International Cancer Conference Journal

Holmium laser enucleation of the prostate is a widely accepted surgical treatment method for benign prostate hyperplasia, but its effect on prostate cancer remains unclear. In this study, we report the cases of two patients with metastatic prostate cancer diagnosed during follow-up after holmium laser enucleation of the prostate. Case 1 was a 74 year-old man who underwent holmium laser enucleation of the prostate. Prostate-specific antigen levels declined from 4.3 to 1.5 ng/mL at 1 month after surgery, but after 19 months, they increased to 6.6 ng/mL. Based on pathological and radiological findings, he was diagnosed as having prostate cancer, with Gleason score 5 + 4 with neuroendocrine differentiation, cT3bN1M1a. Case 2 was a 70 year-old man who also underwent holmium laser enucleation of the prostate. Prostate-specific antigen levels declined from 7.2 to 2.9 ng/mL at 6 months after surgery, but after 12 months, they increased to 12 ng/mL. Based on pathological and radiological findings, he was diagnosed as having prostate cancer, with Gleason score 4 + 5 with intraductal carcinoma of the prostate, cT3bN1M1a. This report suggests that advanced prostate cancer may be newly diagnosed after holmium laser enucleation of the prostate. Even if prostate cancer had not been demonstrated in the enucleated specimen, and postoperative PSA levels were below the standard values, physicians should regularly monitor prostate-specific antigen levels after holmium laser enucleation of the prostate, and further examination should be considered keeping in mind prostate cancer progression.

Mucinous tubular and spindle cell carcinoma (MTSCC) is a low-grade renal epithelial neoplasm that has recently been recognized as a specific entity in the 2004 World Health Organization classification of renal cell carcinoma. A 69-year-old woman was referred to our hospital because of incidental left renal tumor. Abdominal computed tomography showed a hypovascular tumor in the left kidney. Left radical nephrectomy was performed. Hematoxylin and eosin staining revealed cuboidal and oval or spindle-shaped cells in tubular and papillary patterns embedded in the myxoid stroma. Immunohistochemically, the tumor cells were positive for alpha-methylacyl-CoA racemase. On the basis of these findings, we diagnosed the patient as having MTSCC.

Systemic treatment for cancer including chemotherapy or biologic agents can cause different changes in the skin or mucous membranes. These changes may represent a known adverse reaction to these drugs, although other etiologies should be considered. One of these, radiation recall dermatitis, is a rare and unpredictable phenomenon. Herein, we report two cases of this condition in women with metastatic breast cancer secondary to gemcitabine and the combination of capecitabine and ixabepilone.

We report a rare case of a diffuse large B-cell lymphoma (DLBCL) arising from the common bile duct (CBD). A 77-year old man presented with general fatigue and obstructive jaundice. Abdominal computed tomography revealed a well-circumscribed enhancing mass in the midportion of the CBD with proximal bile duct dilatation. Endoscopic retrograde cholangiopancreatography (ERCP) also showed a midportion of the CBD stricture. Direct peroral cholangioscopy revealed smooth mass in the midportion of the CBD, and narrow-band imaging (NBI) showed irregular tortuous microvessels. The brushing cytology of the CBD was performed, and it was diagnosed as suspicious for poorly differentiated adenocarcinoma or malignant lymphoma. We performed extrahepatic bile duct resection for accurate diagnosis. Histological and immunohistochemical examination of the resected specimen revealed DLBCL. Although systemic chemotherapy is the mainstay of treatment for DLBCL, he refused scheduled subsequent chemotherapy, and died of multiple liver metastases 6 months after surgery.

Long-term survival of patients who undergo surgical resection of isolated adrenal metastasis from non-small cell lung cancer (NSCLC) has been reported. In these patients, primary lung cancers were generally resected or resectable. We report a 50-year-old man of NSCLC (T3N2M1) with locally advanced lung adenocarcinoma and solitary ipsilateral adrenal metastasis, which was detected by FDG/PET (fluorodeoxyglucose/positron emission tomography). After the thoracic lesions had been controlled with chemo-radiation therapy for 2 years, the remaining adrenal metastasis was surgically resected. He was disease-free for 7 years. Our case suggests that solitary adrenal metastasis may be resectable in NSCLC patients controlled by chemo-radiation therapy, and FDG/PET is useful to detect and follow adrenal metastasis.

A 60-year-old woman was admitted to a medical clinic because of epigastric pain. Esophagogastroduodenoscopy revealed a submucosal tumor in the upper gastric corpus and, the tumor was subsequently resected using partial gastrectomy. The pathological findings revealed that the tumor was a gastrointestinal stromal tumor. After 4 months of observation without any adjuvant treatment, the patient was found to have liver metastasis and she was admitted to our hospital for treatment. We successfully treated the patient through sequential drug therapies, including imatinib, nilotinib, sunitinib, and regorafenib, and maintaining disease control for more than 5 years.

Large cell neuroendocrine carcinoma (LCNEC) arising in the uterine corpus is a very rare. Here, we report our experience with a primary LCNEC in the uterine corpus that showed prominent myometrial invasion without exhibiting any macroscopically distinct tumor formation in the uterine cavity. The patient was a 54-year-old woman. She had a past medical history of right breast cancer and was referred to our department with irregular genital bleeding, elevated serum carcinoembryonic antigen in periodic medical examinations and computed tomography (CT) findings of uterine cavity dilation. Endometrial biopsy suggested a poorly differentiated tumor. Although magnetic resonance imaging (MRI) showed hematometra-like findings in the uterine cavity, it did not indicate any clear endometrial lesion. The myometrium was unequally thickened, and the entire muscle layer showed a high signal intensity on diffusion-weighted images. Fluorine-18-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) showed strong FDG accumulation in the whole uterus, and on the bottom of the uterus, there was a ring-shaped accumulation mainly in the muscle layer. The postoperative resected specimen did not show any tumor formation in the uterine cavity, whereas the myometrium was hard and thickened, and colored white overall. Histopathological examination revealed prominent myometrial invasion in most layers, cervical stromal invasion and pelvic lymph node metastasis. The diagnosis was a LCNEC of the uterine corpus, at FIGO stage IIIC1 and pT2N1M0. With these patients, we found that functional metabolic images, such as MRI diffusion-weighted images and FDG-PET/CT, were useful in identifying the lesion. Preoperatively, when a poorly differentiated tumor is estimated and characteristic myometrial invasion is suspected, the possibility of LCNEC should be considered.

The differential diagnosis of retroperitoneal tumor associated with aortic aneurysm is a challenge. A 79-year-old frail male elderly, who had the history of lymphoma, was found to have a retroperitoneal tumor adjacent to the left common iliac artery aneurysm. Although there was no distant metastasis detected, the patient was in poor nutritional status, and he complained of pain in the lower left leg. The diagnostic procedure and potential treatment options were discussed in the cancer board. How to set the goal of his treatment was quite difficult. The patient decided to receive the best supportive care, and he did not undergo a biopsy of the tumor to make a pathological diagnosis.

We describe a conservative treatment for atypical polypoid adenomyoma (APA) of the uterus and cervical intraepithelial neoplasia (CIN) 3 followed by a spontaneous pregnancy and full-term delivery in a 27-year-old woman. The patient presented with CIN 3 and underwent repeated Shimodaira–Taniguchi conization and treatment for APA. Medroxyprogesterone acetate (MPA) and low-dose aspirin were administered for 9 months followed by a hysteroscopic transcervical resection (TCR) of residual lesions. Atypical glands were <1 % of all glands. Three months later, the endometrium was fully recovered and biopsies revealed no atypical cells. Further 3 months later, the patient spontaneously conceived and gave birth to a healthy baby boy at full term. To the best of our knowledge, this is the first report on the use of MPA and TCR for treatment of APA patients, followed by a successful pregnancy outcome.

A 48-year-old man presented with a left testicular mass. Computed tomography showed an anterior mediastinal tumor, with positive uptake in positron emission tomography images. Radical orchiectomy was performed; the histology was seminoma. Thus, a diagnosis of testicular seminoma with thymic metastasis (stage III) was made and he underwent four courses of bleomycin, etoposide and cisplatin chemotherapy. The tumor shrank from 2.5 to 1.4 cm, but grew to 1.9 cm 1 month after the fourth course. He underwent two courses of paclitaxel, ifosfamide and cisplatin chemotherapy, followed by the resection of mediastinal tumor, the histopathological diagnosis of which was thymic cancer. Adjuvant radiation therapy was administered and no recurrences were evident at 1 year postoperatively. This is the first reported case of thymic cancer coexisting with stage I testicular seminoma.