In this single center retrospective study, we studied 50 adults with acute myelogeneous leukemia (AML)(n=40) and myelodysplastic syndrome (MDS)(n=10) who received first allogeneic hematopoietic stem cell transplantation (allo-HSCT) to determine pre-transplant prognostic factors. The median age of our patients was 41. 4 years. Thirty two per cent of the patients were transplanted in non-remission and 44% have poor risk chromosomal abnormalities by National Comprehensive Cancer Network (NCCN) for AML and international prognostic scoring system (IPSS) for MDS. At 3 years, probabilities of overall survival, progression free survival, relapse rate and non-relapse mortality rate were 48.8, 41.3, 38.9 and 27.8% for the whole cohort, respectively. The prognostic impact for several pre-transplant parameters was assessed by univariate and by multivariate analyses using the Cox regression model. As a result, we reached conclusions that poor risk chromosomal abnormality was the most important prognostic factor before transplantation. We divided a chromosomal risk into a group of good plus intermediate risk (good risk group) and a group of poor risk (poor risk group) and performed analysis. We obtained conclusions to consider by therapeutic stratification in a chromosome risk in allo-HSCT as well as chemotherapy.

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A 26-year-old primigravida at 10 weeks of gestation was referred to us for prolonged APTT and decreased coagulation factor VIII activity (FVIII: C) . Additional hemostatic studies demonstrated decreased von Willebrand factor (VWF) activity (VWF: Rco) and its antigen (VWF: Ag) levels, and decreased ristocetin-induced platelet agglutination (RIPA) , and defects of high molecular weight (HMW) multimers of VWF. She was diagnosed with von Wilebrand disease (VWD) , type 2A. The pregnancy course was uneventful. She had a baby boy by transvaginal delivery at 39 weeks with the replacement transfusion of FVIII/VWF concentrates. The amount of bleeding during labor was twice above usual, however blood transfusion was unnecessary. The baby was in asphyxia shortly after labor, however soon recovered after intratracheal aspiration. The bleeding at puerperium was minimum. The baby grew up normally without any complications.

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We report a rare respectable case of breast cancer with cartilaginous and/or osseous metaplasia that was StageIV (t4b, n1, m1), on the basis of the Japanese General Rules for Clinical and Pathological Recording of Breast Cancer. A 57-year-old woman visited our hospital because of a left breast painful mass that had increased in size rapidly in March 2009. Further examinations offered a suspicion of malignant tumor. A left mastectomy with axillary lymph node dissection was performed, when the intraoperative pathological examination demonstrated stromal sarcoma of the breast. Postoperative histological diagnosis was a breast cancer with cartilaginous and/or osseous metaplasia and lymph node matastasis of the ductal carcinoma component. Postoperative day 19th, left axillary mass was found, and also chest computed tomography demonstrated a lung mass lesion. Left lung partial resection and left axillary tumorectomy was performed. Pathologically the left axillary mass lesion was panniculitis. On the other hand, the lung mass lesion was the osteosarcoma from the breast cancer with cartilaginous and/or osseous metaplasia belongs to a special type of invasive carcinoma. This type breast cancer with resectable distant metastatic lesions is very rare in literature.

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We report a relatively rare case of duodenum gastrointestinal stromal tumor(GIST)treated by surgery. The patient was a 64-year-old woman who presented anemia; Esophagogastroduo-denoscopy(EGD)revealed a tumor of duodenum with oozing bleeding, and she was referred to our hospital for further examination and treatment. Abdominal CT images showed a mass that was located forward of the duodenum and 85mm in diameter. EGD revealed a duodenal submucosal tumor and GIST was diagnosed by endoscopic biopsy. The tumor was resected at laparotomy and histologically classified as high risk group. Therefore, we added adjuvant chemotherapy by imatinib. We followed up the patient without recurrence.

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