Aki Nakamura

The syndrome of inappropriate antidiuretic hormone secretion associated with chemotherapy for hypopharyngeal cancer

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by hyponatremia and the plasma hypoosmolality induced by water retention attributable to persistent antidiuretic hormone (ADH) release. It has been reported that SIADH may occur due to various factors in patients with malignant tumor. We report a case of hypopharyngeal cancer complicated by SIADH following chemotherapy. A 72-year-old woman with hypopharyngeal cancer was treated by oral administration of S-1 and intravenous administration of low-dose cisplatin following radiation therapy. General fatigue and coma occurred during the third course of this chemotherapy, using S-1 and low-dose cisplatin. We believed that she had SIADH because of the results of examinations including hyponatremia, serum hypoosmolality and increasing serum ADH level. We treated her by fluid restriction and intravenous administration of hypertonic saline and furosemide, and she recovered. Unfortunately, her hypopharyngeal cancer gradually progressed and she died of acute pneumonia three months later.

Transmucosal coil migration after endovascular management for carotid artery pseudoaneurysm: a late complication.

Sir, We previously reported a case of successful obliteration of carotid artery pseudoaneurysm employing endovascular management with a stent and detachable coils [1]. Here we describe the subsequent clinical course of the patient after the endovascular treatment. We carefully followed the patient, and 2 years after the procedure hypopharyngeal discomfort was noted. Fiberoptic pharyngoscopy demonstrated a coil on the hypopharyngeal wall (Figure 1), and radiography of the neck revealed that the coil previously placed in the pseudoaneurysmal sac had migrated transmucosally to the hypopharyngeal surface (Figure 2). Because left carotid angiography demonstrated complete absence of blood flow in both the external carotid artery and the pseudoaneurysm, suggestive of complete embolization of the pseudoaneurysm, we successfully cut and removed the migrated coil without massive bleeding under fiberoptic pharyngoscopy (Figure 3). No special retriever was required for this procedure.

Concurrent Chemoradiotherapy with Pirarubicin and 5-fluorouracil for Resectable Oral and Maxillary Carcinoma

Objective We present the response rate and adverse effects of our regimen of concurrent chemoradiotherapy with pirarubicin (THP) and 5-fluorouracil (5-FU) for oral and maxillary carcinoma. Patients and methods Fifteen patients with oral (10 cases) or maxillary (5 cases) squamous cell carcinoma who underwent our concurrent chemoradiotherapy with the combination of intraarterial pirarubicin, intravenous continuous 5-fluorouracil, and radiation between March 2001 and February 2003 in our department were entered in this study. THP (5 mg/day) was infused into the lingual or maxillary artery one hour before radiation on days 1–5 and 8–12, while intravenous 5-FU (150 mg/m2/day) was instilled continuously on days 1–5, 8–12, 15–19, and 22–26 in accordance with the radiation schedule (2 Gy/day). Consequently, total doses of THP, 5-FU, and radiation were 50 mg, 3000 mg/m2 and 40 Gy, respectively. After the treatment series, response rate and adverse effects were evaluated. Results Response rate achieved 100% (12 cases exhibited a complete response and the remaining 3 a partial response). Notably, all 10 patients with oral carcinoma exhibited complete response. The main adverse effects were leucopenia (6/15) and mucositis (6/15), both of which were acceptable. Conclusions This concurrent chemoradiotherapy is very useful for oral and maxillary carcinoma as a preoperative modality with remarkably high response rate and acceptable adverse events.

Carotid artery pseudoaneurysm as a rare sequela of surgery for laryngeal cancer

Formation of carotid artery pseudoaneurysm is uncommon after intensive treatment for head and neck cancer. We encountered a case of postoperative formation of pseudoaneurysm at the left carotid bifurcation in a diabetic man. The risk factors for carotid artery pseudoaneurysm in the patient included diabetes mellitus, previous radiotherapy to the neck, neck dissection, and postoperative Staphylococcus aureus infection secondary to accidental pharyngocutaneous fistula. We successfully obliterated this pseudoaneurysm using a Smart stent and detachable coils without neurological deficits. The possibility of vascular injury after treatment for head and neck cancer must be considered, especially in patients with risk factors for it due to previous treatment.

Intraductal Papilloma in the Parotid Duct

Intraductal papilloma arising in the major salivary gland is uncommon. We treated intraductal papilloma of the parotid gland in a 41-year-old man with a 3-week history of a painless mass in his right parotid gland. Radiologic imaging studies revealed a well-circumscribed solitary mass, 1 cm in diameter, at the posterior edge of the right parotid superficial lobe. Complete excision of the mass was performed under general anesthesia. Pathologically, the mass consisted mainly of a cystically dilated salivary duct filled with dark brown muddy components and a cluster of growing papillary cells, leading to the diagnosis of intraductal papilloma. The literature on intraductal papillomas of the major salivary glands is reviewed, with particular focus on preoperative diagnosis of this condition.

A case of simultaneous primary carcinomas of the tongue.

Reports of multiple primary cancers are increasing, but simultaneous primary cancers are not frequently reported especially originated in the same organ. We encountered a 71-year-old female who had two simultaneous carcinomas at both edges of the tongue. Histologically, the carcinoma of the right edge was a well-differentiated squamous cell carcinoma, while that on the left edge was a moderately-differentiated squamous cell carcinoma. No other tumors were detected on other examinations, including gallium-67 scintigraphy, CT scan of the chest, upper gastrointestinal fiberscopy and so on. She underwent surgical treatment without other induction treatments such as radiotherapy and chemotherapy. Her postoperative radiotherapy and chemotherapy were also uneventful because of her age. Fourteen-month follow-up revealed neither recurrence nor metastasis.