[A Case of Carcinomatosis of the Bone Marrow Due to Rectal Cancer].

A 33-year-old man was admitted due to dyschezia and melena. Colonoscopy revealed a circulating type 4 rectal tumor. Further examination revealed intestinal obstruction due to rectal cancer, paraaortic lymph node metastasis, and multiple bone metastases, and an ileus tube was transanally inserted for decompression. Bone scintigraphy revealed multiple abnormal uptake regions in the entire skeleton. We planned to perform primary tumor resection and postoperative adjuvant chemotherapy and radiotherapy administration. Peritoneal signs in the lower abdomen appeared after 6 days of tube insertion. Abdominal computed tomography demonstrated intestinal perforation, and emergency surgery was performed. During the surgery, tube penetration in the anterior abdominal wall was observed in the sigmoid colon proximal to the tumor. Postoperatively, the patient developed disseminated intravascular coagulation(DIC). The patient had multiple bone metastases and juvenile cells in peripheral blood figure analysis; therefore, we concluded that DIC was caused by carcinomatosis of the bone marrow. After an informed consent was obtained, FOLFOX4 with simultaneous DIC treatment was initiated, and DIC remission was observed. The patient was transferred to a different hospital near his home, but died 35 days postoperatively.

Rapid growing mediastinal ectopic pancreas within ruptured thymic cyst treated using video-assisted thoracic surgery.

Ectopic pancreas (EP) is typically found within other gastrointestinal organs. Its discovery in other parts of the body, especially in the mediastinum, is exceedingly rare. This paper presents a case of a 17-year-old female patient with EP in a large, rapidly growing thymic cyst. She presented to our institution with persistent chest pain. Video-assisted thoracic surgery revealed a mediastinal mass in the setting of pleural effusion. Analysis of the fluid contents of the mass and the pleural effusion demonstrated high levels of pancreatic amylase, which supported the presence of pancreatic tissue within the mass. This is the first reported case of EP in a thymic cyst with an active pancreatic exocrine function. It is also the first reported case of mediastinal EP rupture secondary to autodigestion by amylase.

Evaluation of Maternal and Neonatal Outcomes of Assisted Reproduction Technology: A Retrospective Cohort Study.

BACKGROUND: To evaluate maternal and neonatal outcomes of assisted reproductive technology (ART). MATERIALS AND METHODS: Pregnant women registered from 2015 through 2017 (n = 6994) at five perinatal centers that managed high-risk pregnancies in Mie, Japan, retrospectively. Rates of preterm birth (<37 gestational weeks), early onset preeclampsia (<34 gestational weeks), late onset preeclampsia (≥34 gestational weeks), low-lying placenta, placenta previa, placenta accreta, placental abruption, atonic bleeding, uterine rupture, and amniotic fluid embolism after ART were evaluated. ART was defined as in vitro fertilization and micro-fertilization. Fisher's exact test, Mann-Whitney's U test, and logistic regression analysis were used to analyze the data. RESULTS: Rates of obstetrical complications including low-lying placenta, placenta previa, placenta accreta, and atonic bleeding were increased with ART compared to those with the control. Particularly, ART was associated with a significantly increased rate of placenta accreta (adjusted odds ratio: 7.35, 95% confidence interval (CI): 3.20-16.6) and significantly decreased rate of placental abruption (adjusted odds ratio: 0.24, 95% CI: 0.07-0.61). CONCLUSIONS: This study showed that ART may reduce placental abruption and increase placenta previa. There is a possibility that the placenta attaches deeper in the myometrium because of ART.

Haemoptysis and bronchial congestion due to pulmonary vein stenosis after maze procedure.

Pulmonary vein stenosis (PVS) is a rare disease that can cause haemoptysis. Acquired PVS is indicated as a complication associated with cardiac catheter intervention; however, the maze procedure has not been reported to induce PVS. Here, we describe the diagnosis and treatment strategy for the first case of PVS with haemoptysis due to the maze procedure. A 56-year-old man who underwent the maze procedure seven years previously was referred for repeated haemoptysis. Contrast-enhanced computed tomography (CT) revealed complete occlusion of the left superior pulmonary vein. Bronchoscopy revealed localized bronchial congestion and varices. He was diagnosed with PVS due to the maze procedure, and he underwent catheter-balloon angioplasty. After treatment, haemoptysis disappeared and bronchial congestion and varices improved. History of cardiac ablation (surgical or catheter intervention) and localized bronchial congestion findings might facilitate the accurate diagnosis of PVS with haemoptysis. Catheter-balloon angioplasty is a minimally invasive treatment for PVS.

Anaplastic ependymoma arising from the lower segment of the uterine corpus: Case report and literature review.

To the best of our knowledge, there are currently no reports on primary uterine ependymoma. We operated on a 38-year-old woman suspected with uterine fibroids; surgical findings led to the diagnosis of primary anaplastic ependymoma of the uterus. Most extraneural ependymomas arising from the ovary and perigenital peritoneum occur in women of reproductive age and express estrogen and progesterone receptors. The etiology of such tumors is unknown, and a treatment strategy has not been established yet. Therefore, it is essential to accumulate cases for identifying mechanisms underlying the pathogenesis and disease progression to facilitate diagnosis and development of an effective treatment.

Aorto-pleural fistula successfully treated by one-lung ventilation and Endobronchial Watanabe Spigots.

Aorto-pleural fistula (APF) is a rare, potentially fatal condition that should be immediately treated by an endovascular or surgical approach. In this case, we treated APF using bronchial occlusion with Endobronchial Watanabe Spigots (EWSs) after one-lung ventilation. Notably, EWS is composed of silicon for endobronchial occlusion under bronchoscopy. An 88-year-old man was referred to our hospital for sudden massive hemoptysis. We maintained the airway by emergent intubation into the right main bronchus through guided bronchoscopy. Computed tomography demonstrated an aortic aneurysm at the aortic arch, penetrating the upper lobe of the left lung. On the 18th hospital day, we performed prophylactic endobronchial occlusion with EWS. The patient was extubated shortly thereafter. Endobronchial occlusion with EWS might be effective in patients with APF who exhibit generally poor conditions. Endobronchial occlusion treatment should be performed after controlling massive bleeding by one-lung ventilation.

A case of solitary paraaortic lymph node recurrence of lung squamous cell carcinoma after resection.

Solitary abdominal paraaortic lymph node recurrence after radical lung cancer surgery is very rare. Here, we report a case of a solitary abdominal paraaortic lymph node recurrence of lung squamous cell carcinoma (SCC). A 63-year-old man was diagnosed with lung SCC (cT1cN0M0 stage IA3), underwent a video-assisted right lower lobectomy (ND2a-1), and the pathological findings showed SCC (pT1cN0M0 stage IA3). The EGFR mutation and ALK translocation statuses of SCC were negative, and adjuvant therapy was not performed. Follow-up positron emission tomography - computed tomography (PET/CT) showed a solitary fluorodeoxyglucose (FDG)-concentrated region in the swollen paraaortic lymph node. A paraaortic lymph node biopsy was performed by open laparotomy, to determine the precise diagnosis and identify the genetic status. Pathological findings revealed that the paraaortic lymph node contained poorly differentiated SCC, which was thought to metastasize from the lung cancer. The genetic status of the lymph node recurrence revealed a lack of EGFR mutations, ALK translocations, and ROS1 mutations, while the tumor proportion score (TPS) of PD-L1 was 55%, and we therefore administered pembrolizumab, an immune checkpoint inhibitor. Biopsies are very important for achieving precise diagnoses and determining the genetic statuses of tumors, since molecular-targeting drugs and immune checkpoint inhibitors are available. J. Med. Invest. 65:283-285, August, 2018.

Pregnancy and cesarean delivery after multimodal therapy for vulvar carcinoma: A case report.

Reports of pregnancy following treatment for vulvar carcinoma are extremely uncommon, as the main problem of subsequent pregnancy is vulvar scarring following radical surgery. We herein report the case of a patient who was diagnosed with stage I squamous cell carcinoma of the vulva at the age of 17 years and was treated with multimodal therapy, including neoadjuvant chemotherapy, wide local excision with bilateral inguinal lymph node dissection and adjuvant radiotherapy. The patient became pregnant spontaneously 9 years after her initial diagnosis and the antenatal course was good, except for mild acute pyelonephritis at 25 weeks of gestation. An elective caesarean section was performed at 38 weeks of gestation due to vulvar scarring following multimodal therapy, particularly radiotherapy. The patient remains alive and well, without signs of recurrence or metastasis 12 years after her diagnosis and treatment. Radical vulvectomy as well as multimodal therapy for vulvar carcinoma, particularly radiotherapy, may cause extensive skin scarring. The presence of vulvar scarring following multimodal therapy for vulvar carcinoma may increase the incidence of caesarean delivery.

[A case of non-acquired immunodeficiency syndrome-defining lung adenocarcinoma in a multidrug-resistant human immunodeficiency virus-positive patient].

We report a case of non-acquired immunodeficiency syndrome-defining lung adenocarcinoma in a multidrug-resistant human immunodeficiency virus (HIV)-positive patient. The patient was a 47-year-old Japanese woman who received salvage combination anti-retroviral therapy with darunavir plus ritonavir plus raltegravir plus tenofovir/emtricitabine in May 2009. She was diagnosed with lung adenocarcinoma (T3N3M1, stage IV) in November 2010 and was not found to possess any activating mutations in the epidermal growth factor receptor gene. Therefore, 6 courses of carboplatin plus pemetrexed and 3 courses of gemcitabine followed by erlotinib were administrated, and therapy was changed to home medical care. The only drug-related adverse event was grade 1 neutropenia, and drug interaction between the simultaneously administered anti-retroviral and chemotherapeutic agents was not confirmed. The patient battled lung adenocarcinoma for 1 year after the diagnosis and died of cancer progression in October 2011. Her performance status was stable and the CD4 (+) lymphocyte count and HIV load were well controlled throughout the course of treatment. In conclusion, the agents used for this patient show high tolerability and can be used as an effective treatment strategy for lung cancer occurring in HIV-positive patients.

Cotyledonoid dissecting leiomyoma treated by laparoscopic surgery: a case report.

A cotyledonoid dissecting leiomyoma is categorized as a leiomyoma with an unusual growth pattern, which is characterized by remarkable extrauterine bulbous growth in continuity with a dissecting myometrial component. A 36-year-old patient was preoperatively diagnosed with a mature cystic teratoma of the left ovary, and according to MRI, the tumor protruded from the uterus into the right broad ligament and was 10 cm in diameter. She underwent laparoscopic surgery to resect ovarian teratoma and the tumor under the right broad ligament. The tumor was almost completely resected and diagnosed as a cotyledonoid dissecting leiomyoma based on intraoperative and pathological findings. Recurrence was not seen for 26 months postoperatively in our case. Gross specimens are often mistaken for malignant lesions, but this was a benign disease. Even if some remnants of the leiomyoma remained postoperatively, recurrence has never been reported. When a cotyledonoid dissecting leiomyoma is resected laparoscopically, intrapelvic structures around it, such as the ureter, uterine artery, bladder, rectum and external iliac vessels, must be given careful attention.

Low-grade appendiceal mucinous neoplasm with disseminated peritoneal adenomucinosis involving the uterus, mimicking primary mucinous endometrial adenocarcinoma: a case report.

We present a patient with a low-grade appendiceal mucinous neoplasm, resulting in disseminated peritoneal adenomucinosis (pseudomyxoma peritonei) with uterine involvement, and mimicking primary mucinous endometrial adenocarcinoma. On immunohistochemistry, neoplastic glands were cytokeratin 7-negative and cytokeratin 20-positive, indicating a gastrointestinal origin rather than a primary ovarian mucinous neoplasm. A diagnosis of uterine metastasis of appendiceal origin was made, based on the constellation of clinicopathological findings, that is, preceding appendiceal neoplasm, peritoneal involvement, absence of coexisting prototypical endometrioid adenocarcinoma or endometrial hyperplasia. The patient underwent hysterectomy and there was no evidence of disease progression at the 12-month follow up. This suggested the indolent nature of this particular neoplasm, despite its advanced stage.

Nonbacterial thrombotic endocarditis complicated with stage Ia ovarian cancer.

Nonbacterial thrombotic endocarditis (NBTE) commonly occurs in advanced malignancies associated with a cancer-related hypercoagulable state, but the prevalence of NBTE in patients with less advanced malignancies is unknown. A 46-year-old woman had multiple thromboembolic events and disseminated intravascular coagulation on admission. Transthoracic echocardiography showed several growths on the mitral valve. Pelvic magnetic resonance imaging revealed a rapidly enlarging large tumor. In spite of anticoagulation therapy, she died 1.5 months after admission. At autopsy, NBTE with stage Ia ovarian cancer was diagnosed. In cases of higher-growth rate tumors with abundant necrosis, NBTE may occur in early-stage (even in stage Ia) ovarian cancer. In the majority of stage Ia ovarian cancers, curative surgical resection can be done. Prognostic improvement may be gained by such positive intervention, although this depends on the patient's general condition when NBTE occurs. With tumor resection, there is a possibility that the patient will recover from the hypercoagulable state and a poor outcome will be avoided.