Surgical treatment for metastatic liver cancer from colorectal cancer has reached a positive consensus owing toeffective new chemotherapies and improvements in surgical techniques. There is currently some evidence available about surgical treatments for metastatic liver cancer from various organs, and it is the beginning of a new erafor radical treatment for noncolorectal cancer. Clinically, the treatment strategy for metastatic cancer is graduallychanging for each organ. Therefore, it is true that some categories of patients can reach longer survival than before.However, the number included in each study is very small, and robust evidence has not been obtained. Therefore,the indication for metastatic liver cancer from noncolorectal cancer remains controversial. The aim of this reviewarticle is to show the current treatment strategies for metastatic liver cancer from various organs, focusing on livermetastasis from colorectal cancer.
Background: Purpura fulminans is a fulminant debilitating disorder with a high mortality rate; its characteristicsinclude disseminated intravascular coagulation, thrombosis, tissue necrosis, cardiovascular collapse, and multipleorgan failure. The most frequent causative pathogens are gram-negative bacteria whose pathogeneses are relatedto endotoxin secretion. Brevundimonas diminuta (B. diminuta) is a ubiquitous aerobic, gram-negative, rod bacterium that causes opportunistic infections, mostly in immunocompromised patients. Although B. diminuta supposedly has low virulence, the clinical features of its infection are unclear due to the limited number of publishedreports.Case presentation: A 30-year-old, previously healthy male presented to the emergency department several hoursafter developing fever, joint pain, and upper abdominal pain. The patient was in shock; his condition rapidly deteriorated, and he subsequently developed skin purpura, hyperfibrinolytic coagulation abnormalities, disturbed consciousness, and multiple organ failure, including acute renal failure. Severe hypercytokinemia and endotoxemiawere observed. Despite intensive care, the patient died 21 hours after hospitalization. B. diminuta was isolatedfrom blood cultures collected prior to antibiotic administration.Conclusion: We describe a fulminant case of hyperfibrinolytic coagulopathy in a previously healthy adult.Although rare, B. diminuta was isolated from blood cultures, and its relationship with purpura fulminans shouldbe considered in this case.
A 65-year-old male was referred to our hospital for the treatment of early gastric cancer. The patient was treated with endoscopic submucosal dissection (ESD). As a result of ESD, the depth of invasion was SM1250 μ, and we performed laparoscopic distal gastrectomy. Computed tomography showed a type VI vascular anomaly in Adachi’s classification. Preoperative vascular construction allowed us to perform the operation without intraoperative complications. To safely perform this operation, preoperative CT angiography is very important.
Terminal deletion of the long arm of chromosome 10 is frequently associated with urogenital anomalies. Renal dysfunction sometimes progresses despite aggressive treatment, and timely interventions are indispensable. Serum creatinine (Cr) overestimates renal function in children with low muscle mass. Meanwhile, serum cystatin-C (cysC) is unaffected by muscle mass. We report the case of a patient with terminal deletion of chromosome 10q associated with low muscle mass and renal dysfunction due to urinary anomalies. Treatment for renal dysfunction was performed by monitoring cysC. At 2 years of age, as cysC increased, although Cr was normal, prostatic diverticulectomy and vesicostomy were performed. At 3 years of age, as cysC was high, although Cr normalized, residual prostatic diverticulectomy was performed. At 5 years of age, cysC normalized later than Cr. CysC enabled accurate evaluation and early intervention of renal dysfunction compared to Cr in a patient with chromosomal abnormalities with low muscle mass.
After the completion of standard treatment for HER2-negative metastatic breast cancer, a 42-year-old female patient underwent the FoundationOne®CDx gene panel test, and the ERBB2 gene was amplified. The HER2 IHC test of the biopsy specimen was 2+, and the FISH test was positive. Anti-HER2 therapy was started, and a partial response was observed. The gene panel test has the potential to change the prognosis of some breast cancer patients, because the test makes it possible to identify eligible patients among the patients who are not eligible for anti-HER2 therapy by the existing HER2 test.
Magnetic resonance imaging (MRI) is widely recognized as an imaging method with relatively higher sensitivity than other imaging modalities for detecting breast cancer (BC), although the specificity is controversial. Wetreated a patient with BC that was detected by MRI and confirmed by examination of an MRI-guided biopsyspecimen. The tumor was not clearly identified by ultrasonography (US), mammography (MMG), or a physicalexamination. A 50-year-old female came to our hospital because a focally asymmetric density (FAD) in the leftbreast was seen on MMG. Physical and US examinations were unremarkable. However, MRI showed enhancednodules distributed segmentally in the right lower internal quadrant. An US performed 3 months later did notshow any findings in the region. Therefore, we referred the patient to a hospital that was equipped to performMRI-guided biopsy. Ultrasound-guided fine needle aspiration and core needle biopsy of the region were unable toconfirm the presence of BC, but ductal carcinoma in situ (DCIS) was seen on an MRI-guided biopsy specimen.The patient then underwent surgery at our hospital. This case taught us the importance of breast MRI andMRI-guided biopsy for lesions not demonstrated on US or MMG.