Background: No previous prospective trials have been reported with capecitabine and gemcitabine (CAP-GEM) in patients with metastatic thymic epithelial tumors (TETs). We conducted a multicenter study to determine the activity and tolerability of this regimen in pretreated TETs.Patients and methods: A total of 15 patients were enrolled in the first stage of phase II study. All patients received CAP-GEM every 3 weeks. The primary end point was objective response rate (RR); secondary end points were toxicity, progression-free survival (PFS) and overall survival.Results: Complete responses (CR) and partial responses were observed in three (20%) and three (20%) patients for a 40% RR, respectively. Grade 1-2 neutropenia, anemia and thrombocytopenia were the most common side-effects, noted in seven (46.7%), five (33.3%) and five (33.3%) patients, respectively. The most common grade 3 toxicity was neutropenia in three patients (20%). Median PFS was 11 months (95% confidence interval 4-17). The 1-and 2-year survival rates were 80% and 67%, respectively. Conclusion:We have decided to publish the preliminary results because this regimen was more active than that expected. Although our results are preliminary, CAP-GEM shows activity and safety in pretreated TETs. Furthermore, multicenter trials, also in first-line setting, are necessary to confirm our results.

Our study shows that a short cycle of i.m. depot MPA injections provides significant and long-lasting relief from postmenopausal hot flashes in patients with a history of breast cancer, offering an alternative to estrogen replacement therapy or prolonged administration of oral megestrol.

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There is no apparent pharmacokinetic interaction between the parent compound epirubicin and paclitaxel or docetaxel. A different pattern of interaction between these taxanes and epirubicin metabolism is clearly evident.

Summary:The case presented here illustrates a 75 year old female patient who underwent surgical resection of a right adrenal mass of uncertain nature. The fi nal histological diagnosis was consistent with leiomyosarcoma arising from the adrenal anatomic site. Primary leiomyosarcoma of the adrenal gland is a very rare malignant mesenchymal neoplasm: to our knowledge, this is only the twelfth case reported in literature. We describe the clinical course and a brief review of clinical and histological features, biologic behaviour, diagnostic approaches and therapeutic strategies. Case ReportA 75-year-old white female was admitted to the Department of Urology of our hospital following the ultrasound fi nding of a right adrenal mass of uncertain nature. Her medical history was unremarkable, except for long-term essential arterial hypertension. For a month prior to hospitalization the patient had complained of persistent and progressive epigastric and right loin pain. Physical examination showed only mild abdominal discomfort at palpation. No enlarged lymph nodes were present. Laboratory tests detected no abnormalities. Urinary levels of vanilmandelic acid, catecolamines and plasmatic level of aldosterone were normal.Chest radiograph and electrocardiogram revealed no pathological fi ndings. Upper gastrointestinal endoscopy detected oesophageal hiatal hernia with refl ux oesophagitis, and total-body CT confi rmed the presence of a right adrenal mass of about 5 × 4 cm, suspected to be an adrenal carcinoma, so radical surgery was planned and performed with the resection of a roundish formation from the adrenal anatomic site. Normal adrenal gland was not visible (Fig. 1).Three days after surgery the patient developed a pulmonary embolism: an inferior vena cava thrombosis was identifi ed by angio-CT scan. Pulmonary embolism was identifi ed by angio-CT scan, too. Moreover, an unexplained progressive drop of hemoglobin concentration down to 7.7 g/dl, requiring infusion of two units of packed red cells, was observed. The patient was transferred to our Intensive Care Unit, where she received routine treatment for pulmonary embolism including anticoagulant therapy fi rst with intravenous heparin and then with warfarin.The clinical course was satisfactory, and subsequent Doppler-ultrasonography confi rmed the return to normal of venous fl ow through inferior vena cava. The patient, clinically stable with a good cardiorespiratory compensation, was discharged on postoperative day 18; continuation of anticoagulant therapy and physical rehabilitation were recommended. No oncological treatment was provided after surgery, and no evidence of recurrent disease was observed one year later.Gross pathological examination of the resected tissue showed a roundish, fi brous neoformation of 8 × 4 × 5 cm. A thrombus was detected inside the adrenal vein; this thrombus was not visible on CT performed before surgery. On sectioning of the mass, no adrenal structure was recognizable. Resection margins were free of disease. Histologically, tissue sect...