Gluteal muscle metastasis with peritoneal dissemination from gastric cancer during postoperative adjuvant chemotherapy: a case report.

BACKGROUND: Skeletal muscle metastasis from gastric cancer is rare and has a poor prognosis. We reported a case of gluteal muscle metastasis with peritoneal dissemination from gastric cancer during postoperative adjuvant chemotherapy. CASE PRESENTATION: A 64-year-old man with gastric cancer underwent distal gastrectomy with D2 lymph node resection. The pathological diagnosis was poorly differentiated adenocarcinoma and signet cell carcinoma, T3N3bM0, Stage IIIC. Metastases were found in all regional lymph nodes, except 11p. The resection margin was negative. S-1 plus docetaxel therapy was administered as postoperative adjuvant chemotherapy. Six month post-operation, the patient presented with right gluteal muscle tenderness and abdominal distension. Computed tomography revealed a solid mass in the right gluteal muscle, a disseminated nodule on the abdominal wall, and massive ascites. Pathological examination of the gluteal muscle revealed signet cell carcinoma, similar to the resected gastric cancer. The tumor was diagnosed as gastric cancer metastases. Ascites cytology was class V. Thereafter, the patient underwent one course of capecitabine plus cisplatin combined with trastuzumab. Radiation therapy was also administered to relieve the pain of gluteal muscle metastasis. However, chemoradiotherapy was ineffective, and the patient died 2 months after the recurrence. CONCLUSIONS: Skeletal muscle metastasis and peritoneal dissemination during adjuvant chemotherapy indicated a poor prognosis.

[A Case of Severe Aortic Thrombosis during the First Chemotherapy Regimen of CapeOX plus Bevacizumab for Metastatic Colon Cancer].

A 61-year-old man underwent CapeOX plus bevacizumab chemotherapyafter right hemicolectomyfor metastatic ascending colon cancer. On the 7th dayafter the first administration, he had sudden abdominal pain and nausea. Contrast-enhanced computed tomographyrevealed aortic thrombosis and a superior mesenteric artery(SMA)embolism that was considered to be associated with bevacizumab. Bevacizumab was discontinued and anticoagulation therapyusing heparin and urokinase was performed. Brain infarction of the left middle cerebral arteryoccurred on the 15th dayafter the first administration and thrombectomywas performed. Anticoagulation therapyusing heparin, bayaspirin, and edoxaban tosilate hydrate was performed. The aortic thrombosis and SMA embolism resolved with treatment, but the patient died following an increase in peritoneal dissemination. It should be noted that unexpectedlysevere aortic thrombosis occurred during the first administration of CapeOX plus bevacizumab for metastatic colon cancer.

Clinically predictive factors of pathologic upstaging in patients with peripherally located clinical stage IA non-small cell lung cancer.

OBJECTIVE: Post-surgical pathologic examination often reveals a more advanced state than clinically defined in non-small cell lung cancer (NSCLC), posing the need for careful consideration of a lesser resection. We investigated the predictive factors for the pathologic upstaging in clinical stage IA NSCLC. METHODS: The clinical features of 253 consecutive patients with peripherally located T1N0M0 NSCLC who underwent complete resection between 1991 and 2004 were investigated in relation to pathologic T- and N-factors. RESULTS: Of the 253 patients, 46 (18.2%) were upstaged after surgery, due to T-factor in 12 patients, N-factor in 32, M-factor in 2 and both T- and N-factors in 1. Among the clinical parameters, a higher level of serum CEA (p=0.0378) and larger tumor size (p=0.0276) were observed in the upstaged patients. Multivariable analysis revealed that tumor size and positive serum CEA were independently associated with pathologic upstaging. When tumor size was greater than 10mm, patients with positive serum CEA (>2.0 ng/ml) showed a significantly higher incidence of pathologic upstaging (29.2%) than the rest (15.5%, p=0.0461). CONCLUSION: Clinically defined peripheral stage IA NSCLC should be carefully indicated for a lesser resection when positive serum CEA and/or tumors greater than 10mm in size are observed.

Ectopic pleural thymoma presenting as a giant mass in the thoracic cavity.

We describe a rare case of a giant thymoma that developed in the right thoracic cavity, and seemed to originate from the visceral pleura. We believe that there have been few reports of thymoma developing from such an unusual origin.