Hemangiosarcoma is a very fatal tumor that has been increasing recently. However, no concrete guide for systematic treatment has yet been proposed. Therefore, we present our current remedy strategy for hemangiosarcoma which is based on our clinical experience in Kitasato University Hospital. The four important points of our remedy strategy are: 1) be well aware of the tumor characteristics, 2) understand the problem points of each treatment, 3) select a treatment suitable for the tumor stage, and 4) obtain sufficient informed consent.
Seven patients with mycosis fungoides (2 patch and 8 plaque stages) were treated with topical 5-aminolevulinic acid photodynamic therapy (ALA-PDT). The total irradiation doses from the excimer dye laser to the patch and plaque lesions were 80 J/cm2 and 200～600 J/cm2, respectively. Regression of eruption and histological disappearance of atypical lymphocytes in the lesions were achieved with 9 lesions in 6 patients. Topical ALA-PDT is a noninvasive treatment that allows repeated irradiation. These results suggest that ALA-PDT can be a useful treatment for mycosis fungoides.
A 37-years-old male, attempted to commit suicide, by injecting xylene into his arm. In a few hours, his arm swelled with pain. Cooling the wound and intravenous fluids controlled the symptoms for about two weeks. Slight urine methylhippuric acid elevation and liver dysfunction due to xylene poisoning were observed during this course. The slight remaining lesion was expected to disappear without treatment. However, two months after the xylene injection, the fatty tissue around the injection site necrosed, and debridement was necessary for saving his arm. Organic solutions, like xylene, have a high affinity for fatty tissue, and we believe that the fatty tissue of his left arm was degenerated by the injected and penetrated xylene. In this kind of case, careful follow up is needed for a long term.
Angiosarcoma is known to be one of the most fatal sarcomas. It frequently metastases to the lung and may become fatal there. Although a standard chemotherapy for angiosarcoma is still not established, the combination chemotherapy with CYVADIC regimen (cyclophosphamide, vincristine, doxorubicin, dacarbazine) is widely accepted. This regimen showed a high response ratio in some early trials, but later trials raised doubts about its effects. Moreover, the CYVADIC regimen frequently causes serious bone marrow suppression, and it put aged cases at high risk. Recently, some authors reported the cases of angiosarcoma successfully treated with a new anti-tumor agent, taxanes. We herein report a case of breast angiosarcoma with multiple metastases in the lung treated with weekly docetaxel (taxotere®) therapy. A complete response was observed after two courses of therapy. This case maintains complete remission for five months as of February 2003.
We examined the prevalence of actinic keratosis (AK) and skin cancers in Oita, Japan, in 2000 and 2001. Two different areas, Himeshima and Naoiri, with the same population of about three thousand, were chosen for this study. The major industry in Himeshima is fishing, and that in Naoiri is agriculture. The prevalences of AK and basal cell carcinoma (BCC) in Himeshima were 1274 and 536 per 100,000 Japanese in 2000, and 1,238 and 48 in 2001, respectively. These values were significantly higher than those in Naoiri, AK 312 and BCC 29 per 100,000 Japanese in 2000, and AK 121 and BCC 30 in 2001. The differences in the prevalences of AK and skin cancer in these two areas seem to be related to the differences in the major industries, fishing and agriculture, although the people engaged in both occupations have been generally supposed to be equally exposed to strong sunlight. The people with skin type I showed a higher prevalence of AK than those with skin types II or III in Himeshima.
Narrow-band UVB therapy is popular in Europe and America. Recently, this therapy has become an established choice of intervention in the treatment of psoriasis in Japan. The most important aspect of this type of therapy is the determination of the optimal irradiation dose for the patient. This dose can be ascertained by the minimal erythema dose in narrow-band UVB therapy (nMED) prior to the commencement of therapy. Our study has exactly measured, and analyzed nMEDs in psoriatic and non-psoriatic patients. We found that nMEDs have quite regular distributions. The average nMED for the psoriatic patients was 0.68 J/cm2 (median 0.49 J/cm2, range 0.32–1.62 J/cm2). There were no significant differences in the average nMED or its distribution for the psoriatic vs. the non-psoriatic patients. The average nMED in our psoriatic patients was slightly higher than those reported in previous studies.