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Objective: It was the aim of this study to evaluate maintenance therapy with bevacizumab + capecitabine following induction with bevacizumab + capecitabine + oxaliplatin (XELOX) versus bevacizumab + XELOX until progression as first-line therapy in metastatic colorectal cancer (mCRC)., Methods: Patients received either bevacizumab (7.5 mg/kg) + XELOX (capecitabine 1,000 mg/m(2) twice daily on days 1-14 + oxaliplatin 130 mg/m(2) on day 1 every 3 weeks) until disease progression (arm A) or the same doses of bevacizumab + XELOX for 6 cycles followed by bevacizumab + capecitabine until disease progression (arm B). The primary endpoint was progression-free survival (PFS); secondary endpoints included overall survival (OS), objective response rate (ORR) and safety., Results: One hundred and twenty-three patients were randomized. Treatment compliance was similar in both groups. Median PFS was significantly longer for arm B than for arm A (11.0 vs. 8.3 months; p = 0.002). There was no significant difference between the two arms for ORR (66.7 vs. 59.0%; p = 0.861) or median OS (23.8 vs. 20.2 months; p = 0.100). Tolerability was acceptable in both treatment arms; the most frequent grade 3/4 treatment-related adverse events (arm B vs. arm A) were fatigue (6.6 vs. 16.1%), diarrhoea (3.3 vs. 11.3%), anorexia (3.3 vs. 11.3%), and neuropathy (1.6 vs. 8.1%)., Conclusions: Maintenance therapy with bevacizumab + capecitabine can be considered an appropriate option following induction bevacizumab + XELOX in patients with mCRC instead of continuation of bevacizumab + XELOX.

Objective: To report pancytopenia caused by temozolomide, a second-generation alkylating agent., Clinical Presentation and Intervention: A 22-year-old patient presenting with seizures and confusion was seen in the emergency room. Cranial magnetic resonance imaging revealed a mass. After surgery, the patient was diagnosed with glioblastoma multiforme and was given temozolomide at 150 mg/m(2) on days 1 through 5 every 4 weeks. During the last cycle of temozolomide, grade 3 thrombocytopenia persisted. Possible causes of pancytopenia including vitamin B(12) deficiency were investigated., Conclusion: This case report shows that vitamin B(12) deficiency can be a potential cause of pancytopenia and it should be kept in mind for patients receiving chemotherapy., (Copyright © 2011 S. Karger AG, Basel.)

Background: Multiple primary malignant tumors are rarely seen. Tobacco is one of the factors in their etiology. We report the case of a heavy smoker with metachronous triple primary cancer occurring in the prostate, kidney and urinary bladder., Case Report: A 70-year-old man with prostate cancer presented with the complaint of hematuria. Computed tomography (CT) showed increased wall thickness of the urinary bladder with an enlarged prostate. After the trans-urothelial resection operation pathological diagnosis was consistent with transitional cell carcinoma of the urinary bladder. After 9 months of follow-up, the control CT showed metastatic lesions in the right and left kidneys and in the right lung. Bilateral partial nephrectomy was performed. Interestingly, renal cell carcinoma (RCC) was diagnosed. Rightsided video-assisted thoracoscopic surgery was also performed. The results of the histopathological examination were consistent with metastatic RCC., Conclusions: Although the patient presented with triple carcinoma, there was no familial cancer history suggesting a genetic association. The patient was a heavy smoker, and tobacco usage may be the underlying cause of the detected cancers. This is one of the rare cases in the published literature with triple primary urogenital cancer., (Copyright 2009 S. Karger AG, Basel.)

Unlabelled: Few recent developments in oncology have generated comparable interest as have the dramatic successes in the therapy of gastrointestinal stromal tumors (GIST) with imatinib mesylate. Imatinib, a selective tyrosine kinase inhibitor, is currently the standard of care first-line treatment for unresectable or metastatic GIST, improving survival time and delaying disease progression. The authors report a 50-year-old male patient referred as relapsed chemotherapy-resistant CD117- leiomyosarcoma. After learning about the failure of chemotherapy, the patient became depressive and considered committing a suicide. We performed a second CD117 staining. As the second analysis was found to be positive, the diagnosis of leiomyosarcoma was changed to GIST. Imatinib 600 mg/day was started. The result with imatinib was appraised as a partial response/stable disease after the chemotherapy failure. The patient's depressive mood was also improved after imatinib. The medical and paramedical perspectives of the case are presented to emphasize the importance of immunohistochemical staining and its inhibition by a novel tyrosine kinase inhibitor in GIST. All nonepithelial tumors, particularly nonepithelial abdominal tumors of leiomyoblastic appearance should be considered to be GIST unless an experienced pathologist who does CD117 staining routinely confirms a different diagnosis. Interestingly, depression due to chemotherapy failure was also alleviated with imatinib. According to a recent study, median time to progression was 24 months, and overall survival was 57 months, reaching 5 years with imatinib., Conclusion: time is a GIFT in GIST., ((c) 2008 S. Karger AG, Basel.)

Background: We describe the case of an isolated bone marrow natural killer (NK) cell lymphoma with central nervous system (CNS) involvement mimicking a cerebral infarct. CNS involvement in isolated bone marrow lymphoma has not been reported previously., Case Report: A 49-year-old man with complaints of fever, confusion, and agitation was presented. A bone marrow biopsy was performed to investigate the etiology of bicytopenia which was consistent with NK-cell lymphoma. Brain MRI findings were suggestive of a subacute infarct., Conclusion: Even if pathological signal changes of the brain without contrast enhancement resembling infarct are detected in patients with lymphoma on the magnetic resonance imaging, CNS involvement of the lymphoma should be kept in mind in the differential diagnosis., ((c) 2008 S. Karger AG, Basel.)

Background: Gastrointestinal stromal tumors (GIST) comprise a majority of tumors previously diagnosed as gastrointestinal leiomyomas, leiomyoblastomas, and leiomyosarcomas. Although GIST may be identified by light microscopy, pathologists commonly employ a panel of immunohistochemical markers to confirm the morphological impression including anti-CD34, smooth-muscle actin, desmin, S100, and CD-117. However, in CD- 117 negative cases, it becomes difficult to diagnose GIST. This is of great importance, since the use of imatinib mesylate has led to a dramatic improvement in survival rates of GIST patients besides improved quality of life., Case Report: We report the case of a 67-year-old male patient diagnosed as having chemotherapy-resistant metastatic leiomyosarcoma. We reviewed the specimen for a possible diagnosis of c-kit negative GIST. Platelet derived growth factor receptor-alpha (PDGFRA) immunohistochemical stain was recommended. The specimen was positively stained for PDGFRA. Imatinib mesylate (400 mg/d) was started. The patient showed an excellent response after receiving imatinib treatment which was documented with 18 fluoro-deoxyglucose positron emission tomography and computed tomography (18F-FDGPET/ CT) prior to and after treatment., Conclusion: The importance of diagnosis of c-kit negative GIST is emphasized while stressing the importance of PDGFRA staining besides PET/CT response evaluation.

Background: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal malignancy of the gastrointestinal tract. Gastric cancer is the second most common neoplasm worldwide. Prostate cancer is the most common non-cutaneous cancer. The most frequently encountered second malignancies in patients with prostate adenocarcinoma include carcinomas of the bladder, stomach, and colon, followed by cutaneous and hematolymphoid malignancies., Case Report: We report the case of a 60-year-old male patient who was diagnosed with GIST and started on imatinib mesylate 400 mg/day. 2 years later, the patient was diagnosed with gastric adenocarcinoma, and a subtotal gastrectomy and gastrojejunostomy were performed. At followup 6 months later, prostate-specific antigen (PSA) levels were elevated, and a prostate biopsy showed a prostate adenocarcinoma., Conclusion: This is the second report of metachronous prostate cancer, gastric cancer, and GIST in the English language literature.

Objective: Anastrozole is a selective aromatase inhibitor and is used for the hormonal treatment of postmenopausal breast cancer. There are major side effects of anastrozole including decrease in both lumbar spine and total hip bone mineral density, increase in the incidence of all bone fractures (especially fractures of spine, hip and wrist), joint disorders and increase in the cholesterol level., Case Summary: We report a case of a 73-year-old postmenopausal woman with stage T2N0M0 breast cancer. Adjuvant chemotherapy was not indicated and anastrozole hormonotherapy was started. Diagnosis of sclerosing glomerulonephritis occurred in this patient during anastrozole use, suggesting a newly defined side effect of anastrozole., Discussion: Renal elimination is not a significant pathway of elimination for anastrozole, clearance of anastrozole is unchanged even in severe renal impairment. Dosing adjustment in patients with renal dysfunction is not necessary for anastrozole. We believe that the acute renal failure in our patient was associated with anastrozole. Renal injury due to anastrozole has not been published in the English literature., Conclusions: Anastrozole may be the causative factor in patients with sclerosing glomerulonephritis., (2008 S. Karger AG, Basel.)

Background: Adenocarcinoma is the most frequent pathological type of stomach cancer. Hodgkin's lymphoma is a lymphoproliferative disease arising from lymphoid tissue which is characterized by Reed-Sternberg cells. Synchronous occurrence of these two malignancies has not been reported in the English literature so far., Case: Here we present a 52-year-old male complaining of epigastric pain and fever diagnosed as stomach adenocarcinoma and Hodgkin's lymphoma., Conclusion: It is thought that this case is the first of a synchronous stomach adenocarcinoma and Hodgkin's lymphoma encountered in the English literature. It should be kept in mind that second malignancies can be seen in mass lesions in patients diagnosed with cancer., (2008 S. Karger AG, Basel.)

Background: Treatment of patients with metastatic breast cancer (MBC) exposed to anthracyclines and taxanes is challenging. Effective and well-tolerated regimens are required. Gemcitabine plus capecitabine combination was assessed in MBC patients pretreated with anthracyclines and taxanes., Patients and Methods: A total of 31 patients treated between November 2004 and September 2005 were retrospectively evaluated in 4 institutions. The median age was 48 years (range 29-77). The patients were given gemcitabine 1,000 mg/m(2) on days 1 and 8, and capecitabine 1,500 mg/m(2) twice daily on days 1-14 every 3 weeks., Results: A total of 160 cycles of chemotherapy were administered with a median of 5 cycles per patient (range 2-12). Three patients achieved a partial response (10%) and 8 patients (26%) stable disease. The median time to disease progression was 6 months (95% CI 5-7), with a median survival of 18 months (95% CI 15-21) at a median follow-up of 16 months (range 2-28). One-year and 2-year survival rates were 67 and 28%, respectively. Grade 3-4 toxicities were as follows: neutropenia (n = 11, 35%), nausea and vomiting (n = 4, 13%), hand-foot syndrome (n = 2, 6%), anemia (n = 2, 6%), thrombocytopenia (n = 2, 6%) and asthenia (n = 1, 3%)., Conclusion: The combination of gemcitabine plus capecitabine was a tolerable regimen with a mild but comparable survival efficacy to similar regimens in patients with MBC after anthracyclines and taxanes., ((c) 2008 S. Karger AG, Basel)

Objective: To assess the significance of cyclo-oxygenase 2 (COX-2) in laryngeal squamous cell carcinoma (LSCC)., Study Design: An immunohistochemical study in which 39 patients with LSCC were included., Methods: Immunohistochemical staining of the paraffin-embedded tumour tissues was performed using isoform-specific COX-2 polyclonal antisera (Santa Cruz, Calif., USA). COX-2 results were compared with the clinical parameters of the patients., Results: COX-2 was detected in all tumour tissues. In the normal laryngeal tissue around the tumour area, which served as control, there was no COX-2 staining. There was no relationship between the COX-2 results and the location of the primary tumour, T stage and N stage, survival, recurrence or pulmonary metastases., Conclusion: The absence of a relation between COX-2 positivity and clinical parameters may suggest an involvement of COX-2 in laryngeal carcinogenesis. Since COX-2 positivity could be detected in all LSCC specimens studied, COX-2 could serve as a therapeutic target in LSCC., (Copyright 2004 S. Karger AG, Basel)

Granulocytic sarcoma (GS) is an extramedullary tumor composed of immature cells of the granulocytic series known to occur in patients with myelodysplastic syndrome, chronic myelogenous leukemia, or acute myelogenous leukemia (AML). Involvement of the gastrointestinal tract is relatively rare in GS. We present an extremely rare case of GS of the colon and liver infiltration in a 60-year-old male patient with AML presenting with jaundice and hematochezia and review the literature. It should be kept in mind that hematochezia may be due to colonic involvement of GS besides thrombocytopenia which is usually encountered in patients with AML.

The clinical utility of tumor markers is limited due to their low specificity. CA 125, an ovarian tumor marker, is a sensitive but nonspecific tumor marker used especially in the follow-up of ovarian cancer for monitoring the efficacy of therapy and for early detection of recurrence. The use of the CA 125 serum assay as a single diagnostic tool is restricted by the fact that the antigen to CA 125 is also produced by normal epithelia (peritoneum, pleura, and pericardium). Since an elevated serum CA 125 level is a marker of ovarian cancer, a laparotomy is the final tool of the physician to clarify the etiology. However, unnecessary operations have been reported in the literature revealing no ovarian pathology (e.g. cirrhosis, tuberculous peritonitis or pancreatic cancer) in such patients. Elevated serum CA 125 levels require a cautious operative planning in patients without a notable tumor mass. A secondary interpretation is needed in case of elevated CA 125 levels whenever serosal (peritoneal, pleural, or pericardial) fluid is present., (Copyright 2003 S. Karger AG, Basel)