[A Case of Monomorphic Epitheliotropic Intestinal T-Cell Lymphoma Causing Perforation of the Small Intestine].

Monomorphic epitheliotropic intestinal T-cell lymphoma(MEITL)is very rare and aggressive subtype of lymphoma with poor prognosis. A 60-year-old man complaining of abdominal pain was underwent partial resection of the jejunum for panperitonitis with a small intestinal perforation. The histopathological and immunohistochemical findings led to the diagnosis of MEITL. Postoperative course was uneventful. One month after the operation, the patient was scheduled for 6 courses of CHOP regimens. He presented with bowel obstruction twice during the 3 courses of CHOP. As the recurrence of MEITL could not be ruled out, diagnostic laparoscopy was performed. Laparoscopic findings revealed no recurrence and adhesive small bowel obstruction. The patient was followed closely without treatment after 6 courses of CHOP. The patient has been alive without recurrence 18 months after the resection. We reported a case of monomorphic epithelial intestinal T- cell lymphoma causing jejunal perforation.

[A Case of Solitary Right Adrenal Metastasis from Rectal Cancer].

An 86-year-old woman underwent laparoscopic high anterior resection for RS rectal cancer. Histological examination showed tub2-por, pT3, pN2a, Stage ⅢB disease. Given the age of the patient, adjuvant chemotherapy was not administered. Five months after the surgery, her carcinoembryonic antigen(CEA)level was elevated and a 42×25mm mass was detected in the right adrenalby computed tomography(CT). Metastasis from rectalcancer was suspected but no other lesions were detected by positron-emission tomography(PET)-CT. Nine months after the surgery, laparoscopic right adrenalectomy was performed. Histological examination revealed that the right adrenal tumor had moderately-differentiated adenocarcinoma very similar to the primary rectalcancer; therefore, the right adrenall esion was diagnosed as metastasis from the previous rectalcancer. The tumor marker levelreturned to normall evelafter the second surgery. The patient was discharged on the 8th post-operative day but declined adjuvant chemotherapy due to her age. Six months later, liver, lung, and peritoneal metastasis were identified by CT. We report this case of solitary adrenalmetastasis from rectalcancer resected by laparoscopic right adrenalectomy.

[Surgical Treatment Outcome of Patients with Colorectal Cancer Having Ulcerative Colitis].

This study aimed to evaluate the surgical treatment outcome of patients with colorectal cancer having ulcerative colitis (UC). METHODS: We examined 112 patients who underwent the surgery from 1998 to 2016. Among the 112 patients, 14 were complicated with malignant tumor(9 with colorectal cancer and 5 with dysplasia-assciated lesion or mass)We performed group comparison between patients with(group A)and without(group B)colorectal cancer. RESULTS: The median age in group A was 58.1 years, which was significantly older than that in group B. The duration of disease in group A was 13.2 years, which was significantly longer than that in group B. Surgical procedures in group B were as follows; 5 cases had ileoanalanastomosis (IAA), 4 cases had ileo-analcanalanastomosis (IACA), 2 cases had ileorectal anastomosis(IRA), and 1 case had interspincteric resection(ISR) and abdominoperinealresection (APR)Laparoscopic sigmoid colectomy was performed in a patient aged 52 years because he was diagnosed with sporadic sigmoid colon cancer. Periodic endoscopic screening was not performed in 5 patients with pT2 colorectalcancer in group B. endoscopic submucosaldissection (ESD)was performed in 2 patients aged>70 years with rectal pTis cancer. CONCLUSION: Elderly patients with UC were often complicated with colorectalcancer, and these patients are indicated for surgicalprocedures other than IAA to preserve defecation function. Patients with UC should undergo periodic endoscopic screening for early detection of malignant tumor and definitive surgicalresection.

[A Case of Metachronous Ascending Colon Metastasis from Gastric Cancer That Was Difficult to Diagnose].

A 60s man with a history of laparoscopic distal gastrectomy(LDG)of gastric cancer in January 2015was followed up in an outpatient clinic. He remained healthy without recurrence for about 2 years, but in February 2017, colonoscopy identified an elevated lesion that covered one-third of the circumference in the ascending colon. Biopsy revealed that this lesion had poorly differentiated adenocarcinoma. No other metastatic lesions were noted on thoraco-abdominal CT, and tumor markers were not elevated in a blood test. Right hemicolectomy with D3 nodal dissection was performed on March 2017. Although regional lymph node metastasis was noted during surgery, distant metastasis was not identified. Histological examination revealed that the ascending colon tumor had poorly differentiated adenocarcinoma very similar to that of the primary gastric cancer, and the lesion was diagnosed as metastasis from previous gastric carcinoma. Pathological findings showed pPM0, pDM0, pRM0, pCY0, and definitive surgical treatment was confirmed. However, 2 months after the surgery, ascites caused by peritoneal and bilateral supraclavicular lymph node metastases were detected on CT. He passed away 6months after the last surgery. We report a case of metachronous ascending colon metastasis from gastric cancer that was difficult to preoperatively diagnose.

[Assessment of Long-Term Sexual Function after Radical Resection for Lower Rectal Cancer].

The aim of this study was to evaluate the long-term sexual function and risk factors of dysfunction after the autonomic nerve preserving operation for lower rectal cancer. METHODS: We evaluated postoperative sexual function assessed by IIEF5 in 91 patients who responded to the questionnaire by mail. RESULTS: After a median follow-up of 5.5 years, univariate analysis identified 4 risk factors associated with poor sexual function: the elder, over 3 years after surgery, pathological stage III , and lateral lymph node dissection(both side). Poor sexual function assessed by multivariate analysis was significantly associated with the elder(over 60 years). CONCLUSION: From the viewpoint of sexual dysfunction, the autonomic nerve preserving operation( AN4)should be considered for elderly people.

[Assessment of Functional Results after Sphincter-Preserving Surgery in Elderly Patients with Low Rectal Cancer].

The aim of this study was to evaluate postoperative dysfunction and potential problems after a sphincter-preserving operation in elderly patients with low rectal cancer. METHODS: Between 2000 and 2012, 307 consecutive patients with low rectal cancer underwent curative sphincter-preserving surgery. We evaluated postoperative anal and urinary dysfunction in 190 patients who responded to a questionnaire by mail. RESULTS: After a median follow-up of 5.7 years, there was no significant difference between the elderly and a younger group in the Wexner incontinence score. Poor anal function assessed by modified FIQL was significantly associated with the elderly. Poor urinary function assessed by the IPSS score was significantly associated with the elderly, diabetes mellitus, and autonomic nerve preservation(AN2-3). CONCLUSION: From the viewpoint of urinary function, sphincter-preserving surgery with all autonomicnerve preservation(AN4)should be considered for elderly people and patients with diabetes.

[A Study of Patients Who Underwent Breast-Conserving Surgery and Developed Cryptogenic Organizing Pneumonia(COP)].

Of the 210 patients who underwent breast-conserving surgery for breast cancer and received radiation therapy for 3 years from April 2012 to March 2015 at the Department of Therapeutic Radiology of our hospital, 6 were diagnosed with cryptogenic organizing pneumonia(COP)-like pneumonia and treated as reported. The mean age of the patients was 51years(40- 65 years), and the pathological subtypes were the luminal type(5 cases)and HER2 type(1case ), all of which were treated with radiation therapy for breast conservation. Postoperative systemic therapy included hormonal therapy with anastrozole in 2 cases, tamoxifen plus LH-RH agonist in 3 cases, and chemotherapy in 1case. The mean onset time of COP was 4.2 months after the completion of irradiation therapy, and all of the 5 patients who received endocrine therapy received it concurrently with radiation therapy. The major symptoms were fever(4 cases)and cough(6 cases). Chest radiography showed an infiltrative shadow consistent with pneumonia. Steroid therapy was effective in all cases while antibiotics were not. It was inferred that COP should be regarded as one of the complications of radiation therapy after breast-conserving surgery.

[Regrowth of Isolated Local Residual Tumor Effectively Treated with Chemoradiotherapy More Than Five Years after a Resection for Pancreatic Cancer with an Involvement of the Portal Vein].

A 55-year-old man who presented with abdominal pain was diagnosed with pancreatic head cancer involving the portal vein. He underwent pylorus-preserving pancreaticoduodenectomy without a resection of the portalvein, resulting in a macroscopic residualtumor, because radicalresection was impossible owing to the severe localinvasion. Postoperative chemotherapy( GEM plus S-1)was administered. The tumor size decreased and CA19-9 values normalized. Five years after the resection, chemotherapy was stopped. The regrowth of an isolated local residual tumor without a distant metastasis was diagnosed 65 months after the resection. He underwent chemoradiotherapy(CRT)with S-1. The size of the tumor remained stable, but FDG-PET demonstrated a disappearance of high FDG uptake in the tumor and CA19-9 values normalized. We reported a case in which CRT was an effective treatment for the regrowth of localresidualtumor after resection for pancreatic cancer.