Limitation of Using Ultrasonography After Positive Sentinel Lymph Node Biopsy in a Patient with Melanoma in the Detection of Lymph Node Metastasis

Recent studies have shown that complete lymph node dissection (CLND) performed immediately did not improve the overall survival in patients with sentinel lymph node (LN)-positive melanoma. According to these results, nodal observation with ultrasonography becomes standard. However, it still has some limitations for detection of metastatic LNs. A 74-year-old woman was diagnosed with acral lentiginous melanoma of her left sole. The sentinel LN was positive for metastasis, but she refused CLND. Sixteen months after operation, ultrasonography showed an abnormal LN in the inguinal region. There was no other abnormal LNs around the LN. We resected the abnormal LN. The resected LN was black in color, and the adjacent LN that showed normal appearance in ultrasonography was also black. A recent study showed only 6.6% sensitivity in preoperative ultrasonographic detection of metastatic melanoma in a LN. We should keep in mind the limitation of ultrasonography for detection of a metastatic LN

Squamous Cell Carcinoma Manifested as a Cutaneous Horn : A Key to Early Detection

We report a case of squamous cell carcinoma manifested as a cutaneous horn. A 92-year-old man was referred to our department for evaluation of a 3-month history of a keratotic cutaneous horn on the left side of his neck. The height of the cutaneous horn was larger than the diameter of erythema at the base. Histopathological examination showed a hyperkeratotic horn developing over a mass of large atypical keratinocytes with large hyperchromatic and pleomorphic nuclei. Based on these findings, a diagnosis of squamous cell carcinoma was made. A recent study showed that cutaneous horns in association with invasive squamous cell carcinoma had a tendency to have less height than the diameter of the base. In our case, however, the height of the cutaneous horn was larger than the diameter of the base, indicating that invasive squamous cell carcinoma sometimes shows a cutaneous horn that is higher than the diameter of the base. Thus, clinical finding of erythema at the base of the cutaneous horn would be a reliable feature for early detection of squamous cell carcinoma

Shiitake Dermatitis-like Eruption Due to Tegafur/Gimeracil/Oteracil Combination Usage

S-1 is a combination drug of tegafur, gimeracil and oteracil potassium that is designed on the basis of 5-fluorouracil. We report here for the first time that S-1 is a causative agent of drug eruption mimicking shiitake dermatitis. A 58-year-old Japanese man presented with pruritic erythemas arranged in a linear fashion. He had been treated with S-1 for esophageal cancer. Although differential diagnosis included shiitake dermatitis and dermatomyositis, he had not eaten raw shiitake mushroom, and he did not have other cutaneous lesion such as Gottron’s sign and abnormalities of peripheral blood examination including Jo-1 antibody and antinuclear antibody. Histopathological examination revealed necrotic keratinocytes in the Malpighian layer, vacuolar change in the basal layer, and lymphocytic and eosinophilic infiltration in the upper dermis. Based on clinical and histological findings, we made a diagnosis of drug eruption due to S-1

Disappearance of lung adenocarcinoma after total en bloc spondylectomy using frozen tumor-bearing vertebra for reconstruction

Purpose: Total en bloc spondylectomy (TES) is a surgical procedure performed to achieve complete resection of an aggressive benign spinal tumor or a malignant spinal tumor. When reconstructing the spine after resection, we have been using liquid nitrogen-frozen resected spine bearing tumor as a bone graft, expecting an immunological response to tumor-specific antigen(s). The purpose of this article is to report a successful treatment case of lung adenocarcinoma metastasis with TES and this cryotherapy. Methods: A 59-year-old male presented with rapid progression of neurological deterioration of the lower limbs due to a spinal metastasis from T8 to T10. The primary lung adenocarcinoma had already been excised under thoracoscopy. The patient underwent TES with reconstruction using frozen tumor-bearing vertebra for the bone graft. Results: One month after surgery, a new nodule appeared at the right middle lobe of the lung. However, we carried out no biopsy of the newly emerged nodule and the patient received no adjuvant chemotherapy or radiotherapy. Six months after surgery, the tumor vanished. No local recurrence or metastasis of the tumor has been observed until now. Conclusions: TES with a liquid nitrogen-frozen tumor specimen could be a promising therapeutic option for cancer patients with spine metastasis. © 2015 Springer-Verlag Berlin HeidelbergEmbargo Period 12 month

Changes of Blood Flow Volume in the Superior Mesenteric Artery and Brachial Artery with Abdominal Thermal Stimulation

In traditional Chinese medicine, moxibustion is a local thermal therapy that is used for several conditions. Quantifying the effects of moxibustion therapy has been difficult because the treatment temperature depends on the physician's experience, and the temperature distribution in the target area is not uniform. This prospective observational study aims to quantify the effect of local thermal stimulation to the abdomen. We developed a heat transfer control device (HTCD) for local thermal stimulation. Twenty-four healthy subjects were enrolled and they underwent abdominal thermal stimulation to the para-umbilical region with the device for 20 min. Blood flow volume in the superior mesenteric artery (SMA) and brachial artery (BA), the heart rate and the blood pressure were measured at rest, 15 min after starting thermal stimulation and 10, 20, 30 and 40 min after completing thermal stimulation. Blood flow parameters were measured by high-resolution ultrasound. In the SMA, blood flow volume was significantly increased during thermal stimulation (P < .01), as well as at 10 min (P < .01) and 20 min (P < .05) after stimulation. In the BA, blood flow volume decreased at 40 min after stimulation (P < .01). In conclusion we could quantify the effect of local thermal stimulation with an HTCD and high-resolution ultrasound. Thermal stimulation of the para-umbilical region increased blood flow in the SMA 20 min after stimulation in healthy subjects