RESUMEN
BACKGROUND: Colonic metastasis from breast carcinoma is very rare. Here, we report a case of colonic metastasis from breast carcinoma. CASE PRESENTATION: The patient was a 51-year-old woman. She had upper abdominal pain, vomiting, and diarrhea, repeatedly. We performed abdominal contrast-enhanced computed tomography (CT) to investigate these symptoms. The CT scan revealed a tumor in the ascending colon with contrast enhancement and showed an expanded small intestine. For further investigation of this tumor, we performed whole positron emission tomography-computed tomography (PET-CT). The PET-CT scan revealed fluorodeoxyglucose uptake in the ascending colon, mesentery, left breast, and left axillary region. Analysis of biopsy samples obtained during colonoscopy revealed signet ring cell-like carcinoma. Moreover, biopsy of the breast tumor revealed invasive lobular carcinoma. Therefore, the preoperative diagnosis was colonic metastasis from breast carcinoma. Open ileocecal resection was performed. The final diagnosis was multiple metastatic breast carcinomas, and the TNM classification was T2N1M1 Stage IV. CONCLUSIONS: We presented a rare case of colonic metastasis from breast carcinoma. PET-CT may be useful in the diagnosis of metastatic breast cancer. When analysis of biopsy samples obtained during colonoscopy reveals signet ring cell-like carcinoma, the possibility of breast cancer as the primary tumor should be considered.
Asunto(s)
Neoplasias de la Mama/patología , Carcinoma Lobular/patología , Carcinoma de Células en Anillo de Sello/secundario , Neoplasias del Colon/secundario , Neoplasias de la Mama/diagnóstico por imagen , Carcinoma Lobular/diagnóstico por imagen , Carcinoma de Células en Anillo de Sello/diagnóstico por imagen , Neoplasias del Colon/diagnóstico por imagen , Colonoscopía , Femenino , Humanos , Persona de Mediana Edad , Pronóstico , Tomografía Computarizada por Rayos XRESUMEN
Irinotecan is an effective drug in the treatment of colorectal cancer. However, there are reports of an association between certain UGT1A1 genetic polymorphisms and the development of adverse reactions(such as neutropenia)related to irinotecan metabolism. We retrospectively investigated UGT1A1 genetic polymorphisms and the occurrences of irinotecan-induced neutropenia in 25 patients of colorectal cancer at our hospital. Analysis of UGT1A1 genetic polymorphisms in these patients yielded the following classifications: a wild-type group( *1/*1)comprising 13 patients(52%), a heterozygous group(*1/ *28, *1/*6)of 10 patients(40%), and a homozygous group(*28/*28, *6/*6)of 2 patients(8%). The frequency of neutropenia was 15.4%(2/13)in the wild-type group, 30%(3/10)in the heterozygous group, and 100%(2/2)in the homozygous group. Grade 4 neutropenia only occurred in the homozygous group. These results suggest that a dose reduction of irinotecan should be considered for patients who fall into the homozygous group upon analysis of their UGT1A1 genetic polymorphisms, as such patients might be susceptible to grade 4 neutropenia.
Asunto(s)
Antineoplásicos Fitogénicos/efectos adversos , Camptotecina/análogos & derivados , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/genética , Glucuronosiltransferasa/genética , Leucopenia/inducido químicamente , Neutropenia/inducido químicamente , Polimorfismo Genético , Adulto , Anciano , Antineoplásicos Fitogénicos/uso terapéutico , Camptotecina/efectos adversos , Camptotecina/uso terapéutico , Femenino , Humanos , Irinotecán , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
We herein report the first case of a single-incision laparoscopic access (SILA) adrenalectomy in Japan. A 74-year-old woman who was a hepatitis B virus carrier was referred to our hospital because of an abnormal screening result during a routine health checkup. Abdominal computed tomography and an endocrinologic workup revealed a 2-cm left adrenal tumor with primary aldosteronism. We prioritized the safety of the SILA adrenalectomy by choosing a left lower abdominal approach. A SILS port was inserted through a 2.5-cm incision. An ultrasonic coagulator was the main tool used during the surgical procedure. The duration of the surgery was 105 min and the blood loss was 1 ml. This result was comparable to that of a conventional laparoscopic adrenalectomy. Based on our experience, an SILA adrenalectomy is thus considered to be feasible and safe, with better cosmetic results and a greater overall patient satisfaction than that of a conventional laparoscopic adrenalectomy. However, further studies will be necessary before the universal adoption of this new technique can be considered.
Asunto(s)
Adrenalectomía/métodos , Hiperaldosteronismo/cirugía , Laparoscopía , Anciano , Femenino , Humanos , Hiperaldosteronismo/diagnósticoRESUMEN
A 60-year-old man was admitted to our hospital with a tumor in the thoracic esophagus, and squamous cell carcinoma was detected by endoscopic biopsy. On computed tomography, the tumor was suspected of having invaded adjacent organs by so the patient was given neoadjuvant chemotherapy consisting of low-dose CDDP and 5-FU. After 2 courses of chemotherapy, a subtotal esophagectomy was performed. The resected specimen showed no residual squamous cell carcinoma but another tumor was found in the submucosal layer which had a cribiform pattern in a solid nest. The tumor cells were positive for S-100 protein and an Alcian-blue-positive substance in the gland, so the tumor was diagnosed as an adenoid-cystic carcinoma.
Asunto(s)
Carcinoma Adenoide Quístico/patología , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Esofágicas/patología , Carcinoma Adenoide Quístico/tratamiento farmacológico , Carcinoma Adenoide Quístico/cirugía , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Diferencial , Neoplasias Esofágicas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Terapia NeoadyuvanteRESUMEN
We present a case of esophageal cancer with multiple lymph node metastases successfully performed early response evaluation for preoperative chemotherapy by FDG-PET. The decrease of SUV from baseline to 11 days after initiation of low-dose FP chemotherapy were 32.8% in the primary lesion, 60.4% in the cervical lymph node and 13.5% in the abdominal lymph node. He underwent extended radical esophagectomy 4 weeks after the end of chemotherapy. The histopathologic response was Grade 1 in the primary lesion, Grade 3 in the cervical lymph node and Grade 0 in the abdominal lymph node. The early response evaluation by FDG-PET in each lesions were consistent with histopathologic response evaluation of after chemotherapy.