RESUMEN

The patient was a 77-year-old female with a history of treatment for cancer of the right breast 27 years earlier, who presented with a chief complaint of a subcutaneous mass in the left lower quadrant of her abdomen. A thorough examination revealed high breast cancer-related tumor marker values, and based on a computed tomography(CT)examination, a tentative diagnosis of multiple lung, liver, retroperitoneal, and abdominal wall metastases was made. Although there were multiple organ metastases, in view of the long interval before the recurrence, absence of any symptoms, and the patient's age, we initiated treatment by weekly administration of an aromatase inhibitor and trastuzumab. The treatment was effective; the multiple metastases regressed, and the tumor marker levels decreased. One year after the start of treatment, the patient had a rebound in the tumor marker levels, and an increase in the size of the liver metastases was observed in diagnostic images. The aromatase inhibitor was discontinued and replaced with high-dose toremifene citrate, and trastuzumab was administered every other week. This regimen achieved efficacy, and the liver metastases regressed. As of 2years since the start of the initial treatment, no progression of the metastases has been observed, and the patient continues to be treated with the same regimen.

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RESUMEN

We herein report the case of a patient who showed a pathological complete response after undergoing chemotherapy with capecitabine, oxaliplatin and bevacizumab. The patient presented with synchronous solitary liver metastasis from sigmoid colon cancer. The maximum diameter of the liver deposit was 5.7 cm and the grade of the liver metastasis was H2 according to the Japanese classification. Deferred hepatectomy after sigmoidectomy was performed, followed by the administration of neoadjuvant chemotherapy. After undergoing sigmoidectomy, the patient received 1,000 mg/m(2) of capecitabine and 130 mg/m(2) of oxaliplatin without bevacizumab as the first cycle of chemotherapy followed by eight cycles of chemotherapy with bevacizumab (7.5 mg/kg) every three weeks. The liver deposit was reduced to 2.2 cm in diameter and the patient showed a partial response to chemotherapy. The patient then underwent metastasectomy of segment 8 of the liver instead of the central hepatectomy that was possibly needed before chemotherapy. Histopathologically, the tumor consisted of fibrous tissue, and no cancer cells were detected in the resected specimen. A pathological complete response in a patient with H2 liver metastasis is considered rare and suggests that capecitabine, oxaliplatin and bevacizumab are efficacious as neoadjuvant chemotherapy.

RESUMEN

BACKGROUND: We report an extremely rare case of concomitant huge exophytic GIST of the stomach and Kasabach-Merritt phenomenon (KMP). CASE PRESENTATION: The patient was a 67-year-old man experiencing abdominal distension since September 2006. A physical examination revealed a 25 x 30 cm hard mass that was palpable in the middle and lower left abdomen minimal intrinsic mobility and massive ascites. Since the admitted patient was diagnosed with DIC, surgery could not be performed. The patient received a platelet transfusion and the DIC was treated. Due to this treatment, the platelet count recovered to 7.0 x 10(4); tumor resection was performed at 16 days after admission. Laparotomy revealed a huge extraluminal tumor arising from the greater curvature of the stomach that measured 25 x 30 cm and had not ruptured into the peritoneal cavity or infiltrated other organs. Partial gastric resection was performed. The resected mass measured 25 x 25 x 20 cm. In cross section, the tumor appeared hard and homogenous with a small polycystic area. Histopathology of the resected specimen showed large spindle cell GIST with >5/50 HPF (high-power field) mitotic activity. The postoperative course was uneventful, and the coagulopathy improved rapidly. CONCLUSION: Since the characteristic of tumor in this case was hypervascularity with bleeding and necrotic lesions, coagulopathy was thought to be caused by the trapping of platelets within a large vasculized tumor mass.

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