Japanese Journal of Cancer and Chemotherapy最新文献

Based on the POTENT trial results, S-1, an oral fluoropyrimidine, is used in the adjuvant setting for various cancers, including hormone receptor-positive and HER2-negative breast cancers. Although S-1 is generally well tolerated, rare but serious adverse effects, such as rhabdomyolysis, have been reported. We present a case of suspected S-1-induced rhabdomyolysis in a 56-year-old woman with a history of hypertension and dyslipidemia, who was taking amlodipine besilate and pravastatin sodium. Sixteen months prior, she underwent nipple-sparing mastectomy with axillary dissection and TRAM flap reconstruction for right breast cancer. Following dose-dense EC therapy and discontinuation of docetaxel owing to drug-induced pneumonitis, she began adjuvant therapy with letrozole and S-1. Serum creatine kinase(CK)level progressively increased, peaking at 4,419 U/L during the 14th course, accompanied by myalgia. After discontinuation of S-1, the CK level returned to normal despite the continuation of other medications. No other obvious cause of rhabdomyolysis was identified. Given the temporal relationship and resolution upon drug withdrawal, S-1 was considered the likely causative agent. Although extremely rare, clinicians should be aware of the potential for S-1-induced rhabdomyolysis and monitor for muscle-related symptoms during treatment.

A female in her 70s, who underwent pancreaticoduodenectomy for pancreatic head carcinoma after preoperative chemoradiotherapy, developed ascites and portal vein stenosis 5 months after the surgery, necessitating metallic stent placement. Four years after stent placement, recurrent gastrointestinal bleeding prompted a CT scan that revealed in-stent thrombosis. Portography confirmed contrast extravasation from the distal end of the stent into the bile duct and jejunum, establishing the diagnosis of a fistula. Sclerotherapy of the superior mesenteric vein varices combined with covered stent redeployment, which addressed both in-stent stenosis and the fistula, resulted in resolution of the portal vein stenosis and cessation of bleeding. Ten months post-procedure, the patient still remains asymptomatic. Portal vein stenting complications, particularly portal-choledochojejunostomy fistulae, are exceedingly rare, but are potentially fatal. This case highlights the importance of considering this rare complication in patients with recurrent gastrointestinal bleeding following portal vein stenting.

KRAS mutations are a major genetic alteration found in approximately 40% of unresectable advanced or recurrent colorectal cancer. KRAS has long been considered an"undruggable"target due to its structural characteristics, but in recent years, inhibitors targeting the KRAS G12C mutant protein have been developed, enabling molecular targeted therapy. Sotorasib is the first KRAS G12C inhibitor to be clinically implemented. Following its approval for non-small cell lung cancer, it has also been approved for chemorefractory metastatic colorectal cancer. In colorectal cancer, combination therapy with a KRAS inhibitor and an anti-EGFR antibody is necessary to suppress the activation of EGFR induced by KRAS inhibition. Currently, it is recommended to confirm the presence of KRAS mutations, including G12C, before initiating first-line therapy. Since sotorasib can be administered based on these results, it is expected to broaden treatment options for colorectal cancer patients harboring the KRAS G12C mutation.

A woman in her 50s was referred to our hospital after a health checkup revealed a large liver tumor on abdominal ultrasonography. Colonoscopy revealed a Type 3 lesion occupying half of the rectosigmoid colon, and a biopsy confirmed a diagnosis of well-differentiated tubular adenocarcinoma. Contrast-enhanced computed tomography revealed multiple liver metastases in both lobes, and laparoscopic high anterior resection was performed(pT3N0M1a, Stage Ⅳ). Post-operatively, chemotherapy was initiated with a single course of mFOLFOX6, followed by 11 courses of mFOLFOX6+bevacizumab. Due to worsening peripheral neuropathy, the regimen was switched to FOLFIRI+bevacizumab, which was administered over 43 courses. Although the liver metastases steadily reduced in size, the response remained as a partial response. Two years and 6 months after the initiation of chemotherapy, the patient elected to discontinue treatment, and follow-up observation was continued thereafter. Three years and 4 months after discontinuation of chemotherapy, the liver metastases continued to regress, suggesting a clinical complete response.

Lipoma and well-differentiated liposarcoma are clinically differentiated by site of origin and length, and pathologically differentiated by immunostaining with MDM2 and CDK4. An 82-year-old male patient. A retroperitoneal lipomatous tumor which compressed intraabdominal organs was found on CT and MRI scan. Laparotomy for retroperitoneal tumor resection was performed. Lipomatous tumor more than 10 cm was extirpated. The pathological diagnosis was retroperitoneal intramuscular lipoma. One year after surgery, there is no sign of tumor recurrence.

An 83-year-old female was referred to our hospital because of bilateral lower extremity edema. Contrast-enhanced computed tomography(CT)showed an irregular mass, 7 cm in diameter, with central necrosis at the left renal hilum, infiltrating the left renal pelvis and ureteral junction with hydronephrosis. Magnetic resonance imaging(MRI)showed restricted diffusion at the tumor margin. Retroperitoneal tumor resection and left renal resection were performed. Although the tumor was close to the jejunum and the pancreas body and tail and spleen it could be separated from the tumor. The histopathological diagnosis was a solid tumor of spindle and polyrhomboidal cells with necrosis extending from the renal vein wall to the vascular lumen and adventitia. Immunohistochemical staining was positive for α-SMA and weakly positive for desmin. The diagnosis of leiomyosarcoma originating from the renal vein was made because of its continuity with the renal vein. Leiomyosarcoma accounts for 5-7% of soft tissue sarcomas and is the second most common retroperitoneal sarcoma liposarcoma. Sixty percent of vascular leiomyosarcomas originate from the inferior vena cava, while originating from the renal vein are rare. The patient has been free from recurrence and metastasis 1 year after surgery.

A 75-year-old man was serendipitously found to have a splenic mass during a routine abdominal ultrasound screening for chronic kidney disease. He was subsequently referred to the gastroenterology department for further evaluation. Contrast- enhanced CT scans revealed multiple splenic lesions with heterogeneous enhancement, while MRI demonstrated low T1 and high T2 signal intensities. The initial diagnostic impression favored either hemangiosarcoma or malignant lymphoma; however, the patient opted for conservative management with regular follow-up. After a 6-month period, the largest splenic mass had increased in size from 77 mm to 110 mm, prompting a referral to the surgical department. With a preoperative diagnosis of hemangiosarcoma, the patient underwent laparoscopic splenectomy along with combined diaphragmatic resection and reconstruction. Postoperative histopathological examination revealed diffuse large B-cell lymphoma. Splenic malignancy is a rare disease, and a definitive diagnosis cannot often be established through imaging alone. When a splenic malignant tumor is suspected, surgical resection should be considered, as it serves both diagnostic and therapeutic purposes.

A 50-year-old woman was diagnosed with left-sided breast cancer 1 decade previously. The patient underwent left partial mastectomy and sentinel lymph node biopsy, which necessitated axillary dissection. The cancer was classified as cT1cN0M0, indicating Stage Ⅰ, ER-positive, and HER2-negative breast cancer, with no metastatic findings on imaging. The final stages were pT1cN1aM0 and pStage ⅡA. Postoperatively, the patient received TC(docetaxel+cyclophosphamide) chemotherapy, total breast irradiation, and tamoxifen for 10 years. Positron emission tomography/computed tomography conducted 10 years postoperatively revealed an enlarged right axillary lymph node with an SUVmax of 1.3. A Class Ⅴ diagnosis was made via US-guided fine-needle aspiration cytology. No additional metastases were suspected and magnetic resonance imaging revealed no bilateral mass lesions in the breasts. Consequently, a histological diagnosis was required to ascertain whether the lesion was recurrent, which led to right axillary lymph node dissection. The specimen was identified as a metastatic carcinoma(GATA-3-positive, ER-positive, and HER2-positive). Considering the different subtypes and absence of other lesions, the patient was considered to have latent breast cancer as a new lesion. Chemotherapy, including anti- HER2 therapy, radiotherapy, and endocrine therapy, was administered as adjuvant treatment.

We report a case of pleomorphic invasive lobular carcinoma that developed after surgery for multiple ipsilateral cancers. The patient was a 54-year-old woman who visited our hospital after a tumor-like lesion was noted in her right breast. A needle biopsy revealed that the patient had invasive ductal carcinoma. No obvious distant metastasis was found;therefore, circular mastectomy and axillary lymph node dissection were performed. Histopathological examination revealed the following tumors;Tumor 1:Invasive ductal carcinoma(solid type), tumor diameter 33 mm, ER negative, PgR negative, HER2 negative, Ki-67 20.4%;and Tumor 2:Invasive lobular carcinoma, tumor diameter 6 mm, ER negative, PgR negative, HER2 negative, Ki-67 30.2%. The resection margin was negative, and lymph node metastasis was diagnosed as 3/12. Postoperative chemotherapy, radiation therapy, and endocrine therapy were performed. One year and 6 months after surgery, a hard lump was found in the remaining breast, and a needle biopsy confirmed it as pleomorphic lobular carcinoma. A pectoral muscle- sparing mastectomy was performed. Pathological examination of the excised specimen revealed new breast cancer:a pleomorphic lobular carcinoma, with tumor diameter 22 mm, and multiple daughter nodules. The resection margins were negative. The results were ER negative, PgR positive, HER2 negative, and Ki-67 25%. As the prognosis and treatment of invasive lobular carcinoma was unclear, caution was required.

We examined 12 cases of high-difficulty hepatobiliary pancreatic surgery performed at our hospital between January 2022 and December 2024 for patients aged 80 and older. The median length of hospital stay after surgery was 33 days. Three cases were discharged due to death, and in all of these cases, the preoperative albumin level was less than 2.5 g/dL. On the other hand, in cases where the preoperative albumin level was 3.5 g/dL or higher, no complications of Clavien- Dindo classification Grade Ⅲ or higher were observed. It has been suggested that the nutritional status before surgery may impact the prognosis after surgery.