[Long- term remission survival with a case of rectal carcinoid tumor with metastasis in the soft tissue effectively treated with the combination therapy of irinotecan/5-fluorouracil/levofolinate followed by resection]

Management of sub-5 mm rectal carcinoids with lymph node metastases

Minute (<5 mm) and small (5–10 mm) rectal carcinoids discovered during colonoscopy are generally considered to be non-aggressive, and the management and surveillance of patients with this entity are usually limited. We present the case of a 61-year-old Chinese female with multiple sub-5 mm carcinoid tumours in the rectum without any computed tomography (CT) evidence of lymph node or distant metastases. She underwent an ultra-low anterior resection for a sessile rectal polyp with the histological appearance of a moderately differentiated adenocarcinoma. Seven foci of minute carcinoids in the rectum and perirectal lymph node metastastic spread from the carcinoid tumours were also discovered on histopathology. There were no lymph node metastases originating from adenocarcinoma. This case report and review of the literature suggests that minute rectal carcinoids are at risk of metastasizing and that these patients should be investigated for lymph node and distant metastatic spread with CT and somatostatin receptor scintigraphy or its equivalent, as this would influence prognosis and surgical management of these patients. Findings relating to lymphovascular invasion, perineural invasion, high Ki-67, mitotic rate, depth of tumour invasion, central ulceration, multifocal tumours and size are useful in predicting metastases and may be used in scoring tools. Size alone is not a good predictor of metastastic spread.

Synovial sarcoma individual chemotherapy directed by collagen gel droplet embedded culture drug sensitivity test: A case report

The collagen gel droplet embedded culture-drug sensitivity test (CD-DST) is an anticancer drug sensitivity test developed about 10 years ago. This study reports the application of this test in the choice of neoadjuvant chemotherapy for the treatment of one patient with a large synovial sarcoma in the right shank. A 28-year old man presented at our hospital with a large mass in his right shank which had a hard texture and an obscure boundary. The histopathological diagnosis of excisional biopsy specimens was synovial sarcoma with low differentiation. Theprubicin/Cisplatin (THP/CDDP) neoadjuvant chemotherapy was selected based on the results obtained from the CD-DST. After three courses, a computed tomography (CT) scan was performed which indicated that the volume of the tumor had decreased significantly. Additionally, tumor necrosis, as well as the clinical response, showed complete response. The histopathological diagnosis of wide excision specimens indicated a grade III chemotherapy response. The patient was alive and without recurrence after a follow-up of 16 months. Our results indicated that the CD-DST is a useful tool for selecting neoadjuvant chemotherapeutic drugs for patients with synovial sarcoma.