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.

[A Case of Alternate-Day Treatment with S-1 in a Patient with Multiple Lung Metastases of Colon Cancer].

The recommended regimen for S-1 internal use is 4 weeks of daily medication and 2 weeks of drug holiday. However, we experience many cases where changing the regimen is ineffective because of adverse events. This time, we report a favorable case of alternate-day treatment with S-1 in an elderly patient with multiple lung metastases of colon cancer. An 84-year-old woman, performance status 2, was diagnosed as having colon cancer and multiple lung metastases. After operation of the colon, she received chemotherapy with the S-1 alternate-day treatment. The lung metastases decreased remarkably, and she was able to continue the treatment without significant adverse events. She has been receiving the treatment without progression for more than 18 months now. The alternate-day treatment with S-1 is reported as a cure with anticancer efficacy and few adverse events. This treatment seems to be a useful chemotherapy for elderly patients with colon cancer.

[A Case of Disseminated Bone Marrow Carcinomatosis Arising from Breast Cancer for Which Paclitaxel and Bevacizumab Treatment Was Effective].

A 42-year-old woman visited our hospital with high fever and general malaise. A CT examination revealed that she had carcinoma of the left breast with axillary lymph node metastases and multiple bone metastases. A blood test showed anemia, thrombopenia and the existence of blast-like cells. Adenocarcinoma cells were detected in a bone marrow aspiration specimen, and the patient was diagnosed with disseminated carcinomatosis of the bone marrow. Systemic chemotherapy with paclitaxel plus bevacizumab was initiated while a blood transfusion was performed. Her symptoms improved, and the blood test results normalized. Disseminated carcinomatosis of the bone marrow is reported to have a poor prognosis, but paclitaxel plus bevacizumab is a possible effective chemotherapy.

Case of intra-abdominal endocrine tumor possibly arising from an ectopic pancreas.

We report an intra-abdominal endocrine tumor possibly arising from an ectopic pancreas. A 45-year-old woman visited the Nippon Medical School Musashi-Kosugi Hospital because of right-sided hypochondralgia and upper abdominal discomfort of 1 years duration. An intra-abdominal tumor was diagnosed on the basis of the results of an ultrasound examination, computed tomography and magnetic resonance. Surgery was subsequently performed using laparoscopic techniques, and a tumor without firm adhesions was found near the wall of the duodenal bulbus. The tumor was easily removed; the resected specimen (55 x 45 x 25 mm, 50 g) was composed of bloody fluid within a cystic tumor. Histological and immunohistochemical examinations of the tumor showed a type 3 ectopic pancreas, according to the classification proposed by Heinrich. The patients recovery was uneventful.