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Tanaka K.,Shizuoka Saiseikai General Hospital | Tanaka K.,Cancer Institute Hospital | Sugitani I.,Cancer Institute Hospital | Fujimoto Y.,Cancer Institute Hospital
Japanese Journal of Clinical Oncology | Year: 2011

Objective: Although anaplastic thyroid carcinoma has a dismal prognosis, some patients show favorable survival following multimodal treatment with surgery, external irradiation and chemotherapy. However, no regimen has yet been established. We reviewed outcomes for patients who underwent a unique chemoradiotherapy regimen between 1998 and 2007. Methods: The regimen consists of external irradiation (40 Gy at 2 Gy/day) combined with concurrent low-dose cisplatin at 5 mg/m2 on Days 1-5, 8-12, 15-19 and 22-26, 5-fluorouracil at 200 mg/m2 on Days 1-26 and doxorubicin at 20 mg/m2 on Days 1 and 15. This regimen was performed on 21 patients (13 men, 8 women) with anaplastic thyroid carcinoma. Median age at the time of treatment was 66 years (range, 54-81 years). Results: The treatment regimen was completed in 19 patients (90%) and was interrupted in 2 (10%) due to progressive distant metastases. After excluding 10 patients who underwent complete resection before chemoradiotherapy, 1 patient (11%) showed partial response, 7 (78%) showed stable disease and 1 (11%) had progressive disease on the basis of Response Evaluation Criteria in Solid Tumors. Overall, 6-month survival rate for patients treated with chemoradiotherapy was 57%. With this novel chemoradiotherapy, death from loco-regional disease was seen in only two patients (11%). Grade 3-4 toxicities were observed in 12 patients (63%), but no treatment-related deaths were encountered. Conclusions: Our new chemoradiotherapy is effective for loco-regional control of anaplastic thyroid carcinoma, particularly when combined with radical surgery. This regimen could not prevent distant metastases, but offers acceptable toxicity while maintaining patient quality of life. © The Author (2011). Published by Oxford University Press. All rights reserved. Source


Tajima S.,Shizuoka Saiseikai General Hospital | Koda K.,Fujieda Municipal General Hospital
International Journal of Clinical and Experimental Pathology | Year: 2015

Urothelial carcinoma has numerous histological variants, and these variants may coexist in a single case. Here, we present a case of a 70-year-old man with urothelial carcinoma of the bladder with a maximal diameter of 5 mm that involved micropapillary and plasmacytoid variants, with villoglandular differentiation. The presence of these variants was confirmed by pathological examination of a transurethral resection specimen, and high-grade urothelial carcinoma was found as a minor component. Although this bladder carcinoma was classified as pT1, cystoprostatectomy, urethrectomy, and lymphadenectomy were performed due to the presence of the micropapillary and plasmacytoid variants, which are known to be aggressive. Examination of a surgically resected specimen revealed no carcinoma. A transition between urothelial carcinoma in situ and non-invasive micropapillary carcinoma was found to be a pivot point connecting the diverse morphologies of this bladder carcinoma, from which there existed two pathways. One pathway was from urothelial carcinoma in situ to the plasmacytoid variant through invasive high-grade urothelial carcinoma, and the other was from non-invasive micropapillary carcinoma to urothelial carcinoma with villoglandular differentiation or to the micropapillary variant. This is the 16th reported case of urothelial carcinoma with villoglandular differentiation in the literature. As urothelial carcinoma with villoglandular differentiation is often associated with aggressive variants, as shown in our case, it should be reported whenever encountered in routine pathological practice. Source


Tajima S.,Shizuoka Saiseikai General Hospital | Koda K.,Fujieda Municipal General Hospital
International Journal of Clinical and Experimental Pathology | Year: 2015

Development of malignant peripheral nerve sheath tumors (MPNSTs) is a stepwise process that involves the alteration of many cell cycle regulators and the double inactivation of the NF1 gene. Inactivation of the TP53 gene and deletion of the CDKN2A/p16 gene are known to play an important role in the process. Herein, we present a 19-year-old man with a familial history of neurofibromatosis type 1, in whom the tumor arose from the intercostal nerve and showed 3 components: a neurofibroma, a low-grade MPNST, and a high-grade MPNST. Loss of p16 expression and homozygous deletion of the CDKN2A/p16 gene were observed in both the low-grade and the high-grade MPNST. In contrast to low-grade MPNSTs, high-grade MPNSTs generally tend to lose expression of p16 and harbor homozygous deletion of the CDKN2A/p16 gene. Loss of p16 expression and homozygous deletion of the CDKN2A/p16 gene in low-grade MPNST in our case might be related to its progression to high-grade MPNST. To the best of our knowledge, this is the first study correlating the p16 expression status and CDKN2A/p16 gene alteration in low-grade MPNSTs. Source


Tajima S.,Shizuoka Saiseikai General Hospital | Koda K.,Fujieda Municipal General Hospital
International Journal of Clinical and Experimental Pathology | Year: 2015

Some neoplasms are associated with granulomatous inflammation. Granuloma formation in tumor tissue is caused by the cytokines derived from either the main tumor or other cells surrounding the tumor. In other instances, granulomatous inflammation is observed in the lymph nodes draining a tumor. This has been recognized as a sarcoid-like reaction. Herein, we report of a 75-year-old man with pulmonary squamous cell carcinoma (SCC), where granulomatous inflammation was observed extensively at the primary site. The carcinoma seemed to partly regress. In the regressing area, tumor cell debris was surrounded by granuloma. In contrast, no granuloma was identified in the dissected regional lymph nodes. To the best of our knowledge, such a case of SCC had not been described thus far. More case studies are required to determine whether tumor-related granuloma is the main cause of regression or whether it is just a secondary phenomenon caused by the attack and destruction of the tumor by lymphocytes. Source


Tajima S.,Shizuoka Saiseikai General Hospital | Koda K.,Fujieda Municipal General Hospital
International Journal of Clinical and Experimental Pathology | Year: 2015

The morphology of thymoma is diverse, although 5 basic subtypes are recognized in the World Health Organization classification system. Sclerosing thymoma was first documented in 1994 and to date only 13 cases have been reported. Sclerosis itself is considered to be an ancient change and can occur in various histological subtypes. Herein, we present a case of a 62-year-old woman incidentally found to have an anterior mediastinal mass, 31 × 24 × 17 mm in size, without an associated autoimmune disease such as myasthenia gravis. The mass was finally diagnosed as sclerosing thymoma derived from type A thymoma. Intraoperative pathological examination using a limited amount of sample did not allow a definitive diagnosis of thymoma in this case. When dealing with fibrous lesions observed in limited samples such as biopsy and intraoperative frozen specimens, recognizing sclerosing thymoma is important since there are several disease entities accompanying fibrosis in the anterior mediastinum. Source

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