A Case of Significant Response to Olaparib in a Patient with Primary Peritoneal Carcinosarcoma Diagnosed by Laparoscopic Surgery.

Primary peritoneal carcinosarcomas which arise from extragenital locations are extremely rare. Carinosarcomas contain both carcinomatous and sarcomatous elements and can be mainly detected in the female genital tract. We herein report a case of primary peritoneal carcinosarcoma diagnosed by laparoscopic surgery and treated with olaparib. A 62-year-old woman referred to our hospital due to abdominal distension. From imaging findings, we suspected advanced primary peritoneal carcinoma, and laparoscopic surgery was thereafter performed. The pathological diagnosis was carcinosarcoma, and the patient received chemotherapy with docetaxel and carboplatin. After three cycles of chemotherapy, the interval debulking surgery was attempted but resulted in suboptimal results. Because the bilateral ovaries were observed with a normal size and normal findings, we considered that the most likely diagnosis was primary peritoneal carcinosarcoma. After the additional chemotherapy and a 6-month observation period, the tumor relapsed. The patient received chemotherapy again, and the peritoneal carcinosarcoma was judged to be a platinum-sensitive tumor. Oral administration of olaparib was thus initiated. Although a dose reduction was needed due to anemia, olaparib was effective, and the patient could continue the drug for another 7 months. This is the first report of primary peritoneal carcinosarcoma treated with olaparib and shows that it could be a treatment option for platinum-sensitive tumors.

[Experiences of caring for patients with lymphedema and dementia].

Recently, the importance of prevention and care of lymphedema patients has been recognized. To improve edema reduction and skin condition, continued care is necessary. However, everyday care requires time and effort, and patients may neglect the required routine. Therefore, it is necessary for patients to recognize the importance of lymphedema and acquire the knowledge and skills to care for their condition. In the case of patients with dementia, it is important to ensure 1) comfortable care for the patients, 2) flexibility of care according to the physical and mental state of the patients, and 3) education of visiting home care staff.

[A case of an end-of-life cancer patient in which lymphedema care improved the QOL enabling home hospice care].

Recently, the importance of prevention and care of lymphedema has been recognized. It appears that the complex physical therapy is relatively taboo for an end-of-life cancer patient with lymphedema. Therefore, an intervention of care is often difficult. In our case, the patient strongly desired a hospice care at home, so we introduced a home hospice care gradually taking a step by step approach with anticipated harmful symptoms. As a result, the home hospice care was doable with ADL and QOL improvements. For lymphedema care of an end-of-life cancer patient, a goal setting, sharing the patient's will based on anticipated symptoms, and an introduction of a gradual care were all important.

[Two cases of Stewart-Treves syndrome observed at Sanshu hospital].

Stewart-Treves syndrome is angiosarcoma, which occurs in the chronic lymphedema of the upper or lower limbs. Presently, an effective therapy is not established. The survival period is only several months to one year. There are some reports that angiosarcoma will occur in the period of 5~15 years after a continuation of lymphedema of the extremities. Therefore, it is important to prevent lymphedema after surgical operations of primary disease and the lymphedema.