[Marginal zone lymphoma of mucosa-associated lymphoid tissue of the parietal pleura; report of a case].

An 76-year-old man was referred to our hospital due to right hydrothorax. The diffuse thickening of parietal pleura with increased fluoro-2-deoxy-D-glucose (FDG) uptake was noted by computed tomography (CT) and positron emission tomography (PET). Surgical biopsy was performed and the tumor was diagnosed as mucosal associated lymphoid tissue (MALT) lymphomas of parietal pleura origin by pathology. Complete remission was achieved by postoperative chemotherapy (R-CHOP), and the patient is now alive without recurrence.

[Lymphoepithelioma-like carcinoma（ LELC） of the lung].

A 77-year-old woman was admitted to our hospital with abnormal chest shadow detected on a medical checkup. Chest computed tomography(CT)showed a well-defined tumor in the upper lobe of the right lung. On positron emission tomography by fluorodeoxyglucose(FDG),the tumor revealed to be positive. We performed right upper lobectomy with hilar and mediastinal lymph node dissection. The histopathological diagnosis was lymphoepithelioma-like carcinoma (LELC). In the past 25-years, 41 cases have been reported in Japan. The average age is 64 years old, including 25 male cases and 16 female cases. Among these cases, more than half were in the early resectable stage.

[Sarcoidosis with right middle lobe atelectasis initially suspected of malignant lymphoma; report of a case].

60-year-old woman was admitted with an abnormal shadow on the chest roentgenogram. Computed tomography showed atelectasis of the right middle lobe and hilar and mediastinal lymphadenopathy. Bronchoscopic examination revealed an obstruction at the orifice of the right middle lobe bronchus and biopsy was performed. The biopsy suggested malignant lymphoma. A diagnosis of methotrexate-associated lymphoproliferative disorders was suspected because the patient was administered methotrexate to treat the rheumatoid arthritis. The video-assisted thoracoscopic surgery was performed. Histological examination showed no malignancy and sarcoidosis in the peribronchial lymph nodes. The compressed middle lobe bronchus by enlarged lymph nodes was consider to be the cause of the middle lobe atelectasis.

[Adult Bochdalek hernia combined with pneumothorax].

A 71-year-old man, who had been given a diagnosis of Bochdalek hernia in infancy, was referred to our hospital for dyspnea The chest X-ray and computed tomography (CT) showed left pneumothorax with bullas and intestines in his left thoracic cavity. He was admitted to our hospital and a chest tube was inserted into the left pleural cavity. The left lung expanded immediately and air leakage was stopped. He became asymptomatic and he was discharged from the hospital on the 8th day. Most Bochdalek hernias are observed in infancy, and adult cases combined with pneumothorax and bullas are very rare.

[Human pulmonary dirofilariasis].

The patient was a 60's-year-old man, who was incidentally pointed out a coin lesion in the right lung by chest radiogram. Chest computed tomography showed a round-shaped, well defined nodule of 2.5 cm in size in the right S1. Positron emission tomography did not show the accumulation of fluorodeoxyglucose in the nodule. We considered the tumor to be benign, but the patient chose surgical treatment. Partial resection of the lung was performed by thoracoscopic surgery. Histopathological diagnosis was human pulmonary dirofilariasis.

Laparoscopic transabdominal preperitoneal hernioplasty for recurrent obturator hernia: A case report.

Reports of recurrence after obturator hernia repair are few. We describe the case of an 89-year-old woman who presented to us with a thrice recurrent obturator hernia. She had undergone open non-mesh repair twice and then laparoscopic non-mesh repair. She was readmitted to our hospital 6 months after the laparoscopic repair. Manual reduction was successful, paving the way for elective transabdominal preperitoneal repair. During the endoscopic repair, surgical mesh was placed extraperitoneally over the hernia defect and then fixed to Cooper's ligament with absorbable tacks. The patient was discharged on postoperative day 2 without complications. In the 2 months that have passed since the surgery there has been no sign of recurrence, but the patient will be carefully followed up. Repair of a recurrent obturator hernia is technically challenging; however, the transabdominal preperitoneal approach seems to be reliable and safe.

Primary extraskeletal osteosarcoma of the mesentery: A case report.

INTRODUCTION: Extraskeletal osteosarcoma is a rare malignant soft tissue tumor without attachment to the bone. To the best of our knowledge, we present here the first report of a primary extraskeletal osteosarcoma of the mesentery in Japan. CASE PRESENTATION: A 46-year-old female underwent a health examination, with no complaint. Following an ultrasonography a solid mass was detected in the abdominal cavity. Computed tomography showed a 38 × 25 mm heterogeneously enhancing mass. The latter was characterized by the presence of mottled calcifications and a cystic portion. The tumor was resected with a single incisional laparoscopic curative resection. Histopathological examination revealed the presence of a primary extraskeletal osteosarcoma arising from the mesentery. Postoperative course was uneventful. The patient did not receive chemotherapy during follow-up. She was recurrence free 10 months post-surgery. DISCUSSION: Patients with extraskeletal osteosarcoma generally have a poor prognosis. A tumor size <5 cm represents an important prognostic factor. Unexpectedly, our case was detected by ultrasonography at an early stage. This is the first report of a single incisional laparoscopic resection. CONCLUSION: A primary extraskeletal osteosarcoma of the mesentery is an extremely rare occurrence. Its diagnosis should be taken into consideration also when a soft tissue mass of the mesentery is found.

Postoperative courses of breast reconstruction using inferior adipofascial tissue repair.

BACKGROUND: Nevertheless in breast conserving surgery, the dissection of inferior part of breast mound will cause severe deformity, which affects the patient's quality of life adversely. We have used an infra-mammary adipofascial tissue to repair the defect, and breast mound could be reconstructed concurrently in primary breast cancer surgery. PATIENTS AND SURGICAL PROCEDURE: From September 2009 to June 2012, we performed the infra-mammary adipofascial tissue repair (IATR) on 25 patients with breast cancer in inferior site of their breast mound. Surgeon makes the skin incision on the infra-mammary line and performs the quadrantectomy as planned. After verifying its negative surgical margin pathologically, we mobilize the adipofascial fat tissue associated with myofascia of the serratus anterior muscle from the infra-mammary area. This tongue-shaped flap is reflected back, and fills the defect of breast mound. We performed routinely examination, mammography, and ultra-sound echogram to the IATR patients who visited our hospital after 1 year from the end of treatment. We, furthermore, performed the QOL questionnaire (QOL-ACD and QOL-ACD-B) to them and retrospectively compared their data to that from the other breast surgery patients. RESULTS: All patients with IATR were treated with irradiation, and no image findings of a partial or total necrosis of the flap recognized 1 year after examination. They produced good cosmetic results; however, they could not elevate the QOL score on the whole.

Inhibition of replication induces non-apoptotic cell death in fibroblast cell lines derived from LEC rats.

Hydroxyurea (HU), an anticancer drug, inhibits ribonucleoside diphosphate reductase and reduces pool sizes of deoxyribonucleoside triphosphate (dNTP). The reduction of dNTP results in inhibition of DNA replication. The cytotoxic effect of HU was investigated using fibroblast cell lines from LEC rats. LEC rat cells showed significantly higher sensitivity to HU than did cell lines from control WKAH rats. No significant differences were observed between the percentages of apoptotic cells in either LEC or WKAH rat cells that had been treated with HU and those that had not been treated with HU. LEC rat cells also showed significantly higher sensitivity to aphidicolin, which blocks DNA synthesis by inhibiting DNA polymerase alpha, than did WKAH rat cells. In both LEC and WKAH rat cells, intensified bands of p53 protein were observed immediately after treatment with HU. Although the high level of p53 protein persisted in WKAH rat cells until 6 hr post-incubation time after treatment with HU, the level of p53 protein had decreased at 6 hr post-incubation time in LEC rat cells. When the cells were X-irradiated in the absence or presence of HU, the ratio of the surviving fraction without HU to that with HU only slightly increased after X-irradiation in WKAH rat cells. In contrast, the ratio in LEC rat cells significantly increased after X-irradiation in a dose-dependent manner.

Cardiac tolerability of concurrent administration of trastuzumab and anthracycline-based regimen as adjuvant chemotherapy for breast cancer.

BACKGROUND: Retrospective analysis suggests that anthracycline-containing regimens may be superior to non-anthracycline-containing regimens in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. However, both trastuzumab and anthracycline have cardiotoxicity, and it remains unclear how to use trastuzumab in combination with an anthracycline to curtail their cardiotoxicity. PATIENTS AND METHODS: From 2010 to 2013, we administered weekly (q1w) paclitaxel (wP) followed by 75 mg/m(2) epirubicin, fluorouracil, and cyclophosphamide (FEC) every third week (q3w) and concurrent q1w trastuzumab (H) to 41 patients with HER2-positive breast cancer (H+ group), and wP followed by FEC100 without trastuzumab to 57 patients who were HER2-negative (H- group). We routinely assessed the left ventricular ejection fraction (LVEF) by echocardiography, at the time of initiation, after wP, and after FEC, and compared them between these 2 groups. RESULTS: LVEF decreased from 63.2 to 60.9% (p = 0.030) in the H+ group and from 63.9 to 61.9% (p = 0.009) in the H- group. These 2 groups showed no significant difference in the reduction rate of LVEF over the period of chemotherapy (0.968 vs. 0.978: NS, p = 0.6457). There was no severe cardiotoxicity or congestive heart failure in either group. CONCLUSION: Concurrent administration of epirubicin (q3w, 75 mg/m(2)) and trastuzumab showed no less cardiac tolerability in an adjuvant setting.