RESUMEN
BACKGROUND: The treatment of hemotogenous solitary sternal metastases by breast cancer remains a controversial issue. Sternal resection for select patients might provide good long-term local control. CASE PRESENTATION: A 63-year-old woman was admitted to our hospital with a mass at the sternum and right second to third costochondral cartilage. She had undergone bilateral mastectomy for breast cancer 13 years earlier. A percutaneous biopsy was performed, and the mass was diagnosed as solitary metastasis due to breast cancer. She received two courses of weekly paclitaxel and bevacizumab, and computed tomography (CT) revealed shrinking of the mass in the sternum. We performed surgical resection with curative intent for a multimodality approach. Parasternectomy and removal of the right second and third costochondral cartilage was performed. A prosthesis was created to fill the defect by sandwiching molded methylmethacrylate between polypropylene mesh. The prosthesis was fixed to the cut ends of the costochondral cartilage and the residual sternum. Finally, a harvested latissimus dorsi myoctaneous flap was transpositioned to cover the chest midline wound. Negative surgical margins at the stump of the sternum and costochondral cartilage were revealed. CONCLUSION: Parasternal resection and reconstruction by the Marlex sandwich technique and implantation of a pedicled latissimus dorsi myocutaneous flap for metastasis due to breast cancer was safely performed.
Asunto(s)
Neoplasias Óseas/cirugía , Neoplasias de la Mama/cirugía , Colgajo Miocutáneo , Procedimientos de Cirugía Plástica/métodos , Esternón/cirugía , Músculos Superficiales de la Espalda/trasplante , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bevacizumab/administración & dosificación , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/tratamiento farmacológico , Neoplasias Óseas/secundario , Sustitutos de Huesos , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/secundario , Quimioterapia Adyuvante , Femenino , Humanos , Mastectomía , Persona de Mediana Edad , Terapia Neoadyuvante , Paclitaxel/administración & dosificación , Polipropilenos , Implantación de Prótesis/métodos , Costillas/cirugía , Esternón/diagnóstico por imagen , Esternón/patología , Mallas Quirúrgicas , Tomografía Computarizada por Rayos XRESUMEN
Three patients diagnosed with HER2-negative resectable advanced gastric cancer with extensive regional lymph node metastases were treated with neoadjuvant chemotherapy(NAC), followed by gastrectomy with D2lymph node dissection. One patient received four 21-day courses of S-1 plus oxaliplatin(G-SOX), and pathological effect(PE)was Grade 3. Two patients received four 21-day courses of capecitabine plus oxaliplatin(CapeOX), and each PE was Grade 2and Grade 1a, respectively. One patient in poor PE was with recurrent liver and peritoneal metastases. This suggested that for resectable advanced gastric cancer with extensive regional lymph node metastases, NAC by SOX or CapeOX was effective for some patients.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias Gástricas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Combinación de Medicamentos , Gastrectomía , Humanos , Terapia Neoadyuvante , Ácido Oxónico/administración & dosificación , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Tegafur/administración & dosificaciónRESUMEN
A 77-year-old woman was diagnosed with HER2-positive unresectable gastric cancer with multiple lymph node and liver metastases(cT3-4, cN3, cM1[HEP, LYM], cStage IV ). Four courses of combination chemotherapy with capecitabine, oxaliplatin, and trastuzumab(XELOX plus Tras)were administered. Though all lesions showed a complete or partial response, anorexia and body weight loss appeared because of the stenosis in the primary gastric lesion. After another course, these symptoms became worse and she underwent laparoscopic gastrojejunostomy. She progressed favorably after the surgery, her anorexia improved and her weight increased. Thirty-four days after the surgery, the same chemotherapy was continued. At present, the metastases are well controlled 12months after the initial treatment. It is suggested that XELOX plus Tras is an effective chemotherapy regimen for HER2-positive unresectable gastric cancer.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/patología , Anciano , Capecitabina/administración & dosificación , Terapia Combinada , Femenino , Gastrectomía , Humanos , Neoplasias Hepáticas/secundario , Metástasis Linfática , Compuestos Organoplatinos/administración & dosificación , Oxaliplatino , Receptor ErbB-2/análisis , Receptor ErbB-2/biosíntesis , Neoplasias Gástricas/química , Neoplasias Gástricas/cirugía , Trastuzumab/administración & dosificaciónRESUMEN
A 57-year-old man presented with abdominal discomfort. A computed tomography (CT) scan revealed a tumor, with a maximum diameter of approximately 5 cm, in the transverse mesocolon near the splenic flexure as well as a small nodular shadow suggestive of peritoneal dissemination on the greater omentum. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) showed marked accumulations of FDG at the same sites. Laparoscopic examination revealed an elastic hard tumor, with a maximum diameter of slightly over 5 cm, at the posterior sheath of the transverse mesocolon and a small nodule on the greater omentum with apparent dissemination. Since radical surgery was considered to be difficult to perform, we only resected the disseminated nodule for diagnostic purposes. The final pathological diagnosis was biphasic- type (mixed epithelial and sarcomatoid type) malignant mesothelioma arising from the peritoneum. Approximately 20 days postoperatively, the patient received combination therapy with pemetrexed and cisplatin with a 3-week interval between the courses. Image assessment after completion of the third course revealed enlargement of the tumor mass and worsening of the peritoneal dissemination. Therefore, the treatment was switched to paclitaxel, which has been reported to be effective as a second-line therapy. The drug was scheduled to be administered on days 1, 8, and 15. However, after the first course on day 1, the patient's condition gradually deteriorated and he subsequently died.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Pulmonares/tratamiento farmacológico , Mesotelioma/tratamiento farmacológico , Neoplasias Peritoneales/tratamiento farmacológico , Quimioterapia Adyuvante , Cisplatino/administración & dosificación , Resultado Fatal , Glutamatos/administración & dosificación , Guanina/administración & dosificación , Guanina/análogos & derivados , Humanos , Neoplasias Pulmonares/cirugía , Masculino , Mesotelioma/cirugía , Mesotelioma Maligno , Persona de Mediana Edad , Pemetrexed , Neoplasias Peritoneales/secundario , Neoplasias Peritoneales/cirugíaRESUMEN
We report a 47-year-old man with abdominal distension without other distinct signs. Massive ascites with any singular lesions was revealed on computed tomography, and the ascites was high-amylase and high-protein. on these findings, pancreatic ascites was suspected and he was first treated with conservative therapy, but it failed. Computed tomography one month from the start of therapy demonstrated a pancreatic cyst, and endoscopic retrograde pancreatography revealed transudation of contrast medium from the cyst. A pancreatic duct stent was placed, and the ascites was smoothly eliminated. Endoscopic pancreatic stenting is considerable treatment for pancreatic ascites.
Asunto(s)
Ascitis/terapia , Drenaje/métodos , Endoscopía del Sistema Digestivo , Enfermedades Pancreáticas/terapia , Stents , Ascitis/diagnóstico , Diagnóstico por Imagen , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Pancreáticas/diagnóstico , Conductos Pancreáticos , Resultado del TratamientoRESUMEN
We report a case of granulocyte-colony stimulating factor producing gastric cancer with multiple liver metastases. A 68-year-old woman who complained of epigastralgia visited our hospital. Upper gastrointestinal endoscopic examination revealed a type-2 gastric cancer. The laboratory data at admission indicated leukocytosis (35,900/microl) and a high level of serum granulocyte-colony stimulating factor (61 pg/mg). Granulocyte-colony stimulating factor producing gastric cancer was diagnosed by immunohistochemistry of biopsy specimen. Since we detected multiple liver metastases, chemotherapy was performed. Granulocyte-colony stimulating factor-producing gastric cancer is relatively rare and we summarize previous reports.
Asunto(s)
Factor Estimulante de Colonias de Granulocitos/biosíntesis , Neoplasias Gástricas/metabolismo , Anciano , Femenino , HumanosRESUMEN
Sixteen patients with highly-advanced gastric cancer were administered low-dose TS-1 and CDDP as a first-line treatment, followed by either paclitaxel or CPT-11/CDDP as a second-line treatment. The results of the 2 second-line treatments are reported herein. Overall response rate for the first-line treatment was 55.6%. For the second-line treatments, responses were noted in both the paclitaxel group and the CPT-11/CDDP group. Overall MST was 16.3 months and 1-year survival was 60%. The paclitaxel group, however, showed significantly better prognoses than the CPT-11/CDDP group. Adverse reactions to the first-line treatment were grade 3 leukopenia in 1 patient, with no other reactions over grade 2 observed. No adverse reaction greater than grade 2 was noted during administration of the second-line treatments. These results appear to present ample data that a first-line treatment of low-dose TS-1/CDDP followed by a second-line treatment of paclitaxel at 1/week in the outpatient setting yields improved prognoses and minimal adverse reactions.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Paclitaxel/administración & dosificación , Neoplasias Gástricas/tratamiento farmacológico , Anciano , Cisplatino/administración & dosificación , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Combinación de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ácido Oxónico/administración & dosificación , Piridinas/administración & dosificación , Neoplasias Gástricas/mortalidad , Tasa de Supervivencia , Tegafur/administración & dosificaciónRESUMEN
We report the case of an 84-year-old woman with vulval extramammary Paget's disease associated with pancreatic cancer who was successfully treated. At first, biweekly low-dose FP (cisplatin 10 mg/body, 5-fluorouracil 250 mg/body) was administered by intravenous infusion. Next, we attempted a regimen of gemcitabine (1,000 mg/body) was administered weekly by intravenous infusion. As a result, the size of the pruritic lesion of the vulva was reduced more than 50%, and the serum level of CA19-9 decreased clearly. These treatments would be a valid option in certain cases of pancreas cancer and extramammary Paget's disease.