Trousseau syndrome is a clinical condition in which a thrombosis and embolism are caused by hypercoagulation associated with a malignant tumor. Here we report on a patient who developed a cerebral infarction during hospitalization in a palliative care unit due to advanced recurrent rectal cancer and was treated with anticoagulation therapy. A 50—year—old woman who experienced lung metastasis and bone metastases after rectal cancer surgery was hospitalized in a palliative care unit because increasing pain made home care difficult. Although her pain was relieved by drug therapy and irradiation, she developed a partial visual field defect and aphasia in succession when she received medical treatment because of respiratory discomfort due to advanced pulmonary metastases. Multiple cerebral infarctions were observed on a magnetic resonance imaging and blood tests revealed disseminated intravascular coagulation； therefore she was diagnosed with Trousseau syndrome. After the initiation of anticoagulation therapy, the aphasia improved. No adverse events were caused by treatment. All patients in the terminal phase should not be equally judged as not being candidates for anticoagulation therapy. It is necessary to examine each patient’s suitability by considering their prognosis and general condition as well as the significance and safety of the treatment.

Marfan's syndrome associated with multiple arterial aneurysms of the abodominal aortic branches in a pair of identical twins is described. The first case, a 21-year-old male, visited our affiliated hospital because of severe upper abdominal pain. Computed tomography (CT) and aortography (AOG) demonstrated multiple abdominal aneurysms, i.e., celiac artery, bilateral renal arteries and superior mesenteric artery, but there were no findings of dissecting aneurysm of the aorta. The aneurysm of the superior mesenteric artery, which had ruptured, was replaced with a greater saphenous vein graft. The postoperative course was uneventful until sudden cardiac arrest occurred on the 5th POD. An autopsy revealed a dissecting aortic aneurysm (DeBakey type I), massive intrathoracic hemorrhage, and subarachnoidal hemorrhage. Two years later, the second case, the 23-year-old twin brother of the prior case, visited our hospital because of upper abdominal pain similar to that of his brother. The clinical course bore a close resemblance to his brother's. CT and AOG revealed the intact aorta and aneurysms of the celiac artery and right renal artery. The ruptured aneurysm of the celiac artery was ligated. Immediately after his returning to the ICU, he developed sudden massive intrathoracic bleeding and cardiac arrest. This is the fourth report of identical twins with Marfan's syndrome in Japan. It is also noteworthy that in both cases rupture of the extra-aortic aneurysm occurred prior to the aortic dissection or aneurysmal formation.

There has been significant progress in the understanding of the pathology and molecular biology of rare ovarian cancers, which has helped both diagnosis and treatment. This paper provides an update on recent advances in the knowledge and treatment of rare ovarian cancers and identifies gaps that need to be addressed by further clinical research. The topics covered include: low-grade serous, mucinous, and clear cell carcinomas of the ovary. Given the molecular heterogeneity and the histopathological rarity of these ovarian cancers, the importance of designing adequately powered trials or finding statistically innovative ways to approach the treatment of these rare tumors has been emphasized. This paper is based on the Rare Ovarian Tumors Conference for Young Investigators which was presented in Tokyo 2015 prior to the 5th Ovarian Cancer Consensus Conference of the Gynecologic Cancer InterGroup (GCIG).
Consensus ; Diagnosis ; Female ; Humans ; Molecular Biology ; Mucins ; Ovarian Neoplasms* ; Ovary ; Pathology ; Population Characteristics ; Rare Diseases ; Research Personnel*