[Show abstract][Hide abstract] ABSTRACT: Invasive papillary carcinoma is a rare type of invasive ductal carcinoma. Neoadjuvant endocrine therapy is now considered as an optional therapy for postmenopausal women with hormone receptor-positive breast cancers, including invasive papillary carcinoma.
We discuss the case of an 83-year-old postmenopausal Japanese female with hormone receptor-positive invasive papillary carcinoma who started treatment with an aromatase inhibitor and achieved pathological complete response after 12 months of endocrine treatment.
Appropriate drugs and durations of neoadjuvant endocrine treatment have yet to be established. Continuing therapy with an aromatase inhibitor until the best clinical response is achieved may represent one of the best strategies in neoadjuvant endocrine therapy.
[Show abstract][Hide abstract] ABSTRACT: IgG4-related disease is a newly recognized fibroinflammatory condition characterized by tumefaction consisting of fibrosis with dense infiltration of IgG4-positive plasma cells; affecting various organs. A case of IgG4-related sclerosing mesenteritis is reported. A 64-year-old man was admitted to our hospital with a suspected tumor of the small intestine. Abdominal computed tomography demonstrated a 6-cm soft tissue mass in the right lower mesentery compressing the jejunum, which also showed accumulation of fluorodeoxyglucose uptake on fluorine-18 fluorodeoxyglucose positron emission tomography. With a preoperative diagnosis of suspected malignant lymphoma with lymphadenopathy in the mesentery, partial small bowel resection was performed. Macroscopically, a hard mass, including several swollen lymph nodes, was detected in the mesentery. Microscopically, marked fibrosis showing partially storiform pattern, obstructive phlebitis, follicular hyperplasia, and abundant infiltration of IgG4-positive plasma cells were detected. IgG4-related mesenteritis was diagnosed histopathologically, but the serum IgG4 level was 81 mg/dl postoperatively. Five months after the surgery, an 11-cm soft tissue mass involving the left ureter appeared. Histological examination of a biopsy specimen from the retroperitoneal mass showed fibrosis with inflammatory infiltration. Although IgG4-related retroperitoneal fibrosis could not be confirmed histologically, the tumor responded well to steroid therapy.
No preview · Article · Nov 2015 · Clinical Journal of Gastroenterology
[Show abstract][Hide abstract] ABSTRACT: An asymptomatic 80-years-old woman with an angiosarcoma of upper arm was incidentally found on PET to have a hot spot in the lower abdomen. She had been prescribed Calcium Polystyrene Sulfonate (CPS) . Colonoscopy revealed polypoid lesion about 30 mm in size in recto sigmoid, which endoscopic diagnosis was submucosal invasive carcinoma, biopsy specimen shows moderately differentiated adenocarcinoma. A year later, she complained bloody stool and lower abdominal pain. Second colonoscopy showed a white coated large polypoid lesion occupying a rectal lumen. Anterior resection was performed, and resected specimen showed 80×50 mm tumor with deep ulcer, pathological finding shows poorly differentiated with moderately differentiated component penetrating to right ovary, lymph node metastasis was positive for cancer. Many CPS crystals were deposited in the ulcer bed. CPS is known as mucosal toxic agents. Our case suggested CPS might be the cause of ulceration and rapid progression of the tumor.
[Show abstract][Hide abstract] ABSTRACT: Pyloric gland adenoma is a rare tumor in which fundus glands differentiate into mucus neck cells at has a predilection for upper and middle body of the stomach but also occures in the duodenum. We retrospectively studied the features of pyloric gland adenomas in the duodenum from August 2010 to June 2014. The study group was comprised of 8 patients (5 males and 3 females) with a mean age of 66 years. Mean diameter of the tumor was 12.5 mm. The locations of the tumor were the bulb (n=6) and the second portion (n=2) . The shape of the tumor were type 0-I (n=7) , and 0-IIa (n=1) . Surface structures were villous (n=6) , and convolute (n=2) . We examined 3 cases with magnifying narrow band imaging. White opaque substance (WOS) was observed in the two cases. Microsurface pattern and microvasicular pattern were observed in 2 cases, width and shape of marginal crypt epithelium (MCE) were heterogeneous, and microvasicular pattern showed caliber variation and angiectopia. Endoscopic treatment was performed in 3 cases [EMR (n=2) , and polypectomy (n=1)], and surgery was done in 2 cases [mucosal resection (n=1) , combined resection with advanced stomach cancer (n=1)], and there was no cases with cancerous foci.
[Show abstract][Hide abstract] ABSTRACT: A woman in her 80s had two episodes of ileus, which led to the diagnosis of advanced jejunal cancer. She was diagnosed with Lynch syndrome when she was in her 60s, for which she underwent annual follow-up with computed tomography for 8 years. Unfortunately, she died from the recurrence of jejunal cancer and liver metastases. Jejunal cancer is relatively rare in Lynch syndrome, and no surveillance strategy has been established for small bowel cancer. In patients with unexplained abdominal complaints, small bowel cancer should be considered.
No preview · Article · Nov 2014 · Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology
[Show abstract][Hide abstract] ABSTRACT: Objectives:
The aim of the study was to determine the significance of miR-126 and miR-20b in colorectal carcinogenesis.
We analyzed the expressions of miR-126 and miR-20b in 136 colorectal tumors from 39 microsatellite stable (MSS) tumors, 23 high microsatellite instability (MSI-H) tumors, 16 Lynch syndrome, and 58 familial adenomatous polyposis (FAP) tumors including adenoma, intramucosal carcinoma, and invasive carcinoma.
All four kinds of tumors showed underexpression of both miR-126 and miR-20b. The frequency of miR-126 downregulation was 100.0% in FAP adenomas, 85.7% in FAP intramucosal carcinomas, 78.9% in invasive carcinomas, 81.3% in Lynch syndrome tumors, 68.4% in MSS tumors, and 65.4% in MSI-H tumors. The frequency of miR-20b downregulation was 64.0% in FAP adenomas, 50.0% in FAP intramucosal carcinomas, 73.3% in invasive carcinomas, 62.5% in Lynch syndrome tumors, 79.5% in MSS tumors, and 91.3% in MSI-H tumors. The current study demonstrated underexpression of miR-126 and miR-20b in various types of colorectal cancer. These findings support the hypothesis that angiogenesis results from underexpressions of miR-126 and miR-20b and occurs as an early event in colorectal carcinogenesis.
Underexpression of miR-126 and miR-20b was observed in various types of colorectal cancer, and occurs as an early event of colorectal carcinogenesis in FAP tumors.
[Show abstract][Hide abstract] ABSTRACT: Angiofibroma of soft tissue is a recently described soft tissue tumor that is characterized by fibroblastic spindle tumor cells with arborizing capillary proliferation. Cytogenetically, it harbors a specific fusion gene involving the nuclear receptor coactivator 2 (NCOA2) gene. We report here additional new pathological and cytogenetic features. A soft tissue tumor in the left thigh of 73‐year‐old female was investigated. Microscopically, histiocytoid tumor cells were scattered in an edematous background with branching capillary proliferation. Immunohistochemically, we identified that the tumor cells were positive for histiocytic markers such as CD68 and CD163. Rearrangement of the NCOA2 gene was detected successfully by chromogenic in situ hybridization; however, abnormal signal patterns were observed in only a small subset of tumor cells. Unlike typical tumors with bland spindle cells, the present tumor needs to be distinguished from myxoid, dendritic and clear cell tumors. This case may suggest that angiofibroma of soft tissue is not in the center of the fibroblastic/myofibroblastic tumor group, but rather shows a fibrohistiocytic nature. We also found intratumor genetic heterogeneity, which is uncommon for a translocation‐associated tumor. Therefore, careful evaluation is required to detect the gene rearrangement in this tumor entity.
No preview · Article · May 2014 · Pathology International
[Show abstract][Hide abstract] ABSTRACT: Ulcerative colitis (UC) is sometimes associated with autoimmune pancreatitis (AIP). Infiltration of immunoglobulin G4 (IgG4)-positive plasma cells is sometimes detected in the colonic mucosa of AIP or UC patients. This study aimed to clarify the relation between UC and IgG4.
Associations with UC were reviewed in 85 AIP patients. IgG4 immunostaining was performed on biopsy specimens from the colonic mucosa of 14 AIP and 32 UC patients.
UC was confirmed in two cases (type 1 AIP, n=1; suspected type 2 AIP, n=1). Abundant infiltration of IgG4-positive plasma cells in the colonic mucosa was detected in the case of suspected type 2 AIP with UC and two cases of type 1 AIP without colitis. Abundant infiltration of IgG4-positive plasma cells was detected in 10 UC cases (IgG4-present, 31%). Although 72% of IgG4-absent UC patients showed mild disease activity, 70% of IgG4-present patients showed moderate to severe disease activity (p<0.05).
UC is sometimes associated with AIP, but it seems that UC is not a manifestation of IgG4-related disease. Infiltration of IgG4-positive plasma cells is sometimes detectable in the colonic mucosa of UC patients and is associated with disease activity.
[Show abstract][Hide abstract] ABSTRACT: Two cases of matrix-producing carcinoma (MPC) of the breast are presented. Case 1 : A 51-year-old woman complained of a mass palpable in the left breast. Left breast cancer (T2N0M0, stage IIA) was diagnosed, and mastectomy and sentinel lymph node biopsy were performed. The histological diagnosis of the excised specimen showed pT2N0, MPC, and sn0/2, and indicated that the tumor was negative for estrogen and progesterone receptors and human epidermal growth factor receptor 2. Four courses of chemotherapy with taxotere and cyclophosphamide were administered postoperatively. Fifty-two months after the operation, the patient is alive and recurrence free. Case 2 : A 48-year-old woman complained of a mass palpable in the left breast. Left breast cancer (T1N0M0, stage I) was diagnosed, and partial mastectomy and sentinel lymph node biopsy were performed. The histological diagnosis of the excised specimen showed pT2N0, MPC, and sn(0/4), and indicated that the tumor was negative for estrogen and progesterone receptors and human epidermal growth factor receptor 2. The patient was administered 4 courses of adjuvant chemotherapy with epirubicin and cyclophosphamide plus bevacizumab followed by bevacizumab monotherapy for 1 year. Twelve months after the operation, lung, bone, and liver metastases were diagnosed. The chemotherapy regimen was changed to weekly paclitaxel ; however, the patient's condition deteriorated, and she died 18 months after the operation.
Preview · Article · Jan 2014 · Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
[Show abstract][Hide abstract] ABSTRACT: A case of acute hemorrhagic rectal ulcer (AHRU) with cytomegalovirus (CMV) enteritis is reported. AHRU is characterized by sudden painless onset of massive hemorrhage from rectal ulcer (s) in patients with serious underlying illnesses. A 70-year-old woman with multiple myeloma was referred to our division for fresh blood in the stool. Endoscopic examination revealed two deep ulcers, one in the lower rectum and the other in the ascending colon. The initial endoscopic diagnosis was AHRU, however, histopathological examination of the biopsy specimen from both ulcers showed evidence of CMV infection. The patient died 22 days later from progression of the multiple myeloma. We reviewed the data of 17 cases (including our case) reported previously from Japan. In conclusion, CMV infection can be a cause or a risk factor for AHRUs.
[Show abstract][Hide abstract] ABSTRACT: To elucidate the clinical characteristics of IgG4-related dacryoadenitis.
Clinical features, laboratory findings, radiological findings, associated diseases, treatment, and prognosis were prospectively examined in 12 patients (seven men, five women; mean age, 60.9 ± 15.1 years) with IgG4-related dacryoadenitis.
In addition to eyelid swelling, other ophthalmologic symptoms were observed in seven patients, including diplopia (n = 4), ptosis (n = 2), visual field disturbance (n = 2), eye pain (n = 2), decrease of visual acuity (n = 2), eye-movement disturbance (n = 1), dry eye (n = 1), corneal ulcer (n = 1), and epiphora (n = 1). Swelling of the lacrimal glands was bilateral in half of the patients. Other IgG4-related diseases were present in nine patients, including sialadenitis (n = 5), autoimmune pancreatitis (n = 4), retroperitoneal fibrosis (n = 2), and lymphadenopathy (n = 8). Serum IgG4 levels were significantly higher in patients with other IgG4-related disease (1070 ± 813 mg/dl) than in those without (197 ± 59 mg/dl, p = 0.017). Allergic histories and elevated serum IgE levels were each detected in six patients. Eight patients showed inflammatory extension beyond the lacrimal gland, such as thickened rectus muscle (n = 6), inflammation of the optic nerve (n = 2), and retrobulbar inflammation (n = 3). Steroid therapy was effective in seven patients, but dacryoadenitis relapsed in two patients with markedly higher serum IgG4 levels and autoimmune pancreatitis.
IgG4-related dacryoadenitis showed various ophthalmologic symptoms due to extensive inflammation beyond the lacrimal gland, frequent association with other IgG4-related disease or allergic phenomena, and steroid responsiveness.
No preview · Article · Dec 2013 · Albrecht von Graæes Archiv für Ophthalmologie
[Show abstract][Hide abstract] ABSTRACT: The case of a 63-year-old male with a large mass in the pancreatic tail and multiple liver metastases, diagnosed as acinar cell carcinoma of the pancreas with a few scattered endocrine cells by liver biopsy is presented. The S-1 chemotherapy was effective, and partial response was obtained with decreased levels of serum CA19.9 and NSE. Ten months after starting chemotherapy, the tumor began to grow accompanied by marked elevation of serum NSE levels (266 ng/ml). The patient died of liver failure due to multiple liver metastasis 18 months after the initiation of the S-1 chemotherapy. Histological findings at autopsy were acinar cell carcinoma with an endocrine component of more than 30 %; the final diagnosis was mixed acinar-endocrine carcinoma of the pancreas. This pathological change and clinical course may imply that S-1 was effective against the acinar component but less effective against the neuroendocrine component caused by tumor differentiation.
No preview · Article · Dec 2013 · Clinical Journal of Gastroenterology
[Show abstract][Hide abstract] ABSTRACT: Coexistence of autoimmune pancreatitis (AIP) and pancreatic cancer, elevation of serum IgG4 levels in pancreatic cancer patients, and infiltration of IgG4-positive plasma cells in peritumorous pancreatitis have been described in a few reports. This study examined the relationship between intraductal papillary mucinous neoplasm (IPMN) of the pancreas and peritumorous IgG4-positive lymphoplasmacytic infiltrates.
Serum IgG4 levels were measured in 54 patients with IPMN (median 70 years, 26 males and 28 females; 13 main duct type and 41 branch duct type). Histological findings focusing on dense lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis were reviewed, and immunostaining with IgG4 and IgG was performed in 23 surgically resected IPMN cases (18 main duct type and 5 branch duct type). The presence of IgG4-positive plasma cells >10/hpf and an IgG4-positive/IgG-positive plasma cell ratio >40% were considered significant.
Serum IgG4 levels were elevated in 2 (4%) IPMN patients. Significant infiltration of IgG4-positive plasma cells was detected in 4 IPMN cases (17%). The IgG4-positive/IgG-positive plasma cell ratio was >40% in all 4 cases. In one case with a markedly elevated serum IgG4 level (624 mg/dL), typical lymphoplasmacytic sclerosing pancreatitis (AIP type 1) lesions surrounded the whole IPMN. In the 3 other cases, infiltration of IgG4-positive plasma cells with fibrosis was focally detected mainly in the periductal area around the IPMN.
In a few patients with IPMNs, IgG4-positive plasma cell infiltration can occur in the peritumorous area. The association of an IPMN with AIP type 1-like changes seems to be exceptional and coincidental.
[Show abstract][Hide abstract] ABSTRACT: Sunitinib is an oral multi-targeted tyrosine kinase inhibitor approved for use in patients with advanced renal cell carcinoma (RCC). However, despite its preclinical biological effect on breast cancer, it is yet to be proven effective for clinical use in patients with breast cancer. The present report describes a case of a 69-year-old woman with advanced clear-cell RCC and a luminal B subtype invasive ductal carcinoma of the right breast that showed a partial response to monotherapy with sunitinib. This is the first report of the effect of sunitinib monotherapy in a patient with early-stage breast cancer.
[Show abstract][Hide abstract] ABSTRACT: Meningiomas are generally benign tumors, but rarely metastasize outside of the central nervous system. A 25-year-old female was admitted to our institute because of an abnormal shadow on her chest x-ray. A computed tomography (CT) scan showed a 3-cm, well- circumscribed mass in the right lower lobe of the lung. We performed thoracotomy and resected three pulmonary tumors at the right lung and diaphragm. Histological examination revealed a benign meningothelial meningioma. Six months later, she complained of heaviness of her head and a head CT scan revealed an intracranial mass. A craniotomy was performed and a brain tumor was found to be histologically identical to the lung tumors. During the 21 years since the first operation, we performed three times of pulmonary and pleural metastasectomies and two times of resection of intracranial local recurrences. All of those tumors were meningothelial meningioma without malignant change. The patient is alive without metastasis after the last resection of metastatic tumors.
[Show abstract][Hide abstract] ABSTRACT: Two cases of small intestinal metastasis from pulmonary cancer are reported. Case 1 : A 64-year-old man was diagnosed with non-small-cell lung cancer in November 2011. First-line chemotherapy was ineffective, and in July 2012 the patient was admitted to the hospital with abdominal pain, hematemesis, hematochezia and anemia. Abdominal CT and capsule endoscopy were suggestive of an ulcerative tumor with bleeding in the jejunum. Partial jejunectomy was performed. Pathological diagnosis was small intestinal metastasis from the pulmonary cancer. The patient could eat and his anemia was controlled until he died seven months post-surgery. Case 2 : A 46-year-old man received surgery for treatment of a large cell carcinoma of the right lung in February 2012. He was admitted to the hospital in July 2012 with anorexia, abdominal pain and dyschezia. Abdominal CT showed an enhanced tumor in the ileum. Single-balloon assisted endoscopy revealed an ulcerative tumor. Pathological findings based on the biopsy specimen were compatible with small intestinal metastasis from the pulmonary cancer. After palliative ilectomy, the patient’s symptoms were controlled. He received second-line and third-line chemotherapies, until peritoneal metastasis progressed and he died four months after ilectomy.
[Show abstract][Hide abstract] ABSTRACT: An asymptomatic 57-year-old woman was admitted to our hospital for further investigation of a duodenal tumor detected by screening abdominal CT. Duodenoscopy revealed an ulcerative tumor at the major duodenal papilla fistula on the longitudinal fold. A biopsy specimen from the ampullary tumor showed tubular adenocarcinoma. Endoscopic retrograde cholangiopancreatography through the fistula revealed a communication with the common bile duct. After diagnosis of ampullary carcinoma, pylorus-preserving pancreatoduodenectomy was performed. Microscopically, infiltration of cancer cells was detected beneath the normal duodenal mucosa around the fistula. According to histopathological data, the mechanism of the fistula formation was speculated to have been created by cancer invasion, explaining why this patient was not jaundiced. To our knowledge, choledochoduodenal fistulae formed by cancer invasion are rare.