Two case reports of intra-articular nodular fasciitis of the knee confirmed by MYH9-USP6 gene fusion expression.

AIM: To describe two cases of intra-articular nodular fasciitis (NF) which developed within the knee joint and were associated with the expression of the MYH9-USP6 gene fusion. PATIENTS AND METHODS: Two women, 30 and 56 years of age, with no history of joint disease or knee joint trauma, are presented in our cases. We report these cases describing the clinical presentation, assessment, histopathological examination, gene expression, and clinical management. RESULTS: Both patients presented with knee pain and limitation in the range of flexion. We diagnosed our two cases as intraarticular nodular fasciitis based on histological findings and by the detection of the MYH9-USP6 gene fusion. The transcript of MYH9-USP6 gene fusion was identified by RT-PCR and direct sequencing in both cases. CONCLUSION: We report the first cases of intra-articular NF involving the knee joint, with identification of a MYH9-USP6 gene fusion by RT-PCR. NF should be considered in the differential diagnosis of intra-articular lesions.

Malignant phyllodes tumor of the breast with rapid progression: a case report.

BACKGROUND: Malignant phyllodes tumors (PTs) of the breast occur infrequently and are difficult to treat with adjuvant therapy. Here, we present a case of a female patient with a huge malignant PT with rapid progression in a short period. CASE PRESENTATION: A 44-year-old woman presented to our hospital with a rapid growth mass in her right breast, measuring 20 cm. She was initially diagnosed as having a borderline phyllodes tumor by core needle biopsy and underwent total mastectomy and artificial dermis was grafted, 20 days later, latissimus dorsi muscle flap and free skin grafting were performed. Two courses of doxorubicin-ifosfamide therapy were administered because of recurrence, but the patient died 4 months after the mastectomy. CONCLUSIONS: A standard therapeutic strategy for malignant PTs is needed in urgently to reduce the risk of tumor recurrence.

[A Case of Metastatic Carcinoma of Anal Fistula].

A 58-year-old man underwent rectal resection(D2 dissection)for rectal cancer and liver/lung metastases in August 2009. Histopathological findings were Ra, type 2, 70×80mm, tub1>tub2, int, pSI(peritoneum), INF b, ly1, v1, pN1(2/13), pPM0, pDM0, M1a(H1, PUL1), fStage IV . The lung metastasis had disappeared on chest CT after postoperative chemotherapy and we were able to perform radical resection of the liver metastasis by performing hepatectomy twice. In October 2013, anal pain appeared and a painful tumor approximately 2 cm in size was found in the 5 o'clock direction of the anus. Biopsy revealed a well-differentiated tubular adenocarcinoma similar to rectal cancer, and it was diagnosed as a fistula metastasis of rectal cancer.We performed chemoradiotherapy(S-1 120mg/day plus RT 60 Gy/30 Fr)as surgery was recommended but refused. As a result, the tumor reduced markedly in size. In December 2015, the tumor enlarged in size and the patient and family requested surgery. We, therefore, performed abdominoperineal resection. Currently, the patient is alive at 18 months after surgery with no recurrence.

[A case of HER2-positive breast cancer for which preoperative chemotherapy with pertuzumab resulted in a pathological complete response].

A right breast tumor was identified during screening in a 56-year-old woman, and she was then diagnosed with Stage II B breast cancer (T2N1M0) of Luminal -HER2 type. She was treated with preoperative chemotherapy with pertuzumab, trastuzumab, and docetaxel followed by epirubicin, cyclophosphamide, and fluorouracil. She was judged to have achieved a clinical complete response after 4 courses of pertuzumab, trastuzumab, and docetaxel, and she then underwent partial resection of the right breast and sentinel lymph node dissection. Pathological examination revealed that a pathological complete response was achieved. Combination therapy with pertuzumab, trastuzumab, and docetaxel seems to be a useful preoperative chemotherapy regimen for HER2-positive breast cancer.

Prognostic value of intraoperative pleural lavage cytology for lung cancer without carcinomatous pleuritis: importance in patients with early stage disease during long-term follow-up.

PURPOSE: The clinical significance of intraoperative pleural lavage cytology (PLC) for lung cancer has been insufficiently elucidated. We therefore reviewed the surgical results of lung cancer patients without carcinomatous pleuritis followed up over the long term to elucidate PLC implications. PATIENTS AND METHODS: PLC was performed immediately after thoracotomy in consecutive lung cancer patients without carcinomatous pleuritis undergoing tumor resection between 1988 and 1997. Postoperative follow-up was generally performed for at least 5 years while checking tumor recurrence and survival. RESULTS: Eighty-nine (13.1%) of 679 patients had positive PLC findings, which were observed more frequently in patients with advanced stage, larger tumor size, higher involvement of the pleura, lymph node, lymphatics and vessels. The overall 5- and 10-year survival rates in PLC-positive patients were 43% and 25%, respectively, while those in PLC-negative patients were 66% and 58%, respectively (p<0.0001). Among 395 patients with stage I disease, 35 (8.9%) showed PLC-positive findings, and their overall survival rate was significantly poor compared with those with PLC-negative findings (p<0.0001). In contrast, such differences were not observed among patients with more advanced stage diseases. In regard to histological type, a difference in the postoperative survival rate according to PLC status was statistically found in adenocarcinoma type (p<0.0001), but not in squamous cell carcinoma type (p=0.24). According to multivariate analysis, PLC was an independent prognostic factor for all tested patients (p=0.007, hazard ratio=0.60) as well as for those with stage I disease (p=0.0135, hazard ratio=0.51). When examining postoperative pleural recurrence, the rate for PLC-positive patients was statistically higher than that for PLC-negative patients (p<0.0001, hazard ratio=0.08). Interestingly, late pleural recurrence more than 5 years occurred in five (5.6%) of PLC-positive patients, all of whom were included in stage I. CONCLUSIONS: Based on the present analysis of long-term follow-up after operation, PLC may also be an independent prognostic factor. In particular, the PLC status of patients with stage I disease or adenocarcinoma type has an important impact on survival. PLC-positive findings may be a high risk for postoperative pleural recurrence. For PLC-positive patients with stage I disease, careful serial follow-up for more than 5 years is required while paying attention to late pleural recurrence.