[A case of Schneiderian middle-ear and sinonasal papilloma with intracranial complications].

Unlike Schneiderian papilloma, a widespread benign epithelial neoplasm arising in the sinonasal tract mucosa of the nasal cavity, paranasal sinus, trachea, and larynx, middle-ear Schneiderian papilloma is extremely rare. We report a case of recurrent Schneiderian papilloma spreading to the bilateral middle ear and right paranasal sinus, and eventually causing cerebellar complications. A-52-year old woman seen for episodes of inarticulateness was first, found to have middle right ear and right ethmoid papilloma, that occurred thereafter is the middle left ear. This bilateral middle-ear papilloma is, to our knowledge, the only case reported thus far, and fell into a low-risk malignant formation group based on HPV-DNA testing. Given previous cases, we concluded that ours warranted meticulous follow-up because recurrence and malignancy are more common in multiple-site middle-ear papilloma as in our case rather than papilloma of the middle ear alone.

[Chemotherapy for elderly colorectal cancer patients in a regional hospital--problems in regional cancer care].

At Nara Social Insurance Hospital, from January 2005 to September 2008, chemotherapy for older adult (>or=70) colorectal cancer patients was performed in 18 adjuvant cases and 10 advanced cases. In adjuvant cases, 18 out of 33 patients of >or= stage IIIa received chemotherapy, and 13 completed treatment safely. In advanced cases, all patients received FLOFOX or FOLFIRI, with or without bevacizumab as first-line treatment with a response rate of 50%. Although adverse events were relatively frequent in the older adult patients, there was no difference in the survival rate between elderly and younger patient groups. Cancer chemotherapy for older adults with a high comorbidity rate requires more skill and experience than for younger patients. It was possible even for a small-volume hospital, which plays an important role in regional medical service for elderly patients, to build up a system providing standard chemotherapy for colorectal cancer. However, considering the limited financial and human resources, it is essential to form a regional alliance of designated cancer care hospitals and other clinics in order to maintain the level of practice.

Low-grade cribriform cystadenocarcinoma of the parotid gland: a case report.

Low-grade cribriform cystadenocarcinoma is a rare tumor that is recognized as a variant of cystadenocarcinoma by the 2005 WHO classification. We report a case of low-grade cribriform cystadenocarcinoma. The patient was a 32-year-old woman who presented with a mass in the right parotid region. Computed tomography and magnetic resonance imaging revealed a polycystic mass in the right parotid gland. The preoperative fine needle aspiration biopsy showed no malignancy, however the frozen section during surgery showed carcinoma. The patient subsequently underwent total parotidectomy with preservation of the facial nerve. Microscopically, the tumor had a typical feature of intraductal proliferation. There was a golden brown pigment and PAS-positive/diastase-resistant cytoplasmic granules in the epithelium of the cysts. Immunohistochemically, smooth muscle actin highlighted the cells rimming the cystic spaces. The tumor cells were negative for S-100 protein. The patient has no recurrence and no facial palsy after the treatment.