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A 34-year-old woman underwent total hysterectomy for management of uterine leiomyoma. At the same time, a paraurethral tumor (2 cm in size) was diagnosed based on magnetic resonance imaging (MRI). However, the patient was not treated for the tumor considering its small size. Eight years later, the patient was referred to our institution with a chief complaint of urethral bleeding. Computed tomography revealed a paraurethral mass at the same location, which was 13 cm in size. A percutaneous needle biopsy was performed and the tumor was diagnosed as leiomyoma. Tumor extirpation was performed and immunohistochemical analysis of the specimen demonstrated positive estrogen and progesterone receptors. Recurrence was not observed on MRI taken 6 months after the surgery. Paraurethral leiomyoma is rare, but relatively common in young women.

In proton magnetic resonance (MR) spectroscopy ( 1 H-MRS) of the breast cancer, choline peak could be detected. The purpose of this study was to evaluate the influences of the tumor volume, full width at half maximum (FWHM) of the water peak (FWHM), and T 2 * value of water (T 2 * value) on the detection rate of the choline peaks at 3.0 T-MRI. We measured FWHM and T 2 * value in 109 cases, and we evaluated the effect of tumor volume on the detection rate of the choline peaks and the effect of FWHM and T 2 * value on the detection of choline peaks. In 1 H-MRS of breast cancer at 3.0 T-MRI, the detection rate of the choline peaks improved as the tumor volume was larger. As a shimming environment when acquiring 1 H-MRS of breast cancer, FWHM is preferably 57.4 Hz or less and T 2 * value should be 11 ms or more, and T 2 * value has a great influence on the detection rate of the choline peaks.

The treatment for desmoid-type fibromatosis involves surgical resection and medication therapy, but the standard treatment has not yet been established. In the West, the usefulness of radiation therapy has been reported. We encountered a patient with desmoid-type fibromatosis in the pelvis who was treated by radiation and medication therapies and achieved a good tumor reduction effect. The patient was a 70-year-old man. He had a 6-year history of pain in the right leg and had a palpable mass on the right side of the anus; he was admitted to our department. CT showed a 12×7×12 cm mass in the pelvis, and CT-guided needle biopsy revealed a desmoid-type fibromatosis. Because tumor exclusion resulted in obstruction of the rectum, radiation therapy(60 Gy in 30 Fr)was started after performing transverse colon colostomy; simultaneous medication therapy with a COX-2 inhibitor and the anti-allergic agent tranilast was administered. Cystic degeneration was observed 5 months after the end of radiation therapy, and after 12 months, the tumor volume had halved. Around 28 months after the end of radiation therapy, medication treatment has been continued with slow contraction.

Objectives: Recent advancement in detection of small-sized early-stage lung cancer has made limited lung resection with curative intent a practical and vital option. In this retrospective study, we investigated the validity of choice of procedures at our institute with examining the survival outcomes of lung cancer patients who underwent surgery., Methods: Data from consecutive patients with cTanyN0M0 lung cancer who underwent surgery between January 2006 and December 2012 were extracted by chart review, and the overall and recurrence-free survivals of the patients operated by wedge resection, by segmentectomy and by lobectomy were compared using the univariate and multivariate Cox proportional hazard model. A stepwise backward elimination method with a probability level of 0.15 was used to select the most powerful sets of outcome predictors. For all analyses, a p-value<0.05 was considered statistically significant., Results: Limited lung resection (wedge resection and segmentectomy) were selected for higher age patients, for lower respiratory function patients and for smaller size tumor than lobectomy group. By univariate and multivariate analysis, surgical procedure was not identified as independent risk factor for overall and recurrence-free survival., Conclusion: In this study cohort, mode of surgical procedure did not affect the relapse risk and prognosis. The choice of procedures at our institute in this study period seemed to be appropriate.

The tumors with the size of 15 mm or less and less than 50 percent of solid component have been eligible for our radical surgical indication of 3-port thoracoscopic limited resection. The objective is to evaluate the indication. Between 2010 and 2015, we reviewed 206 segmentectomy and 87 partial resection. In those patients, non-radical limited resections included 129 segmentectomy and 29 partial resection. As for imaging findings, the maximum tumor diameter were 16.7 mm vs 10.8 mm and the consolidation/tumor (C/T) ratio were 0.54 vs 0.39. At a mean follow up of 48 months, 5-year overall survival (OS) were 91.4% vs 93.1%, and 5-year recurrent free survival (RFS) were 88.6% vs 93.1%. Overall recurrence(10 patients vs 6 patients) happened in the patients with non-radical limited resections for pure or part solid tumors, therefore it is necessary to consider an indication of limited resection for solid tumors carefully.

Objective: The present study aimed to clarify gross tumor volume (GTV) contouring accuracy at the diaphragm boundary using respiratory-gated PET/CT., Methods: The lung/diaphragm boundary was simulated using a phantom containing 18 F solution (10.6 kBq/mL). Tumors were simulated using spheres (diameter, 11-38 mm) containing 18 F and located at the positions of the lungs and liver. The tumor background ratios (TBR) were 2, 4, and 8. The phantom was moved from the superior to inferior direction with a 20-mm motion displacement at 3.6 s intervals. The recovery coefficient (RC), volume RC (VRC), and standardized uptake value (SUV) threshold were calculated using stationary, non-gated (3D), and gated (4D) PET/CT., Results: In lung cancer simulation, RC and VRC in 3D PET images were, respectively, underestimated and overestimated in smaller tumors, whereas both improved in 4D PET images regardless of tumor size and TBR. The optimal SUV threshold was about 30% in 4D PET images. In liver cancer simulation, RC and VRC were, respectively, underestimated and overestimated in smaller tumors, and when the TBR was lower, but both improved in 4D PET images when tumors were >17 mm and the TBR was >4. The optimal SUV threshold tended to depend on the TBR., Conclusions: The contouring accuracy of GTV was improved by considering TBR and using an optimal SUV threshold acquired from 4D PET images.

Follicular lymphoma (FL) is incurable with the current standard therapeutic strategy, although the natural history of FL has improved in the last few decades. Treatment strategy for FL is considered by stage and tumor burden. For advanced-stage FL patients with low tumor burden, monitoring remains an appropriate approach. Single agent rituximab is also suggested as a good alternative. The addition of rituximab to chemotherapy has improved overall survival in advanced-stage FL patients with high tumor burden. The optimal chemotherapy to partner with rituximab might be CHOP or bendamustine. Rituximab maintenance after successful induction rituximab-based chemotherapy prolongs PFS. Recently, progression within 24 months of first-line chemotherapy has been established as a predictor of inferior outcome, with a 50% risk of death in 5 years. Addressing this high-risk group is important for optimal future treatment strategies.

Treatment options for follicular lymphoma (FL) are considered when patients have limited stage, low tumor burden advanced stage, and high tumor burden advanced stage disease. Although patients with limited stage FL are managed with radiotherapy (24-36 Gy), watchful waiting (WW), rituximab monotherapy, and rituximab combined with chemotherapy need to be evaluated. In patients with low tumor burdens, WW is regarded as the standard management. The usefulness of rituximab monotherapy was also recently suggested. Rituximab combined with chemotherapy improved overall survival (OS) in patients with high tumor burdens and the optimal reference regimen might be R-CHOP or rituximab combined with bendamustine. As to efficacy, improved relapse-free survival, with rituximab maintenance, has been shown. In patients with primary macroglobulinemia, fludarabine improved both progression-free survival and OS as compared with chlorambucil. As to extra-nodal marginal-zone B cell lymphoma, the addition of rituximab to chlorambucil improves both the response rate and event-free survival. Large clinical trials of lenalidomide, idelalisib, and ibrutinib are now ongoing.

Recent studies have shown that cancer cells surviving in a microenvironment characterized by hypoxia, low pH, and low glucose level have an ability to adapt to the adverse conditions. We measured the pH in the central tumor area of primary lung cancer, and evaluated its association with clinicopathological factors. There was a negative correlation between the tumor size and pH;with an increase in the tumor size, the pH decreased. Cancer cells grow at a markedly low pH compared with the physiological environment. There is a possibility that this low pH is a microenvironment that is appropriate rather than adverse for the growth and development of cancer cells.

Microscopic and endoscopic techniques requiring superior skills are required for the examination of parasellar tumors. However, the parasellar region is surgically inaccessible, and complete excision of parasellar tumors remains a challenge. CyberKnife (CK) enables frameless radiosurgery and provides chronological and spatial freedom. We have previously treated parasellar tumors with stereotactic radiotherapy (SRT). Here, we evaluated the feasibility of CK surgery for parasellar tumors. Between June 2000 and August 2010, we conducted CK surgery for 4,500 patients. This study included 246 patients with pituitary adenoma (PA); 78, craniopharyngioma (CP); 38, parasellar meningioma (PM); and 6, metastatic pituitary tumor (M). The tumor volume ranged from 0.3 to 107 mL (median: 4.8 mL), and the patients were treated with 1-5 sessions of SRT. The treatment results were analyzed with a follow-up period of more than a year (range, 12-120 months; median: 35 months). The control rate of PA, CP, PM, and M was 96.6%, 79.0%, 100%, and 100%, respectively. Treatment failure in the case of CP was related to tumor volume. One PA patient had visual deterioration, and another had new hypopituitarism. One M patient showed visual loss 12 months after the CK treatment, which was related to the treatment dose. Thus, CK was found to be feasible for parasellar tumors, although its safety and efficacy must be observed in long-term follow up.

We examined whether the tumor volume (TV) is a good predictor of PSA recurrence after radical prostatectomy. Data were collected for 158 patients with clinically localized prostate cancer undergoing radical prostatectomy without neoadjuvant hormonal therapy in our hospital since April 2005 to September 2007. Along with the routine pathological assessment, TV was assessed in all prostatectomy specimens. PSA recurrence was defined as PSA levels of greater than 0.2 ng/ml. The TVs were 1.81+/-1.66 ml (mean +/-SD) ranging from 0.02 to 8.20 ml. The TV in cT1c was 1.77+/-1.64, and 1.89+/-1.72 ml in cT2 (not significant). Significant differences were observed between TV and pT. The TVs in pT2a, pT2b and pT3/4 were 0.54+/-0.54, 1.63+/-1.47 and 2.67+/-1.80 ml, respectively. The median follow-up period was 32.3 months (range from 15 to 45) after radical prostatectomy, and PSA recurrence was observed in 32 cases. Patients with smaller TV (TV <1.3 ml) had a higher PSA-free survival rate (89.5%) than those with a larger TV (TV > or = 1.3 ml, 66.7%) with a significant difference atp <0.001 (log-rank test). A multivariate analysis was performed for PSA, TV, pT, Gleason Score (GS), and surgical margins. Significant differences were observed for GS, and surgical margins, but not for TV. Clinically organ-confined disease in Japanese patients with prostate cancer included various cancers from clinically insignificant to locally advanced ones. In our series, TV was not regarded as a predictor of PSA recurrence after radical prostatectomy.

We studied the impact of combined transurethral resection of the prostate (TURP) and high intensity focused ultrasound (HIFU) for localized prostate cancer (CaP) to decrease side effects such as prolonged urinary voiding disturbance observed after HIFU treatment. Included in this study were 18 patients with clinically localized CaP indicated for HIFU just followed by TURP (TUR combination group). Complete response was defined in accordance with ASTRO consensus statement and negative sample in biopsies performed 6 months after the HIFU treatment. Prostate specific antigen (PSA) nadir, International Prostate Symptom Score (IPSS) and morbidity during follow-up of TUR combination group were compared with those of a control of 18 patients who took HIFU treatment alone (HIFU monotherapy group). No statistical significances on the values of preoperative parameters (PSA, prostate volume, Gleason score, and IPSS) between these two groups. The median follow-up duration was 10 (5-15) months in both groups. A statistically significant impact was observed between TUR combination group and HIFU monotherapy group on median catheter time (5 versus 13 days, P<0.0001), PSA nadir (0.096 ng/ml versus 0.430 ng/ml in median, P<0.05) and the evolution of the post-treatment IPSS (8 versus 13.5 in median, P<0.0003) at 3 months after treatment. Urethral stricture necessary for urethral dilation was noted in 1 patient (5.6%) in the TUR combination group while in 2 (11.1%) in the HIFU monotherapy group. CR was obtained in 88.9% in the TUR combination group and 83.3% in the HIFU monotherapy group. Our study suggests that the combination of TURP with HIFU treatment improves posttreatment urinary status without additional morbidity.