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Haploidentical-related donor transplantation using posttransplant cyclophosphamide (PTCy-haplo) and cord blood transplantation (CBT) are valid alternatives for patients with hematological malignancies when HLA-matched donor transplantation (MDT) is unavailable. However, the effects of graft-versus-host disease (GVHD) on outcomes after these transplants have not been fully elucidated. Therefore, we evaluated the effects of acute and chronic GVHD on transplant outcomes after PTCy-haplo transplants and compared them with CBT and MDT. We included a total of 914 adult patients with hematological malignancies in the Kyoto Stem Cell Transplantation Group registry who received PTCy-haplo (N = 120), CBT (N = 402), and MDT (N = 392), and achieved neutrophil engraftment. A multivariate analysis revealed that grade I-II acute GVHD improved of overall survival (OS) after PTCy-haplo [hazard ratio (HR) = 0.39, P = 0.018] and CBT (HR = 0.48, P < 0.001), but not after MDT (HR = 0.80, P = 0.267) compared with patients without acute GVHD. Grade I-II acute GVHD had a trend toward reducing the risk of nonrelapse mortality (NRM) after PTCy-haplo (HR = 0.13, P = 0.060) and this positive effect was significant after CBT (HR = 0.39, P = 0.003). A negative impact of grade III-IV acute GVHD on NRM was observed after CBT and MDT, but not after PTCy-haplo. Limited chronic GVHD had a positive impact on OS after CBT and MDT, but not after PTCy-haplo. In conclusion, mild acute GVHD improved outcomes after PTCy-haplo and CBT, and limited chronic GVHD improved outcomes after CBT and MDT. These data indicated that the effects of GVHD on transplant outcomes depended on transplant platforms.

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INTRODUCTION: Mixed epithelial-stromal tumor is a biphasic tumor with stromal and benign epithelial components. Only 40 cases of mixed epithelial-stromal tumor originating from a seminal vesicle have previously been published in English. CASE PRESENTATION: A 52-year-old man was transferred to our hospital for evaluation of a 3.0-cm pelvic tumor detected incidentally by computed tomography. Robot-assisted laparoscopic vesicle prostatectomy was performed. We approached the Retzius space from both levels of the pouch of Douglas and peritoneal top of the bladder to clarify the tumor's environment. Pathologically, the tumor was diagnosed as a low-grade mixed epithelial-stromal tumor originating from the right seminal vesicle. There was no evidence of disease recurrence within 51 months. CONCLUSION: This is the first report of robot-assisted laparoscopic vesicle prostatectomy for a seminal vesicle mixed epithelial-stromal tumor. Long-term observation is warranted due to the lack of reports with sufficient follow-up to ensure the procedure's safety.

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We evaluated the clinical significance of indoleamine 2,3-dioxygenase(IDO)during fulvestrant therapyfor multiple metastatic breast cancer patients. IDO activitycan be measured using the tryptophan(Trp)/kynurenine(Kyn)ratio. Trp and Kyn were measured using high-performance liquid chromatography(HPLC). The serum Trp/Kyn level in patients with multiple metastatic breast cancer was lower than in patients without metastases. IDO activityincreased after breast cancer metastases developed. IDO activitywas correlated with the number of metastatic lesions during toremifene and fulvestrant therapy. These results suggested that measurement of the Trp/Kyn ratio is useful to evaluate immunological metastatic status during endocrine therapy.

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Obesitychanges the regulatorymechanisms of the immune system, resulting in impaired immunity. In cancer immune mechanisms, the greater the degree of obesity, the lower the activity of the lymphocytes. Herein, we examined the relationship between obesity and lymphocytes in breast cancer patients undergoing chemotherapy. We recruited 10 recurrent or metastatic breast cancer patients who were administered eribulin. Using bodymass index(BMI), we classified these patients into a non-obese group(BMI<25)and an obese group(BMI>25). We measured the number of lymphocytes before chemotherapy and 8 days after eribulin administration. We examined the decreasing rates of lymphocytes before and after eribulin administration in the 2 groups. The average age was 63.1 years. Non-obese and obese groups comprised 6 and 4 cases, respectively. The average rates of lymphocyte decrease before and after eribulin administration were 13.3%and 12.3% in the non-obese and obese groups, respectively. There were no significant differences between the 2 groups.

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To determine the role of immunosuppressive acidic protein(IAP)in the host defense of surgical patients, we investigated the kinetics of the post-operative elevation of IAP, as well as factors influencing the increase in serum IAP concentration, in 17 patients who underwent breast surgery. IAP was not increased in the pre-operation phase, post-operation phase, or 2 weeks after surgery, byvarious breast surgerymethods. In contrast, IL-6 was increased in the post-operation phase byall breast surgerymethods. IL-6 correlated with anesthesia time. These results suggest that breast surgical methods are less immunologicallyinvasive than other major surgery.

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Locallyadvanced breast cancer lesions often compromise the patient's qualityof life(QOL). Mohs paste is a histopathological fixative containing zinc chloride as the main ingredient. It has been applied to perform chemosurgeryon skin tumors. In recent years, this paste has reportedlybeen veryeffective for controlling various symptoms of skin metastases in inoperable advanced cancer, such as pungent odor and hemorrhage, in the field of palliative care. We evaluated the clinical significance of immunosuppressive acidic protein(IAP)and C-reactive protein(CRP)in the serum of patients with locallyadvanced breast cancer duringMohs paste treatment. The tryptophan(Trp)/kynurenine(Kyn)ratio measures IDO activity. Trp and Kyn were measured byhigh performance liquid chromatography(HPLC). We took serum samples from 3 locallyadvanced breast cancer cases, in the pre-treatment phase, 2 times after the treatment phase, and 5 times after the treatment phase. Then, we measured IAP and CRP in these samples during Mohs paste treatment. Serum IAP values did not differ significantlybetween each of the phases; however, serum CRP values were decreased byMohs paste treatment. These results suggested that Mohs paste treatment for locallyadvanced breast cancer lesions was useful for enhancing the patient QOL, without immunosuppression.

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We evaluated the clinical significance of indoleamine 2,3-dioxygenase(IDO)in intra-cystic tumors of the breast. IDO activitycan be measured byusing the tryptophan(Trp)/kynurenine(Kyn)ratio. Trp and Kyn were measured by high performance liquid chromatography(HPLC). We took liquid from 3 intra-cystic papilloma cases and 5 intra-cystic breast cancer cases. Then, we measured the Trp/Kyn ratio in these samples, and we evaluated the difference in the Trp/Kyn ratio between the papilloma group and the breast cancer group. The Trp/Kyn ratio was significantly lower in the breast cancer group than in the papilloma group. These results suggest that measuring the Trp/Kyn ratio in cystic liquid from intra-cystic breast lesions is useful to distinguish benign intra-cystic lesions from malignant intra-cystic lesions.

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We report a case of breast cancer with microinvasion and lymph node metastasis. The patient was a 72-year-old woman who had spontaneous nipple discharge from her left breast. There was no detectable lesion on mammographyor duct endoscopy. Ultrasonography showed a low echoic lesion, 23×15mm in diameter, in the CD area of her left breast. Contrastenhanced MRI showed a high intensityarea, 25mm in diameter, in her left breast, so microdochectomywas performed. The histopathological diagnosis was invasive ductal carcinoma(invasion of 2mm)and the surgical margin was positive. Therefore, she underwent breast conserving surgeryplus axillaryly mph node dissection. The pathological diagnosis from the resected surgical specimen was invasive ductal carcinoma with micro lymph node metastasis, positive for ER and PgR and negative for HER2/neu protein expression. The Ki-67 labeling index was 10% and the surgical margins were negative. She was treated with radiation and endocrine therapy as adjuvant therapy. One year and 6 months after surgery, she was well without metastasis.

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A 75-year-old woman consulted our hospital for a lump on her left breast. The tumor was 5 cm in diameter and was palpable in the ABE area. The tumor was identified as an intra-cystic tumor using ultrasonography. Contrast-enhanced magnetic resonance imaging showed a tumor with cystic components that were slowly stained in a dynamic study. A fine needle aspiration biopsywas performed, and the pathological diagnosis was class V. Metastatic work-up revealed no evidence of metastasis. Therefore, we determined the clinical stage as T3N0M0, stage II B. Breast reduction surgeryand sentinel lymph node biopsywere performed on the left breast. The histopathological findings from the surgicallyresected specimens showed mucinous components with some invasive ductal components. Therefore, the pathological diagnosis was mixed mucinous carcinoma of the breast. The tumor size was 8 cm in diameter. Here, we report a case of mucinous carcinoma that showed a huge intra-cystic tumor, which is rarely described in the literature.

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We report a case of non-invasive apocrine carcinoma. In this case, we could not identifythe surgical margin. The patient was 39-year-old woman. Micro calcifications were discovered on her right breast during breast cancer screening. Stereotactic vacuum assisted core needle biopsywas performed and the pathological diagnosis was sclerosing adenosis. A low echoic lesion, 26mm in diameter, was discovered in the CDE area of her left breast byultrasonography . A contrast enhanced MRI showed a high intensityarea, 26mm in diameter, on her left breast. Ultrasonographyguided vacuum assisted core needle biopsywas conducted on the low echoic area. The pathological diagnosis was non-invasive ductal carcinoma. We checked her whole bodyand found no metastatic lesion. She underwent breast conserving surgeryplus sentinel lymph node biopsy. We had great difficultyin classifying the surgical margin. The pathological diagnosis from the resected surgical specimen was non-invasive apocrine carcinoma, negative for ER and PgR, and positive for HER2/neu protein expression. The Ki-67 labeling index was 20%, the surgical margins were negative, and the clinical Stage was 0(Tis, N0, M0). She was administered radiation therapy and endocrine therapy as adjuvant therapy. Two years and 6 months after surgery, she is well without metastasis.

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We report a case of occult cancer. In this case, axillaryly mph node dissection and chemotherapywere useful treatments. The patient was a 71-year-old woman who had left axillaryly mph node swelling. Mammographyshowed the swollen axillary lymph nodes, but there was no lesion in either breast. Ultrasonographyalso showed the swollen axillaryly mph nodes, but there was no malignant lesion in her breasts. CT showed swollen axillaryand mediastinal lymph nodes. We checked her entire body, but could not find a malignant lesion, so we diagnosed an occult cancer. She underwent axillary lymph node dissection. The pathological diagnosis from the resected surgical specimen was metastatic carcinoma, negative for ER and PgR, and negative for HER2/neu protein expression. She was given TC chemotherapyand her CEA value decreased. After 8 cycles of TC chemotherapy, she was well without metastasis.

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We evaluated the clinical significance of indoleamine 2,3-dioxygenase (IDO) during fulvestrant therapy for aromatase inhibitor (AI)-resistant metastatic breast cancer. IDO activity can be measured by the tryptophan (Trp)/kynurenine (Kyn) ratio. Trp and Kyn were measured with high performance liquid chromatography (HPLC). Patients with AI resistant metastatic breast cancer had a 28.6% response rate to fulvestrant therapy, and the clinical benefit rate was 76.2%. AI-resistant metastatic breast cancer patients with distant metastases had a lower serum Trp/Kyn level than patients who had local recurrences. During fulvestrant therapy, IDO activity significantly decreased in the fulvestrant responder group compared to that in the fulvestrant non-responder group. During fulvestrant therapy, the IDO activity correlated with the number of metastatic lesions. These results suggest that measuring the Trp/Kyn ratio is useful for evaluating immunological metastatic status during endocrine therapy.

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We evaluated the clinical significance of indoleamine 2,3-dioxygenase (IDO) during I131-radioisotope therapy for metastatic thyroid cancer. The IDO activity can be measured by the tryptophan (Trp)/kynurenine (Kyn) ratio. Trp and Kyn were measured by using high performance liquid chromatography (HPLC). The serum Trp/Kyn levels of were lower in thyroid cancer patients with lung metastases than in patients without metastases. The IDO activity increased after the development of lung metastases from thyroid cancer. The IDO activity was correlated with the number of metastatic lesions during I131-radioisotope therapy. These results suggest that measurement of the Trp/Kyn ratio is useful in the evaluation of the immunological metastatic status during I131-radioisotope therapy.

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We investigated the usefulness of local therapy in elderly breast cancer patients with distant metastases. Sixty-four elderly breast cancer patients were encountered during 10 years. Fifty-one patients had complications. The proportion of endocrine receptor-positive tumors was 95.2%. Patients who had metastases at the first visit represented 22.6% of the study group. Advanced-stage cancers were recognized in elderly patients than other patients. The mean observation time for all the patients was 7.4 years. The mortality from cancer was 6.5%, and the mortality from other diseases was 58.1%. We divided the patients into 2 groups, the non-metastases group (group A, n=48), and the metastases group (group B, n=14). There were no significant differences between groups A and B in the rates of endocrine receptor-positive tumors, surgery rate, and survival rate. These results suggest that endocrine therapy without surgery should be considered in elderly breast cancer patients with endocrine receptor-positive tumors.

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We report a case of interval breast cancer that was an invasive ductal carcinoma of the breast with neuroendocrine differentiation. The patient was a 66-year-old woman who had a breast lump. She had received breast cancer screening every other year. The last screening was 1 year and 6 months prior to diagnosis. A core needle biopsy for breast tumor led to a diagnosis of invasive ductal carcinoma. Breast conserving surgery plus sentinel lymph node biopsy was performed. The pathological diagnosis from the resected surgical specimen was invasive ductal carcinoma with neuroendocrine differentiation, positive for ER and PgR, and negative for HER2/neu protein expression. The surgical margins were negative, and there was no metastasis in the sentinel lymph node. She was administered radiation therapy and adjuvant endocrine therapy. Two years after surgery, she is well without metastasis.

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Sentinel lymph node biopsy using the dye method is generally performed for patients with breast cancer. However, identification of the sentinel lymph node in the mammary gland is occasionally difficult after breast partial resection, as lymph flow is changed under the influence of surgery. Sentinel lymph node biopsy for patients with breast cancer who underwent partial mastectomy without axillary lymph node dissection is grade C1 in the breast cancer clinical practice guideline ver.2 2013. We examined the identification rate of the sentinel lymph node for patients with breast cancer who underwent lumpectomy or partial mastectomy. Lumpectomy and partial mastectomy were performed in 4 and 3 patients, respectively. It was possible to identify the sentinel lymph node in 6 patients, and no metastasis of cancer cells was identified in any patient. In 1 patient who underwent partial mastectomy, it was impossible to identify the sentinel lymph node, and thus, Level Ⅰlymph node sampling was performed. However, the pathological diagnosis was no metastasis of cancer cells. This patient underwent partial mastectomy of the C area and a smaller volume of the mammary gland. Therefore, we consider that lymph flow changed under the influence of surgery. Sentinel lymph node biopsy using the dye method after partial breast resection is useful, but partial mastectomy of the C area makes it difficult to perform sentinel lymph node biopsy.

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