Precursor T lymphoblastic lymphoma (T-LBL) often manifests as a mediastinal mass sometimes compressing vital structures like vessels or large airways. This case was a 40-year-old male who developed T-LBL presenting as respiratory failure caused by mediastinal T-LBL. He presented with persistent life threatening hypoxia despite tracheal intubation. We successfully managed this respiratory failure using venovenous (VV) ECMO. Induction chemotherapy was started after stabilizing oxygenation and the mediastinal lesion shrank rapidly. Respiratory failure caused by compression of the central airway by tumor is an oncologic emergency. VV ECMO may be an effective way to manage this type of respiratory failure as a bridge to chemotherapy.

Adult-onset hemophagocytic lymphohistiocytosis (HLH) has features that are distinct from that of HLH in pediatric patients. The clinical records at the Japanese Red Cross Kumamoto Hospital were reviewed. We retrospectively analyzed 34 patients who fulfilled the diagnostic criteria of HLH-2004. The median age of patients was 60.0 (range 15-86). Underlying diseases were diagnosed in 17 patients. They consisted of malignant lymphoma (n=3), other neoplastic disease (n=3), viral infection (n=4), collagen vascular disease (n=3), Kikuchi’s disease (n=3) and drug (n=1). Underlying diseases were not diagnosed in 17 patients despite examination. The treatments were steroids (n=18), dexamethasone + cyclosporine A (CSA) + etoposide (n=4), multidrug chemotherapy (n=2), steroids and CSA (n=3). Eleven patients died during observation. In a multivariate analysis, the significant predictor for death was age at onset (hazard ratio, 1.22; 95%CI, 1.02-1.44; P=0.027). Autopsy was performed in 4 cases, but the underlying disease remained unknown in 3 of those cases. Adult-onset HLH has high diversity and various outcomes. The mechanism of adult-onset HLH is not fully understood and further research is required.

We suggest that monitoring the number of CTCs may be helpful in predicting the efficacy of the treatment and the prognosis. CTCs might be especially useful with patients whose lesions are difficult to assess.

Background: The purpose of this study was to determine the primary chemosensitivity and prognosis among women with four common breast subtypes, Luminal A, Luminal B, HER2 and Triple negative (TN). In this study, we evaluated the response to primary chemotherapy of each subtype, reported the outcome of each subgroup after primary chemotherapy. Method: We analyzed the outcome and characteristics of patients treated with primary chemotherapy using anthracycline and/or taxanes. Before initiation of chemotherapy, invasive carcinoma was confirmed on initial biopsy specimen obtained and hormone receptor status and HER2/neu status was also determined on this specimen. ER and PgR positivity was recognized at a cut-off of > 10% positive nuclei by immunohistochemistory (IHC). HER2/neu-positive status was defined as either 3+ by IHC or presence of gene amplification by fluorescence in situ hybridization testing. Breast cancer subtypes were defied as follow, TN (ER-, PgR-, HER2-), Luminal A (ER+ and/or PgR+, HER2-), Luminal B (ER+ and/or PgR+, HER2+), HER2 (ER-, PgR-, HER2+). Result: Between 2000 and 2007, 639 breast cancer patients were treated with primary chemotherapy at Cancer Institute Hospital. Clinical and immunohistochemical data was available on 503 patients. Median observation period was 49.9 months (2.8-122.4). In these cases, 105 cases (20.9%) were defined as TN, 276 cases (54.9%) were defined as Luminal A, 49 cases (9.7%) were defined as Luminal B, 73 cases (14.5%) were defined as HER2, respectively. 138 patients (27.4%) received anthracycline-based regimen, 139 patients (27.6%) received taxane, 227 patients (45.1%) received taxane-anthracycline combination regimen. The pathologic complete response (pCR) rate of each group was 15.2%, 2.0%, 8.2%, 16.4%, in TN, Luminal A, Luminal B, HER2, respectively (P<0.001). The 5-yr disease free survival estimated 69.1%, 74.4%, 62.8%, 70.6% (p=0.140), and the 5-yr overall survival estimated 69.1%, 75.6%, 88.6%, 69.4% in TN, Luminal A, Luminal B, HER2, respectively (p=0.007). Mean survival time from the first recurrence was 21.1 months (95%CI 11.5-30.7), 40.6 months (95%CI 31.6-49.6), 81.8 months (95%CI 59.1-104.5), 30.0 months (95%CI 21.1-38.9), respectively (P<0.001). According to the first recurrence, most frequent visceral metastatic site of TN and HER2 patients was brain (P<0.001), and median time to brain metastasis was 13.2 months (95%CI 8.5-17.9). Surprisingly, three (21.4%) of the patients who had brain metastasis resulted in pCR by primary chemotherapy. Of note, Luminal A patients were more likely to have bone metastasis than other groups at first (p=0.003), and median time to bone metastasis was 16.3 months (95%CI 14.1-18.6). Conclusions: With primary chemotherapy, pCR rate of TN and HER2 were higher than Luminal groups, but they developed brain metastasis early irrespective of pCR, this might contribute to their worse prognosis. In contrast, Luminal A developed bone metastasis at first, this might result in good prognosis instead of their low pCR rate. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-11-13.