Neoadjuvant Chemotherapy with or without Concurrent Hormone Therapy in Estrogen Receptor-Positive Breast Cancer:NACED-Randomized Multicenter Phase II Trial

Although in the neoadjuvant setting for estrogen receptor (ER)-positive breast cancers, chemotherapy or hormone therapy alone does not result in satisfactory tumor response, it is unknown whether concurrent chemo-endocrine therapy is superior to chemotherapy alone in clinical outcomes. We conducted a randomized phase II trial to test the responses of ER-positive patients to concurrent administration of chemo-endocrine therapy in the neoadjuvant setting. Women with stage II-III, ER-positive, invasive breast cancer (n=28) received paclitaxel followed by fluorouracil, epirubicin, cyclophosphamide (T-FEC) and were randomized to receive concurrent chemo-endocrine therapy consisting of goserelin administered subcutaneously for premenopausal women or an aromatase inhibitor for postmenopausal women. The primary endpoint was the pathological complete response (pCR) rate after neoadjuvant therapy. Twenty-eight patients were randomized. There were no significant differences in pCR rate between the concurrent group (12.5%;2/16) and the chemotherapy alone group (8.3%;1/12). Tumor size after therapy was significantly reduced in the concurrent therapy group (p=0.035), but not in the chemotherapy-alone group (p=0.622). Neoadjuvant chemotherapy with concurrent hormone therapy provided no significant improvement in pCR rate in ER-positive breast cancers. These preliminary results should be followed up by further studies

A Morgagni hernia repaired laparoscopically using Ventralight ST® mesh

A 78-year-old Japanese woman was referred to our hospital because of fecal occult blood. Barium enema and CT colonography revealed the herniation of the transverse colon and the greater omentum into the right hemithorax through a retrosternal defect. We diagnosed a Morgagni hernia, and we performed a laparoscopic hernia repair with a three-port approach. The invaginated transverse colon and omentum were easily reduced into the abdominal cavity. The size of the hernial orifice was estimated to be approx. 2.5×4 cm. We placed Ventralight ST® mesh over the hernial orifice without hernial sac resection, and we used the double-crown technique to fix the mesh with a hernia stapler. The postoperative course was uneventful, and the patient was discharged on the 5th postoperative day with no complications. There has been no recurrence at 2 years after the surgery. Laparoscopic repair is a safe, less-invasive and useful method for repairing a Morgagni hernia

Extra-intestinal transverse colon leiomyoma with a cyst

A 51-year-old Japanese woman was suspected of having an ovarian tumor. Magnetic resonance imaging suggested a mesenteric origin. A solid tumor measuring 104 mm and a 26-mm cystic tumor were confirmed in the mesenterium (the left pelvis side) by abdominal computed tomography. Based on a preoperative diagnosis of gastrointestinal stromal tumor（GIST） or other stromal tumors, the patient underwent surgery. The tumors were connected with a capsule and detected in the transverse mesocolon. The tumors grew extramurally from the colon wall with thin bunches, and they originated in the transverse colon. Histopathologic staining revealed smooth muscle cells with small nuclei and eosinophilic fibrillar cytoplasm, growing in a fascicular form. Immunohistochemical staining showed that the tumor cells were negative for c-kit, CD34, CD56, and S100 and positive for α-smooth muscle actin. The final diagnosis was colon leiomyoma. We provide further details of this case of extra-intestinal transverse colon leiomyoma with a cyst formation in the transverse mesocolon