[A case of metastatic bladder cancer occurring after surgery for differentiated gastric cancer controlled by combination therapy of paclitaxel/S-1].

A 70-year-old male visited the hospital with a complaint of stomachache. Hydronephrosis was observed in the right kidney, and further examination confirmed a diagnosis of metastatic cancer limited to the bladder and rectovesical pouch after surgery for differentiated gastric cancer. Chemotherapy using paclitaxel(PTX)/S-1 was initiated. One course included 14 days of administration of S-1 (100 mg/body) followed by a 7-day interval, and the administration of PTX (60 mg/body) on the 1st and 15th days. General malaise developed after 4 courses, the dose of S-1 was reduced (80 mg/body), and PTX was administered only on the 1st day. CT conducted 9 months after the start of chemotherapy revealed the disappearance of ascites, decreased thickness of the bladder wall, and reduced size of the tumor in the rectovesical pouch. No new distal metastasis or peritoneal metastatic nodule has been observed, and there has been no tendency toward exacerbation for one year after the initial diagnosis. PTX/S-1 was suggested to be an effective treatment for metastatic cancer limited to the bladder and rectovesical pouch after surgery for differentiated gastric cancer.

[Long-term disease-free survival following multimodal treatment in a patient with curatively unresectable advanced gastric cancer with metachronous liver metastasis].

A case was a 57-year-old man. Despite a diagnosis of cStage IV gastric cancer (cN2, cH0, cM0, cT3 (SE), cP1), we preferentially performed a non-curative surgery to avoid stenosis or bleeding by tumor invasion. Since no evidence of peritoneal metastasis was found at surgery, distal gastrectomy with D2 lymph node dissection was performed, and lymph nodes anterior to the pancreatic head were sampled. The pathological diagnosis was pT3 (SE), pN2, sH0, pM1 (LYM), pStage IV. After the surgery, S-1 was administered. One year and 9 months later, a solitary metastasis was found in S6 of the liver, and the patient underwent radiofrequency ablation (RFA) followed by adjuvant S-1. Currently, 5 years and 10 months after the surgery, the patient is under follow-up, and remains alive with recurrence-free. We speculate that in the presence of N or M (LYM) factors for stage IV gastric cancer, surgery with lymphadenectomy, which does not prevent the completion of adjuvant chemotherapy, followed by multimodal treatments such as continued chemotherapy and RFA, led to the long-term survival.

[A patient with metachronous ovarian metastases of signet-ring cell carcinoma of the transverse colon showing long-term survival after surgery].

The patient was a 43-year-old female who consulted a local physician due primarily to lower abdominal pain. She was referred to our hospital for close evaluation and treatment. Since circumferential cancer was detected in the transverse colon by lower digestive tract endoscopy, the patient was hospitalized for surgical treatment. Transverse colectomy (Cur A) was performed, histopathological examination indicated signet-ring cell carcinoma of the transverse colon, and the lesion was diagnosed as type 4, SS, ly3, v0, n1 (+), Stage III a. Postoperative adjuvant chemotherapy was recommended, but the patient was psychologically unstable and strongly rejected chemotherapy. The patient was periodically followed-up after surgery, but a mass was detected in the left ovary by CT after 1 year and 6 months, and bilateral ovariectomy was performed with a diagnosis of ovarian metastasis. The histopathological diagnosis was signet-ring cell carcinoma, and the ovarian lesions were judged to be metastases of the transverse colon carcinoma. Since the patient did not consent to postoperative chemotherapy, as after the initial surgery, she was followed-up without treatment. She was admitted with ileus due to peritoneal metastasis 4 years and 10 months after the initial surgery, and, despite of the surgery, she died due to carcinoma 5 years after the initial surgery.