Notes

Probable Infanticidal Event of an Aye-Aye (Daubentonia madagascariensis) throughout Torotorofotsy, Madagascar.
The most common presenting symptoms of leptomeningeal carcinomatosis (LC) are ocular manifestations with vision loss. There are multiple reports of undiagnosed LC causing sudden, complete, monocular vision loss as the presenting symptom; however, sudden bilateral vision loss 6 months following diagnosis has not been described. Any new ocular involvement or worsening of previous ocular symptoms warrants reimaging and prompt ophthalmology consultation, as this likely indicates disease progression. This report details a unique case of LC where a previously diagnosed patient developed sudden, complete, bilateral vision loss and multiple cranial nerve palsies with progression of LC on imaging.We report an unusual presentation of primary hepatic neuroendocrine tumor which was initially misdiagnosed as intrahepatic cholangiocarcinoma. The diagnosis was only revealed after a major liver resection by histopathology. With adjuvant lanreotide injection, the patient survived for more than 16 months after the operation without tumor recurrence. Diagnosis of this rare tumor has been a major challenge and we emphasize the importance of a preoperative diagnosis. Surgical resection remains the mainstay for curative treatment, while peptide receptor radionuclide therapy is an emerging treatment option which has provided promising results.Severe thrombocytopenia is a rare adverse event of panitumumab. Here, we report the first patient with metastatic colorectal cancer who developed severe thrombocytopenia, diagnosed as panitumumab-associated drug-induced immune thrombocytopenia (DITP). A clinical diagnosis of DITP can be obtained by excluding other causes of thrombocytopenia and is confirmed by the recovery of thrombocytopenia after the discontinuation of the suspected drug. Treatment includes permanent discontinuation of the suspected drug. Re-exposure should be avoided. It should be kept in mind that panitumumab can induce DITP in the case of a new, sudden, unexpected, and isolated drop in platelet count after excluding other causes of thrombocytopenia.Orbital hemangiopericytomas (HPCs) are rare mesenchymal tumors with a high tendency to recur. SN38 Treatment options are quite limited in case of a relapse, but re-irradiation can be useful. Most of the available data limit the possibility of re-irradiation, while novel techniques (e.g., pencil beam proton therapy [PT]) open new approaches for the safe repeating of treatment. To the best of our knowledge, this is the first well-documented case of multi-times (>3) irradiation of tumors located intracranially. The case reported here describes orbital HPCs with proton irradiation performed two times since 1999 in a 30-year-old woman with a medical history as well as surgery followed by conventional radiotherapy (RT) and chemotherapy, and two times stereotactic RT (in 2009 and 2013). In 2016 the patient came to our hospital with the 3rd relapse of the tumor, located in the left orbit, with an intracranial part, involving cavernous sinus, which was close to the temporal lobe. The 4th course of irradiation was done in May to June 2016 by pencil beam PT. Radiation necrosis occurred after 2 years and was treated with bevacizumab (BVZ). Three years later, another relapse was treated with PT and BVZ. The 9-month follow-up showed complete tumor response without signs of brain toxicity. The patient died due to a brain abscess 1 year after the 5th irradiation. This case shows a possibility of irradiation, applied 5 times to the same location, with promising results and manageable toxicity.A 78-year-old man with metastatic prostate cancer was referred to the hospital 5 weeks after the initiation of systemic therapy with goserelin (GnRH agonist) because of a significant increase in alkaline phosphatase (ALP) concentration despite clinical improvement. Further workup revealed a decrease in prostate-specific antigen levels and a lack of radiological signs of disease progression. Subsequently, the ALP dropped spontaneously. This case report is an example for an early ALP flare after initiation of endocrine therapy in patients with bone metastasis which is consistent with a treatment response. Clinicians should be familiar with the ALP flare phenomenon in this setting, which does not reflect disease progression or treatment failure, in order to prevent unnecessary investigations, hospital admissions, or even erroneous termination of successful therapy.Liver metastasis from gastric cancer has a very poor prognosis. Herein, we present two cases of liver metastases (synchronous and metachronous) from advanced gastric cancer. In the first case, the patient underwent radical subtotal gastrectomy. Liver metastases occurred 6 months after surgery while the patient was receiving adjuvant chemotherapy, but two hepatic tumors were successfully removed by radiofrequency ablation (RFA). In the second case, liver metastases occurred 15 months after surgery for gastric cancer. The patient also received RFA for one hepatic tumor, and other suspicious metastatic tumors were treated with systemic chemotherapy. Although these case presentations are limited for the efficacy of RFA treatment with systemic chemotherapy for hepatic metastases from gastric cancer, our findings showed long-term survival (overall survival for 108 and 67 months, respectively) of the affected patients, without recurrence. Therefore, we suggest that RFA treatment with systemic chemotherapy could be an effective alternative treatment modality for hepatic metastases from gastric cancer.Pertuzumab, a humanized antibody drug, has improved outcomes of patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer, when administered in combination with trastuzumab and other chemotherapies. Cardiotoxicity due to trastuzumab is widely recognized, while data on pertuzumab-based treatments in daily clinical practice are lacking. We herein report 2 Japanese patients, aged 72 and 49 years, who developed left ventricular dysfunction after pertuzumab administration, following long-term trastuzumab treatments. Both patients underwent curative surgery for their HER2-positive breast cancer and received anthracycline-based treatments. After developing metastatic disease, trastuzumab-based treatments were administered without cardiac toxicity, but both patients developed left ventricular dysfunction after pertuzumab administration (6 and 13 cycles, respectively). Although several large randomized trials have shown no additive effect of pertuzumab on cardiac dysfunction, careful monitoring of cardiac function appears to be necessary in daily practice, particularly for patients with prior long-term trastuzumab treatments.
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