Background: Peliosis is characterized by multiple cyst-like blood-filled cavities, and is potentially hazardous because of the possibility of spontaneous rupture. Herein, we describe a patient with ectopic spleen accompanied by peliosis and epithelial cyst, which mimicked a pancreatic cystic neoplasm. Case: A 44-year-old asymptomatic male patient was referred for treatment of an enlarged mass in the pancreatic tail.Abdominal computed tomography and magnetic resonance imaging revealed a 3.5-cm cystic lesion with a clear, thick, and smooth cyst wall, which was enhanced by contrast media. Under a tentative diagnosis of mucinous cystic neoplasm of the pancreas, the patient underwent distal pancreatectomy. Postoperative pathological examination identified the lesions as peliosis and epithelial cyst of the intrapancreatic heterotopic spleen. Conclusion: Cystic formations in the intrapancreatic spleen mimic mucin-producing neoplastic lesions and can be misdiagnosed. Peliosis may cause rapid growth of the cysts, mistakenly indicating a malignant potential of the lesion.
Pneumatosis intestinalis is a condition characterized by the presence of gas within the wall of the small or large intestine. The causes, clinical features, and prognosis vary among individual cases, and careful assessment is crucial for appropriate treatment. Herein, we describe three cases of pneumatosis intestinalis with different clinical features. The small intestine was involved in two patients, whereas the ascending colon was involved in the third patient. Surgical intervention was chosen in two patients because of severe abdominal pain, decreased base excess, and the presence of portal venous gas (in one patient). However, there were no signs of intestinal necrosis on pathological examination. In the third case, computed tomography revealed free air within the peritoneum. Despite this, the patient was not experiencing any severe abdominal pain or deterioration of vital signs, and was treated successfully with fasting and antibiotics. The third patient was on several medications, such as immunosuppressant, prednisolone for cutaneous malignant lymphoma, and α-glucosidase inhibitor for diabetes mellitus, and the condition was suggested as drug-induced pneumatosis intestinalis. In conclusion, patients with pneumatosis intestinalis present with various clinical features from critical to mild conditions. Some are accompanied by severe signs such as portal venous gas, intraperitoneal free air, and metabolic acidosis, necessitating urgent intervention; contrarily, the other can be managed conservatively. For successful treatment, the evaluation of the severity of the disease and the accompanying conditions such as perforation and necrosis of the intestine is mandatory.
Purpose: S-1, an orally administered fluorinated pyrimidine (FP), is reported to be effective for the treatment of metastatic breast cancer (MBC). Although capecitabine, another oral FP, is widely accepted as the third-line chemotherapy for MBC, many patients treated with capecitabine suffer from hand-foot syndrome (HFS). HFS also affects survival in patients with metastatic colorectal and breast cancer. We retrospectively evaluated the potential association of HFS and survival in patients with MBC receiving S-1. Methods: Forty-four patients with MBC treated with S-1 between 2005 and 2012 were analyzed. S-1 was administered at a standard dose of 50 mg/body twice daily for 4 weeks, followed by a 2-week interval. Partly, the drug was administered for 2 weeks, followed by a one-week interval. Trastuzumab (2 mg/kg/week) was added to the regimen for HER2-positive patients. Results: The median follow-up period was 25.8 months and 12 patients (27.3%) developed HFS. Grade (G) 1 HFS was observed in 9 patients (20.5%) and G2 in 3 patients (6.8%). No G3/4 HFS was observed. Baseline demographic characteristics were comparable between the HFS and non-HFS patient groups. The HFS group showed a superior response rate (50.0% vs. 9.4%; P=0.0046), and improved median PFS (9.8 vs. 4.7 months; log-rank P=0.0446) and OS (51.5 vs. 17.5 months; logrank P=0.0196). In multivariate analysis, HFS is the only and independent prognostic factor (HR 2.93; 95% CI, 1.12 to 9.27; P=0.0269) of OS. Conclusion: HFS observed in patients with S-1 not only correlates with an antitumor effect, but is also an independent prognostic factor.
Background: Carcinomatous meningitis (CM) in non-small cell lung cancer (NSCLC) has no standard treatment and poor prognosis, with a median survival of 4-9 weeks. Recently, NSCLC subgroups with driver mutations were identified, with mutation of epidermal growth factor receptor gene (EGFR) being the most frequent. This retrospective study investigated the frequency and characteristics of CM in EGFR-mutated patients. Methods: From April 2007 to June 2013, consecutive NSCLC patients were screened for EGFR mutations using the PNA-LNA PCR Clamp in one institution. Diagnosis of CM was based on the presence of malignant cells in cerebrospinal fluid and/or MRI detection of leptomeningeal enhancement. Incidence and clinical features of CM patients were investigated from medical records. Results: Of 1343 NSCLC patients, 387 (28.8%) harboring EGFR mutations. Thirty-five patients (2.6%) developed CM; the rate of CM in EGFR-mutated patients (25/387, 6.46%) was significantly higher than in patients lacking the mutations (10/956, 1.04%; p < 0.01). Multiplex logistic analysis indicated strong associations between CM and EGFR mutation (p < 0.0001), brain metastasis (p < 0.0001) and non-squamous cell carcinoma histology (p = 0.026). Conclusions: NSCLC patients with EGFR mutations are more likely to develop CM than those with wild EGFR.