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Purpose: This study examines the post-traumatic growth (PTG) of bereaved families who care for cancer patients and related factors in Japan., Methods: Participants included 1298 members of bereaved families of cancer patients (aged 20 or older). An anonymous self-administered questionnaire on PTG, coping, and social support was mailed to 496 bereaved families who provided written informed consent., Results: Responses were obtained from 476 bereaved families; however, since 28 families had missing data, 448 were included for the analyses. The mean age of participants was 61.4 years: 69% women and 45% spouses. The average age of the deceased was 72.8 years old for men (59%). The PTG score of the bereaved families was higher for women than for men (p < 0.0001). Moreover, the Post-Traumatic Growth Inventory Score for those above 65 years of age was higher than of those below 65 years of age (p < 0.0001). A regression analysis confirmed that emotion-focused coping, problem-focused coping, relationship with the deceased, advanced age of bereaved families, and emotional support impacted PTG., Conclusion: The significance of the deceased for the bereaved, bereaved family members being older in age, emotion-focused coping, problem-focused coping, and emotional support suggest that these aspects are associated with psychological growth in terms of accepting the death of a loved one and moving forward. It is necessary to evaluate the relationship between the bereaved family and the deceased, the age and gender of the bereaved, coping behaviors, and support status and establish a higher quality bereaved family care system., (Copyright © 2021. Published by Elsevier Ltd.)

We herein report a case of infiltrative esophageal signet-ring cell carcinoma resembling gastric signet-ring cell carcinoma. Grossly, the tumor was a diffusely infiltrative carcinoma involving the lower esophagus measuring 11 cm in diameter. The tumor extensively metastasized to the cervical, mediastinal, and abdominal lymph nodes, and the patient died of peritonitis and pleuritis carcinomatosa soon after undergoing a radical esophagectomy. Histologically, the tumor was signet-ring cell carcinoma covered with normal squamous epithelium. However, the most superficial part of the tumor center contained a region of Barrett's mucosa with incomplete-type intestinal metaplasia and a well-differentiated adenocarcinoma component with goblet cells. The expression of cytokeratins 7 and 20 also indicated that both the Barrett's mucosa and the signet-ring cell carcinoma had an esophageal origin. Esophageal signet-ring cell carcinoma with diffuse infiltrative growth is quite rare, and may need a special treatment strategy because of its highly aggressive behavior and poor treatment outcome.

Objective: Our objective was to determine the causes and relative prevalence of hypercalcemia in patients at a major community hospital in Okinawa, Japan. Additionally, we compared these causes of hypercalcemia with the previously published international data., Materials and Methods: We analyzed all patients with hypercalcemia in a community teaching hospital in Okinawa, Japan, from 1999 to 2002 and determined the cause of hypercalcemia in each patient. We also performed a literature review of the original articles describing causes of hypercalcemia in patients from Eastern as well as Western countries., Results: We identified 145 patients with hypercalcemia (median age, 69; range, 22 to 97). Major causes included malignant disorders (n=100; 69%), primary hyperparathyroidism (n=31; 21%), vitamin D-induced (n=4; 3%), and miscellaneous or unknown cause in 11 (8%). Among malignant disorders, adult T cell leukemia was the most frequent (n=35), being followed by lung cancer (n=25). Breast carcinoma was less prevalent (n=4)., Conclusion: The major causes of hypercalcemia are malignancy and primary hyperparathyroidism in Okinawan Japanese patients. Adult T cell leukemia and lung carcinoma are among the top leading malignancies, while breast carcinoma is less frequent in this patient population. The etiologic prevalence of hypercalcemia in the Eastern population including Okinawans is significantly different from that in the Western population.

A 56-year-old woman was admitted to our hospital with the chief complaint of left back pain. We detected left pleural effusion on chest X-ray and performed chest drainage. No malignant cells were detected in the effusion. Chest CT demonstrated a tumor shadow over the left diaphragm and left pleural effusion 6 months later. She underwent en bloc resection of the tumor and left diaphragm. Histological evaluation revealed malignant fibrous histiocytoma (MFH). Recurrent tumors were found in the abdomen 8 months after the operation, and she underwent resection of the abdominal recurrent tumors. Histological evaluation of the recurrent tumors also showed MFH. The patient died 28 months after the first operation.

A 68-year-old man presented to another hospital with progressive shortness of breath, dry cough, and systemic edema. A chest X-ray, echocardiogram, and chest CT showed a mediastinal mass and massive pericardial effusion. His symptoms improved after the treatment for heart failure. The pericardial effusion was bloody. In that, malignant cell wasn't proved. Thoracotomy was performed to diagnose the mediastinal tumor and to extirpate it. Pathological diagnosis after operation was thymoma with direct invasion to pericardium and tunica externa of aorta. Thymomas are routinely asymptomatic for prolonged periods of time. Symptomatic pericardial tamponade as initial manifestation due to a thymoma with a massive pericardial effusion is uncommon.

The authors report a case with esophageal cancer who had undergone a non-curative resection and showed a recurrence. Treatment with only oral 5'-DFUR resulted in complete response. This was followed by oral ftorafur, and the case has remained complete response for 40 months. It is rare to obtain such an effect in esophageal cancers by oral and sole administration of a drug in the 5-FU class. Our experience with this case is described.

A 33-year-old man showing the right anterior mediastinal mass on his chest x-ray film admitted to our hospital. At thoracotomy extirpation of the cystic tumor was performed. The tumor was 7 x 7 x 5 cm in size and contained coffee-coloured fluid. Histological examination confirmed undifferentiated carcinoma. Postoperatively he was treated with 60Co 50 Gy and chemotherapy. He has been well 4 years after operation.

A 39-year-old woman complained of an oppressive feeling in her chest and abnormal shadows were detected in the left lower lobe. On a preoperative diagnosis of primary or metastatic lung cancer, left lower lobectomy was performed. There were 3 nodular tumors in the left S6, S10 but no metastasis to regional lymph nodes was found. Histological examination confirmed "so-called" sclerosing hemangioma. She has remained well for 4 years after surgery. A review of the literatures on sclerosing hemangioma in Japan showed that 12 (5%) of 225 cases of sclerosing hemangiomas had multiple tumors.