We report the first case of 68-year-old Japanese woman with metastatic HER2-positive extramammary Paget's disease that showed the validity of trastuzumab monotherapy. We administered trastuzumab at a loading dose of 8 mg/kg i.v., followed by a 6 mg/kg maintenance dose every three weeks according to a protocol for HER2-positive metastatic breast cancers and a near-complete response was achieved after the tenth infusion. The patient experienced a moderate headache and flushing during the first infusion, but had no advanced effects during subsequent infusions with ibuprofen and d-chlorpheniramine maleate. Given the dramatic response, the patient has had 17 infusions of trastuzumab with no disease progression. Thus, trastuzumab has few side effects and is well tolerated for elderly patients. It may become a new choice of the adjubant therapy of this disease.

Ultrasonographic features of tumor nodules in 64 patients with hepatocellular carcinoma and 87 with metastatic liver cancer were analyzed for differential diagnosis. Sonographic characteristics of hepatocellular carcinoma were the mosaic, posterior echo enhancement, and lateral shadow patterns, which were rarely observed in metastatic liver cancers. Small hepatocellular carcinomas, less than 3 cm in diameter, showed a hypoechoic pattern. Metastatic liver cancers originating from the gastrointestinal tract were frequently hyperechoic irrespective of their size and the bull's-eye-like pattern was specific for metastases from the lung. These results indicate that ultrasonography is useful for the differential diagnosis of hepatocellular carcinoma and metastatic liver cancer.

No abstract

Splenic infarction was recognized in five of 37 patients who had hepatic neoplasms and who were being examined after transcatheter hepatic arterial embolization by CT during a follow-up study. CT images of the spleen showed multiple low density areas of a wedge or fused-wedge shape in most patients and of a rod or round shape in others. These low density areas decreased in size in time, and in two patients they disappeared in three months. Three of the five patients complained of a dull pain in the left upper quadrant that did not require any treatment. CT is effective in the diagnosis and assessment of splenic infarction. Awareness of this complication will help to avoid it when hepatic arterial embolization is being performed.

The value of the routine pharmacologically-aided double-contrast examination of the upper gastrointestinal tract in demonstrating superficial gastric erosions was assessed. Ten cases of erosive gastritis were diagnosed during a six-month period. It appears that erosive gastritis is more common than generally believed. Diagnosis requires relaxation of the stomach and demonstration of fine mucosal relief by the double-contrast technique.