Undifferentiated carcinoma of the esophagus with rapid growth of lymph node. A case report and review of the literature.

We present a case of undifferentiated carcinoma of the esophagus (UCE) treated with chemotherapy consisting of 5-fluorouracil plus nedaplatin and radiotherapy. The patient developed rapid growth of lymph nodes and died of massive hematemesis 2 months after the diagnosis. UCE is rare but highly malignant. Since there is no established treatment for UCE, its clinical outcome is invariably poor. We also reviewed the effectiveness of chemotherapy against UCE.

Gastrectomy for patients with gastric cancer and non-uremic renal failure.

AIM: To investigate the safety and outcome of gastrectomy for patients with gastric cancer and non-uremic renal failure (NURF). METHODS: One hundred forty-seven patients who underwent gastrectomy for carcinoma were retrospectively divided into two groups: a group with Ccr values of > or = 50 mL/min (Group 1; n = 110), and one with Ccr values of > or = 20 to < 50 mL/min (Group 2; n = 37). Preoperative patient characteristics, intraoperative parameters (including operation time and blood loss), and postoperative management and complications were evaluated. RESULTS: There were no statistically significant differences between the two groups in operation time (297.9 min vs 272.6 min, P = 0.137) or blood loss (435 mL vs 428 mL, P = 0.078). The differences in postoperative complications and hospital stay between the groups were not statistically significant. None of the patients in Group 2 required dialysis therapy, and no patients died due to gastrectomy or gastrectomy-related causes. The overall 4-year survival rates in Groups 1 and 2 were 86.6% and 81.8%, respectively (P = 0.48), and the corresponding 4-year disease-free survival rates for stage I, II, and III patients were 88.7% and 83.5%, respectively (P = 0.65). CONCLUSION: Gastrectomy can be performed as safely in patients with NURF similar to patients with normal renal function.

Laparoscopic splenectomy for recurrent splenic cyst after laparoscopic marsupialization.

We describe laparoscopic splenectomy for recurrent splenic cyst after laparoscopic marsupialization. The patient was a 24-year-old woman with a 20-cm palpable mass in the left upper quadrant. She had undergone laparoscopic marsupialization for splenic cyst 62 months previously. Abdominal ultrasonography and computed tomography revealed a huge cystic lesion of the spleen, and magnetic resonance imaging demonstrated multiple cystic lesions occupying almost the entire spleen. We performed laparoscopic splenectomy for the recurrent splenic cyst. The operation took 170 minutes. Histologic examination of the resected spleen revealed a hemangioma with cyst formation. The cyst wall consisted of fibrous tissue, covered by stratified cuboid or squamous epithelium. The patient had no abdominal symptoms during 13 months of follow-up. Postoperative follow-up examination by ultrasound or computed tomography is required after surgical treatment for splenic cyst to exclude the possibility of recurrence after preservation of the spleen.

Laparoscopic treatment of paraesophageal hiatal hernia with incarceration of the pancreas and jejunum.

We present a successful laparoscopic treatment of paraesophageal hiatal hernia with an incarceration of the pancreas and jejunum. The patient was a 75-year-old woman who had complaints of epigastric pain and dysphasia. A chest x-ray revealed a mediastinal air-fluid level. Chest computed tomography showed intestinal contents, body and tail of the pancreas, and the splenic artery within the mediastinum. At laparoscopy, jejunum was incarcerated into the mediastinal cavity through the internal hernia of transverse mesocolon. Body and tail of the pancreas and the splenic artery were also dislocated within the hernia sac. The operation time took 115 minutes. The patient tolerated a regular diet on the first postoperative day and was discharged uneventfully. There were no recurrence or abdominal symptoms during the 29-month follow-up period. In the case of asymptomatic paraesophageal hiatal hernia with incarcerating pancreas on diagnostic imagings, elective surgical treatment is required to prevent a critical outcome.

[Pilot study of primary systemic chemotherapy with docetaxel (DOC), epirubicin (EPI) and capecitabine (Xeloda) in patients with advanced breast cancer].

We evaluated the safety and efficacy of primary systemic chemotherapy (PSC) with docetaxel (DOC), epirubicin (EPI) and capecitabine (Xeloda:XLD) in 10 patients with advanced breast cancer. Their mean age was 54.7 years,and preoperative stages were IIB, seven cases; IIIA, two; and IV, one,respectively. The regimen consisted of XLD (2,400 or 3,000 mg/day) orally for 14 consecutive days, and DOC (60 or 70 mg/m2) and EPI (50 or 60 mg/m2) intravenously on day 8. This was repeated 4 times every 3 weeks. One patient discontinued this regimen after one course at her own request. Although the results revealed leucopenia and neutropenia of more than grade 3 in 8 and 10 patients,they could be treated on an outpatient basis with the use of G-CSF to maintain this regimen. Alopecia of grade 2 was found in all patients,neutropenic fever of more than 38.5 degrees C in 5,and hand-foot syndrome in 3. Downstaging after PSC was demonstrated in 7 cases (Stage IIB to I, three cases; IIB to IIA, three; and III A to I, one), with a response rate of 77.8%. Breast conserving therapy was performed in 8/10 patients. Pathological findings on cytological degeneration showed grade 0, one; grade 1a,seven; grade 2, one; and grade 3, one, respectively. Axillary lymph node metastasis was revealed in 7 cases. This regimen would be an alternative to PSC on an outpatient basis while taking great care of myelosuppression and hand-foot syndrome.

[Experience with capecitabine in patients with anthracycline and/or taxane-resistant recurrent breast cancer].

We evaluated the safety and efficacy of capecitabine in 12 patients with anthracycline and/or taxane-resistant metastatic breast cancer on an outpatient basis. Their mean age was 57 years, and they previously received chemotherapy consisting of anthracycline in 7 cases, taxane in 12 and doxifluridine in 8. Their mean disease-free interval was 28.5 months, HER 2/neu and ER and/or PgR-positive was shown in 2 and 8 cases, respectively. The recurrent sites were lymph node in 9 cases, lung in 6, skin in 5, pleural effusion in 4, liver, bone and pleura in 3, brain and CBS in 2, and thyroid, ascites and pericardial effusion in one, respectively. The administration dose was 2,400 mg/day in 11 cases and 3,000 mg/day in one. Capecitabine was administered orally for 21 consecutive days followed by a one-week rest. The mean follow-up period was 6.5 months. The overall response rate was 18.2% in 11 cases, including 2 partial responses, 4 stable diseases and 5 progressive diseases. Clinical benefit was 36.4% including two long stable diseases. The mean time to treatment failure was 6.5 months. Adverse events included Hand-Foot Syndrome in 5 cases, nausea in 3, diarrhea, appetite loss and high fever in one, respectively. In two of them administration was discontinued due to adverse events. Capecitabine had satisfactory effects with tolerable adverse events for anthracycline- and/or taxane-resistant metastatic breast cancer.

[Docetaxel (TXT), epirubicin (EPI) and doxifluridine (5'-DFUR) combination neoadjuvant chemotherapy for outpatients with locally advanced breast cancer].

We evaluated the safety and efficacy of neoadjuvant chemotherapy with docetaxel (TXT), epirubicin (EPI) and doxifluridine (5'-DFUR) in 5 patients with locally advanced breast cancer on an outpatient basis. Their mean age was 49.6 years, and preoperative stages were IIa: one case, IIb: two; and IlIb: two; respectively. The regimen consisted of 5'-DFUR (800 mg/day) orally for 14 consecutive days, and TXT (60 or 70 mg/m2) and EPI (50 or 60 mg/m2) intravenously on day 8. It was repeated 4 times every 3 weeks. Although the results revealed leucopenia and neutropenia of more than grade 3 in 4/5 patients, no other adverse events were observed. The use of G-CSF was necessary to maintain this regimen, and the patients could be treated on an outpatient basis. Breast conserving therapy was performed in two patients. Pathological findings revealed Grade 2 and 3 cytological degeneration in two and one patients, respectively, and parasternal lymph node metastasis in one, but no axillary lymph node metastasis. These findings suggested satisfactory effects of this neoadjuvant chemotherapy regimen. This combination chemotherapy without severe adverse events would be an alternative choice of neoadjuvant chemotherapy on an outpatient basis.

[Two cases of recurrent breast cancer successfully treated with paclitaxel weekly therapy].

The patients were a 57-year-old and a 38-year-old woman who had supraclavicular lymph node and multiple lung metastases from breast cancer. They were given 3 and 4 courses of paclitaxel (TXL) weekly therapy (80 mg/m2, day 1, 8, 15, repeated every 4 weeks). One patient had received docetaxel (TXT) and CEF therapy previously. There were no severe adverse effects except leukopenia, neutropenia and alopecia. The weekly TXL therapy brought complete remission against the supraclavicular lymph node and multiple lung metastases. The durations of the response to this weekly therapy were 15 and 5 months, respectively, and their effects have continued to the present. We believe that the weekly TXL therapy is a well-tolerated, feasible and safe administration schedule on an outpatient basis, and improves the patient's quality of life. Furthermore, we suggest the possibility of TXL being effective against both TXT and anthracycline-resistant breast cancer.

Intraoperative identification of sentinel lymph nodes by near-infrared fluorescence imaging in patients with breast cancer.

We present a novel method for sentinel lymph node (SLN) identification by fluorescence imaging that provides a high detection rate and a low false-negativity rate. Twenty-five breast cancer patients with tumors less than 3 cm in diameter were enrolled. A combination of indocyanine green and indigo carmine was injected subdermally in the areola. Subcutaneous lymphatic channels draining from the areola to the axilla were immediately showed by fluorescence imaging. After incising the axillary skin near the point of disappearance of the fluorescence, the SLN was dissected under fluorescence guidance. In all patients, the lymphatic channels and SLN were successfully visualized. The mean number of fluorescent SLN and blue-dyed SLN were 5.5 and 2.3. Eight patients were found to have lymph node metastases pathologically. All of them were recognized by fluorescence imaging. This method is feasible and safe for intraoperative detection of SLN allowing real-time observation without any need for training.