Breast cancer commonly metastasizes to the lungs, bones, liver, and brain; however, gastrointestinal involvement is uncommon. Simultaneous metastases to both the stomach and colon are extremely rare. We report the case of a 53-year-old woman with bilateral breast cancer (right invasive ductal carcinoma and left invasive lobular carcinoma [ILC]) who developed gastric and colonic metastases, presenting with rare endoscopic findings characterized by multiple polypoid lesions, along with disseminated carcinomatosis of the bone marrow. Biopsies from the stomach and colon revealed poorly differentiated adenocarcinomas that were estrogen receptor-positive and negative for E-cadherin in the colon, consistent with ILC metastases. Endocrine therapy with letrozole led to systemic improvement. However, diarrhea and abdominal pain persisted until palbociclib was initiated, after which both symptoms markedly improved. Follow-up endoscopy demonstrated regression of the gastric and colonic lesions. This case is of educational value because it demonstrates, with high-quality images, subtle mucosal changes with a polypoid appearance that are not widely recognized as typical findings of colonic metastasis from ILC, and includes a review of previously reported cases. In patients with breast cancer, particularly ILC, persistent gastrointestinal symptoms may suggest metastasis. Careful endoscopic evaluation with biopsy is essential for diagnosis and monitoring the treatment response.
AIM:The effect of treatment response to anticoagulant therapy on prognosis of patients with cirrhosis and portal vein thrombosis (PVT) remains unclear. METHODS:Forty-one patients with cirrhosis and first PVT treated with intravenous anticoagulant therapy between January 2015 and April 2018 at 10 Japanese hospitals were included. Treatment response was defined based on change in size of PVT after anticoagulant therapy as the following: complete response (CR, 0%), partial response (PR, ≤ 50%), stable disease (SD, 51%-100%), and progressive disease (PD, ≥ 101%). CR and PR were combined as the effective group and SD and PD formed as the ineffective group. RESULTS:The median age was 69 years, and 56% of the patients had Child-Pugh class B. Overall, 5 (12%) achieved CR, 22 (54%) achieved PR, 12 (29%) had SD and 2 (5%) had PD. During a median follow-up of 31.8 months from the date of assessment of treatment response, 17 patients died. The overall survival rates at 1- and 3-year were 82.5% and 65.1%, respectively. In the multivariate analysis, the model for end-stage liver disease-Na score was significantly associated with overall survival, whereas treatment response was not significant. Twenty-five patients experienced liver-related events with hospitalization, and the 3-year cumulative rate of liver-related events was 63.9%. In the multivariate analysis, treatment response was significantly associated with liver-related events. The 3-year cumulative rates of liver-related events were 56.7% and 75.5% in the effective and ineffective groups, respectively (p = 0.008). CONCLUSIONS:Among patients with cirrhosis, treatment response to anticoagulant therapy for PVT correlated with the incidence of liver-related hospitalization events.
BACKGROUND:First-line chemotherapy with maintenance therapy is expected to be well-tolerated and improve survival in patients with metastatic colorectal cancer (mCRC). This study evaluated the efficacy and safety of trifluridine/tipiracil (TAS-102) plus bevacizumab (Bev) as maintenance therapy for mCRC, omitting both oxaliplatin and fluoropyrimidines. MATERIALS AND METHODS:Patients with untreated mCRC initially received induction chemotherapy with fluoropyrimidine, oxaliplatin plus bevacizumab for 3-4 months. After achieving stable disease or better on imaging, 52 patients transitioned to maintenance therapy with TAS+Bev: TAS-102 (35 mg/m2, twice daily on days 1-5 and 8-12) plus Bev (5.0 mg/kg on Days 1 and 15, intravenously). Progression-free survival 1 (PFS1), defined as the time from the start of maintenance therapy to disease progression or death, was evaluated as the primary endpoint. RESULTS:The median cumulative dose of oxaliplatin during induction was 529 mg/m2. Median PFS1 during TAS+Bev maintenance was 8.7 months (95% CI: 5.5-12.3). The response rate and disease control rate during maintenance were 59.6% and 94.2%, respectively. Oxaliplatin reintroduction was feasible in 53.8% (28/52) of patient with a median total first-line chemotherapy duration was 16.2 months (95% CI: 14.5-20.6). Safety outcomes, including dose intensity and adverse events, were acceptable. CONCLUSION:This strategy of switching to first-line maintenance therapy with TAS+Bev demonstrated promising efficacy and safety. This strategy effectively avoided cumulative neurotoxicity, preserved quality of life and enabled reintroduction of oxaliplatin, suggesting it may represent a promising alternative strategy for patients ineligible for prolonged oxaliplatin-based treatment. Overall survival analysis is currently ongoing. [UMIN Trial ID: UMIN000031317].
Long-term nucleos(t)ide analog (NUC) treatment improves the outcomes of patients with chronic hepatitis B virus (HBV) infection. However, only a limited number of patients treated with NUC can achieve hepatitis B surface antigen (HBsAg) seroclearance, the so-called “functional cure.” However, it remains unclear how on-treatment viral factors affect HBsAg seroclearance during long-term NUC treatment. We aimed to investigate whether the baseline and on-treatment HBV markers can predict HBsAg seroclearance and reduction in patients treated with long-term NUC treatment. This study included two independent cohorts consisting of 843 patients in the derivation cohort and 1781 patients in the validation cohort. HBsAg seroclearance was infrequent (3.7–6.2
We report the case of a woman in her late 60s who presented to our hospital with fever and general fatigue. Investigation revealed bicytopenia, splenomegaly and central hypothyroidism. Brain MRI revealed enlargement of the anterior pituitary lobe. A random skin biopsy demonstrated clusters of atypical lymphocytes within small vessels, leading to a diagnosis of intravascular large B-cell lymphoma (IVLBCL). The patient achieved complete remission following multi-agent chemotherapy and autologous peripheral blood stem cell transplantation, with normalisation of her endocrine function. This case represents a rare instance of IVLBCL presenting with hypopituitarism as a clinical manifestation.
