[A Case of Long-Term Survival Following Two-Stage Surgery for Perforated Advanced Gastric Cancer Caused by Chemotherapy].

A 74-year-old man with bloody vomit was diagnosed as having clinical Stage Ⅳ advanced gastric cancer with lymph node metastasis around the abdominal aorta. Initially, for curative surgery, he was administered neoadjuvant chemotherapy. On day 32, in the second course of chemotherapy containing S-1 after 12 courses of chemotherapy containing S-1 and cisplatin, he developed pan-peritonitis owing to the perforation of gastric cancer caused by chemotherapy, and thus, we performed emergency omental implantation and peritoneal drainage. He was discharged from the hospital after 14 days with no trouble. His gastric cancer was judged to be resectable without retaining metastatic lymph nodes based on intraoperative findings and abdominal computed tomography. Therefore, 3 months after the emergency surgery, he underwent total gastrectomy with D1+(+No. 11d)lymphadenectomy. The postoperative course was uneventful. He rejected adjuvant chemotherapy despite our recommendation. Regrettably, intraabdominal dissemination was observed 15 months after total gastrectomy, and he then received chemotherapy again. He has remained alive for 57 months after the first visit to our hospital.

Treatment of HER2-positive cutaneous apocrine carcinoma of the axilla.

Cutaneous apocrine carcinoma (CAC) is an extremely rare skin appendage malignant tumor that develops in the apocrine sweat glands, and no evidence-based drug therapy has been established. A 61-year-old female patient was diagnosed with axillary CAC with axillary lymph node metastasis and underwent surgery. Pathological examination revealed seven lymph node metastases. Immunostaining revealed that the tumor cells were estrogen receptor (ER)-positive, progesterone receptor (PgR)-positive, and human epidermal growth factor receptor 2 (HER2)-positive. The patient received chemotherapy, including anti-HER2 drugs, and hormone therapy to prevent recurrence. No recurrence was observed for > 3 years after surgery. The apocrine glands in the skin and mammary glands have similar characteristics and mammary glands are thought to be modified or derived from the apocrine glands present in the subcutaneous adipose tissue. Therefore, ER, PgR, and HER2 levels may be positive in CAC. Drug treatments for breast cancer may also be effective for CAC.

Very Late Recurrence in Breast Cancer: Is Breast Cancer a Chronic Disease?

Although breast cancer treatments have made great strides in recent decades, there are still many recurrences. Late recurrence is one of the characteristics of breast cancer. Here, we present four cases of recurrence more than 10 years after the initial diagnosis. The time from diagnosis to recurrence was 13 to 20 years in our four cases, which were all estrogen receptor (ER)-positive, and one was also human epidermal growth factor receptor 2-positive. Long-term hormone therapy for 10 years is necessary to prevent late recurrence of breast cancer, but we need to know that late recurrence remains common. Risk factors for late recurrence include ER positivity, progesterone receptor positivity, and low Ki67. The most common sites of recurrence are the lungs/pleura and bones, which was also the case in our experience. It is no exaggeration to say that breast cancer is a chronic disease similar to hypertension and diabetes. This is because breast cancer is not completely cured by surgery alone and lasts for a long time, with patients requiring long-term hormone therapy. Moreover, it can recur even after 10 years or more.

Using Computed Tomography Lymphography for Mapping of Sentinel Lymph Nodes in Patients with Breast Cancer.

OBJECTIVES: In breast cancer surgery, the combined use of the dye method and radioisotope (RI) method is recommended for identifying sentinel lymph nodes. However, the RI method is difficult to license, expensive, and difficult to introduce. Thus, we introduced computed tomography lymphography (CTLG) and investigated the characteristics and usefulness of CTLG. MATERIAL AND METHODS: Among breast cancer patients who underwent surgery during a 6-year period from January 2013 to December 2018, CTLG was performed on 141 patients with clinically negative lymph node metastasis. These cases were then retrospectively investigated. The number and location of lymph vessel, true sentinel lymph nodes, and the positional relationships with surrounding muscles and blood vessels were confirmed from the constructed 3D images. The actual surgeries were then performed using a dye method with indigo carmine based on images obtained using CTLG. RESULTS: CTLG was able to identify lymph vessels and true sentinel lymph nodes in 131 of the 141 cases (92.91%). There were 97 patients in whom the first true sentinel lymph node reached from the breast was one node, 30 with two nodes, and 4 with three nodes. Moreover, there were three cases in which sentinel lymph nodes were present at Level II. During surgery, sentinel lymph nodes were identified in 131 patients (92.91%) using dye. CONCLUSION: CTLG has a high identification rate in sentinel lymph nodes, and it is considered a convenient and useful examination method because a lot of information, such as the number and position of sentinel lymph nodes, can be obtained.

[Percutaneous transthoracic needle biopsies under a guide of real-time three image computed tomography].

PURPOSES: Experiences of percutaneous transthoracic needle biopsies under a guide of a real time 3 image display computed tomography (3 image CT) is reported. MATERIALS AND METHODS: Twenty seven biopsies from 23 patients were performed. For 3 image CT, Somatom was used. This equipment can render 3 pictures of serial slices on a screen simultaneously and have X-ray exploration-reduction system for both the patients (35% reduction) and operator's hands (72% reduction). RESULTS: The median size of the masses was 1.7 (0.5-6.3) cm; the median distance from the pleura to the mass was 0.66 (0-6.5) cm; and the median time to perform biopsies was 12 minutes. We had only 3 failed cases to obtain biopsied specimen (11%). COMPLICATIONS: Needle biopsy of the lung lesion under a guide of a 3 sectional CT is a safe and timesaving method with a high success rate to obtain biopsied tissues even for small lesions or difficult lesion.