The Clinical Validity of Urinary Pellet DNA Monitoring for the Diagnosis of Recurrent Bladder Cancer.

The aim of this study was to evaluate the clinical validity of monitoring urine pellet DNA (upDNA) of bladder cancer (BC) by digital PCR (dPCR) as a biomarker for early recurrence prediction, treatment efficacy evaluation, and no-recurrence corroboration. Tumor panel sequencing was first performed to select patient-unique somatic mutations to monitor both upDNA and circulating tumor DNA (ctDNA) by dPCR. For longitudinal monitoring using upDNA as well as plasma ctDNA, an average of 7.2 (range, 2 to 12) time points per case were performed with the dPCR assay for 32 previously treated and untreated patients with BC. Clinical recurrence based on imaging and urine cytology was compared using upDNA variant allele frequency (VAF) dynamics. A continuous increasing trend of upDNA VAF ≥1% was considered to indicate molecular recurrence. Most (30/32; 93.8%) cases showed at least one traceable somatic mutation. In 5 of 7 cases (71.4%) with clinical recurrence, upDNA VAF >1% was detected 7 to 15 months earlier than the imaging diagnosis. The upDNA VAF remained high after initial treatment for locally recurrent cases. The clinical validity of upDNA monitoring was confirmed with the observation that 26 of 30 cases (86.7%) were traceable. Local recurrences were not indicated by ctDNA alone. The results support the clinical validity of upDNA monitoring in the management of recurrent BC.

[A case of ulcerative colitis with mesalazine intolerance complicated with agranulocytosis and septic shock during salazosulfapyridine administration].

A 73-year-old woman developed ulcerative colitis with mesalazine intolerance a year ago. She relapsed 10 months later. Although she was in clinical remission with salazosulfapyridine (SASP) and prednisolone administration, she developed agranulocytosis 53 days following SASP administration. She went into septic shock;however, she recovered with antibiotics, granulocyte colony-stimulating factor, and cardiotonic agents. Drug-induced lymphocyte stimulation test was positive for both mesalazine and SASP. Drug selection should be carefully determined in patients with 5-aminosalicylic acid intolerance.

Efficacy of combination therapy with pembrolizumab and axitinib for metastatic renal collecting duct cell carcinoma: A report on two cases.

Introduction: Immunotherapy-based combinations have become the standard first-line therapy for metastatic renal cell carcinoma. However, combined immunotherapy for renal collecting duct carcinoma had been reported, but its therapeutic efficacy had been unclear. Case presentation: The first case was a 62-year-old man treated with pembrolizumab and axitinib for renal collecting duct carcinoma with multiple bone metastases. After 7 months, the primary and metastatic lesions shrunk and were evaluated as a partial response. The second case was a 71-year-old man treated with pembrolizumab and axitinib for renal collecting duct carcinoma with lymph node and lung metastases. After 9 months, the primary and metastatic lesions shrunk and were evaluated as a partial response. In both cases, the tumor cell expression of programmed death ligand-1 was negative, and CD4+ and CD8+ cells were observed in the tumor. Conclusion: Combined immunotherapy with pembrolizumab and axitinib may be effective for metastatic renal collecting duct carcinoma.

Advance renal pelvic cancer caused obstructive jaundice: A case report.

We report a case of advanced renal pelvic cancer in a 69-year-old woman who presented with fatigue, appetite loss, and yellow sclera. Contrast-enhanced computed tomography revealed a large lesion mass extending from the right renal pelvis to the duodenum and surrounding enlarged lymph nodes. Gastroduodenal endoscopy revealed a mass in the ampulla of Vater, and an endoscopic biopsy was performed. Histological and immunohistochemical examination of the biopsy specimen confirmed a diagnosis of urothelial carcinoma. To the best of our knowledge, this is the first report of advanced renal pelvic cancer causing obstructive jaundice.

Long-Term Efficacy of S-1 Chemotherapy plus Administration of Octreotide for a Patient with Metastatic Neuroendocrine Tumor (Gastrinoma).

Metastatic neuroendocrine tumors (gastrinomas) have a poor prognosis. Octreotide can reduce gastrin levels and alleviate hormonal symptoms, and possibly slow tumor growth as well. No drugs were available except streptozocin for the treatment of metastatic pancreatic neuroendocrine tumor (PNET) in 2008. We report a case of PNET in a 53-year-old woman with multiple liver tumors treated with S-1 plus octreotide. After 6 months from the initiation of the treatment, the pancreatic tumor and liver metastases regressed, and the patient achieved partial response without the development of any serious adverse event. For more than 8 years, the patient has remained asymptomatic without disease progression and is continuing treatment with octreotide and S-1. A marked suppression of gastrin levels has also been achieved. Combination therapy with octreotide and S-1 has been effective and well tolerated in patients with metastatic gastrinoma.

[Retrospective analysis concerning AFP-producing gastric cancer].

The α-fetoprotein(AFP)-producing gastric cancer is a group of gastric cancers with poor prognosis because of its rapid growth and aggressive metastatic character. We examined AFP-producing gastric cancer in our department from 2008 to 2010. Of 12 patients studied, the median of the AFP level was 16, 038(96. 1-167, 360)ng/mL. All patients had liver metastasis. Four patients were ECOG performance status(PS)3, and were unable to receive chemotherapy. Eight patients received chemotherapy. Two cases who received cisplatin+paclitaxel(CDDP+PTX)therapy showed partial response(PR). Median survival time was 5. 6 months. Compared to AFP non-producing gastric cancer, this disease is definitely considered to have a poorer prognosis. The clinical effect and survival time seemed to have a relative correlation. PR and SD groups tend to have longer survival. Those with a decline of serum LDH levels at the first three weeks after chemotherapy have a strong tendency to be PR and SD(p=0. 11). Changing the serum LDH level may enable us to estimate the clinical effect while still in the early stages of chemotherapy.

Osteolipoma arising adjacent to the sternoclavicular joint. A case report.

A 45-year-old woman presented with one-year history of a mass on her chest. Computed tomography and magnetic resonance imaging demonstrated a tumour near the sternoclavicular joint. The tumour was diagnosed as osteolipoma histologically after resection. Osteolipoma is a rare tumour and this may be the first report of osteolipoma arising adjacent to the sternoclavicular joint.

[A case of bacterial aneurysm that occurred in the external carotid artery].

Occurrence of a mycotic aneurysm extracranially is extremely rare. We report our experience with a case of mycotic aneurysm that occurred in the external carotid artery accompanying infectious endocarditis. The case was a 33-year-old male. He visited our hospital with principal complaints of weakness in the lower left side and visual difficulty. Multiple cerebral infarctions were noted in a head MRI. In addition, vegetation was noted on the mitral valve in an echocardiogram, and the patient was admitted to cardiology for infectious endocarditis. Aneurysms were noted in the external carotid artery and the posterior cerebral artery in a cerebral angiogram performed before valve replacement. After administration of antibiotics for 5 weeks, radical surgery was performed for the external carotid artery aneurysm that had remained unchanged. With a satisfactory postoperative course, the patient was able to walk independently after mitral valve replacement and was discharged. We have scoured the literature with regard to mycotic aneurysm occurring extracranially and have studied this case because of this characteristic. When performing cerebral angiography to search for a mycotic aneurysm, the area outside the cranium as well as inside must be closely examined.

Liver cirrhosis induced by long-term administration of a daily low dose of amiodarone: a case report.

The anti-arrhythmic agent amiodarone (AD) is associated with numerous adverse effects, but serious liver disease is rare. The improved safety of administration of daily low doses of AD has already been established and this regimen is used for long-term medication. Nevertheless, asymptomatic continuous liver injury by AD may increase the risk of step-wise progression of non-alcoholic fatty liver disease. We present an autopsy case of AD-induced liver cirrhosis in a patient who had been treated with a low dose of AD (200 mg/d) daily for 84 mo. The patient was a 85-year-old male with a history of ischemic heart disease. Seven years after initiation of treatment with AD, he was admitted with cardiac congestion. The total dose of AD was 528 g. Mild elevation of serum aminotransferase and hepatomegaly were present. Liver biopsy specimens revealed cirrhosis, and under electron microscopy numerous lysosomes with electron-dense, whorled, lamellar inclusions characteristic of a secondary phospholipidosis were observed. Initially, withdrawal of AD led to a slight improvement of serum aminotransferase levels, but unfortunately his general condition deteriorated and he died from complications of pneumonia and renal failure. Long-term administration of daily low doses of AD carries the risk of progression to irreversible liver injury. Therefore, periodic examination of liver function and/or liver biopsy is required for the management of patients receiving long-term treatment with AD.

[A case of primary meningeal melanocytoma of the left middle fossa].

A 29-year-old woman presented with a primary meningeal melanocytoma of the left middle fossa manifesting as headache and nausea. Computed tomography (CT) with contrast medium demonstrated a clearly demarcated, homogeneously enhanced high density area surrounded by a cyst in the left temporal lobe. Magnetic resonance (MR) imaging showed the mass as a slightly high signal intensity area on the T1-weighted image and as a low signal intensity area on the T2-weighted image. Cerebral angiography revealed shift of the middle cerebral artery but no tumor stain. The solid part of the tumor had rapidly increased in size with reduction of the cyst 3 months later. Left frontotemporal craniotomy disclosed a clearly demarcated jet-black tumor attached to the dura. The black-colored lesion in the dura and the bone extended to the skull base, so malignant melanoma was a possibility. The solid part of the tumor was gross totally removed, and the dura and the skull bone were preserved. Histological examination of the tumor specimen revealed meningeal melanocytoma. Melanophages were present in the specimen of the black-colored lesion in the dura and the bone, but no neoplastic infiltration was present. The postoperative course was uneventful, and the patient's headache and nausea disappeared. CT and MR imaging taken 1 month later confirmed total removal of the tumor. No recurrence has been observed for 2.5 years after surgery. Preoperative differentiation of meningeal melanocytoma from malignant melanoma is difficult, but the primary goal of therapy is gross total resection of the solid part of the tumor irrespective of tumor type.