[Osteosarcoma Secondary to Polyostotoic Fibrous Dysplasia of the Ribs].

Sarcomatous transformation of fibrous dysplasia is extremely rare. We present the case of a 54-yearold man with multiple rib masses, multiple enlarged lymph nodes throughout the body, and multiple osteolytic lesions on computed tomography( CT). A positron emission tomography( PET) scan showed abnormal enhancement in each. A needle biopsy of the right supraclavicular fossa lymph node revealed sarcoidosis. Considering the possibility of malignancy associated with sarcoidosis, a rib tumor resection and mediastinal lymph node biopsy were performed to confirm the diagnosis of the rib lesion. The pathology results showed that the rib mass was a low-grade central osteosarcoma and the mediastinal lymph node was sarcoidosis. The distribution of the lesions was consistent with osteosarcoma secondary to multiple fibrous bone dysplasia. As the osteosarcoma was low grade, the patient was followed up. Three years after surgery, there was no increase in residual disease.

[A Case of Stage â £ Gastric Cancer with Multiple Liver Metastases, Resected Primary Tumor after Chemotherapy, and Alive for 3.5 Years without Recurrence].

A 67-year-old man visited our hospital for epigastric pain. Esophagogastroduodenoscopy(EGD)revealed type 2 gastric cancer from the cardia to the gastric angle, and histopathological examination revealed papillary adenocarcinoma(pap), HER2-positive. Contrast-enhanced CT showed wall thickening mainly in the posterior wall of the gastric body, enlarged lymph nodes that were lumped together with the main lesion, and 8 low-absorption areas with ring shaped contrast effects in both lobes of the liver. The patient was diagnosed as gastric cancer cT4aN(+)M1[HEP], clinical Stage ⅣB. Six courses of capecitabine plus cisplatin plus trastuzumab(XP plus Tmab)therapy and 17 courses of capecitabine plus trastuzumab(X plus Tmab)therapy were performed. After chemotherapy, liver and lymph node metastases disappeared on CT and MRI. EGD showed residual gastric cancer, and the policy was to resect the primary tumor. Laparoscopic total gastrectomy with D2 lymph node dissection was performed. Pathological results showed T1b(SM)depth, no lymph node metastasis, and histologic response was Grade 2a. Six courses of X plus Tmab were administered as postoperative adjuvant chemotherapy, but were discontinued at the patient's request. Currently, 5 years have passed since the first chemotherapy and 3.5 years have passed since the surgery, and the patient is alive without recurrence, suggesting that the conversion surgery may have contributed to the prolonged survival.

[Thymoma with Pure Red-cell Aplasia and Hypogammaglobulinemia].

Thymoma presenting concurrent pure red-cell aplasia (PRCA) and hypogammaglobulinemia are extremely rare. A 67-year-old woman with a short of breath was referred to our hospital due to anemia and the chest abnormal shadow. Laboratory investigations revealed a hemoglobin level of 5.6 g/dl and reticulocyte percentage of 0.2%. Her serum gamma-globulin level was low. Chest computed tomography (CT) revealed a 7-cm tumor in the left upper mediastinum. We diagnosed the patient with thymoma accompanied by PRCA and hypogammaglobulinemia. The patient underwent thymectomy and PRCA has been successfully treated by postoperative cyclosporine administration. Monthly intravenous infusion of gamma-globulin has been necessary for the control of hypogammaglobulinemia. Currently, she is doing well without recurrence of thymoma or PRCA five years after the surgery.

[A Case of Postoperative Peritoneal Dissemination Recurrence of CY1 Gastric Cancer with cCR after Nab-PTX Therapy].

A 72-year-old man visited his local doctor for gastric discomfort. Esophagogastroduodenoscopy revealed a type 3 tumor on the gastric antrum, and histopathological examination revealed a moderately differentiated adenocarcinoma(tub2). The patient was referred to our hospital and CT scan revealed wall thickening with contrast effect in the gastric angle but no enlarged lymph nodes in the region. The patient was diagnosed as cT3N0M0, Stage ⅡB gastric cancer and underwent open distal gastrectomy and D2 lymph node dissection. No peritoneal dissemination was observed, but intraoperative laparoscopic cytology showed Class Ⅴ. The patient was diagnosed as CY1 Stage Ⅳ gastric cancer, and treated with S-1 plus Tmab therapy starting 1 month after surgery. One year postoperative follow-up CT revealed recurrence of peritoneal disseminations, and the patient was treated with nab-PTX as a second-line therapy. Tumor shrinkage was achieved steadily, and the peritoneal disseminations disappeared at the CT after 12 courses, resulting in cCR. Thereafter, cCR continued and treatment was terminated at the 17th course. Seven years have passed since the end of chemotherapy, and the patient is still alive without recurrence.

[A Case of Postoperative Recurrence of Liver Metastasis after Gastrectomy for Gastric Cancer-No Recurrence for Five Years after Twice Liver Resections].

The patient was an 89-year-old man. He underwent laparoscopic distal gastrectomy for gastric cancer and was diagnosed as T1bN1M0, Stage ⅠB. Eight months after surgery, a CT scan showed an 18 mm-sized hypodense mass in S6 of the liver, and the patient was diagnosed with recurrent liver metastasis. He was treated with 3 courses of CapeOX therapy, and the response was judged as partial response(PR). Laparoscopic partial hepatic S6 resection was performed for the single liver metastasis. The pathological results showed liver metastasis of gastric cancer. Capecitabine was started as adjuvant chemotherapy. Nine months after surgery for liver metastasis, CT scan showed a 12 mm-sized single tumor in S5 and the patient was diagnosed with recurrent liver metastasis. The patient underwent laparoscopic partial hepatectomy after 3 courses of weekly paclitaxel plus ramucirumab therapy. The pathological result showed liver metastasis of gastric cancer. After the surgery, adjuvant chemotherapy was not administered according to the patient's request. Seven years have passed since the resection of the gastric cancer, and 5 years have passed since the resection of the second liver metastasis, and the patient has not had any recurrence.

[Mucoepidermoid Carcinoma Suspectedly Developed from a Bronchogenic Cyst in the Posterior Mediastinum].

Mucoepidermoid carcinoma developing from a bronchogenic cyst is extremely rare. We present a case of a 74-year-old man with a cystic mass in the posterior mediastinum detected by chest computed tomography( CT) and magnetic resonance imaging. A bronchogenic cyst or neurogenic tumor was suspected. He did not accept surgical treatment and was followed up at outpatient. Since the enlargement of the mass was shown by chest CT after seven years, the resection of the mass was performed by thoracoscopic surgery, however the cyst wall remained due to the severe adhesion and the residual mucosa was cauterized. The mass was diagnosed as a mucoepidermoid carcinoma by pathology which was likely to develop from a bronchogenic cyst. After postoperative radiotherapy, the patient is well without recurrence 10 months after surgery.

Thrombocytopaenia successfully treated by a multilocular thymic cyst resection.

The multilocular thymic cyst (MTC) is a rare, acquired disease caused by inflammatory changes in the thymus, and is associated with autoimmune diseases. We report a case of MTC with thrombocytopaenia, which improved following surgical resection. A 45-year-old man developed thrombocytopaenia with an anterior mediastinal tumour. Thrombocytopaenia due to an autoimmune mechanism, associated with thymoma or thymus-related disease, was suspected. Pathologic analysis following thoracoscopic thymectomy confirmed MTC. The platelet level recovered postoperatively. Our findings suggested a relationship between the acquired formation of MTC and the development of autoimmune antibodies. However, further investigation is needed to obtain more information.

Video-assisted thoracoscopic surgery using a three-dimensional thoracoscopic system as an educational tool for surgical trainees in general thoracic surgery.

OBJECTIVE: The clinical practice of safe and efficient surgery and professional development of general thoracic surgical trainee are both important issues for mentors. We investigated the usefulness of a three-dimensional (3D) endoscopic system application for lung cancer treatment as a tool for training surgical trainees. METHODS: Supervised by mentors, general thoracic surgical trainees were trained with video-assisted thoracoscopic surgery (VATS) for primary lung cancer using a 3D endoscopic system to enable them to become operators. Video clinics using 3D images were held weekly. The group using 3D endoscopic system (66 cases in the 3D-VATS group) was compared with the group using conventional two-dimensional (2D) thoracoscopic system (35 cases in the 2D-VATS group) to perform VATS lobectomies. RESULTS: There was no significant difference in operative time between both groups. However, the 3D-VATS group comprised significantly less experience than the 2D-VATS group. The intraoperative blood loss was significantly reduced for the 3D group (34 mL in the 3D-VATS group vs. 76 mL in the 2D-VATS group, P = 0.0007). There were no cases of conversion from VATS to open thoracotomy and intraoperative transfusion in either group. CONCLUSION: 3D-VATS and video clinics using 3D videos are useful training tools for general thoracic surgical trainees with little experience in open thoracotomy.

Cryotherapy for the prevention of weekly paclitaxel-induced peripheral adverse events in breast cancer patients.

PURPOSE: This randomized phase II study was conducted to investigate the efficacy of cryotherapy in preventing peripheral neuropathy and dermatological adverse events in breast cancer patients treated with weekly paclitaxel. METHODS: Patients treated with 12 weekly doses of paclitaxel for breast cancer were randomized (1:1) into a cryotherapy or control group. The primary endpoint was the percentage of patients with a marked decrease in the Functional Assessment of Cancer Therapy-Neurotoxicity (FACT-NTX) score. The secondary endpoints were Patient Neurotoxicity Questionnaire (PNQ), Common Terminology Criteria for Adverse Event (CTCAE) for peripheral neuropathy, and FACT-Taxane score. RESULTS: Forty-four patients were randomly assigned to the cryotherapy (n = 22) or control groups (n = 22). The percentage of patients with a marked decrease in FACT-NTX scores was significantly lower in the cryotherapy group than in the control group (41 vs. 73%, p = 0.03). The incidence of CTCAE grade ≥ 2 sensory (p = 0.001) and motor peripheral neuropathy (p = 0.01), and PNQ grade D or higher for sensory peripheral neuropathy (p = 0.02), and decrease in the FACT-Taxane score (p = 0.02) were also significantly lower in the cryotherapy group than in the control group. There were no serious side effects associated with cryotherapy. CONCLUSION: Cryotherapy is an effective approach for prevention of peripheral neuropathy and dermatological adverse events in breast cancer patients treated with weekly paclitaxel.

Efficacy of complete video-assisted thoracoscopic surgery lobectomy using the three-dimensional endoscopic system for lung cancer.

OBJECTIVE: We aimed to investigate the efficacy of complete video-assisted thoracoscopic surgery (cVATS) lobectomy using the three-dimensional (3D) endoscopic system in patients with lung cancer and compare it with that of cVATS lobectomy using the conventional two-dimensional (2D) endoscopic system in former consecutive cases. METHODS: We retrospectively analyzed the prospectively collected database of patients with clinical stage I lung cancer who underwent cVATS lobectomy using the 3D endoscopic system; the patients who underwent surgery using the 2D endoscopic system were considered the historical control group. The operative and perioperative data were compared, and propensity-score matched comparisons were used to assess the potential impact of selection bias. RESULTS: We performed 189 cVATS lobectomies. Of these, 105 were performed using the 3D endoscopic system, while 84 were performed using the 2D endoscopic system. After matching, there was no significant difference in the preoperative factors between the two groups. The operation time was significantly shortened (P = 0.003), and the intraoperative blood loss was significantly reduced in the 3D group (P < 0.001). In particular, there was only one case of intraoperative hemorrhage of 201 mL or more in the 3D group, compared to 12 cases in the 2D group (P < 0.001). After matching, the intraoperative blood loss and operation time were significantly reduced in the 3D group. CONCLUSIONS: Our results showed that the 3D endoscopic system for cVATS lobectomy may be a useful surgical tool and switching to it from the 2D endoscopic system can be performed safely.

Minimal prognostic significance of sentinel lymph node metastasis in patients with cT1-2 and cN0 breast cancer.

BACKGROUND: The prognostic value of sentinel lymph node (SLN) metastases may be minimized by the limited disease burden of lymph node metastases and tailoring adjuvant therapy based on breast cancer biology. The aim of this study is to assess the prognostic significance of SLN metastasis in patients with cT1-2N0M0 breast cancer. PATIENTS AND METHODS: Between January 2006 and December 2015, 582 patients underwent SLN biopsy for cT1-2N0M0 breast cancers. cN0 was essentially diagnosed by ultrasound sonography. The prognostic values of SLN metastases were retrospectively evaluated. RESULTS: Among 582 patients with cT1-2N0M0 breast cancer, 111 patients (19.1%) were positive for SLN metastasis, including 39 cases (6.7%) of micrometastasis and 72 cases (12.4%) of macrometastases. The median size of SLN metastasis was 3.0 mm (range 0.2-16 mm, mean 4.1 mm). In log-rank test, presence of SLN metastasis was not associated with breast cancer recurrence (p = 0.21); 5-year and 10-year recurrence-free survival (RFS) were 93.0% and 96.5%, and 93.0% and 90.4% in the SLN-positive and SLN-negative groups, respectively. In the propensity score matching cohort (n = 178), there was no significant difference in RFS between the SLN-positive and SLN-negative groups (p = 0.90). In Cox regression analysis, a continuous value of Ki67 expression was a significant prognostic factor (HR 1.03; 95% CI 1.01-1.05, p = 0.017). CONCLUSION: SLN metastasis has a minimal impact on RFS for patients with cT1-2N0M0 breast cancer in the modern medical era. A proliferation marker is a better factor for poor prognosis than the presence of SLN metastases in this population.