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    Clinicopathological Study of Neuroendocrine Carcinoma of the Breast

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    This work is licensed under the Creative Commons Attribution International License (CC BY 4.0)Introduction: Neuroendocrine carcinoma (NEC) occurs mostly in the digestive organs, such as the pancreas and gastrointestinal tract, and the lungs. Primary NEC of the breast is a rare entity. There are not many studies on this disease, and this study was carried out in order to know the clinical pathology of this disease. Methods: Of 2354 patients who underwent surgery for breast cancer in our hospital during the period from January 2000 to July 2015, 8 (0.34%) were pathologically diagnosed with NEC of the breast. This study is retrospectively registered. Result: The histological types were small cell carcinoma in one patient and invasive ductal carcinoma (IDC) with neuroendocrine differentiation in the remaining 7. The mean patient age was slightly higher than that of patients with usual IDC. On pathological examination, the NEC tumors were more hormone dependent and often HER2 negative, as compared to usual IDC, though there was no significant difference in nuclear grade. The patients with NEC of the breast showed positivity for neuroendocrine markers on immunohistological staining, and had favorable outcomes. Conclusion: NEC of the breast is rare, and there is no established consensus regarding the pathological significance, prognosis, and treatment method. Further accumulation of cases is necessary

    75歳以上の高齢関節リウマチ患者におけるエタネルセプトの有効性と安全性

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    目的:近年関節リウマチ(RA)患者の高齢化に伴い高齢RA患者に対しても生物学的製剤を使用する機会が増えている。エタネルセプト(ETN)は血中半減期の短さから、高齢関節リウマチ(RA)患者にも比較的安全に使用可能であると考えられ、既に多数例に使用されていると思われるが、その使用成績の報告は少ない。我々は75歳以上でETNを開始した高齢RA患者48名におけるETNの有効性と安全性を検討した。対象・方法:2008年5月から2014年3月に当院でETNを導入した336人のRA患者のうち、導入時の年齢が75歳以上であった48例(男性18例、女性30例)を対象に、24ヵ月を最終評価時として、患者背景、疾患活動性の推移、有害事象をretrospectiveに解析した。結果:患者の平均年齢は79.0±2.9歳で、ETN使用により関節所見、血清学的所見、疾患活動性スコアはいずれも有意に改善を認め、使用前に比べ最終評価時ではプレドニゾロン(PSL)の平均使用量も有意に少なかった。有害事象は11例に認め、7例でETNの使用が中止され、そのうち4例は感染症であった。結核(85歳)、ニューモシスチス肺炎(80歳)による死亡を各1例ずつ認めた。結論:75歳以上の高齢RA患者において、ETNは重篤な感染症については注意が必要であるが、有効な治療手段であると考えられた

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