Effective multidisciplinary treatment for ovarian granulosa cell tumor with multiple metastases--a case report.

Ovarian granulosa cell tumor (GCT) is among the ovarian sex-cord stromal tumors that are classified as borderline malignancies. We report a case of GCT with multiple metastases for which multidisciplinary treatment including surgery, chemotherapy and radiotherapy was effective. A 41-year-old woman underwent left salpingo-oophorectomy because of an ovarian tumor in 2004. Final pathology confirmed a granulosa cell tumor adult type, FIGO Stage IC. In 2008, tumorectomy of the lower abdominal wall metastases was also performed. After three cycles of BEP chemotherapy for metastases of the right lung, liver, paraaortic lymph node and rectus, surgical resection was performed in 2009. In 2010, local radiation was performed for the first lumbar vertebral metastasis. Ovarian GCTs exhibit slow growth but if the surgical stage is IC or higher, there is the possibility of recurrence. It is important to treat recurrent tumors with the combination of surgery, chemotherapy, and radiation therapy.

Phase III trial of docetaxel plus gemcitabine versus docetaxel in second-line treatment for non-small-cell lung cancer: results of a Japan Clinical Oncology Group trial (JCOG0104).

BACKGROUND: This trial evaluated whether a combination of docetaxel and gemcitabine provides better survival than docetaxel alone in patients with previously treated non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Eligibility included pathologically or cytologically proven NSCLC, failure of one platinum-based regimen, performance status of zero or one, 20-75 years old, and adequate organ function. Patients received docetaxel 60 mg/m(2) (day 1) or docetaxel 60 mg/m(2) (day 8) and gemcitabine 800 mg/m(2) (days 1 and 8), both administered every 21 days until disease progression. RESULTS: Sixty-five patients participated in each arm. This trial was terminated early due to an unexpected high incidence of interstitial lung disease (ILD) and three treatment-related deaths due to ILD in the combination arm. Docetaxel plus gemcitabine compared with docetaxel-alone patients experienced similar grade and incidence of toxicity, except for ILD. No baseline factor was identified for predicting ILD. Median survival times were 10.3 and 10.1 months (one-sided P = 0.36) for docetaxel plus gemcitabine and docetaxel arms, respectively. CONCLUSION: Docetaxel alone is still the standard second-line treatment for NSCLC. The incidence of ILD is higher for docetaxel combined with gemcitabine than for docetaxel alone in patients with previously treated NSCLC.

[Inter-individual variability of mean latencies in the dynamic topography of short latency visual evoked potentials and the origin of brainstem potentials evaluated by the dipole tracing method in normal subjects].

To determine the normal pattern of the short latency visual evoked potentials (SVEP) in clinical diagnosis, in a previous report, the normal responses were classified into the following three types: uniform type, brainstem dominant type and occipital dominant type, according to the strength of the potentials. In the present report the latencies of N40 and P50, which constitute the SVEP, were investigated. In addition, the burst origin of these potentials was investigated using the dipole tracing method for P50 obtained through dynamic topography. Optic nerve potentials of N40 appeared first in the anterior region (from 37.1msec to 40.4msec following the stimulus) after the fourth retinal oscillatory potentials and soon extended to the posterior region (after about 2msec). This potential appeared in approximately about 65%, because of the low amplitude. P50 appeared 45.8-53.6msec after the stimulus about 100% and burst 2-4 times in the same place. Using the dipole tracing method, the origin of P50 was estimated to the near the deep center of the brain, probably around the brainstem. The same results were obtained using dynamic topography.

[A long-term survivor of extensive-stage small cell lung cancer].

A 53-year-old man was admitted for evaluation of multiple hepatic tumors. A thoracic CT scan revealed a mass lesion in the right middle lobe. Transcutaneous needle aspiration cytology from the lung tumor and transcutaneous hepatic tumor biopsy were performed, from which the cytohistological diagnosis was small cell lung cancer with liver metastasis. The patient was treated with 3 courses of high dose cisplatin with vindesine and mitomycin and 5 courses of carboplatin with etoposide, and achieved a complete response. We herein report a long-term survivor of extensive-stage small cell lung cancer.

[Primary pulmonary cryptococcosis diagnosed by medical examinations in 12 patients].

Primary pulmonary cryptococcosis is thought to be relatively less common than other lung mycoses, but recently there has been an increase in reports of patients with this disease. Our report covers 12 cases of primary pulmonary cryptococcosis in which the diagnosis was based on medical examinations. The patients consisted of 11 men and 1 woman, aged 27 to 58 years. Only 3 exhibited subjective symptoms. Roentgenograms showed cavitating tumor shadows in the lungs of 2 of the patients with subjective symptoms, and nodular shadows with diameters of 1.0 to 2.8 cm in all patients without subjective symptoms, indicating the possibility of lung cancer. The disease was diagnosed in 3 patients on the basis of transbronchial biopsy findings, and in 9 on the basis of needle aspiration biopsy findings. One patient was diabetic, but the others did not exhibit malignancies or other immunocompromised states. Antifungal drugs significantly reduced or eliminated the nodular shadows in 10 patients. Because patients with primary pulmonary cryptococcosis frequently lack subjective symptoms, prompt diagnosis is critical, particularly in view of the need to distinguish the disease from lung cancer.

Intrapleural hypotonic cisplatin treatment for malignant pleural effusion in 80 patients with non-small-cell lung cancer: a multi-institutional phase II trial.

To assess the effect and toxicity of hypotonic cisplatin treatment (HPT) consisting of the intrapleural administration of cisplatin in distilled water for malignant pleural effusion in patients with non-small-cell lung cancer (NSCLC). Non-small-cell lung cancer patients with cytologically proven and previously untreated malignant pleural effusion were enrolled into this study. Firstly, the lung was fully re-expanded by a tube thoracostomy, and then 25 mg cisplatin in 500 ml of distilled water was instilled through a chest tube and then the tube was clamped. After 1 h, the tube was declamped and allowed to drain. The chest tube was removed when the pleural effusion volume decreased to 200 ml or less per day. A complete response (CR) was considered to occur when the pleural effusion disappeared. A partial response (PR) was determined to occur when the volume of pleural effusion remained under (1/4) of hemithorax. The response at 4 weeks was evaluated by an extramural review. Out of 84 patients enrolled from February 1998 to August 2002, 80 patients were eligible and analysed in the present study. The toxicity of HPT was acceptable. Neither a haematological toxicity of any grade nor grade 4 nonhaematological toxicity was observed. Grade 3 nonhaematological toxicities were observed, including nausea (4%), vomiting (3%), pyothorax (1%) and dyspnoea (1%). The median time of drainage from HTP was 4 days. Twenty-seven (34%) and 39 (49%) patients achieved CR and PR, respectively, for an overall response rate of 83% (95% confidence interval, 74-91%). The median duration of the response was 206 days. The median survival time of all patients was 239 days. Hypotonic cisplatin treatment for malignant pleural effusion of NSCLC is therefore considered to be feasible and effective. A phase III study of HPT is thus warranted.

UFT plus gemcitabine combination chemotherapy in patients with advanced non-small-cell lung cancer: a multi-institutional phase II trial.

A multi-institutional phase II trial was conducted to evaluate the efficacy and toxicity of combination chemotherapy consisting of gemcitabine and UFT, which is composed of tegafur and uracil, for non-small-cell lung cancer (NSCLC) patients. Patients with advanced NSCLC received an oral administration of UFT (tegafur 200 mg m(-2)) b.i.d. from days 1 to 14 and intravenous injection of gemcitabine 900 mg m(-2) on days 8 and 15. This treatment was repeated every 4 weeks. A total of 44 patients were enrolled into this trial. The median age of all patients was 74 years, with 23 patients younger than 75 years and 21 patients with 75 years of age or older. A total of 18 patients (41%) achieved a partial response. The median survival time was 13.2 months and the 1-year survival rate was 59%. The most common grade 3-4 toxicity was neutropenia (57%). The frequency of grade 3 nonhaematologic toxicities was less than 5%. In addition, no significant difference in the response, survival or toxicities was observed between the patients younger than and those older than 75 years of age. This combination chemotherapy demonstrated a promising effectiveness and acceptable toxicity in patients with advanced NSCLC, even in patients older than 75 years. .

A para-site-specific hydroxylation of aromatic compounds by Mycobacterium sp. strain 12523: stabilization of the hydroxylation activity.

Mycobacterium sp. strain 12523 has a para-site-specific hydroxylation activity, which produce para-substituted phenols from various aromatic compounds. However, the activity is unstable and the reactions are inactivated within 24 h. In order to extend the reaction period, the factors that affected reaction stability were examined. The hydroxylation activity of the cells incubated in buffer was significantly stabilized by the inclusion of an inducer such as methyl ethyl ketone. It is suggested that a regulatory mechanism is involved in controlling the activity. This study resulted in the development of a convenient method to stabilize the hydroxylation activity, involving the addition of an inducer, such as acetone, to the reaction system. This method permitted the hydroxylation reaction to continue for more than 67 h.

[Clinical evaluation of diagnosis and treatment in three cases of primary pulmonary cryptococcosis].

Pulmonary cryptococcosis has been considered as a disease associated with depressed immune function of the host. However, it may develop in healthy individuals without any underlying disease. Recently, we experienced three cases of primary pulmonary cryptococcosis. Case 1. A 30-year-old woman in the sixth week postpartum developed cough and low-grade fever. Chest X-ray showed infiltrative shadows in right S2 and left S6. A diagnosis of pulmonary cryptococcosis was made from transbronchial brushings and histological examination. Case 2. A 51-year-old man was noted to have abnormal shadows on chest X-ray film at a regular medical checkup. Chest X-ray examination showed a small nodular density in left S9. A diagnosis of pulmonary cryptococcosis was made from percutaneous pulmonary paracentesis. Case 3. A 58-year-old man was noted to have an abnormal shadow on chest X-ray film at a regular medical checkup. Chest X-ray examination showed a nodular density in right S8. A diagnosis of pulmonary cryptococcosis was made from transbronchial brushings and histological examination. All three cases showed no impairment in their immune functions. These cases are described with a discussion of the literature.

[Availability of diagnosis by percutaneous needle aspiration cytology of the lung in cases who showed a peripheral solitary tumorous shadow on chest Xp and diagnostic rate of transbronchial approach].

We report the availability of diagnosis by percutaneous needle aspiration cytology of the lung (NAC) in 526 cases who showed a peripheral solitary tumorous shadow on chest Xp. The positive rate of the transbronchial approach was 62% (147 of 238) in lung cancer cases and 43% (6 of 14) in metastatic lung tumor cases. The positive rate of NAC in relation to lung cancer increased with decrease of diameter of the tumor. The positive rate of NAC was significantly higher than the positive rate of the transbronchial approach with NAC. Complications of NAC were bloody sputum (11%), pneumothorax (8%) and subcutaneous emphysema (0.2%), which did not create therapeutic problems. Pleural dissemination (0.4%) was a serious complication of NAC.

[Thoracoscopy with two bronchoscopes in 50 patients with pleural effusion of unknown origin].

When performing thoracoscopy in patients with pleural effusion of unknown origin, we used two bronchoscopes simultaneously, one for observation and one for biopsy. A total of 50 patients with pleural effusion of unknown origin were studied. In all of those studies, pleural effusion was exudative, lymphocyte-dominant, had a low level of adenosine deaminase, no malignant cells, and no tuberculosis or other bacteria in pleural effusion smears. Fourteen were out-patients. A catheter was inserted into the pleural space under local anesthesia, and 300 ml to 500 ml of pure oxygen was injected to create a pneumothorax. Two flexible fiberoptic bronchoscopes were used simultaneously, one for observation and one for biopsy. Approximately 1 hour after the examination, the out patients were able to return home. Lesions in the pleural cavity were found in 42 of these 50 patients, and histological diagnosis was possible in 46. This is a simple procedure with no major side effects. The equipment required is familiar to pulmonary physicians, and the diagnostic yield is high.

A phase I study of combination chemotherapy with gemcitabine and oral UFT for advanced non-small cell lung cancer.

A phase I study was carried out to determine the optimal dose and administration schedule for combined UFT plus gemcitabine therapy in patients with non-small cell lung cancer. Twenty-four patients (including 11 patients previously treated with cisplatin as the key drug) received oral UFT 400 mg x m(-2) on days 1 to 14 with intravenous infusions of gemcitabine (800 mg x m(-2) on days 8 and 15, or 900 mg x m(-2) on days 8 and 15, or 900 mg x m(-2) on days 1, 8 and 15). The most appropriate dosing option appeared to be 400 mg x m(-2) per day of oral UFT for 14 consecutive days with 900 mg x m(-2) gemcitabine on days 8 and 15. Eight of the 24 patients achieved partial response. The combination chemotherapy UFT and gemcitabine was well tolerated and may benefit patients with advanced non-small cell lung cancer. A multicentre phase II study using a 3-weekly regimen is in progress.