Tadanori Nagai

Meningeal carcinomatosis from an ovarian primary with complete response to adjuvant chemotherapy after cranial irradiation.

Abstract Meningeal metastasis is rare in the clinical course of ovarian carcinoma, and its prognosis is poor. Meningeal dissemination of carcinoma is usually treated by intrathecal administration of methotrexate and total brain irradiation, although these treatments are usually ineffective. We experienced a case of meningeal relapse from ovarian carcinoma resistant to multiple antineoplastic agents in a 64-year-old woman who was treated with eight different chemotherapy regimens after her initial operation 7 years previously. Intrathecal administrations of methotrexate or cisplatin with dexamethasone were not effective. Fifty-Gy whole cranial irradiation inhibited increases in serum carbohydrate antigen (CA)125 levels and further tumor growth. Adjuvant chemotherapy was required to alleviate frequent headaches and to decrease serum CA125 level and tumor size. Intravenous administration of 45 mg paclitaxel and 35 mg cisplatin, and oral administration of 50 mg etoposide were carried out for 5 days. This treatment was repeated every 3 weeks. After four courses of treatment, meningeal carcinomatosis was not detectable on computed tomography (CT) and magnetic resonance imaging (MRI) scans. The patients serum levels of CA125 rapidly fell to beneath normal limits and remained normal. She is still alive and clinically free of recurrence 4 months after the last cycle of chemotherapy. As well as reporting our experience with this case, we also present a review of the literature on meningeal carcinomatosis from ovarian cancer.

A Pleural Effusion Caused by Fibrous Hematopoietic Tumor Successfully Treated With Prednisolone in a Patient With Agnogenic Myeloid Metaplasia With Myelofibrosis

A 46-year-old woman suffering from agnogenic myeloid metaplasia (AMM) since 1994 was being followed as an outpatient. In November 1999, she exhibited respiratory failure caused by massive pulmonary effusion, which was speculated to have been produced by chest tumors. A biopsy specimen revealed findings compatible with fibrous hematopoietic tumor (FHT): prominent fibroblasts and fibrosis with scanty megakaryocytes. Serum concentrations of transforming growth factor (TGF)-β and platelet-derived growth factor (PDGF) were significantly higher than those of other cases of AMM without FHT. The effusion did not respond to administrations of various chemotherapeutic agents, but after prednisolone administration, the effusion disappeared and the tumors also diminished.TGF-β and PDGF were the possible causes of FHT formation, and for such fibrotic extramedullary regions, the administration of prednisolone should be considered.

A CASE OF PARATHYROID HORMONE PRODUCING CARCINOMA OF LIVER

本来hormoneを産生しない臓器から発生した腫瘍組織がhormoneを産生するものを異所性hormone産生腫瘍と呼んでいる.この異所性hormone産生腫瘍は,癌細胞の偏倚および発癌機構の解明に示唆を与える材料として注目されている.異所hormone産生腫瘍の直接的表付けは,腫瘍組織中に含まれるhormoneが有意に高いことの証明である.今回われわれは,63才,男性で,肝腫張,腹水を来たして来院し,α-fetoproteinが強陽性で,超音波断層像,血管造影などから原発性肝癌と診断し,経過中に著明な高Ca血症を認めた症例を経験した.本例の血清,腹水および腫瘍組織中に異常高値のPTHをradioimmunoassayにより証明し,剖検後の病理組織学的検索では,脇上皮化性型腺癌の像が主体であるが,索状配列の部位もあり多彩な縁を呈した.本例はα-fetoproteinと異所性hOrmoneの産生機序を考察するうえで示唆に富む症例と考えられたので報告する.