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Background Adenomyoepithelioma (AME) of the breast is a very rare tumor and is generally considered to be benign. However, some show malignant transformation, which results in local recurrences or distant metastases. The morphological features of AME that might predict malignant potential have not been elucidated. Moreover, there is also no established multidisciplinary treatment for malignant AME aside from complete excision at an early stage. Case presentation A 64-year-old female diagnosed with AME of the left breast underwent lumpectomy. The surgical margins were negative. Six months after the operation, however, malignant AME recurred locally in the left breast. MRI showed multiple masses, which invaded the skin. A left mastectomy with axillary lymph node dissection was performed. Additional areas of AME were found in about one third of the entire breast. Eight months after the mastectomy, lung metastases were detected. She underwent chemotherapy with fluorouracil, epirubicin, and cyclophosphamide (FEC) for 9 cycles with little response. Lung metastasectomy was performed. Nine months after lung metastasectomy, the metastases were widespread to the brain, heart, and kidney; she subsequently died 2 months later. Conclusions Malignant AME has various morphological features, and in this report, we characterize new findings from both imaging and pathology/autopsy. Malignant potency is related to the tumor size, tumor appearance, and mitoses, even if only a few. Given that ductal spread is one of the morphological features of malignant AME, it is of paramount importance to assess the surgical margins.

Background: Chronic obstructive pulmonary disease is a smoking-related disease, and is categorized into the emphysema and airway dominant phenotypes. We examined the relationship between emphysematous changes and epidermal growth factor receptor (EGFR) mutation status in patients with lung adenocarcinoma. Patients and Methods: The medical records for 250 patients with lung adenocarcinoma were retrospectively reviewed. All patients were categorized into the emphysema or non-emphysema group. Results: Wild-type EGFR was detected in 136 (54%) and mutant EGFR in 48 (19%). Emphysematous changes were observed in 87 (36%) patients. EGFR mutation was highly frequent in the non-emphysema group (p=0.0014). Multivariate logistic regression analysis showed that emphysema was an independent risk factor for reduced frequency of EGFR mutation (Odds Ratio=3.47, p=0.005). Conclusion: Our data showed a relationship between emphysematous changes and EGFR mutation status. There might be mutually exclusive genetic risk factors for carcinogenesis and development of emphysematous changes.

Immune checkpoint inhibitors (ICIs), including nivolumab, have exhibited substantial benefits in the treatment of several types of cancers. However, treatment with ICIs is often accompanied by immune-related adverse events (irAEs), and a clear understanding of the precise indications and management of irAEs is important for harnessing the full potential of these agents. While skin- or gastrointestinal-associated irAEs have been relatively well studied, there are few reports regarding nivolumab-induced cholangitis. We retrospectively reviewed data from patients with advanced or recurrent non-small cell lung cancer who were treated with nivolumab between December 2015 and December 2018 at Tottori University in Japan. Among the 59 patients, we identified four patients who experienced nivolumab-induced cholangitis. Of these four patients, stable disease (SD) was observed in two patients (50%), while partial response (PR) was achieved in two patients (50%) under nivolumab treatment. Patients were treated with corticosteroid alone (n=2) or in combination with mycophenolate mofetil (MMF) (n=2); these treatments resulted in improvements in nivolumab-induced cholangitis in three patients. In conclusion, the present retrospective study identified four cases of nivolumab-induced cholangitis. The combination of corticosteroid and MMF was effective in two cases with grade 4 nivolumab-induced cholangitis. Further reports are needed to establish the optimal management of patients with this irAE.

Background Precision medicine based on driver oncogenes is now developed for non-small cell lung cancer. Recent approval of next-generation sequencing (NGS)-based companion diagnostics has increased the need for the use of high-quality specimens for the diagnosis. Methods From August 2015 to May 2018, 82 patients who were enrolled in a nation-wide genome screening, LC-SCRUM-Japan, from our institution were examined for the success rates of genetic analysis according to sample types. A NGS analysis, Oncomine Comprehensive Assay, was performed using DNA and RNA extracted from lung cancer specimens. Results The success rates of DNA and RNA analyses were 100% (82/82 cases) and 78% (64/82), respectively. Of the 82 samples analyzed, 80 (98%) were tissues and two (2%) were pleural effusions. The success rates of RNA analysis in the 80 tissue samples were 45/60 (73%) in bronchoscopic byopsy, 10/10(100%) in operation, 5/6(83%) in Percutaneous biopsy and 3/4(75%) in others. Of the 60 bronchoscopic samples, the success rates were 72% (18/25) in EBUS-TBNA, 88% (7/8) in EBUS-GS (large diameter), 69% (11/16) in EBUS-GS (small diameter) and 82% (9/11) in direct vision biopsy. In the 82 cases analyzed, a total of 52 actionable gene alterations (18 KRAS mut, 6 EGFR mut, 6 MET amp/fus, 5 RET fus, 5 ALK fus, 4 PIK3CA mut, 2 ERBB2 mut, 2 ROS1 fus, 2 FGFR1 amp, 1 BRAF mut, 1 FGFR3 fus) were detected in 48 cases (59%). Twelve of the 48 (15%) were registered in ongoing clinical trials of targeted drugs. Conclusions All the samples were available for DNA analysis of the NGS. The success rates of RNA analysis were lower in samples obtained from EBUS-TBNA and EBUS-GS (small diameter), suggesting that the success rates depend on the sample size.

Objectives Zoledronate (ZOL) is usually used for prevention of skeletal-related events in cancer patients with bone metastases. The first administration of ZOL is occasionally associated with development of acute-phase reaction (APR), which is due to activation of γδ T cells. ZOL-related APR was associated with better overall survival (OS) of patients with non-small cell lung cancer (NSCLC) in our previous retrospective study. However, it remains to be clarified whether γδ T cells are more activated in patients who experienced ZOL-related APR, and whether γδ T cell activation is involved in prolongation of OS. Materials and Methods Twenty-three patients with advanced NSCLC were recruited between 2012 and 2014 in this study. We administered ZOL to participants with standard care. The patient characteristics, change in γδ T cell counts and cytokines, OS, and skeletal-related event-free survival were compared between patients with APR (APR group) and those without APR (non-APR group). Results Ten patients (43.5%) experienced a ZOL-related APR. The number of γδ T cells at baseline in the APR group was significantly higher than that in the non-APR group. Serum interleukin-6 and tumor necrosis factor-α in the APR group were significantly increased, but no change in the number of γδ T cells was observed after the first administration of ZOL in both groups. OS in the APR group was significantly longer than that in the non-APR group (median survival time: 23.1 vs. 14.5 months, p Conclusion We showed that APR is related to higher numbers of γδ T cells at baseline and increased cytokines after the first ZOL administration, but not to proliferative responses of γδ T cells. In addition, better OS was observed in the APR group. Therefore, the number of γδ T cells might be a prognostic marker in patients with NSCLC.

We present a case report of a 35-year-old woman who had splenic infarction. She had persistent high fever, systemic joint pain, and abnormal liver function. She was diagnosed with cytomegalovirus and human parvovirus B19 concomitant infection. Her coagulopathy test revealed no abnormal results. She was treated with intravenous ganciclovir for 13 days; consequently, her splenic infarction improved after 7 weeks. As per our knowledge, this is the first case of cytomegalovirus and parvovirus B19 coinfection complicated by splenic infarction. Cytomegalovirus and parvovirus B19 may induce a hypercoagulation state during the acute phase.

Epidermal growth factor receptor (EGFR) gene mutation testing is essential for choosing appropriate treatment options in patients with advanced non-small cell lung cancer (NSCLC). However, a time delay occurs between histological diagnosis and molecular diagnosis in clinical situations. To minimize this delay, we developed a novel point-of-care test for EGFR mutations, based on a high-speed real-time polymerase chain reaction (PCR) system designated here as ultrarapid PCR combined with highly accurate bronchoscopic sampling. We investigated whether our system for detecting EGFR mutations was valid by comparing test results with those obtained using a commercialized EGFR mutation test. We obtained small amounts of bronchial lavage fluids after transbronchial biopsies (TBBs) were performed on enrolled patients (n=168) who underwent endobronchial ultrasonography using a guide sheath (EBUS-GS). EGFR mutation analysis was performed by ultrarapid PCR immediately after EBUS-GS-TBBs were obtained (on the same day). After pathological diagnoses of NSCLC, EGFR mutation status in formalin-fixed, paraffin- embedded samples was confirmed by the PCR-invader method, and the concordance rates between the PCR methods were compared. The total diagnostic yield of EBUS-GS-TBB was 91.0%. The positive concordance rates for detecting 19del and L858R with the ultrarapid PCR and PCR-invader methods were both 100%. Negative concordance rates were 97.2 and 98.1%, respectively. We also demonstrated a dramatic effect of early erlotinib administration, based on ultrarapid PCR results, for a 52-year-old woman suffering from respiratory failure due to severe intrapulmonary metastases with poor performance status. In conclusion, ultrarapid PCR combined with EBUS-GS-TBB enabled rapid and reliable point-of-care testing for EGFR mutations.

Aromatase inhibitors are superior to tamoxifen as adjuvant therapy in postmenopausal patients with hormone-responsive breast cancer. We report the follow-up efficacy results from the N-SAS BC 03 trial (UMIN CTRID: C000000056) where anastrozole was compared with tamoxifen as adjuvant therapy in postmenopausal Japanese patients with hormone-responsive early breast cancer. The full analysis set contained 696 patients (anastrozole arm, n = 345; tamoxifen arm, n = 351). The log-rank test was used to compare the two groups in terms of disease-free survival (DFS) and relapse-free survival (RFS); Kaplan–Meier estimates were calculated. The treatment effects were estimated by Cox’s proportional hazards model. To examine time-varying effect of hazard ratios, we estimated time-varying hazard ratios at time t [HR(t)] using data from time t up to 12 months. After a median follow-up of 98.5 months, hazard ratios (95 % CIs) were 0.90 (0.65–1.24; log-rank p = 0.526) for DFS and 0.83 (0.56–1.23; log-rank p = 0.344) for RFS. Hazard ratios (95 % CIs) for DFS and RFS up to 36 months were 0.69 (0.40–1.17) and 0.54 (0.27–1.06) and those after 36 months were 1.06 (0.70–1.59) and 1.05 (0.64–1.73), respectively. Time-varying hazard ratios for both DFS and RFS showed that hazard ratios were initially in favor of anastrozole and approached 1.0 at around 36 months. Superior efficacy of anastrozole to tamoxifen suggested by the initial analysis was not confirmed in the present analysis after a long-term follow-up period. Advantage of anastrozole was the greatest immediately after switching from tamoxifen and then decreased thereafter.

As part of our research for novel calcium-sensing receptor (CaSR) antagonists that can function as oral bone anabolic agents, we recently reported the discovery of a tetrahydropyrazolopyrimidine derivative featuring adamantyl group 1b with potent CaSR antagonistic activity. To explore the potential of this calcilytic congener, we introduced the gem-dialkyl benzyl group at the 3-position of the tetrahydropyrazolopyrimidine ring, forming a bioisostere of the adamantyl group by mimicking the adamantyl group's lipophilicity and bulkiness. Optimization directed toward the improvement of solubility and metabolic stability led to the discovery of compound 9e, which stimulated transient PTH secretion when orally administered to normal rats. Further, compound 9e proved to be fully effective in an osteopenic ovariectomized rat model.

The aim of the study was to determine the feasibility and validity of a newly developed patient-based instrument--the Patient Neurotoxicity Questionnaire (PNQ)--for grading chemotherapy-induced peripheral neuropathy (CIPN).We prospectively collected data from 300 female patients who were treated with taxane chemotherapy for primary breast cancer as part of a national multicenter phase III randomized trial (N-SAS BC 02). We evaluated patient compliance with the PNQ and several validation parameters, including concordance between CIPN grades noted by physicians (National Cancer Institute Common Toxicity Criteria) and patients (PNQ), and the concurrent validity and responsiveness of the PNQ versus the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) utilizing data at pre-treatment and before three, five, and seven treatment cycles.The questionnaire completion rate was90% at all assessments. Evaluation by physicians always resulted in lower neuropathy assessment scores compared with those reported directly by patients (weighted kappa coefficients, 0.02-0.06). Both PNQ sensory and motor scores were significantly correlated with the FACT/GOG-Ntx (r = 0.66 and 0.51, respectively). In the repeated measures analysis of variance model, PNQ grades increased considerably as treatment continued, indicating progressively worsening CIPN over time.The PNQ has an applicable degree of feasibility and validity, useful for the diagnosis of CIPN as well as for clinical treatment decision-making, where the development of CIPN is a potential treatment-limiting consideration. Physicians underreport and underestimate the severity of CIPN symptoms compared with patients, thereby supporting the importance of assessing patient-reported outcomes using the PNQ.

症例は38歳，女性．左乳房痛と左乳房腫瘤を主訴に近医を受診し，乳腺症の診断で経過観察されていた．半年後，腫瘤が増大したため当院を受診した．視診では，乳頭上部に紫斑と乳頭陥凹が認められ，触診では左の乳頭を中心に約5.2cm大の軟らかい，可動性良好な腫瘤を触知した．CTでは内部が不均一に造影される5cm大の腫瘤が認められたが，細胞診は判別困難だった．針生検にて乳腺血管肉腫と診断され，左乳房単純切除術を施行した．切除標本では乳頭付近に皮下出血が認められ，割面では，乳頭直下に3×9cm大の腫瘤が認められた．病理診断はlow grade主体で一部intermediate gradeの乳腺血管肉腫であった．術後補助療法として胸壁照射を施行し，現在経過観察中である．乳腺血管肉腫は比較的稀な疾患であり，診断に難渋する．今回，乳腺血管肉腫の1例を経験したので報告する．

原因となりうる腫瘍性病変を伴わずに腸重積を来し, 肛門外まで脱出した巨大結腸症の1例を経験したので報告する. 症例は38歳の女性で, 排便時に肛門からの腸管脱出を来し当院を受診した. 直腸診で直腸壁は保たれていることから, 直腸よりも口側の腸重積および肛門外脱出と診断し, 緊急手術を施行した. 腸重積を整復後, S状結腸を切除した. 切除腸管に腸重積の原因となる腫瘍性病変は認められなかった. 腸重積を来し肛門外まで脱出した症例は本邦では30例ほどが報告されており, すべて腸重積の原因となる腫瘍性病変を伴っていた. 自験例は巨大結腸症で, 腸重積の原因となる腫瘍性病変も伴っておらず, 非常にまれな例であった. 本症においては原因病変の有無を含めた的確な診断と, 手術の際に無理な整復を行わないことが重要である.

FDG-PETが診断に有用であった直腸癌甲状腺転移を経験したので報告する. 症例は60歳の女性で, 平成13年9月に直腸癌に対し腹会陰式直腸切断術を施行した. 平成14年1月に肺転移に対し左肺楔状切除を施行した. 術後l-LV・5-FU療法を7コース施行したが, 次第にCEAの上昇を認めたためCTおよびシンチグラムなどで全身検索を行ったが明らかな転移巣および局所再発を指摘できなかった. 12月にFDG-PETを施行したところ左頸部にFDGの集積が指摘された. 直腸癌甲状腺転移の診断で平成16年1月甲状腺左葉切除を施行した. 病理組織学的検査所見は腺癌の甲状腺転移であった. 直腸癌の甲状腺転移は非常にまれであり, 本邦報告例は自験例を含め5例であった. FDG-PETは, 従来の画像検査で異常を指摘できないが腫瘍マーカーの上昇を来している直腸癌術後患者の転移の検索に有用であると考えられた.

乳癌の消化管転移,なかでも大腸への転移は臨床では極めて稀である.われわれは乳腺浸潤性小葉癌術後で大腸転移をきたした1例を経験したので報告する.症例は45歳,女性.腹痛,嘔吐を主訴に来院し,腸閉塞と診断された.消化管造影,大腸内視鏡検査で下行結腸に完全狭窄が認められ,生検では悪性所見は認められなかったが,原発性または転移性大腸癌を考え,手術を施行した.下行結腸以外にも複数の腫瘍があり,さらにリンパ節転移や播種性病変も認められ,根治性なしと判断した.腸閉塞解除目的に腸管切除を施行し,病理組織学的検査で乳癌の転移と診断された.ゴセレリン・タモキシフェン併用療法を施行し,術後9カ月経過しSDを継続中である.乳癌患者において腹部症状の訴えの際には消化管転移の可能性を考える必要がある.また,消化管転移をきたした状態でもホルモン療法,化学療法の効果が期待できるため手術でのQOLの改善は有用である.

A 70-year-old man was admitted to our hospital because of dyspnea after taking an antihistaminic agent (homochlorcyclizine hydrochloride) for itching. Chest roentgenogram showed infiltration in the left lung field, and laboratory data revealed eosinophilia. Examination of the bronchoalveolar lavage fluid revealed an increased eosinophil count. A drug lymphocyte stimulation test was positive only for calcium stearate, an additive contained in the homochlorcyclizine hydrochloride tablet. The pulmonary infiltration and clinical symptoms subsided after withdrawal of all drugs and initiation of glucocorticoid therapy. Therefore, we concluded that this patient's pulmonary disease was caused by calcium stearate, an additive for an antihistaminic drug. An allergic reaction to a drug's additive material should be considered as a rare cause of drug-induced acute eosinophilic pneumonia.

The chronic inflammation of bronchial asthma is characterized by swelling of the subepithelial mucosa. However, it is difficult to assess subepithelial edema clinically. We report the case of a patient with asthma whose subepithelial edema was evaluated by endobronchial ultrasonography. Receiving montelukast 10 mg/day for 2 weeks, a 42-year-old man with mild, persistent asthma had his symptoms controlled by beta2-inhalation alone. Pretreatment endobronchial ultrasonography revealed subepithelial thickening in the right main stem bronchus, with a low absorption area suggestive of edema. Two weeks of montelukast therapy diminished the amount of subepithelial edema. Endobronchial ultrasonography is a promising technique for determining subepithelial edema in the asthmatic airway.

Although cytotoxic chemotherapy is essential in epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC), it is unclear which regimen is most effective. We retrospectively compared the efficacy of standard platinum-based chemotherapy with that of combination chemotherapy using vinorelbine (VNR) plus dihydropyrimidine dehydrogenase-inhibitory fluoropyrimidine (DIF) in EGFR-mutated lung adenocarcinomas, and we investigated a potential mechanism by which the combination chemotherapy of VNR + DIF was favorable in the treatment of EGFR-mutated lung adenocarcinoma in vitro. In our retrospective analysis, the response rate and disease control rate afforded by the VNR + DIF treatment tended to be better than those by platinum-based chemotherapy, and the progression-free survival of the 24 VNR + DIF-treated patients was significantly longer than that of the 15 platinum-based chemotherapy patients. In EGFR-mutated PC9 cells, VNR induced EGFR dephosphorylation at a clinically achievable concentration. 1BR3-LR cells, a line of fibroblast cells transfected with a mutant EGFR construct, were completely resistant to gefitinib in the medium containing 10% fetal bovine serum (FBS), whereas the sensitivity of these cells to gefitinib was increased in 0.5% FBS-containing medium. Similarly, the sensitivity of 1BR3-LR cells to VNR was increased when they were cultured in low-serum condition. In addition, sodium orthovanadate (Na3VO4) inhibited the EGFR dephosphorylation induced by VNR or gefitinib and suppressed the cell growth inhibition by these agents in PC9 cells. VNR and gefitinib showed synergistic cell growth inhibition in combination with 5-fluorouracil (5-FU) in PC9 cells. We propose that the EGFR dephosphorylation induced by VNR is related to cell growth inhibitory activity of VNR, and that this is one of the mechanisms of the synergistic effect of VNR + 5-FU in EGFR-mutated lung cancer cells. In conclusion, the combination chemotherapy of VNR + DIF may be a promising treatment for NSCLC patients with EGFR mutations.

Background The purpose of this study was to evaluate the accuracy of contrast-enhanced high resolution helical computed tomography (CT) for assessing locoregional staging of palpable Tl-2 invasive breast cancer. Methods: Helical CT studies of 156 lesions from 156 patients with invasive breast cancer before breast-conserving surgery were examined. A lesion was defined as positive if focal enhancement was detected by CT within 100 seconds after contrast material administration. After resection, tumors were histopathologically mapped and comparison made with the extent of contrast enhancement.

The feasibility of using microcapsules containing a bone formation stimulant, (2R,4S)-(−)-N-(4-diethoxyphosphorylmethylphenyl)-1,2,4,5-tetrahydro-4-methyl-7,8-methylenedioxy-5-oxo-3-benzothiepin-2-carboxamide (TAK-778) to enhance fracture repair was assessed in rats with streptozotocin-induced diabetes. The release profile of the microcapsules was designed to mimic a dosing regimen of multiple injections of TAK-778 solution. The solution was injected locally every third day from day 0 (the day of operation) to day 27 according to several dosing regimens, and fracture repair was assessed at day 28. The production of callus was most prominent when TAK-778 solution was injected so that 50–75% of the total dose (5 mg TAK-778/site) was administered during the first half of the treatment period. Thus, injectable microcapsules of 30 μm in mean diameter were prepared in order to release TAK-778 over 4 weeks using a biodegradable polymer, poly(d,l-lactic/glycolic) acid, with a copolymer ratio of 85:15 (mol/mol) and an average molecular weight of 14,000. A single local injection of the microcapsules markedly enhanced fracture repair, which resulted in recovery of destructive bending strength of the bone at day 28. Histologically, the injection of TAK-778 microcapsules stimulated both fibrous and cartilaginous proliferation and periosteal ossification in the callus at day 7; bony bridge formation was observed at day 28. At day 56, the callus was remodeled and cortical bony union was evidenced in the microcapsule-treated fractures compared with the controls, which showed only fibrous union. © 2000 John Wiley & Sons, Inc. J Biomed Mater Res, 51, 299–306, 2000.

1988年から1998年4月までに当科で切除した胆嚢癌52例を臨床病理学的に検討し,そのリンパ節転移度から至適郭清範囲を検討した. m, mp症例は全例n0であり,胆嚢摘除術+D0-1で累積生存率100%と予後良好であった. ss以上32例におけるリンパ節転移陰性15例の累積生存率は73.1%で,陽性例の16.2%に比し有意に予後良好であった(p=0.0001).さらにss以上例をリンパ節転移度別に検討して見るとn0, n1症例の累積生存率は73.1%と予後良好でbinf0, hinf0であれば全層胆摘+D2で十分と考えられたがbinf, hinf陽性例の予後は不良で拡大手術が必要と考えられた. n2症例の累積生存率は20.8%と不良であったが,無再発生存例が2例あり,いずれもPpPD(PD)併施例で深達度ss, binf1以下, hinf2以下の症例であった. n3, n4症例は予後不良であった.現在当科ではn2(+)のss, se胆嚢癌においてhinf1-2, binf0-1であれば肝切除+PpPD(PD)+D3の良い適応と考え,胆嚢癌治療を行っている.

We have studied the expression of keratin 19 mRNA (K-19) in the axillary lymph nodes of breast cancer patients (n=100, serially from October 1997 to May 1998) in order to detect the micrometastasis by reverse transcriptase-polymerase chain reaction (RT-PCR). During the course of this study, (1) we encountered the 6 cases showing [n+, K-19(-)]. (2) To clear the discrepancy of the finding between histology and RT-PCR, some other primer pairs were used. In one case out of 6, K-19 was detected. (3) Further, the sequence of RT-PCR products showed diversity and could be roughly classified into 4 groups. Namely, group a (same sequence to the report of Genbank except for two bases), group b (almost same to group a except for one deletion and several point mutations), group c (approximate 50 bases were deleted from group a and with approximate 50 point mutations) and group d (almost same to group c except for several point mutations). Until now, we have not read the reports describing [n+, K-19(-)]. The discrepancy like these cases we experienced were partially cleared by using appropriate primer pairs.

Background The optimum dose of granulocyte colony-stimulating factor (G-CSF) for peripheral blood stem cell (PBSC) mobilization after disease-oriented, conventional-dose chemotherapy remains unknown. Methods A multicenter dose-finding study of glycosylated G-CSF (lenograstim) for the mobilization of PBSCs following adjuvant CAF chemotherapy (cyclophosphamide, doxorubicin and 5-fluorouracil) was performed in 38 patients with postoperative breast cancer. Each 10, ten and eight patients were sequentially allocated to one of the three dose groups (2, 5 and 10 micrograms/kg, respectively) of lenograstim. Lenograstim was administered subcutaneously (s.c.) daily from day 8 to the day of the last apheresis and CD34+ cells and colony-forming units-granulocyte macrophage (CFU-GMs) in peripheral blood were measured serially. Additionally, 10 patients who received adjuvant CAF chemotherapy alone also participated in the study, as a control. Results Lenograstim was well tolerated up to 10 micrograms/kg, except for one patient given 10 micrograms/kg who developed transient grade 3 hepatic enzyme elevation. The peak levels of CD34+ cells and CFU-GMs in peripheral blood showed dose-response relationships. The median peak CD34+ cells for the 0, 2, 5 and 10 micrograms/kg dose groups were 5.4, 34.3, 55.0 and 127.6 cells/microliter, respectively, and those of CFU-GMs for the 0, 2, 5 and 10 micrograms/kg dose groups were 0.01, 0.33, 1.32 and 3.30 CFU-GMs/microliter, respectively. Conclusions Considering the previous reports suggesting that a pre-apheresis number of 40-50 CD34+ cells/microliter in peripheral blood is highly predictive for achievement of more than 2.5 x 10(6) CD34+ cells/kg in a standard apheresis procedure of 10 litres, the optimum dose of lenograstim for PBSC mobilization following CAF chemotherapy in patients with postoperative breast cancer is 5 micrograms/kg/day s.c.

Forty-seven cases of phyllodes tumor of the breast (resected and diagosed pathologicaly at this hospital from 1994 to August 1997) were evaluated clinicopathologically. Thirty-nine patients were classified as benign, 5 as borderline and 3 as malignant. Eighty-one percent of all tumors found were 5cm or less in diameter, and 38 tumors were 2cm or less in diameter. In this study, no clinical findings characteristic of benign or malignant tumors were identified. Some tumors needed to be differentiated from breast cancer. If an adequate surgical margin can be achieved, it would appear that local excision is an acceptable form of primary surgical treatment

Pancreatoduodenectomy (PD) has been applied for advanced gastric cancer with pancreatic and/or duodenal invasion. Twenty-one patients with gastric cancer underwent PD in our hospital from 1966 to 1996. No patients were lost to follow up. In this study, the clinicopathological factors and outcomes of these 21patients were analyzed. The numbers of patients with tumor invasion depths of T3 and T4 were 1 and 20, respectively. None had hepatic or peritoneal metastases, the exception being one patients who had adjacent peritoneal dissemination. Curative resection with extended lymphadenectomy beyond D2 was performed in all patients. The cumulative 1-year and 5-years survival rates were 65.2% and 41.5%, respectively. and the median survival time was 593days. There were five 5-year survivors. The survival rate in 5patients with positive lymph nodes on the posterior surface of the pancreatic head (No. 13 lymph node) was significantly lower than that in 16patients without No. 13 lymph node metastasis (p

Thirty seven patients with resectable peritoneal dissemination that were curability B in colorectal cancer were analyzed clinically and assessed factors which influence the survival. The 5-year survival rate was 31.4% and according to the multivariate analysis, there were two prognosis regulating factors included the number of disseminations of 3 and fewer and lymph node metastasis of n2 and under. Patients possess above two factors have good prognosis (survival at 5 years=56.8%). Based on prior statistical analysis. P1 and P2 divided into two groups according to the number of disseminations of 3 and fewer or 4 and over respectively. There were no statistical difference in two groups in P1. But in P2, three and fewer group had a statistically superior survival than 4 and over. And there were no statistical difference between 3 and fewer group of P2 and all of P1. These results suggest that it is appropriate that disseminations to the remole peritoneum of 3 and fewer are included P1 and 4 and over are included P2.

術前診断にて根治切除不可能と判定した進行胃癌21例に対し, 1993年より術前化学療法 (NAC) としてFLP療法 (CDDP 50mg/m2, day 1 day 8, 5FU 333mg/m2 and Leucovorin 30mg/body, day 1-8) を2クール以上施行してきた.19例に手術がなされ, 18例 (85.7%) が切除可能であった.【成績】(1) PR例は12例 (57.1%) 存在し, 根治Bとなった症例が7例存在した.(2) 部位別奏効率は, No.16リンパ節転移64.7%, 原発巣47.6%, 肝転移40%, 腹膜播種11.1%であった.(3) 21例の50%生存期間 (MST) は322日, 1生率40.5%であった.PR12例はMSTが471日で, 無効例は209日であった.(4) 根治度別では, 根治BのMST 835日に対し, 根治Cは310日で17.5か月MSTが延長していた.(5) 治療関連死亡, grade 4は1例もなく, grade 3以上の有害事象は白血球減少19.0%, 貧血14.3%, 口内炎9.5%などで安全性が確認された.【結語】FLP療法によるNACは, 非治癒因子がNo.16リンパ節転移である場合に治療効果が期待でき, PR例および根治B症例には生存率の向上も認められた.

新潟県は胃癌の多発県のひとつであり, 当院はその約1割を手術している.主に早期胃癌 (EGC) に対し, 外科的局所切除 (SLR) 112例, 腹腔鏡下楔状胃切除 (LAP) 5例, 幽門保存胃切除術 (PPG) 51例, 噴門側胃切除術 (PXG) 38例, 大網温存縮小胃切除術 (OPG) 377例を施行したので各種縮小術式につき臨床評価を加えた.【成績】(1) SLRには術後の愁訴は殆どなかった.再治療を要したのは6例 (再発2例, 多発4例) であるが, 姑息切除の1例を除き胃癌死はなく他病死を含む5生率は81.9%であった.(2) LAPには, 再発例はなく全例生存中である.(3) PPGは残胃炎, 食道炎が少なく, 体重の回復は良好であったが, 残胃への胆汁逆流は24%に認められた.再手術は2例に施行されたが, 全例外来通院中である.(4) PXGに胃癌死はないが, 5生率は84.2%である.(5) OPGは術後イレウスの発生が少なく, 現在まで原病死はない.【結語】EGCに対し, QOLの向上をはかり, 遠隔成績を損なうことなく合理的縮小手術が可能であった.

他病死を除いた2, 3型進行胃癌106例を対象に, p53蛋白の異常発現を免疫染色法 (ABC法) にて解析し, 臨床病理学的諸因子と対比しながら予後因子になりうるか否か検討した. なお, p53陽性細胞が10%以上を陽性, 10%未満を陰性と判定した. 成績:(1) p53蛋白の陽性率は47.2%であった.(2) p53陽性例の遠隔成績 (5生率40.0%) は, p53陰性例 (5生率60.7%) より明らかに不良であった.(3) 単因子解析ではリンパ節郭清度, 占居部位, T因子, N因子, P因子, H因子, t因子, n因子, ly, v, 根治度, p53が予後因子であった.(4) Coxの比例ハザードモデルによる多変量解析では, 根治度>>リンパ節転移 (n)>占居部位の順に予後に影響を与えていた. 結語: 免疫組織染色による検討にて, p53は独立した予後因子にはなりえないが, 予後不良な2, 3型進行胃癌症例の予測が可能であり, 拡大リンパ節郭清などの拡大手術やintensive chemotherapyの適応を決定する上で参考となりうる.

We herein report the case of a 63-year-old woman who underwent curative surgery consisting of a subtotal gastrectomy with D2 lymph node dissection for advanced stomach cancer in June 1984, and later underwent systemic dissection of recurrent abdominal paraaortic lymph nodes by a retromesenteric approach in June 1989. Metastatic nodes were found in nos. 16b1 (interaorticocaval), 16b2 (interaorticocaval), and 280 (aortic carinal). One of the resected nodes, which was histologically diagnosed as being poorly differentiated adenocarcinoma, measured approximately 10 x 7 cm and infiltrated the inferior caval vein. There was no distant metastasis except for nodal metastases. Since the reoperation, the patient has been disease-free for 6 years and 4 months, and she continues to visit our hospital as an outpatient. The findings of this case therefore suggest the significance of paraaortic lymph node dissection. To our knowledge, this is the first report in the world of a gastric cancer patient who has remained disease-free for more than 5 years after the systemic dissection of recurrent paraaortic lymph nodes.

In a period from 1980 to 1995, we experienced 67 cases of mucinous carcinoma (3.2%) out of 2, 801 primary breast carcinomas. These 67 cases were subjected to a study of clinical features and prognosis. There were 43 pure and 24 mixed types. Mean age of the patients was 54.1±14.2 years. TNM classification almost resulted in Stage I and Stage II but one patient of pure type and one patient of mixed type were in Stage IV. Only two patients (5%) of pure type mucinous carcinoma showed lymph node metastasis. Two patients with pure type mucinous carcinoma experienced recurrence to the lung, but they are still alive, as of 11 years 2 months and 4 years 11 months after the recurrence, respectively. We suggest that if pure type mucinous carcinoma is exactly diagnosed, the operation without lymphadenectomy may be permitted.

Paraganglioma is a rare tumor arising in the paranglion tissue other than the adrenal medulla. The preoperative diagnosis of asymptomatic paraganglioma not causing excessive secretion of catecholamines is made with difficulty. We encountered a woman who was diagnosed as having a paraganglioma based on hypertension induced by operative manipulation. A 49-year-old woman visited the medical department in our hospital because of abdominal discomfort. Since close examination showed a neurogenic retroperitoneal tumor, she was admitted to the department. On laparotomy, a solid tumor (7×3×5cm) was observed between the abdominal aorta and inferior vena cava and was resected. The initiation of tumor detachment induced hypertension, and increase in the cardiac rate, and increases in all catecholamine fractions. Before the termination of tumor resection, the blood pressure decreased, and the catecholamine fraction levels were rapidly normalized. Her clinical course suggested a paraganiglioma, which was confirmed by intraoperative histopathological examination. In functional paraganglioma even in the absence of symptoms, measures against acute changes in hemodynamics during and after operation are necessary.

A retrospective review was made of 58 patients who undergoing breast-conserving surgery without radiotherapy at the department since January 1988 until July 1993. Breast-conserving surgery consisted of quadrantectomy with axillary dissection. The incidence of local recurrence was 13.8% (8 cases), There were no significant differences between the patients with local recurrence and those without local recurrence in clinical features such as age, tumor size in diameter and tumor-areolar distance. No difference was found in microscopical and biochemical findings such as incidence of cases with intraductal component, with positive estrogen receptor and with positive lymph node metastasis. So it seemed difficult to predict local recurrence. Among the patients who had undergone mastectomy immediately after breast-conserving surgery because of positive resected margin toward the nipple decided by intra-operative frozen section diagnosis, one case showed extensive intraductal involvement by carcinoma and two invasive lesions within the resected breast. It is important to exclude the cases with EIC using preoperative image diagnosis from the indication of breast-conserving surgery and to identify the extent and degree of stromal invasion, intraductal spreading and intralymphatic extention by the serial pathological examination of the resected specimen in order to decrease the incidence of local recurrence following breast-conserving surgery in the future.

[Case 1] A 55-year-old woman was seen at the department because of a mass in the right breast. The patient underwent modified radical mastectomy after confirmation of the presence of a mass 2.2 cm in diameter in the region C. The histopatological diagnosis was apocrine carcinoma. [Case 2] A 66-year-old woman was seen at the department after a disease cource of 9 years for a breast tumor. Modified radical mastectomy was performed to remove a giant cystic mass accompanied by redness and ulcer measuring 15 cm in diameter and affecting the entire right breast. Histopathological examination revealed cancer cells with abundant cytoplasm containing fine eosinophil granules, characteristic of apocrine carcinoma. In a review of the Japanese literature 39 cases of mammary apocrine carcinoma were seen. The mean age of the patients was relatively high, 58.6 years, and cases of no represented for 69.2% of them. The localized solid type was predominant, and cystic formation was found in 25.6%. Data on these previous cases show that this type of carcinoma, even when present in the form of a giant tumor, is likely to have cyst formation, and that lymph node metastasis is rare. A low grade of biological malignancy of the disease is indicated.

In 2383 cases operated on for breast carcinoma at the department from April 1966 to April 1993, five cases (0.21%) of squamous cell carcinoma of the breast were experienced. Histopathologically, there were three cases of mixed type and two cases of pure type. The average age of 45.4 was younger than that of usual types and the average tumor size of 9.0cm was a little larger. One of three cases which were performed mammorgraphy, had a tumor shadow showing benign feature. On macroscopical view of section of the tumor, four cases showed circumscribed pattern, none of invasive pattern being revealed. Two cases of pure type had central necrosis. Two cases had nodal involvement, microscopically squamous cell carcinoma. One of the two cases had distant metastasis one year after the operation and another one year later died of recurrence. The remaining one case having nodal involvement is alive for 10 years and node negative patients are also alive for 10 years.

門脈内に細径超音波プローブを挿入し観察を行った (transportal ultrasonography: 以下, TPUSと略記) ので報告する.使用した細径超音波プロープは, 外径2.4mm.そのスキャナーは, メカニカルラジアル走査方式, 周波数15MHzである.この細径超音波プローブを術中に空腸静脈より挿入し, 門脈へと誘導していく.TPUSにより, 門脈内腫瘍を診断しえた胆管癌症例を呈示する.患者は74歳の女性で, 黄疸を主訴に来院.CTにて肝十二指腸間膜背側に径9cmの腫瘤および肝内胆管の拡張を認めた, 術中TPUSを行うと, 門脈内に腫瘤像が描出され, その部位での門脈壁は厚く, 腫瘍と連続していたため門脈内浸潤ありと診断した.術前の血管造影では, 門脈内腫瘍の診断は困難であった.また, 膵癌による門脈浸潤がある症例にも施行し, 浸潤部位の門脈壁が厚く高輝度に描出された.TPUSは術前診断困難な腫瘍の進展を描出できるなど, 手術術式を左右するような情報を提供することもあり有用である.

Carcinoid tumor of the breast is rare and classified into special type of breast carcinoma. Two patients with primary carcinoid tumor of the breast are reported. One was a 40-year-old female who had a 2.0×1.8cm hard mass in the A region of the right breast. Aspiration biopsy cytology revealed class V. Auchincloss operation was performed. The other was a 47-year-old female who had a 5.0×3.0cm unmovable hard mass in the A region of the right breast. Aspiration biopsy cytology revealed class V. She had lymph node metastasis on her axillar and supraclavicular regions. Halsted operation was performed. Histopathologically, both tumors were identical and composed of small cells arranged in solid nests or in a trabecular pattern. Grimelius technique demonstrated argyrophil-positive cytolplsmic granules in both cases. Electron microscopic study showed neurosecretory granules. On special stains, only neuron specific enulase (NSE) was positive in both cases.

To elucidate whether adjuvant taxane monotherapy is a feasible and tolerable for postoperative breast cancer patients, we evaluated the severity of chemotherapy-induced peripheral neuropathy (CIPN) and the relative tolerability of regimens by health-related quality of life (HRQOL) assessment in node-positive breast cancer patients treated with taxane-containing regimens.We evaluated CIPN and HRQOL in the first 300 patients enrolled in a larger (1,060 total) multicenter phase III trial randomized to one of four adjuvant regimens: (1) anthracycline-cyclophosphamide followed by paclitaxel (ACP), (2) AC followed by docetaxel (ACD), (3) paclitaxel alone (PTX), or (4) docetaxel alone (DTX). CIPN was assessed by the Patient Neurotoxicity Questionnaire (PNQ) and the National Cancer Institute Common Toxicity Criteria, and HRQOL by Functional Assessment of Cancer Therapy-General (FACT-G). CIPN and HRQOL scores were compared between ACP and ACD vs. PTX and DTX, and ACP and PTX vs. ACD and DTX.PNQ sensory scores were significantly higher in patients treated with taxane monotherapy compared to treatment with AC followed by taxane (P = .003). No significant differences in PNQ sensory scores were observed between the ACP and PTX vs. ACD and DTX regimens (P = .669). Regardless of taxane regimen, PNQ severity scores for CIPN appear to be largely reversible within 1 year of adjuvant treatment. No significant difference in FACT-G scores was observed between any regimens during the study treatments.Patient-reported CIPN was significantly more severe with single-agent adjuvant taxane compared to AC followed by taxane treatment; however, the HRQOL findings support that single-agent taxane treatment is tolerable.

Extreme caution should be taken to avoid uncontrollable bleeding in treating hypervascular tumors via bronchoscope. We report two cases of endobronchial metastasis of renal cell carcinoma treated with bronchial artery embolization (BAE) before endoscopic treatments. The intraluminal lesions were removed swiftly and safely. Although arterial embolization is not always efficacious in cases of tracheal lesions, BAE is effective for tumors located in the carina, bilateral main bronchus or intermediate bronchus. The addition of BAE before endoscopic tumor removal should be considered a treatment option in patients suffering from airway obstructions due to hypervascular tumors such as renal cell carcinoma.

高齢者食道癌手術の術後肺合併症発生に対する術前栄養管理の意義について検討した.術前の各種栄養指標, 筋力, 呼吸機能を測定し, 術後肺合併症発生との関係について, 70歳以上群 (高齢者群) 45例と70歳未満群106例に分け, retrospectiveに比較検討した.その結果, 70歳以上群では術前から70歳未満群に比べ栄養状態, 筋力, 呼吸機能が低下しており, 術後肺合併症の発生率は高かった. 栄養低下症例に術前栄養管理を行った時, 血清アルブミン値の低下と体重増加を同時に示す術前栄養管理反応不良例の発生率は, 70歳以上群で10例中7例であり, 70歳未満群の19例中12例と差はなかった. しかし, 術前栄養管理に対する反応不良例のうちで, 術後肺合併症は70歳以上群で57% (7例中4例) と70歳未満群の0% (12例中0例) に比べて明らかに高率に発生した. 今後はより効果的な術前栄養管理法の検討が必要であると思われた.

We present herein a rare case of a long-term survivor after major hepatectomy performed for a metastatic liver tumor from carcinoma of the papilla of Vater. A 74-year-old man had undergone a pancreaticoduodenectomy for carcinoma of the papilla of Vater with obstructive jaundice, in April 1995. Histologically, an exposed mass-forming type of tumor, measuring 40 x 30 mm, was composed of mucinous and papillary adenocarcinoma, invading into the muscularis propria of the duodenum, without lymph node metastases. The patient did not receive any type of chemotherapy. In September 1999, a solitary hepatic tumor, 3.5 cm in diameter, was detected in segment VIII of the liver by computed tomography. In November 1999, right hepatic lobectomy was carried out. The anterior and posterior portal pedicles were ligated and dissected in the hepatic parenchyma so as not to compromise the hepaticojejunostomy. After the hepatectomy, the patient was treated with low-dose tegafur/uracil/cisplatin therapy for approximately 2 years. He has been doing well, without recurrence, for 5 years after the hepatectomy. Hepatectomy for hepatic metastases from carcinoma of the papilla of Vater is thought to be a useful surgical treatment in selected patients.

We report an autopsy case of Epstein-Barr virus (EBV)-infected malignant lymphoma in a young male who had hypersensitivity to mosquito bites. The autopsy revealed multiple confluent lymphoma lesions in the lungs, and on the right leg irregular-shaped skin ulcers were seen. The left pleural effusion also contained a large number of lymphoma cells. The lymphoma cells were determined as T/NK-cell type cells by immunohistochemistry. EBV DNA was detected most intensively in the lungs and EBV-encoded small RNAs-positive lymphoma cells were also observed in the lungs at a high frequency. EBV latent membrane protein-1 expression and a high Ki-67 labeling indices were noted in the lymphoma cells of the lung lesions. These findings indicate that the development of the malignant lymphoma was associated with the proliferation of EBV-infected lymphoma cells, and the cells that infiltrated the whole the body, especially the lungs, caused the patient's death.

TAK-778 [(2R,4S)-(-)-N-(4-Diethoxyphosphorylmethylphenyl)-1,2,4,5-tetrahydro-4-methyl-7,8-methylenedioxy-5-oxo-3-benzothiepin-2-carboxamide: mw 505.52], a novel compound promoting osteoblast differentiation, promotes osteogenesis in vitro and enhances bone formation during skeletal repair in vivo. In this study, we further evaluated the effects of TAK-778 on the differentiation of cultured bone marrow stromal cells into osteoblasts in the presence of dexamethasone, paying particular attention to the expression of transcription factors involved in regulating osteoblast differentiation. Treatment of TAK-778 (10(-7)-10(-5) M) for 4 h resulted in an increase in the mRNA expression of Msx2, but not Cbfa1 or Dlx5. This transcriptional alteration preceded the changes in other markers related to the osteoblast phenotype, such as alkaline phosphatase and osteocalcin mRNA. The transfection of Msx2-antisense in the cells caused a significant reduction in the levels of alkaline phosphatase mRNA expression induced by TAK-778. These results suggest that TAK-778 promotes osteoblast differentiation partly through the expression of Msx2, a homeobox-related gene.

Backgrounds: Bevacizumab (BEV) in combination with paclitaxel (PTX) and carboplatin (Cb) has provided survival benefit for advanced non-small cell lung cancer (NSCLC) as first-line treatment. However, tri-weekly PTX therapy induce severe peripheral neuropathy frequently, and may deteriorate quality of life. Because of this toxicity, platinum plus pemetrexed regimen may be preferred as first-line treatment over Cb/PTX/BEV regimen. Weekly paclitaxel (w-PTX) regimen has proved to be effective and safe in a large number of clinical trials for advanced solid tumors. However, few clinical studies have focused on the comparison between w-PTX and tri-weekly PTX in advanced NSCLC. We previously reported that fractionated administration of paclitaxel may be less toxic and more active against advanced NSCLC in clinical trials. Furthermore, several studies have reported that combination chemotherapy of w-PTX and BEV proved survival benefit in patients with advanced breast cancer. Therefore, we conducted a phase II trial to evaluate the efficacy and toxicity for the combination chemotherapy of w-PTX and BEV in patients with advanced non-squamous (non-Sq) NSCLC who have failed previous treatment. Methods: Eligibility required ECOG performance status 0-2 and prior cytotoxic chemotherapy. The primary end point of the phase II study was the progression free survival (PFS). PTX was infused on days 1, 8 and 15, and BEV (15 mg/kg) was administered on day 1 of a 4-week cycle until PD. Toxicity evaluations were based on CTCAE (version 4). Results: Between September 2011 and January 2014 a total of 30 eligible patients were enrolled onto the study. Conclusions: This combination of w-PTX and BEV is both feasible and active in the treatment of patients with advanced non-Sq NSCLC. We will soon start a phase II study evaluating this combination as first-line treatment.