showed tumor invasion. Sixty-four days after operation, he died due to respiratory insufficiency. Case 2 was 71-year-old male who was pointed out to have an abnormal shadow by X-ray mass screening and was admitted to our hospital. Chest X-ray and chest CT revealed the presence of an anterior mediastinal tumor. Resection of the tumor was done on February 13, 1986. Although the tumor showed mediastinal lymph node metastasis and invaded to the pericardium and the right lung, it was resected completely. Cytological examination of pericardial effusion showed tumor cells at the time of resection. He is now quite well and without any evidence of recurrence 3 year and 1 months after operation. Histopathologically, the tumors of two cases consisted of relatively uniform cells with abundant clear or slightly eosinophilic cytoplasm and regularly and centrally located nuclei. Mitotic figures were occasionally seen in both cases. Many tumor cells were positively to Grimelius stain. On the other hand, Fontana-masson stain was negative. Immunohistochemically, the tumor cells were positively stained with anti-NSE and anti-GRP antibodies in Case 1 and with anti-NSE antibody in Case 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Multimodal treatment of hepatocellular carcinoma.

Our multimodal treatment of hepatocellular carcinoma (HCC) has brought about a significant improvement of the survival rate. It consists of a combination of hepatectomy and transcatheter arterial embolization using lipiodol (L-TAE). In order to facilitate L-TAE, we have developed a special catheter with notches. A group of patients with HCC (124 cases), excluding cases with absolutely non-curative resections and operative deaths, were treated between December 1980 and November 1986. Each case was treated for more than 1 year after hepatectomy. The patients were divided into two groups: A, patients with a single tumor not larger than 5 cm, and B, cases with larger tumors or more than one lesion. Some patients in each group were treated with L-TAE after hepatectomy. In group A, there was no significant difference in survival between treated and non-treated cases. In group B, L-TAE gave a significantly better survival than no postoperative treatment.

[Multiple primary cancers in surgically resected lung cancer patients].

Among 337 cases of surgically resected lung cancer from April 1977 to March 1984, there were 24 cases (7.12%) of multiple primary cancers including 22 cases of double cancer and one case each of triple and quadruple cancer. They consisted of 17 males and 7 females and the patient age at the time of the lung resection ranged from 32 to 81 years old (average: 67.4). In double cancer cases, the most common site of the other primary cancer was the lung (9 cases), followed by the stomach (5 cases), the colon (4 cases), the pancreas (2 cases), and there was one case each of the salivary gland and the skin. The cases of triple and quadruple cancer involved multiple primary lung cancer associated with mammary and esophageal cancer, respectively. There were 14 synchronous and 8 metachronous cases. The histology of lung cancer in 13 cases of double cancer was adenocarcinoma in 6, squamous cell carcinoma in 2, large cell carcinoma in 3, small cell carcinoma in 1, and adenosquamous cell carcinoma in 1. The histology of 11 cases of double or triple primary lung cancers was squamous cell carcinoma in 17, adenocarcinoma in 5, and large cell carcinoma in 1. In 24 cases 19 lobectomies, 4 pneumonectomies and one partial resection of the lung was performed for the first primary lung cancer. All cancer lesions of other organs apart from the lung were also surgically resected.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of morphine in cancer pain].

The usefulness of oral morphine to alleviate pain has been tested in 70 patients with cancer. The efficacy was found to be 87% (61/70). The starting dose was 10 mg/d-12 mg/d (mean 36 mg/d), and the maximum dose was 10 mg/d-3,600 mg/d. Twenty four of these patients were able to stay at home or go to the hospital for dose treatment. In 27 patients, oral morphine dose were able to administrated until death. Although vomiting and constipation were frequent side effects, the administration of adjuvant drugs relieved these symptoms. It was found that these oral morphine doses did not shorten a patient's life span. Thus we have concluded that oral morphine proved a useful, safe, and convenient drug for the control of cancer pain.

[Advantages and disadvantages of L-TAE in diagnosis and treatment of hepatocellular carcinoma].

Transcatheter arterial embolization using lipiodol ultra-fluid (L-TAE) is frequently used for hepatocellular carcinoma (HCC). Its advantages are: (1) Excellent therapeutic and diagnostic ability in our pathological study of 153 resected tumors. (2) Preoperatively, we can localize HCC and prevent spreading of cancer cells by manipulation at hepatectomy. (3) Postoperatively, we can detect and treat recurrence early, and we hope to prevent recurrence by repeated L-TAE. (1) Liver infarction has occurred after L-TAE, because some lipiodol flows into the portal vein. Lipiodol remains long in the infarction area and interferes with the diagnosis of HCC. (2) Liver abscess has rarely occurred. (3) Repeated L-TAE does not impair the liver function much.

Combined peripheral and central chemoembolization of liver tumors. Experience with lipiodol-doxorubicin and gelatin sponge (L-TAE).

Patients with primary and a few with secondary liver tumors were embolized through the hepatic artery. Lipiodol and doxorubicin occluded peripherally, which was immediately followed by central embolization with gelatin sponge cubes. Preoperative embolizations were made for diagnostic and possible surgical adjuvant purposes. Extensive postembolization necrosis was common in tumors less than 5 cm in diameter, and tumor markers usually decreased temporarily after treatment. There were moderate side effects of pain, fever and nausea, and an acceptable complication and mortality rate with no deaths after embolization alone. This warrants further research on the method, which also seemed to improve the detection rate for small hepatocellular carcinomas.

Selective portal branch occlusion by balloon catheter during liver resection.

An intraoperative ultrasonographically guided introduction of a balloon catheter into labor or smaller branches of the portal vein within the liver parenchyma made it possible to temporarily occlude them and perform regional staining during resection for tumors. The technique minimized blood loss without hilar dissection for vascular control, and the presence of the catheter facilitated intraparenchymal dissection of the portal stalk to the part of the liver to be resected.

[A combination chemotherapy of cisplatin and etoposide in small cell lung cancer].

Fourteen patients with small cell lung cancer were treated with cisplatin (80 mg/m2 i.v.) and etoposide (300, 400, 500 mg/m2 i.v.). This combination chemotherapy was administered over a three- or four-week period. Eleven of 13 evaluable patients showed a greater than 50% tumor reduction, but there were 3 complete responses and 5 partial responses, giving a response rate of 61%. Four patients who were initially treated achieved major responses. In 9 patients who had received prior chemotherapy, 4 achieved a major response. Of 3 complete responders, 2 patients had previously received etoposide treatment alone. The renal toxicity of this regimen was minimal and no patients developed any clinical symptoms. Nausea and vomiting were well controlled by high-dose metoclopramide and methylprednisolone. All patients, however, experienced appetite loss after treatment. The dose-limiting toxic effect of this regimen was hematologic toxicity. We therefore concluded that the combination of etoposide (300 mg/m2 i.v.) and cisplatin (80 mg/m2 i.v.) is repeatable at 3 or 4 week intervals and effective in patients with small cell lung cancer.

[Multidisciplinary therapy of hepatocellular carcinoma--TAI. TAE treatment by intra-arterial catheterization].

Two hundred sixty-six cases of hepatocellular carcinoma (HCC) were treated between June 1980 and October 1985 (4 years and 4 months) at our hospital. Hepatectomy was performed in 118 patients, 82 of which had received transcatheter arterial embolization with iodized oil (Lipiodol) 58 of then with an intraarterial catheter. HCC tumors were often multiple when they were combined with liver cirrhosis and smaller than 3 cm in diameter. For this reason treatment of HCC by surgery alone has limitations for prolongation of life. A multidisciplinary treatment is therefore necessary. We have found hepatectomy and transarterial embolization to be the most effective treatment for HCC. In order to perform repeated embolizations after hepatectomy, we developed a heparinized catheter with notches to permit safe fixation. This is suitable for long-term intraarterial use. While previous arterial catheters only permitted infusion of drugs due to their small diameters, our new catheter can be used for embolizations with Lipiodol and Gelfoam and for angiography. It is inserted through the right gastroepiploic artery into the gastroduodenal artery so that its tip lies at the level of the hepatic artery. It is brought out through the abdominal skin and flushed at two-week intervals with heparin-urokinase. The indications for the use of the catheter have been repeated embolizations 1) for prevention of tumor recurrence (surgical adjuvant therapy), and 2) after absolutely non-curative operations. For the first indication, we have found that multiple tumors and tumors larger than 5 cm frequently recur within 1 year after surgery. We have, since July 1983, used the catheter treatment to prevent recurrence in 30 such cases. Embolization with Lipiodol + Adriamycin followed by Gelfoam cubes is performed at three-month intervals for one year after surgery, starting one month after surgery, as a rule. The preliminary results indicate an improved survival rate after the treatment.

Lung cancer in chromate workers--analysis of 11 cases.

We have experienced 11 cases of lung carcinoma in workers at a chromate factory during the past 14 years. All patients were males. The age of onset ranged from 41 to 68 years. Ten of the 11 were heavy smokers. The time of exposure to chromate was from 17 to 29 years and the average was 23.9 years. Seven patients had perforation of their nasal septa. The primary sites of the cancers were from the lobar to the subsegmental bronchi. There were nine squamous cell carcinomas and three small cell carcinomas. Four squamous cell carcinomas were hilar type early stage cancers and two of them were found in one patient at the same time. The chromium content of the lung tissue in the seven patients tested was from 13.9 to 2,368.4 micrograms/g of dry tissue and was higher than that of lung cancer or non-lung cancer cases without chromate exposure. There was no severe dysplasia of the bronchial epithelium in these 11 patients.

[Experience with induced hypertension chemotherapy for lung cancer].

Induced hypertension chemotherapy (IHC) using angiotensin II was applied for patients with lung cancer who had not been treated previously, and the results compared with those of preceding conventional chemotherapy as a sequential control. Twenty-nine patients with non-small cell lung cancer (non-SCLC) were treated with MTX and MMC. Response rate among evaluable cases was 23.1% (3/13) for conventional chemotherapy and 18.2% (2/11) for IHC. Twenty-eight patients with small cell lung cancer (SCLC) were treated with VCR, CPA and ACNU. Among evaluable cases, both chemotherapy groups with and without IHC showed the same response rate, 66.7% (8/12). With respect to response rate, there were no differences between conventional chemotherapy and IHC for non-SCLC or SCLC.

[Two cases of early squamous cell carcinoma of the hilar region of the lung cured by bronchofiberscopic excision].

We experienced two patients with early squamous cell carcinoma at the hilar region of the lung. The carcinoma were completely eliminated by tumor biopsy using a bronchofiberscope. In both cases, there was either pulmonary tuberculosis or a second primary lung cancer (bronchiolo-alveolar carcinoma) on the contralateral side. After bronchoscopic excision of the tumor, the patients were closely observed using by repeat bronchoscopy at 5 to 6 week intervals. One patient is free of recurrence at 4.5 years after treatment and is deemed to be cured. The other patient died of recurrence and metastasis from a second primary bronchioloalveolar carcinoma at 1 year and 5 months after treatment, however he had no recurrence of the squamous cell carcinoma.

Early hilar-type squamous cell carcinoma of the lung resected by bronchofiberscopy surviving 5 years.

We record a case of early squamous cell carcinoma located in the hilar region of the lung, which was completely resected by multiple tumor biopsies through the bronchofiberscope. In this case, there was concomitant contralateral pulmonary tuberculosis which was treated by right upper lobe lobectomy. The patient had a long history of smoking and had worked for 27 years in a factory that used chromate. Bronchoscopically, there were no abnormal findings in the visible branches of the right bronchial tree, but an early stage squamous cell carcinoma lesion was found at the bifurcation of left B8 and B9+10 bronchi. After bronchofiberscopic excision of the tumor, the patient was closely followed-up by repeated bronchoscopy at intervals of 4 weeks to 6 months. The patient is currently free of recurrence 5 years and 3 months following the initial bronchoscopic excision and is judged to have been cured.

[Experience with psychotropic agents Pyrethia and Contomin in the terminal care of lung cancer patients].

Among patients with lung cancer, those having PS 4 ( Performance Status 4) and cancer pain received " Pyrecon ", a psychotropic agent, consisting of promethazine hydrochloride ( Pyrethia ) and chlorpromazine hydrochloride ( Contomin ). A mixture of 125 mg of Pyrethia and 50 mg of Contomin was diluted in 500 ml of regular IV solution and given through the central vein at a rate of 20 ml/hr. Pyrecon was found to be effective in patients with severe cancer pain in whom Brompton cocktail was ineffective. Pyrecon was also effective in patients whose daily life rhythm was unsteady due to insomnia caused by anxiety or unrest. We suggest that Pyrecon is effective in the treatment of cancer pain.