Treatment-free remission (TFR) is an emerging goal for patients with chronic myeloid leukemia (CML) treated with tyrosine kinase inhibitors (TKI). However, long-term TFR durability in real-world settings remains understudied. The J-SKI study, a large observational study, was conducted to evaluate long-term TFR outcomes in Japanese patients with CML. This interim analysis included 795 eligible patients from the prospective (n = 283) and retrospective (n = 512) cohorts. With a median follow-up of 32 months (range 0.8–168) after TKI discontinuation, the 5-year TFR rate was 65.2
The JCOG1806 trial (jRCTs031190129) is underway to evaluate the omission of surgery in patients with human epidermal growth factor receptor (HER2)-positive early breast cancer who have a clinical complete response (cCR) after primary systemic therapy (PST). We aimed to assess the cCR rate in this trial and identify predictive factors. HER2-positivity was defined as an immunohistochemistry (IHC) score of 3 + or in situ hybridization-positivity. A cCR was defined as the absence of detectable lesions upon palpation, contrast-enhanced magnetic resonance imaging, and ultrasonography; biopsy-based confirmation was optional in hormone receptor (HR)-negative cases and mandatory in HR-positive cases. Multivariate logistic regression analyses were used to identify predictors of a cCR. The cCR rate was 57.6
Background:Sulfuric acid inhalation can cause respiratory tract injury and life-threatening respiratory failure. Reports of delayed hypoxemia after exposure to acid aerosols generated from foaming lead-acid batteries are rare. Case Presentation:An 80-year-old auto mechanic inhaled an odorless aerosol for seconds while leaning over a foaming lead-acid battery in an enclosed garage, and presented with dyspnea and type I respiratory failure (PaO2/FiO2 ratio = 195) after 13 days. Chest computed tomography showed bilateral ground-glass opacities with superimposed right lung consolidation. Microbiological tests and autoantibody panel results were negative. High-flow nasal cannula oxygen and intravenous systemic corticosteroids were initiated, with rapid improvement. Antibiotics were discontinued on day 8 and corticosteroids were tapered over 40 days followed by the patient's discharge on day 43. Conclusion:Sulfuric acid inhalation can follow a subacute and progressive course. In severe cases, multimodal supportive care and selective systemic corticosteroids may be considered post-assessment.
To compare whole-lesion apparent diffusion coefficient (ADC) histogram analysis with representative ADC value for assessing muscle invasion in bladder cancer, and to build a decision tree model that combines bi-parametric Vesical Imaging Reporting and Data System (bp VI-RADS) with ADC values. This retrospective study included 82 patients with bladder cancer who underwent 3T MRI and transurethral resection. The bp VI-RADS was scored using T2-weighted and diffusion-weighted imaging, and ADC maps. For histogram analysis, tumors were segmented on all ADC slices to obtain ADC percentiles. For a representative ADC, three regions of interest were placed in visually lowest ADC areas and averaged to obtain the minimum mean ADC. ADC parameters were compared between muscle invasive (MIBC) and non-muscle invasive (NMIBC) disease. Diagnostic performance was assessed using receiver operating characteristic curve analysis with area under the curve (AUC), and combination models were constructed using logistic regression and decision tree analysis. Among histogram-derived parameters, the 25th percentile ADC achieved the highest AUC, and the minimum mean ADC was strongly correlated with it. As single parameters, bp VI-RADS, the 25th percentile and the minimum mean ADC showed similar accuracy (0.74–0.76). Logistic regression models combining bp VI-RADS with the 25th percentile or the minimum mean ADC achieved higher accuracy (0.88 and 0.87). Decision tree models using bp VI-RADS and ADC reached accuracy of 0.82 and 0.80. In both decision tree models, ADC provided additional stratification primarily for bp VI-RADS 4 lesions, using cutoffs of 1,183 × 10⁻6 mm²/s (25th percentile ADC) and 1,100 × 10⁻6 mm²/s (minimum mean ADC). The 25th percentile and the minimum mean ADC showed similar diagnostic performance for predicting muscle invasion. A decision tree combining bp VI-RADS with ADC measurements may provide an interpretable and clinically applicable approach, particularly for bp VI-RADS 4 lesions.
We present a case of occult apocrine breast cancer in a man presenting with back pain and multiple bone and large liver metastases. The primary tumour was not identified, and the patient was initially considered to have cancer of unknown primary origin. During referral to our hospital, 2 months had passed since the initial consultation, and the prognosis was considered poor. Empirical treatment with carboplatin and paclitaxel was then administered. Histological examination of the liver metastases revealed large cells with eosinophilic cytoplasm, morphologically suggestive of apocrine breast cancer, but no tumour was found in the breast. The diagnosis of occult apocrine breast cancer was confirmed by concurrent immunohistochemical examination of the biopsy tissue sample, revealing androgen receptor positivity, oestrogen receptor negativity, gross cystic disease fluid protein 15 positivity, human epidermal growth factor receptor 2 overexpression, and gene amplification. Carboplatin and paclitaxel treatment resulted in the near-complete remission of liver metastases and reduction of bone metastases. The reduction has still been maintained at 16 months since the symptom onset. Molecular targeted therapy, including trastuzumab, is expected to further extend survival. Male occult apocrine breast cancer is extremely rare, with only one other case reported in the literature. We report the diagnosis and treatment response of this extremely rare case.
