We report a case of early esophageal carcinomas associated with achalasia treated by endoscopic submucosal dissection. A 46-year-old man was diagnosed of esophageal achalasia, flask type and Grade II in 2001, and had been treated by pneumatic dilatation for symptomatic achalasia conservatively. The patient was operated by Tokai University method, Heller's long esophagomyectomy, Hill's posterior cardiopexy, fundoplication and selective proximal vagotomy using a laparotomy in August 2009. One year and three months after the operation, two lesions of early carcinomas of type 0-IIb and 0-IIc, each 1cm in size, were detected in the middle thoracic esophagus, and treated by endoscopic submucosal dissection. Pathological examination of the each lesion revealed proliferation of squamous cell carcinoma in situ (T1a-EP). The entire esophageal mucosa around the carcinoma demonstrated hyperplastic changes of stratified squamous epithelium and foci of intraepithelial neoplasia. In the patient of achalasia, food stasis in esophagus is thought to induce chronic hyperplastic esophagitis, converting eventually to malignant transformation. Achalasia is known as a risk factor of esophageal squamous cell carcinoma. Careful long-term follow-up for patients of achalasia by endoscopic screening is recommended, even if after treatment by pneumatic dilatation or operation for achalasia.
Prominent lymphocytic infiltration and lymphoid follicles surrounding tumor cells are extremely rare findings in esophageal carcinoma. We report on the endoscopic, histological, and immunohistochemical features of a rare case of squamous cell carcinoma of the esophagus with lymphoid stroma. A 59-year-old woman was diagnosed with type 0-Is superficial esophageal carcinoma and underwent radical esophagectomy with lymph node dissection. Macroscopically, the tumor was protruding, and was covered with normal epithelium resembling a submucosal tumor. Histopathological examination demonstrated that the esophageal lesion was classified as a poorly differentiated squamous cell carcinoma with lymphoid stroma, extending to the deep submucosa (SM3) with lymph node metastasis (T1b, N2, M0, stage II). Epstein-Barr virus infection was ruled out by immunohistochemical and in situ hybridization analyses. Infiltrating B-lymphocytes were observed forming lymphoid follicles adjacent to carcinoma cell nests, and numerous T lymphocytes were widely spread throughout the specimen, as well as distributed in the marginal zone of the lymphoid follicles. Prominent human leukocyte antigen DR region (HLA-DR) immunoreactivity was noted in most carcinoma cells and focally infiltrating B cells in the lymphoid follicles, and these observations were thought to be due to activation of immunological interactions between carcinoma cells positive for HLA-DR and host lymphocytes.
Purpose: A feasibility study was conducted to investigate whether synchronized intra-aortic chemotherapy (SIAC) could be a safe method, and improve quality of life of far advanced gastric cancer patients with tumor-related symptoms. Patients and Methods: Sixty-seven patients disordered their performance status with stage IV or recurrent gastric cancer localized to the abdominal cavity were entered in the study. SIAC regimen consisted of bolus intra-aortic injection (IA) of cisplatin 6 mg/m2/body and methotrexate 6 mg/m2/body per day on days 1 to 5 in the morning, followed by continuous IA of 5-fluorouracil 150 mg/m2/body/day for 5 days, and systemic infusion of l-leucovorin 15 mg/m2/body/day on days 2 to 6 at 8 PM, repeated every 3 weeks for the first three courses and every 1-3 months after the fourth course. Results: The response rate was 61% (CR 2, PR 37). The tumor control rate (CR+PR+NC) was 89%. Performance status were improved in 51% of the patients. The incidences of side effects of grade 3 or more was anorexia 8.9%, leucopenia 4.5%, and nausea 3.0%. Conclusion: These data suggest that SIAC regimen is safe and effective for response rate and performance status in patients with stage IV advanced gastric cancer, localized in the abdominal cavity.
Background: The aim of this study was to evaluate the activity and toxicity of EC (epirubicin/cyclophosphamide) followed by docetaxel (DTX) as primary systemic therapy in locally advanced breast cancer. We previously reported the pathological and objective responses of this study. Another follow-up period of 5 years (5-y) has passed, and the 5-y overall survival (OS) and relapse-free survival (RFS) rates have been determined. Patients and Methods: Patients of the T2-4 (＞3 cm) or N1-3 were included. Patients received E (90 mg/m2) and C (600 mg/m2) for 4 cycles followed by DTX (70 mg/m2) for 4 cycles. Results: Overall (n=46), 5-y OS was 93.2% and 5-y RFS was 72.9%. In subgroup analysis, 5-y OS and RFS were 96.4% and 70.6% in luminal, 100% and 50% in luminal-HER2, 71.4% and 57.1% in HER2, 100% and 100% in triple negative. Conclusion: This treatment provides survival benefit especially for patients with triple-negative breast cancer.
We report a case of undifferentiated carcinoma of the extrahepatic bile duct. An 81-year-old woman was admitted with appetite loss and high fever. She was diagnosed with obstructive jaundice due to extrahepatic bile duct carcinoma with bulky lymph node metastases. High fever had continued after the effective percutaneous transhepatic biliary drainage (PTBD) and antibiotics administration. We performed a pancreaticoduodenectomy, and the patient became antipyretic immediately after the surgery. The histological findings revealed undifferentiated carcinoma with multiple lymph node metastases and infiltration of a large number of inflammatory cells in the stroma without abscess or necrosis. Two months after the surgery, high fever appeared together with intrahepatic bile duct recurrence, multiple lymph node metastases, and peritoneal metastases. The patient died 112 days after the surgery. Undifferentiated carcinoma arising from the extrahepatic bile duct is rare, and neoplastic fever was strongly suspected from the clinical course and the findings of examinations in this case.
Background: Hyperthermia has not been approved as a standard treatment method in oncology. One of the major problems is that there is no reference point for this therapy. Another problem is that radiofrequency hyperthermia has a fatal flaw, the hot spot phenomenon, which does not allow continuation of treatment without lowering the output. Patients and Methods: Hyperthermia treatment was administered either alone or concomitantly with chemotherapy and/or radiotherapy to 76 consecutive patients with malignancies, using Thermotron RF-8, between December 2011 and April 2014. Radiofrequency hyperthermia was administered 5 times for 5 weeks with 50 min irradiation in all patients. Results: Complete response (CR) was seen in 35.2% of primary cases, but in 4.5% of recurrent cases, and this rate was higher in patients with three days after first chemoradiation. There was significant correlation among the initial irradiation output at which complications occurred, initial time at which complications occurred and the physical status of the patients, such as visceral fat area. All patients with CR had significantly higher increased body temperature than the other patients. However, patients with progressive disease and 17 or more Hidaka output points showed significantly higher increased body temperature than patients with partial response or stable disease. Conclusions: Patients with CR had higher temperatures, but some patients with higher temperature also showed progressive disease. Further studies to examine the discrepancy between the clinical and histological response by using a large sample of surgically resected cases and to validate and reconfirm our findings are warranted.