Multiple endotracheal metastases of combined small cell lung carcinoma.

We report a very rare case of combined small cell lung carcinoma (C-SCLC) which presented as persistent cough and was due to endotracheal metastases. Clinicians should be aware of this unusual site of metastases from a C-SCLC.

Immunoglobulin G4-positive interstitial pneumonia associated with pleuroparenchymal fibroelastosis.

A 79-year-old former smoking Japanese man was admitted to our hospital with a 2-year history of dry cough and dyspnoea on exertion. High-resolution computed tomography of the chest revealed reticulation and perilobular opacity with bronchial wall thickening and ground-glass opacities (GGOs) in both lungs, in addition to subpleural dense consolidation (pleuroparenchymal fibroelastosis-like lesion; PPFE-like lesion) predominantly in the bilateral upper lobes. Serum immunoglobulin G4 (IgG4) was elevated (348 mg/dl). Lung biopsy specimens obtained by video-assisted surgery revealed a mixture of usual interstitial pneumonia (IP) and non-specific IP pattern admixed with PPFE. In addition, immunohistochemical staining of IgG4 showed numerous IgG4-positive plasma cells. Consequently, he was diagnosed with IgG4-positive IP associated with PPFE. We initiated a combination therapy with prednisolone and cyclosporine as a calcineurin inhibitor. During prednisolone tapering, his clinical conditions and GGOs improved gradually over 12 months. However, reticular opacities and PPFE-like lesions remained unchanged, and pulmonary function test findings slightly deteriorated.

Post-coronavirus disease 2019 organizing pneumonia confirmed pathologically by video-assisted thoracoscopic surgery.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has become a global pandemic. Many survivors of serious COVID-19 pneumonia have long-term residual pulmonary disease. However, there is little documentation of the histopathological characteristics of lung sequelae post-COVID-19 and effective treatments. We present two Japanese cases of lung sequelae post-COVID-19. The patients were histopathologically diagnosed with organizing pneumonia (OP) or OP with fibrosis and no diffuse alveolar damage on video-assisted thoracoscopic surgery. Case 1, who had been diagnosed with OP, was successfully treated with corticosteroid and other immunosuppressive agents over a 6-month period. Although case 2, who had been diagnosed with OP with fibrosis, had a partial and unsatisfactory response to immunosuppressive agents, the patient responded to antifibrotic treatment including nintedanib.

Acute exacerbation in chronic bird fancier's lung with pleuroparenchymal fibroelastosis.

A 71-year-old non-smoker woman was admitted to our hospital complaining of a six-month history of dry cough. She had kept java sparrow for nine years and has been raising budgerigars for the previous eight months. High-resolution computed tomography (HRCT) images of the chest revealed reticulonodular lesions predominantly in the bilateral upper lobes. Surgical lung biopsy specimens showed non-caseous epithelioid cell granulomas in the alveolar spaces, including irregular and centrilobular fibrosis with pleuroparenchymal fibroelastosis. When she started using a duck feather duvet at home, she developed dyspnoea and chest HRCT abnormalities progressively deteriorated. The results of precipitation of antibodies against duck feather, java sparrow, and budgerigars dropping extracts were positive in sera. Consequently, the patient was diagnosed as having chronic bird fancier's lung with acute exacerbation caused by the use of a feather duvet. After combination treatments with corticosteroid and cyclosporine, her respiratory symptoms and reticulonodular shadow immediately improved.

Miliary opacities in pulmonary sarcoidosis.

Pulmonary sarcoidosis should be considered in the differential diagnosis of miliary opacities in bilateral upper lobes predominance.

Lymph Node Positivity in One-Step Nucleic Acid Amplification is a Prognostic Factor for Postoperative Cancer Recurrence in Patients with Stage II Colorectal Cancer: A Prospective, Multicenter Study.

BACKGROUND: For colorectal cancer (CRC) patients, the standard histological lymph node (LN) evaluation has low sensitivity. Our previously developed one-step nucleic acid amplification (OSNA™) assay measures cytokeratin 19 gene expression in whole LNs. We recently showed that 17.6% of pN0 stage II CRC patients were OSNA positive, suggesting a correlation between OSNA results and disease recurrence. This multicenter, prospective study investigateed the prognostic value of the OSNA assay for pStage II CRC patients. METHODS: We examined 204 CRC patients who were preoperatively diagnosed as cN0 and cN1 and surgically treated at 11 medical institutions across Japan. Nine patients were excluded, and 195 patients (Stage I: n = 50, Stage II: n = 70, Stage III: n = 75) were examined. All LNs, harvested from patients, were examined histopathologically using one-slice hematoxylin-eosin staining. Furthermore, half of the LNs was examined by the OSNA assay. Patients were classified according to the UICC staging criteria and OSNA results, and the 3-year, disease-free survival (DFS) of each cohort was analyzed. RESULTS: Average 21.2 LNs/patient were subject to pathological examination. Approximately half of all harvested LNs (average, 9.4 LNs/patient) were suitable for the OSNA assay. Significantly lower 3-year DFS rates were observed in pStage (pathological Stage) II OSNA-positive patients than in OSNA-negative patients (p = 0.005). Among all assessed clinical and pathological parameters, only the OSNA result significantly affected 3-year DFS rates in pStage II CRC patients (p = 0.027). CONCLUSIONS: This study shows that OSNA positivity is a risk factor for recurrence of the patients with pStage II CRC.

Peritoneal cancer arising after total abdominal hysterectomy and bilateral salpingo-oophorectomy for cervical cancer in a patient with right breast cancer and germline mutation of BRCA1 gene: a case report and literature review.

Primary peritoneal carcinoma is usually advanced at diagnosis and curability is low unless the patient has a small tumor burden. Peritoneal carcinoma can occur in association with hereditary breast and ovarian cancer syndrome, which is thought to account for 5-6% of all breast cancer. Mutations of two breast cancer susceptibility genes, BRCA1 and BRCA2, are responsible for hereditary breast and ovarian cancer. Women with BRCA1/2 mutations often undergo risk-reducing salpingo-oophorectomy (RRSO) to prevent both ovarian and breast cancer. However, peritoneal carcinoma has been reported to develop after RRSO in patients with BRCA1/2 mutations. We experienced a patient with peritoneal carcinoma and inguinal lymph node metastasis after surgical resection of breast cancer and subsequent RRSO. This report describes the first case of peritoneal carcinoma arising after RRSO in a Japanese patient with BRCA1 mutation, including a review of the literature on peritoneal carcinoma associated with BRCA1/2 mutation.

OSNA-Assisted Molecular Staging in Colorectal Cancer: A Prospective Multicenter Trial in Japan.

BACKGROUND: We previously reported that the one-step nucleic acid amplification (OSNA) assay provided a judgment performance for colorectal cancer equivalent to a 2-mm-interval histopathological examination of lymph nodes (concordance 97.1 %, n = 385 lymph nodes). In this prospective multicenter study, we uncovered an OSNA-assisted pathology to detect lymph node metastasis. METHODS: A total of 204 (50 stage I, 74 stage II, and 80 stage III) colorectal cancer patients. All 4324 lymph nodes were examined by the standard histology (one-slice H&E staining) and 1925 lymph nodes (44.5 %) of them were also subject to the OSNA analysis. RESULTS: The concordance rate between 1 slice hematoxylin/eosin and OSNA assay was 95.7 % (1,842/1925 lymph nodes). The sensitivity and specificity of the OSNA assay were 86.2 % (125/145) and 96.5 % (1717/1780), respectively. Among 124 node-negative patients (pN0), the respective upstaging rates of pStages I, IIA, IIB, and IIC were 2.0 % (1/50), 17.7 % (11/62), 12.5 % (1/8), and 25 % (1/4). OSNA-positive patients had deeper invasion to the colonic wall and severe lymphatic invasion (P = 0.048 and P = 0.004, respectively). The sum of the quantitative results of OSNA and total tumor load increased as the number of metastasized lymph nodes increased: 1550 copies/µL in pN0, 24,050 copies/µL in pN1, and 90,600 copies/µL in pN2. CONCLUSIONS: The present study on colorectal cancer provided fundamental data regarding OSNA-assisted pathology of lymph node metastasis in Japan.

Viabilidade técnica do kit QuickStix™ na identificação de Phakopsora pachyrhizi capturados com coletor de esporos / Technical feasibility of the QuickStix kit™ in identifying Phakopsora pachyrhizi captured by the spores collector

O objetivo deste trabalho foi testar a eficiência do uso do kitQuickStix™ para a identificação de esporos de Phakopsora pachyrhizi, agente causal da ferrugem asiática da soja, coletados por meio de um coletor SIGA. O kit QuickStix é capaz de detectar a presença de Phakopsora pachyrhizi nos estágios iniciais da infecção foliar, determinando a presença ou ausência do patógeno na amostra. Ele captura propágulos de fungos presentes no ar, que são identificados ou quantificados por varredura de lâminas em microscópio óptico comum. Foram testados diferentes números de esporos com 4, 8 e 12 gotas da solução extratora. Para os resultados positivos, foram avaliados a intensidade da linha de teste e o tempo para sua ocorrência. O kit foi capaz de detectar pequenas quantidades de esporos, sendo que a proporção de resultados positivos foi diretamente proporcional ao número de esporos e inversamente proporcional ao total de gotas. A porção adequada de gotas da solução extratora foi de quatro, pois apresentou mais resultados positivos para todas as classes dos números de esporos. Não foi possível observar uma diferença entre o tempo para a ocorrência dos resultados positivos aos diferentes tratamentos. A intensidade da linha de teste foi superior para as classes com mais esporos.(AU)

The aim of this study was to test the efficiency of QuickStix™ kit use for identification of Phakopsora pachyrhizi spores, which are the causal agents of Asian soybean rust, collected by "SIGA" spores collector. This kit is capable of detecting the presence of Phakopsora pachyrhizi in the early stages of leaf infection by determining the presence or absence of pathogen in the sample. It captures propagules of fungi present in the air that are identified or quantified by scanning blades in ordinary optical microscope. Different numbers of spores were tested with 4, 8 and 12 drops of extraction solution. For positive results, intensity of the test line and time for its occurrence were evaluated. The kit was able to detect small amounts of spores and the proportion of positive results was directly proportional to the number of spores and inversely proportional to the amount of drops. The proper portion of drops of extraction solution was four, as it showed more positive results for all classes of numbers of spores. No difference was found between the time to occurrence of positive results for the different treatments. The intensity of the test line was higher for classes with larger numbers of spores.(AU)

Aplicação de fungicidas na soja baseada na detecção de uredósporos de Phakopsora pachyrhizi / Fungicide application on soybean plants based on the detection of Phakopsora pachyrhizi uredospores

Para estabelecer o momento adequado da aplicação de fungicidas no manejo da ferrugem asiática da soja (FAS), avaliou-se a época da pulverização dos fungicidas epoxiconazole e piraclostrobina (FEP) com base na detecção de uredósporos de Phakopsora pachyrhizi (PP) em condições de campo na área experimental da Faculdade Integrado de Campo Mourão, no Paraná, na safra verão de 2009/2010. O delineamento experimental foi realizado em blocos ao acaso, com sete tratamentos e quatro repetições, sendo: 1) aplicação do FEP com umidade acima de 80%; 2-5) aplicação do FEP 1-2, 6-7, 11-12 e 18-20 dias após a detecção dos primeiros esporos de PP, respectivamente; 6) aplicação do FEP após a detecção dos primeiros sintomas da FAS; 7) aplicação do FEP no estádio R1. A testemunha foi composta por plantas não tratadas com FEP. Houve redução da severidade da FAS em todos os tratamentos. Os valores da área abaixo da curva de progresso da FAS (AACPFA), taxa de progresso da doença (r) e severidade máxima (Y max ) na testemunha foram de 520,31; 0,06 e 45,65%, respectivamente. Foram detectados os menores valores de AACPFA (39,73), r (0,02) e Y max (3,91%) no tratamento 1. No entanto, o maior número de pulverizações do FEP foi realizado neste tratamento, com quatro aplicações. No tratamento 4, houve duas aplicações. Registrou-se a menor produtividade na testemunha (2085 kg. ha-1). A maior produtividade foi obtida nos tratamentos 1, 2, 3, 4, 6 e 7, acima de 3000 kg ha-1. Além disso, registrou-se o menor valor da massa de mil grãos na testemunha. Os maiores valores foram obtidos nos tratamentos 1, 2, 3 e 6. Portanto, a época de aplicação de fungicida baseada na detecção de uredósporos de PP é eficiente no manejo da FAS.(AU)

In order to establish the adequate timing of fungicide application in the management of Asian soybean rust (ASR), the spraying of epoxiconazol and pyraclostrobin fungicide (EPF) was evaluated based on the detection of Phakopsora pachyrhizi (PP) uredospores in field conditions at the research farm of Faculdade Integrado de Campo Mourão, in the state of Paraná, in the crop season of 2009/2010. The experimental design was performed in randomized complete blocks with four replications composed by: 1) EPF application with humidity higher than 80%; 2-5) EPF application 1-2, 6-7, 11-12, and 18-20 days after the first detection of PP spores, respectively; 6) EPF application after the first detection of ASR symptoms; 7) EPF application in the R1 stage. Control was constituted by plants not treated with EPF. There was reduced ASR severity in all treatments. The values of the area under ASR progress curve (AUASRPC), rate of disease progress (r), and maximum severity (Y max ) in control were 520.31, 0.06, and 45.65%, respectively. The lowest values of AUASRPC (39.73), r (0.02), and Y max (3.91%) were found in treatment 1. Nevertheless, the higher number of EPF spraying was carried out in this treatment with four applications. On the other hand, there were two applications in treatment 4. The lowest yield was recorded in control (2085 kg. ha-1). The highest yield was obtained in treatments 1, 2, 3, 4, 6, and 7, being higher than 3000 kg/ha. Furthermore, the lowest value of the thousand grain weight was estimated in control. The highest values were estimated in treatments 1, 2, 3, and 6. Therefore, the timing of fungicide application based on the detection of PP uredospores is efficient in the ASR management.(AU)

Collision tumors of hepatocellular carcinoma and malignant peritoneal mesothelioma.

We report a case of synchronous hepatocellular carcinoma (HCC) and malignant peritoneal mesothelioma (MM-per). A 56-year-old man with no past history of asbestos exposure, chronic viral hepatitis, or alcoholic liver injury was admitted to our hospital with left flank pain and abdominal tumor. Partial hepatectomy, splenectomy, partial diaphragm resection, and partial gastrectomy were performed. The tumor in the lateral segment of the liver was gray to white, massive in appearance, and contained focal bile-producing nodules and extensive fibrous firm lesion. It had directly invaded the spleen and diaphragm. Liver cirrhosis was not found. The peritoneum contained multiple small nodules especially around the diaphragm, which mimicked carcinoma dissemination. After histological examination, the liver tumor was diagnosed as HCC. It had trabecular and scirrhous patterns and positive immunoreactivities for Hep-Par-1 and α-fetoprotein. The peritoneal nodules were diagnosed as MM-per, epithelioid type, with positive immunoreactivities for calretinin and cytokeratin 5/6. The two tumors collided around the diaphragm. Cases of MM synchronous with other primary malignant tumors have been reported, but most had a history of asbestos exposure unlike the present case. The carcinogenic background was unclear for two tumors in this case. This is an extremely rare and valuable case.

Comparison of three measurements on computed tomography for the prediction of less invasiveness in patients with clinical stage I non-small cell lung cancer.

BACKGROUND: A greater proportion of ground-glass opacity (GGO) is well known to be strongly associated with less invasive lung adenocarcinoma. Recently, the solid area diameter has also been reported to be a simple and better marker for the same purpose compared with the whole nodule diameter. METHODS: From 1997 to 2009, 383 patients with clinical T1-2N0M0 non-small cell lung cancer (NSCLC) with a solid area of 3 cm or less underwent surgical resection, and their preoperative high-resolution computed tomographic images were preserved in Digital Imaging and Communications in Medicine format. Less invasive lung cancer was defined as having no vascular, lymphatic, or pleural invasion or lymph node metastasis. We compared the solid area and whole nodule diameters and proportion of GGO, with the objective of predicting less invasive lung cancer. RESULTS: Among the 383 patients, 187 were men, 335 had adenocarcinoma histologic type, 242 had less invasive lung cancer, and 43 experienced recurrence. Receiver operating characteristic (ROC) analysis to predict less invasive lung cancer showed that the area under the curve of proportion of GGO was the highest (0.848; 95% confidence interval [CI], 0.810-0.886), followed by the solid area diameter (0.785; 95% CI, 0.740-0.829), and then whole nodule diameter (0.621; 95% CI, 0.565-0.677). Multiple logistic regression analyses revealed that proportion of GGO was the only significant predictor of less invasive lung cancer. The proportion of GGO was also found to be a significant prognostic factor of disease-free survival (DFS) along with solid area diameter by multivariate analysis. Regardless of the solid area diameter, no patient with a greater proportion of GGO (> 50%) experienced recurrence. CONCLUSIONS: Proportion of GGO remains important for predicting less invasive lung cancer.

[An autopsy case of unresectable colon cancer who developed lung injury by cetuximab].

We report the case of a woman in her 60s with unresectable advanced colon cancer. After the first course of cetuximab as second-line therapy, she had developed drug-induced lung injury. Steroid pulse therapy had been ineffective, and she died of respiratory failure on day 9. The pathological examination of autopsy lung specimens revealed diffuse alveolar damage(DAD). Details of the cetuximab-induced lung injury are unclear. However, in 3 previous reports of lung injury by cetuximab, the postmortem findings were similar to this case. We concluded that DAD seems to be one of the pathological features of lung injury caused by cetuximab.

Characteristics of subsolid pulmonary nodules showing growth during follow-up with CT scanning.

OBJECTIVE: The positive results of a screening CT scan trial are likely to lead to an increase in the use of CT scanning, and, consequently, an increase in the detection of subsolid nodules. Noninvasive methods including follow-up with CT scanning, to determine which nodules require invasive diagnosis and surgical treatment, should be defined promptly. METHODS: Between 2000 and 2008, from our database of . 60,000 examinations with CT scanning, we identified 174 subsolid nodules, which showed a ground-glass opacity area . 20% of the nodule and measured 2 cm in diameter, in 171 patients. We investigated the clinical characteristics and CT images of the subsolid nodules in relation to changes identified during the follow-up period. RESULTS: The nodule sizes ranged from 4 mm to 20 mm at the fi rst presentation. Nonsolid nodules numbered 98. During the follow-up period, 18 nodules showed resolution or shrinkage, and 41 showed growth of 2 mm or more in diameter. The time to 2-mm nodule-growth curves calculated by Kaplan-Meier methods indicated that the 2-year and 5-year cumulative percentages of growing nodules were 13% and 23% in patients with nonsolid nodules and 38% and 55% in patients with part-solid nodules, respectively. Multivariate analysis disclosed that a large nodule size ( . 10 mm) and history of lung cancer were significant predictive factors of growth in nonsolid nodules. CONCLUSIONS: An effective schedule for follow-up with CT scanning for subsolid nodules should be developed according to the type of subsolid nodule, initial nodule size, and history of lung cancer.

Tratamento químico de sementes sobre o desenvolvimento de mancha marrom em plantas de trigo / Chemical treatment in seeds on the development of the spot blotch in wheat plants

O objetivo do trabalho foi avaliar o efeito dos fungicidas difenoconazole e carboxin + thiram aplicados em sementes de trigo cultivares 'CD 104' e 'OR Mirante', inoculadas com Cochliobolus sativus. O delineamento experimental foi inteiramente casualizado, em esquema fatorial 2x3 (2 cultivares e 2 fungicidas + testemunha sem controle) em sete repetições. O fungo foi isolado e reproduzido em meio de cultura BDA (batata-dextrose-ágar) e, posteriormente, multiplicado em sementes de trigo pré-cozidas, constituindo a fonte de inóculo. As avaliações foram do número de lesões na folha basal de cinco plantas por vaso aos 22, 25, 29, 31, 35 e 38 dias após a semeadura (DAS) e aos 41 dias foram avaliados o comprimento (cm), massa fresca (g) e seca (g) da parte aérea e das raízes. A partir das avaliações do número de lesões, também foi calculada a área abaixo da curva de progresso da doença (AACPD), cujos dados foram submetidos à análise de variância e as médias comparadas pelo teste de Tukey, a 5% de probabilidade. A cultivar 'CD 104' foi mais suscetível ao patógeno do que 'OR Mirante'; difenoconazole foi eficiente no controle da doença na parte aérea, enquanto carboxin + thiram se igualou à testemunha; os dois fungicidas interferiram negativamente no desenvolvimento das plantas, uma vez que as médias de comprimento, massa fresca e seca da parte aérea e das raízes obtidas das sementes tratadas é inferior à média das sementes não tratadas.

The objective of this research was to evaluate the effect of fungicides difenoconazole and carboxin + thiram applied in seed wheat cultivars 'CD 104' and 'OR Mirante', inoculated with Cochliobolus sativus. The experimental design was completely randomized in a 2x3 factorial design (2 cultivars and 2 fungicides + untreated control) in seven replications. The fungi was isolated and reproduced in PDA culture medium (potato-dextrose-agar) and subsequently multiplied in seeds of wheat pre-cooked and is the source of inoculum. The evaluations were the number of lesions in the basal leaf of five plants per pot at 22, 25, 29, 31, 35 and 38 days after sowing (DAS), and at 41DAS were evaluated the length (cm), fresh weight (g) and dry weight (g) of shoot and root. From the evaluations of the number of lesions was also calculated the area under the disease progress curve (AUDPC). The datas were subjected to analysis of variance and means were compared by Tukey test at 5% probability. The 'CD 104' cultivar was more susceptible to the pathogen than 'OR Mirante'; difenoconazole was efficient to control the disease as carboxin + thiram equaled the witness; both fungicides interfered negatively on plant development, since the average length, fresh weight and dry shoot and root obtained from treated seed is lower than the untreated seeds.

Proposal of new nodal classifications for non-small-cell lung cancer based on the number and ratio of metastatic lymph nodes.

OBJECTIVE: The study aimed to evaluate the effectiveness of two new nodal classifications based on the number of metastatic lymph nodes (LNs) or ratio of metastatic to examined LNs (LNR) in making a prognosis, compared with the current nodal classification based on the location of metastatic LNs. METHODS: We analyzed 651 non-small-cell lung cancer patients who had undergone complete resection with the removal of more than five LNs between 1986 and 2003, excluding preoperative treatment cases, and a Tis, T4, N3, and M1 status, along with limited resection and operative death cases. The cutoff numbers for each category in the two new nodal classifications (number of metastatic LNs (nN0-2): 0, 1-2, and >3, and LNR (rN0-2): 0, 1-12, and >12%) were defined so that the numbers corresponded with paired categories within the current nodal classification. RESULTS: The 5-year survival rate was 75.4% for patients with the N0 categories in all three classifications. The 5-year survival rates for patients with N1 and N2 categories were 52.2% and 42.6% according to the current nodal classification, 54.3% and 39.8% according to the number of metastatic LNs, and 58.8% and 35.0% according to the LNR, respectively. Although all three nodal classifications were independent prognostic factors along with the age and pathological T status, when the three nodal classifications were entered into multivariate analysis individually, the hazard ratio of rN2 was the highest, at 3.15, followed by that of nN2 at 2.96. CONCLUSIONS: The LNR followed by the number of metastatic LNs may be more effective prognostic indicators than the current nodal classification based on the location of metastatic LNs. For the future revision, the number of metastatic LNs and LNR should be evaluated as indicators for the nodal classification of lung cancer.

[Clinical analysis of 3 cases with primary splenic diffuse large B-cell lymphoma].

The definition of primary splenic lymphoma is controversial, but it has been reported to be a rare disease that comprises less than 1% of all malignant lymphomas. Three cases of primary splenic diffuse large B-cell lymphoma treated at our institution are described here. Median follow-up was 34.6 months (range 8.7∼39.2) and median age at diagnosis was 72 years old (range 65∼73). In all three cases, the diagnosis was definitively established not by splenectomy but by ultrasonically guided percutaneous splenic tissue core biopsy. Using the Hans classifier, one of the cases was subclassified as the germinal center B-cell like (GCB) subtype and two as non-GCB subtype. One case was CD5-positive diffuse large B-cell lymphoma. Two patients were in Ann Arbor stage II and one was in stage III. Using the International Prognostic Index, one was categorized as Low/intermediate risk, one as high/intermediate risk, and one as high risk. All patients underwent eight cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisolone followed by irradiation therapy. These three patients attained complete response. Although the follow-up period to date has been short, all patients have maintained a complete response and are currently alive. To determine whether our management protocol is valid, further observations are needed.

[A case report of conversion therapy for initially unresectable colorectal cancer liver metastases after cetuximab as third-line treatment].

The introduction of monoclonal antibodies into the treatment protocols for metastatic colorectal cancer(mCRC)has significantly improved outcomes. There are some patients with mCRC, initially judged unresectable, who become resectable after chemotherapy. For patients with isolated liver metastases, surgical resection is recommended when feasible. We experienced a case in which an initially unresectable mCRC liver metastases converted into a resectable one after cetuximab monotherapy as third-line treatment. The sample from hepatectomy was a pathologically complete response; no remnants were detected. The management of liver metastases contributes to improvements in the clinical setting. For conducting a multimodal treatment of mCRC, the participation of various specialists such as medical oncologists, colorectal/hepaticsurgeons and diagnostic/therapeutic radiologists is indispensable. Furthermore, it is necessary to construct an evidence-based consensus on potentially resectable CRC liver metastases in each hospital.