Japanese Journal of Cancer and Chemotherapy最新文献

Background: In 2019, 4 patients with borderline resectable-pancreatic ductal adenocarcinoma(BR-PDAC)received neoadjuvant chemotherapy(NAC)with 3 cycles of gemcitabine plus nab-paclitaxel(GnP)over 12 weeks in combination with intestinal care, and subsequently underwent pancreatectomy. Surprisingly, histological response to NAC was Grade 3(viable tumor cells <10%)in 3 out of 4 patients. Aim/subjects: This study aimed to clarify the histopathological findings common to 3 patients with Grade 3 histological response to NAC.

Results: Common histopathological findings were as follows: 1)each tumor bed was extensively replaced by fibrous connective tissues with a high degree of inflammatory cell infiltration, and almost no viable cancer cells were observed; 2)all cancer cells within the perineural space where perineural invasion is usually seen, had undergone cytolysis; 3)tertiary lymphoid structures(TLSs)with germinal centers were found at the periphery of each tumor bed, and many plasma cells were seen adjacent to TLSs; and 4)a lot of tingible body macrophages that phagocytosed apoptotic B cells were present around germinal center.

Conclusions: NAC with 3 cycles of GnP over 12 weeks in combination with intestinal care elicited a potent antitumor immune response through enhanced germinal center reactions within TLSs.

A 58-year-old man was treated with radical excision for rectal cancer. Pathological findings were pT3N1M0, Stage ⅢB, RAS: mutant, BRAF: mutant, MSS. The patient was followed up without adjuvant chemotherapy. Eight months after surgery, a CT scan showed recurrence of liver metastases, and chemotherapy was started. The patient was started on regorafenib as the fourth-line therapy for multiple liver metastases, distant lymph node metastases, and peritoneal dissemination. Twenty-three days after the first course, he developed severe abdominal pain and visited the emergency department on day 25. Suspecting generalized peritonitis due to perforation of the upper gastrointestinal tract, he was treated with emergency laparotomy and drainage. A perforation was found in the anterior wall of the lower gastrointestinal body and was sutured closed. There were no adverse events, and the patient was discharged on the 21st postoperative day. regorafenib is a multi-kinase inhibitor, and gastrointestinal perforation has been reported as a serious adverse event, although it is rare. We report a case of upper gastrointestinal perforation during regorafenib administration, with some discussion of the literature.

An 80-year-old woman presented to our hospital complaining of nausea and abdominal distention. An abdominal computed tomography scan revealed wall thickening of the small intestine, a dilated oral intestinal tract, swollen intra-abdominal lymph nodes, and splenomegaly. Moreover, the soluble interleukin-2 receptor level was increased at 2,120 U/mL. Accordingly, we diagnosed the patient with a small bowel obstruction due to malignant lymphoma of the small intestine, for which we performed a laparoscopy-assisted partial resection of the small intestine after decompression. The resected specimen was pathologically diagnosed as diffuse large B-cell lymphoma. The patient's general condition recovered rapidly after laparoscopic surgery, and her clinical course proceeded smoothly to the initiation of chemotherapy(R-CHOP)at the Department of Hematology. The tumor remains in remission now. Here, we report a case of laparoscopic surgery for malignant lymphoma of the small intestine that caused bowel obstruction due to luminal narrowing along with a relevant literature review.

A 77-year-old man underwent a right hemihepatectomy for hepatocellular carcinoma in 2002. The patient remained alive without recurrence for 17 years after surgery. In September 2019, he was diagnosed with a tumor in the lower lobe of the right lung by follow-up CT. A partial right lung resection was performed in February 2020. Histological and immunohistochemical staining confirmed the recurrence of a previous hepatocellular carcinoma. Late lung cancer recurrence after radical hepatectomy is rare. Here, we report a case of hepatocellular carcinoma relapse in the lungs 17 years after liver resection.

We report 2 cases of early breast cancer treated with adjuvant S-1 plus endocrine therapy. In case 1, a 70-year-old woman was diagnosed with right breast cancer and underwent partial mastectomy. The histopathological diagnosis was invasive ductal carcinoma(solid type), positive for estrogen receptor(ER)and progesterone receptor(PgR), negative for HER2/neu. The Ki-67 labeling index was 14%. The diameter of invasion was 27 mm, no lymph node metastasis was observed, and we confirmed the diagnosis as pT2N0M0, Stage ⅡA. A venous invasion was observed and the histological grade was Ⅱ. In case 2, a 53-year-old woman was diagnosed with left breast cancer and underwent lumpectomy. The histopathological findings showed a solid-tubular carcinoma, characterized by ER-positive, PgR-positive, HER2-negative. The Ki-67 labeling index was 24%. The tumor had an invasion of 20 mm and was diagnosed as Stage Ⅰ early-stage cancer, but there were some venous invasions and the histological grade was Ⅲ. We judged that both patients were at intermediate risk of recurrence and administered S-1 in addition to endocrine therapy. Even in cases without axillary lymph node metastasis, this combination of S-1 with endocrine therapy was considered to be a useful treatment option if the criteria of the POTENT trial were met.

We experienced cases of malnutrition and vitamin B1 deficiency after gastrointestinal cancer surgery, but they had a good course after vitamin B1 administration. Case 1 is a woman in her 70s who underwent laparoscopic distal gastrectomy for gastric cancer 2 months ago. While under outpatient observation, she was found collapsed at home and urgently brought to the hospital. She lost 3 kg of body weight in 2 weeks and was able to take in oral intake by giving fluids for malnutrition, but was unable to sit up unaided. During the course of hospitalization, vitamin B1 deficiency was reported, and vitamin B1 administration was started, which enabled her to walk independently. Case 2 is a man in her 50s who underwent video-assisted thoracic esophagectomy for esophageal cancer approximately 1 year ago. He was urgently brought to the hospital due to decreased oral intake due to alcohol dependence. 17.1 kg/m2 BMI, malnutrition, 67/40 mmHg blood pressure, and decreased left ventricular septal wall motion were observed. Vitamin B1 deficiency due to alcohol dependence was suspected, so vitamin B1 administration was started, and blood pressure increased within a few hours.

Online medicine has become more common since the COVID-19 pandemic, but there are few cases of hospitals introducing online genetic counseling(OGC)in Japan. We introduced the online medical consultation application at 2 medical institutions for OGC. Genetic counseling for hereditary tumors will need to be broadened and implemented widely. Using the application makes it easy to make and complete reservations. OGC, which can reduce the time and space burden on clients, is a promising option of genetic counseling. It is hoped that OGC will become more widespread as a form of genetic medicine in the future, so that a limited number of genetic specialists can respond to a wide range of needs. In order to increase the number of users in the future, it is necessary to 1)raise awareness among the general public through public relations activities, and 2)collaborate with medical facilities that do not have specialized outpatient clinics for hereditary tumors.