Notes

Laserlight Microdissection of FFPE Muscle Areas as well as Future Entire Genome Boosting by Ampli1™.
The patient has remained relapse-free for 6 years without further treatments.An 80 year old Japanese man with bilateral ureteral cancer underwent laparoscopic bilateral nephroureterectomy and lymph-node dissection. The pathological stage of the left and right ureteral tumors was pT3pN0M0. He received two courses of adjuvant gemcitabine and cisplatin chemotherapy while undergoing hemodialysis. The standard dose of gemcitabine and 50% of the standard dose of cisplatin were administered on the same day. Hemodialysis was started 6 h after gemcitabine administration and 1 h after cisplatin administration. The side effects were evaluated according to the Common Terminology Criteria for Adverse Events v4.0. In the first course, Grade 4 side effects including leukopenia, neutropenia, and thrombocytopenia were observed. He was treated with granulocyte colony-stimulating factor and platelet transfusion. Because the second course was administered without reducing the doses, granulocyte colony-stimulating factor was administered prophylactically, and Grade 4 side effects were reduced to Grade 3. Gemcitabine plus cisplatin chemotherapy can be administered safely in a patient with advanced ureteral cancer undergoing hemodialysis by adequately managing adverse events.Stage IV Gastric/Esophagogastric junction cancer (G/EGJ) has an unfavorable prognosis and poor curability. In this study, we report the case of long-term survival after multidisciplinary treatments for advanced esophagogastric junction cancer. A 53-year-old male patient was diagnosed with HER2 positive advanced esophagogastric junction cancer and mediastinal and paraaortic lymph node metastasis. After systemic chemotherapy for 1 year, minimally invasive esophagectomy was conducted as conversion surgery. However, peritoneal and liver metastasis was observed on 3 months after curative surgery. 2 years after operation, solitary brain metastasis was detected and stereotactic radiosurgery (SRS) using a gamma knife was underwent. After 1 year, despite the continuous administration of Nivolumab, the paraaortic lymph node increased in size again and radiation therapy was conducted. Currently, he is alive and undergoing chemotherapy.The reports for secondary esophageal cancer treated by radiotherapy or chemoradiotherapy is few, however they potentially yield a cure for esophageal cancer. We report a case of definitive radiotherapy for a patient with secondary locally advanced unresectable esophageal cancer after hematopoietic stem cell transplantation for acute myeloid leukemia. Definitive radiotherapy for the current patient was completed with acceptable toxicity despite the poor general condition with long-term chronic graft-versus-host disease. Radiotherapy may be the definitive treatment for this population unfit for concurrent chemotherapy or surgery.A 62-year-old woman with edema and color changes in her fingers underwent computed tomography (CT); slight interstitial changes were detected in the lungs with multiple tumors in the anterior and hilar region of the liver. Based on the blood test findings, she was diagnosed with interstitial pneumonia associated with systemic sclerosis. Ultrasound-guided biopsy from the hepatic hilar lymph node revealed poorly differentiated serous adenocarcinoma cells. High serum CA-125 levels suggested primary peritoneal serous carcinoma (PPSC). Owing to increased interstitial shadows on chest CT images and worsening respiratory distress, intravenous cyclophosphamide and oral prednisolone treatment was started. The skin-related symptoms, respiratory distress, and interstitial shadows improved, and the tumor size reduced. Eighteen months later, the patient has had no exacerbation of interstitial pneumonia, and the PPSC is well controlled.We experienced an extremely rare case of recurrent esophageal adenosquamous carcinoma showing cutis, bone and adrenal gland metastases. Furthermore, the patient showed complete remission by chemotherapy and irradiation, with a long-term survival of over 8 years. A 46-year-old man with esophago-gastric junction cancer of clinical stage II was administered two cycles of neo-adjuvant chemotherapy with FP (5FU 800 mg/mm2 Cisplatin 80 mg/mm2 every 3 weeks), subsequently, underwent esophagectomy and mediastinal and celiac lymph node dissection. However, at 1 month after the surgery, he was admitted again due to a 1 cm cutaneous metastasis at the anterior chest wall and left side adrenal gland metastasis. Furthermore, magnetic resonance imaging showed bone metastasis at the second cervical vertebra. He was administered weekly docetaxel at 40 mg/body (3 times every 4 weeks) for 27 cycles. Irradiation therapy (liniac 36 Gy/16Fr) was performed for the vertebral metastasis. The cutaneous and adrenal metastases were diminished and complete remission persisted for over 8 years.Immunohistochemistry of mismatch repair proteins is a universal strategy for Lynch syndrome screening. In this case, Lynch syndrome was suspected, because MLH1 and PMS2 expression was negative by IHC. However, mismatch repair genetic analysis revealed a variant of unknown significance of c.454-13A > G in MLH1. Therefore, we performed reverse transcription-PCR using mRNA extracted from the patient's lymphocytes and detected a heterozygous gene allele indicating splicing abnormalities that complex splicing, with exon 5 followed by only the first codon (ACG) of exon 6 and leading to exon 7 of the MLH1. Two years later, this mutation was corrected to "likely pathogenic". For Lynch syndrome in which mismatch repair protein expression is undetectable by immunohistochemistry, reverse transcription-PCR may be useful to identify an intronic variant of unknown significance as the likely pathogenic variant.A majority of breast cancer (BC) molecular subtype in BRCA1 variants carriers is triple-negative type. In contrast, human epidermal growth factor 2 (HER2)-positive BC among carriers of BRCA1 variants is rarely reported. A 42-year-old woman who previously received adjuvant endocrine therapy against left BC developed a left BC relapse and a right new primary BC. Her mother had BC and ovary cancer, and her cousin had BC. Genetic testing revealed a pathogenic large deletion of exons 1-8 in BRCA1. She was diagnosed with hereditary breast and ovary cancer and underwent bilateral mastectomy. The molecular subtypes of her right and left primary BC were HER2-enriched type and luminal-HER2 type, respectively. After completion of adjuvant therapy for right BC, risk-reducing salpingo-oophorectomy (RRSO) is planned. The present case makes us consider the frequency of BRCA1 large rearrangements in Japanese, the association between HER2 amplification and BRCA1 variants, and the optimal timing of RRSO in patients receiving adjuvant therapy for BC.It is still unclear whether cell-free DNA (cfDNA) can replace solid-tissue biopsy. A 59-year-old man developed castration-resistant prostate cancer with a liver metastasis. We performed a liver biopsy and collected a cfDNA sample. Although he underwent radiofrequency ablation, tumors recurred and he was transferred to another hospital. We performed next-generation sequencing using DNA from the biopsy tissue and cfDNA. BRCA2 p.T3033fs and AURKA F31I were detected in both the biopsy tissue and the cfDNA. cfDNA may be useful as a liquid biopsy for monitoring the gene profile of aggressive prostate cancer.
The online version contains supplementary material available at 10.1007/s13691-021-00482-2.
The online version contains supplementary material available at 10.1007/s13691-021-00482-2.We report a rare case of localized prostate cancer with BRCA2 and RB1 co-loss, which is usually found at a more advanced stage with a poor prognosis. A 59-year-old male with prostate cancer was referred to our hospital for surgical treatment. He had schizophrenia that was well controlled by medicine. He had no family history of prostate cancer, breast cancer, or ovarian cancer. His initial PSA was 4.5 ng/mL, and Gleason score 3 + 4 adenocarcinoma was detected in one of 12 needle biopsy cores. Imaging studies demonstrated the clinical stage to be cT2aN0M0. Therefore, robot-assisted laparoscopic radical prostatectomy (RALP) with bilateral nerve sparing was performed. Based on histopathological analysis, the Gleason score was 4 + 3 and the pathological stage was pT2N0M0 with a negative surgical margin. Genetic sequencing identified BRCA2 and RB1 co-loss with limited loss of heterogeneity (LOH). At 12 months after surgery, his PSA level remained 
The online version contains supplementary material available at 10.1007/s13691-021-00469-z.
The online version contains supplementary material available at 10.1007/s13691-021-00469-z.The diagnosis and management of borderline ovarian tumors during pregnancy are still not standardized, because these tumors are rarely encountered. We report the case of a 27-year-old pregnant woman who presented with an ovarian mass in her first trimester. Magnetic resonance imaging revealed a multilocular cystic component with papillary lesions in the background of endometriosis, suggesting a seromucinous borderline tumor or ovarian cancer. A right salpingo-oophorectomy and partial omentectomy were performed at 7 weeks of gestation. Pathological examination demonstrated a serous borderline tumor. The subsequent pregnancy course was uneventful, and she gave birth to a healthy baby at 39 weeks of gestation. She wanted to retain fertility, and close follow-up was performed. Four years later, she became pregnant, and a lesion suggesting recurrence in the left ovary was detected. An abdominal left ovarian cystectomy was performed at 13 weeks of gestation, which demonstrated recurrence of the serous borderline tumor. Linsitinib in vitro She gave birth to a healthy baby at 39 weeks of gestation. Two months after delivery, she underwent total abdominal hysterectomy with left salpingo-oophorectomy, which revealed no malignant findings. We also reviewed 10 reports that included 58 cases of borderline ovarian tumors diagnosed during pregnancy. The borderline ovarian tumors diagnosed during pregnancy exhibited different characteristics according to each subtype, suggesting the importance of diagnosing borderline ovarian tumor subtypes preoperatively.In epidemiology, the effective reproduction number R e is used to characterize the growth rate of an epidemic outbreak. If R e > 1 , the epidemic worsens, and if R e less then 1 , then it subsides and eventually dies out. In this paper, we investigate properties of R e for a modified SEIR model of COVID-19 in the city of Houston, TX USA, in which the population is divided into low-risk and high-risk subpopulations. The response of R e to two types of control measures (testing and distancing) applied to the two different subpopulations is characterized. A nonlinear cost model is used for control measures, to include the effects of diminishing returns. Lowest-cost control combinations for reducing instantaneous R e to a given value are computed. We propose three types of heuristic strategies for mitigating COVID-19 that are targeted at reducing R e , and we exhibit the tradeoffs between strategy implementation costs and number of deaths. We also consider two variants of each type of strategy basic strategies, which consider only the effects of controls on R e , without regard to subpopulation; and high-risk prioritizing strategies, which maximize control of the high-risk subpopulation.
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