[Breast and Advanced Ovarian Double Cancer with a BRCA2 Pathogenic Variant-A Case Report].

A 49-year-old woman presented with abdominal pain. A computed tomography scan revealed a left breast mass with suspected peritoneal dissemination. She had no notable family history of the disease. Following a detailed examination, she was diagnosed with ovarian cancer(Stage ⅢC)and left breast cancer(Stage Ⅰ). After confirming the diagnosis of ovarian cancer with a laparoscopic biopsy, neoadjuvant chemotherapy was scheduled. Due to its efficiency in reducing tumor burden, debulking surgery was also performed. While receiving adjuvant chemotherapy for ovarian cancer, concomitant anastrozole was administered for breast cancer. A pathogenic variant of BRCA2 was subsequently identified. Once adjuvant chemotherapy for ovarian cancer had been completed, a left mastectomy and sentinel lymph node biopsy were performed as management for breast cancer. The patient will continue treatment with anastrozole for breast cancer and olaparib for ovarian cancer and will be followed up appropriately.

[Ciliated Muconodular Papillary Tumor of the Lung:Report of a Case].

Ciliated muconodular papillary tumor( CMPT) is a rare true pulmonary tumor consisting of bronchiolar cellular elements. Although this tumor cannot be classified as benign or malignant, it is mostly believed to be a benign bronchiolar adenoma. Recently, CMPT has been divided into two subtypes: proximal and distal. Herein, we report a case of a proximal type of CMPT containing abundant mucus cells in a 70-year-old woman. Thoracoscopic resection of the tumor in the left lower lobe was successfully performed, and the patient has been well without recurrence or metastasis for more than three years after surgery.

Ruptured Abdominal Aortic Aneurysm with a Duplicated Inferior Vena Cava.

We report a very rare case of a ruptured abdominal aortic aneurysm (AAA) with an anomaly of the inferior vena cava (IVC). The AAA was covered with a large hematoma and an expanded vein was on its left side. It was not until we could not locate the IVC on the right side of AAA that we recognized the anomaly during the operation. Although we reviewed the findings on enhanced computed tomography, we were confused whether the case was a duplicated or left-sided IVC. Subsequently, a bifurcated vascular prosthesis was implanted without ligation of the left renal vein to join the left-sided IVC.

Ruptured Deep Femoral Artery Aneurysm Confused with an Incarcerated Inguinal Hernia: a Case of an Elderly Patient.

Deep femoral artery (DFA) aneurysms are rare. DFA is protected by the adductor canal, which may delay the diagnosis. Then, its early diagnosis may be difficult and it is possible to be misdiagnosis with incarcerated inguinal hernia, which occurs more often in elderly people. We report a very rare case of a treatment of an advanced elderly patient with an isolated ruptured DFA aneurysm that was preoperatively confused with an incarcerated inguinal hernia. A 97-year-old man was admitted to a neighboring hospital due to a painful mass of the right groin after transient consciousness loss and the patient was diagnosed with right incarcerated inguinal hernia by a nonenhanced computed tomography (CT). Although he was observed for 3 days, he suddenly lost consciousness again with a decrease in blood pressure. Thus, he was referred to our hospital due to the painful pulsatile inguinal mass after resuscitation from shock. As we diagnosed a ruptured DFA aneurysm by an enhanced CT, we emergently performed an excision of the aneurysm with revascularization of the right DFA. The postoperative course was uneventful without ischemic change of the lower leg.

[A Case of Carcinomatous Pericarditis of Breast Cancer Successfully Treated with Intrapericardial Mitomycin C Instillations and Systemic Chemotherapy].

A 67-year-old woman who underwent left breast mastectomy and right breast partial mastectomy under the diagnosis of left breast cancer and suspected right breast cancer 10 years earlier was admitted because of dyspnea. Chest computed tomography revealed pericardial fluid accumulation. The patient was treated with pericardial drainage; thereby, 800 mL of bloody fluid was removed. The cytological diagnosis was malignancy. After receiving mitomycin C instillation, she underwent systemic chemotherapy and endocrine therapy. At the last follow-up more than 5 years after the recurrence, no reaccumulation of the pericardial fluid was observed, and she remained alive in good condition.

[Lung Cancer Treated with Wedge Resection of the Lower Lobe of the Left Lung with the Assistance of Extracorporeal Membrane Oxygenation(ECMO) after Right Pneumonectomy].

A 59-year-old male was admitted to our hospital with an abnormal shadow on a chest X-ray. Right pneumonectomy and lymph node dissection (ND2a) were performed. A pathological examination revealed adenocarcinoma( pT3N2M0). Fourteen years later, chest computed tomography(CT) showed a tumor shadow in the lower lobe of the left lung. His pulmonary function was sufficient to allow a 2nd operation. He underwent wedge resection of the lower lobe of the left lung with the assistance of extra corporeal membrane oxygenation (ECMO). His postoperative course was uneventful. A pathological examination revealed large cell neuroendocrine carcinoma, which was 18 mm in diameter. His performance status declined slightly, but he had no problems associated with the activities of daily life. The patient is currently alive 6 months after the 2nd operation without any sign of recurrence. ECMO is a useful technique for thoracic surgery after pneumonectomy.

Elective treatment of middle colic artery aneurysm.

Middle colic artery aneurysms are rare and most have been reported with rupture or symptom. We report the successful elective treatment of a middle colic artery aneurysm without symptom, which is very rare. It failed to perform transcatheter arterial embolization for anatomical reasons, and, thus, the patient, a 77-year-old man, underwent surgical resection in spite of a history of laparotomy. Although a common cause of middle colic artery aneurysms is segmental arterial mediolysis, the present pathological findings indicated that fragmented or degenerated elastic fibers may also play an important role like aortic aneurysms.

Application of a real-space three-dimensional image reconstruction method in the structural analysis of noncrystalline biological macromolecules enveloped by water in coherent x-ray diffraction microscopy.

Coherent x-ray diffraction microscopy is a novel technique in the structural analyses of particles that are difficult to crystallize, such as the biological particles composing living cells. As water is indispensable for maintaining particles in functional structures, sufficient hydration of targeted particles is required during sample preparation for diffraction microscopy experiments. However, the water enveloping particles also contributes significantly to the diffraction patterns and reduces the electron-density contrast of the sample particles. In this study, we propose a protocol for the structural analyses of particles in water by applying a three-dimensional reconstruction method in real space for the projection images phase-retrieved from diffraction patterns, together with a developed density modification technique. We examined the feasibility of the protocol through three simulations involving a protein molecule in a vacuum, and enveloped in either a droplet or a cube-shaped water. The simulations were carried out for the diffraction patterns in the reciprocal planes normal to the incident x-ray beam. This assumption and the simulation conditions corresponded to experiments using x-ray wavelengths of shorter than 0.03 Å. The analyses demonstrated that our protocol provided an interpretable electron-density map. Based on the results, we discuss the advantages and limitations of the proposed protocol and its practical application for experimental data. In particular, we examined the influence of Poisson noise in diffraction patterns on the reconstructed three-dimensional electron density in the proposed protocol.

[Pulmonary leiomyosarcoma treated with surgery; report of a case].

Primary pulmonary leiomyosarcoma is a rare malignant tumor of the lungs. A 79-year-old woman showed a mass of 9 cm in diameter in a chest X-ray and computed tomography (CT) scan. A malignant tumor was suspected and left lower lobectomy was performed. From pathological findings, pulmonary leiomyosarcoma was diagnosed. The disease stage was pT2N0M0, p0d0e0pm0 (p0), pIB. From histopathological findings, the tumor appeared to be high grade, but no recurrences have occurred 2 years postoperatively and surgical treatment was considered effective.

Large-cell carcinoma of the lung with a remarkable preoperative elevation of serum carcinoembryonic antigen level.

Carcinoembryonic antigen, a serum tumor marker, is useful for diagnosing cancer and for following the response to therapy in cancer cases. Serum carcinoembryonic antigen levels are also important as a predictive tool in evaluating prognosis. A 56-year-old man presented with an abnormal shadow on a chest X-ray. His preoperative serum carcinoembryonic antigen was at an elevated level of 1274.0 ng/ml. Chest computed tomography revealed a tumor in the posterior segment of the right lung and a swollen right interlobar lymph node. Right lung pneumonectomy and node dissection were performed. A histological diagnosis determined that the tumor was a large-cell carcinoma at clinical stage IIA. Immunohistochemical analysis detected the production of carcinoembryonic antigen by the tumor cells. Following surgery, the patient's carcinoembryonic antigen levels were maintained within the normal range. This is a rare case of lung cancer with no evidence of recurrence and metastasis for 8 years despite markedly elevated preoperative carcinoembryonic antigen levels.