The Safety and Efficacy of Weekly Paclitaxel Administration for Anaplastic Thyroid Cancer Patients: A Nationwide Prospective Study.

BACKGROUND: Anaplastic thyroid cancer (ATC) is a rare and extremely aggressive malignancy, with a median survival of less than 6 months due to rapid progression and resistance to multimodal therapies. Effective treatment strategies have not been identified. A prospective clinical study was performed to objectively evaluate outcomes of treatment with paclitaxel. METHODS: An investigator-initiated, multicenter, nonrandomized, open-label, single-arm study to evaluate the feasibility and efficacy of weekly paclitaxel (80 mg/m(2)) administration for patients with pathologically confirmed ATC was conducted in a nationwide organization. RESULTS: Feasibility was analyzed in 56 patients. More than one course of treatment was performed in 52 (93%) patients retaining sufficient dose intensity (>84%). No patient had to terminate the treatment because of an adverse event. The median overall survival was 6.7 months [confidence interval 4.4-9.0]. The 6-month survival was 54%. Among the 42 patients with an evaluable lesion, none demonstrated complete remission, 9 (21%) showed partial remission, 22 (52%) achieved stable disease, and 8 (19%) exhibited progressive disease; 3 did not complete the initial treatment course. The objective response rate was 21%, and the clinical benefit rate was 73%. The median time to progression was 1.6 months. Statistically, no additional effect of concomitant radiation was demonstrated in 6 patients receiving combined therapy. Eight patients, in whom a complete post-treatment surgical removal of the tumor was feasible, survived significantly longer (median 7.6 months [CI 8.1-23.0]) than the other 34 patients in whom the tumor could not be completely removed after chemotherapy (5.4 months [CI 3.0-7.8], p = 0.018). SUMMARY: The study demonstrates objective and accurate information concerning the feasibility and efficacy of a standardized treatment with weekly paclitaxel administration for ATC patients. CONCLUSIONS: Weekly paclitaxel administration for ATC patients can be of clinical benefit in a neo-adjuvant setting.

Bronchial artery aneurysm treated with video-assisted thoracoscopic surgery.

Bronchial artery aneurysms (BAA) are a rarely noted. Asymptomatic cases of BAA are very rare. Most patients are correctly diagnosed only after BAA ruptures. The conventional treatment includes aneurysm resection through thoracotomy or transcatheter arterial embolization. In the present report, we describe a case of an asymptomatic BAA treated using video-assisted thoracoscopic surgery and careful evaluation of the vessels by three-dimensional computed tomography.

Epidermal growth factor receptor mutations: effect on volume doubling time of non-small-cell lung cancer patients.

BACKGROUND: The purpose of this study was to retrospectively compare the volume doubling time (VDT) on serial computed tomography (CT) of non-small-cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutation with that of NSCLC without the mutation. METHODS: One hundred and two pathologically proven NSCLCs, including 69 patients with lung adenocarcinoma, were reviewed with helical CT. Each tumor underwent at least two CT scans. The VDT was calculated using a modified Schwartz formula. EGFR mutations at exons 18-21 were determined by common fragment analysis and Cycleave method. RESULT: The median VDT of all the patients was 188 days. EGFR mutations were noted in 35 of the 102 patients. The VDT in the 35 patients with EGFR mutations (median 676 days) was longer than that in the 67 patients without EGFR mutations (median 139 days) (p <0.001). By histology subtype, the VDT of adenocarcinoma (305 days) was longer than that of squamous cell carcinoma (81 days) and other types (90 days; p <0.001). CONCLUSION: In NSCLC patients, positive EGFR mutation status may be associated with longer VDT, which seemed to have a slowly progressive and less-aggressive character. More accurate evaluation of VDT may be helpful for understanding the natural history of EGFR mutation-positive NSCLC and treatment with EGFR tyrosine kinase inhibitors.

A case of intestinal obstruction caused by prominent kyphosis resulting in compression of the intestine by the costal arch.

An 85-year-old woman with no history of abdominal surgery complained of abdominal pain and vomiting and was referred to us with a diagnosis of intestinal obstruction a few days later. Upon admission to our facility, she presented with marked abdominal swelling and prominent kyphosis. Because of the kyphosis, most of the dilated bowel was compressing her thoracic cavity. No obvious strangulation or free air was observed via abdominal computed tomography imaging. We attempted decompression using a nasogastric tube, but the symptoms persisted. Surgery was performed 2 days after admission. The origin of the obstruction was a compression of the ileocecal region by the costal arch. The bowel was discolored, and thus surgically excised. There were no major postsurgical complications other than a mild wound infection. Until now, there have been no reports of advanced kyphosis inducing ileus, but there are concerns of an increase in similar cases as society continues to age.

Chronic diverticulitis of the large intestine characterized by stenosis symptoms in Japan: report of 6 cases.

The concept of chronic diverticulitis, which is characterized by stenosis symptoms, has recently been proposed. However, it is not widely known in Japan. To stress the prevalence of this disease in Japan, we herein report 6 patients with chronic diverticulitis who required surgery. The present study involved both clinicopathological analyses of 6 patients and a review of case reports in Japan. The site involved in all 6 patients was the left-sided colon. Stenosis symptoms (i.e., ileus) were observed in all 6 patients. Preoperative clinical diagnoses were diverticulitis (n = 4) and suspected type 4 colon cancer (n = 2). Histopathological examination confirmed the presence of diverticulitis and fibrous thickening of the bowel wall due to chronic diverticulitis in all patients. Our review of the case reports of 32 patients with chronic diverticulitis in Japan revealed that the site most frequently involved was the left-sided colon, despite the fact that diverticulitis occurs most frequently in the right-sided colon in Japan. The present report confirmed that chronic diverticulitis is not an uncommon disease, with the same preponderance in the left-sided colon also in Japan. Therefore, we need to bear in mind the concept of chronic diverticulitis for patients with colonic obstruction.

Autoimmune pancreatitis and biliary intraepithelial neoplasia of the common bile duct: a case with diagnostically challenging but pathogenetically significant association.

Autoimmune pancreatitis (AIP) (also called IgG4-related sclerosing pancreatitis (IgG4-SP)) and IgG4-related sclerosing cholangitis (IgG4-SC) are frequently associated with each other. It is generally believed that association of these diseases with pancreatobiliary malignancy is, however, rare. Here, we report on the case of a patient with AIP whose biliary cytology revealed severely atypical cells. Surgically resected specimens from this patient showed typical AIP with IgG4-SC, as well as a mildly elevated lesion in the common bile duct with varying degrees of cellular atypia. In addition, the atypical cells tested positive for the mucin-core protein, MUC5AC and p53 overexpression. These findings led us to diagnose the common bile duct lesion as biliary intraepithelial neoplasia (BilIN, mainly BilIN-1/2). Recently, associations between K-ras mutations and pancreatobiliary carcinoma have been reported in patients with AIP. This case, therefore, provides important new insight into the potential association of AIP and/or IgG4-SC with malignancy (or precursor lesions) of the pancreatobiliary system.

World Health Organization Classification (2004)-based re-evaluation of 95 nonfunctioning "malignant" pancreatic endocrine tumors reported in Japan.

PURPOSE: The World Health Organization (WHO) classification (2004) defines pancreatic endocrine carcinoma as tumors with gross local invasion or metastasis, and the mere occurrence of angioinvasion or perineural invasion constitute insufficient criteria of malignancy. The significance of this classification remains to be assessed in Japan. METHODS: Nonfunctioning "malignant" endocrine tumors hitherto reported in Japan were analyzed, reclassified according to the WHO criteria, and thereafter survival analyses were conducted. RESULTS: Ninety-five "malignant" endocrine tumors were reclassified into 40 cases of "well-differentiated endocrine tumor, uncertain behavior (UB)" and 55 cases of "well-differentiated endocrine carcinoma (WEC)" according to the WHO classification. The estimated overall 5-year survival of all patients was 86.0%. A univariate analysis revealed that the following factors were significant for overall survival: WHO classification (UB vs WEC; P = 0.001), lymph node metastasis (P = 0.008), distant metastasis (P = 0.023), and curability (P = 0.018). Of these, only the WHO classification was recorded as significant by a multivariate analysis (Cox proportional hazards regression; hazard ratio 6.2, 95% confidence interval 1.3-30, P = 0.025). CONCLUSION: These data confirm the validity of the malignancy criteria of the WHO classification, thus indicating its impact on the diagnosis and treatment of pancreatic endocrine tumors in Japan.

Submassive hepatocellular necrosis associated with infiltration by peripheral T-cell lymphoma of cytotoxic phenotype: report of two cases.

Hepatocellular necrosis may be complicated in the clinical course of T-cell lymphoma. Herein are reported two cases of peripheral T-cell lymphoma associated with a rapid increase of serum transaminases in their final course. The final diagnoses were enteropathy-type T-cell lymphoma of the jejunum (patient 1) and hepatosplenic T-cell lymphoma (patient 2). The livers of both patients had non-zonal, well-demarcated coagulation necrosis (approximately 70% in patient 1 and 40% in patient 2) that was infiltrated by lymphoma cells bearing a cytolytic granule content (granzyme B). Hepatocytes in the necrotic areas in patient 2 showed immunoreactivity for human simplex virus type 1. Although the mechanism of the hepatocyte necrosis is unclear, it is suggested that the hepatocyte submassive necrosis may be related to an infection complicated in the final course of lymphoma or by certain direct effects of the tumor cells.