An Improvement of Exertional Dyspnea by the Reintroduction of Anti-EGFR Antibody in Patients with Metastatic Rectal Cancer Who Developed Cancerous Lymphangiopathy: A Case Report.

Introduction: Reexposure to anti-EGFR antibodies, such as a reintroduction or rechallenge with anti-EGFR antibodies, has attracted much attention in the field of metastatic colorectal cancer. A reintroduction of anti-EGFR antibodies often shows good therapeutic outcomes, as most patients eligible for such reintroduction discontinued treatment due to adverse events despite a good treatment response during front-line treatment. We herein report a case demonstrating an improvement in exertional dyspnea after the reintroduction of anti-EGFR antibody in a patient with metastatic rectal cancer who developed cancerous lymphangiopathy. Case Presentation: A 68-year-old man who had undergone curative surgery for stage IIIB rectal cancer was diagnosed with multiple lung metastases. During the late-line treatment, respiratory failure developed because of multiple lung metastases and cancerous lymphangiopathy. Two months after the initiation of irinotecan + cetuximab, which had been discontinued due to acneiform eruptions despite a good treatment response as a first-line treatment, his dyspnea and performance status dramatically improved. Conclusion: This case indicates that the reintroduction of anti-EGFR antibody to patients who have discontinued anti-EGFR antibody due to skin toxicity despite a good treatment response is a very useful treatment option for metastatic colorectal cancer.

The Effect of Bidirectional Barbed Sutures on the Duration of Common Enterotomy Closure in Intracorporeal Anastomosis.

BACKGROUND/AIM: The adoption of intracorporeal anastomosis in minimally invasive surgery for colon cancer has gradually expanded owing to its many advantages. However, intracorporeal anastomosis has the disadvantage of a longer operative time than extracorporeal anastomosis. One reason that intracorporeal anastomosis takes longer to perform is the closure of the common enterotomy. The present study evaluated the effect of bidirectional barbed sutures on the duration of common enterotomy closure in intracorporeal anastomosis for minimally invasive colectomy. MATERIALS AND METHODS: The time required for common enterotomy closure was measured with a simulator using an intestinal model. A two-layer suture with continuous full-thickness suture followed by a continuous serosal-muscular suture was adopted. The time required to close the common enterotomy using two unidirectional barbed sutures and one bidirectional barbed suture was measured five times each. RESULTS: The duration of common enterotomy closure using bidirectional barbed suture was significantly shorter than that using two conventional barbed sutures. CONCLUSION: Bidirectional barbed sutures are useful for closing the common enterotomy in intracorporeal anastomosis for minimally invasive colectomy.

[A Case of Multicentric HER2-Positive Breast Cancer with Alterations of the Intrinsic Subtype].

In cases where there are 2 or more tumors, it is crucial to conduct core needle biopsies on each of them. A 39-year-old woman presented at our hospital with pain in her left breast. Ultrasonography(US)revealed the presence of 2 contiguous tumors: a 35 mm tumor(tumor 1)and a 20 mm tumor(tumor 2)in the AC area of the left breast. US-guided core needle biopsies(CNB)were performed. The histological findings confirmed an invasive ductal carcinoma, characterized by ER(-)/ PR(-)/HER2(3+). Neoadjuvant chemotherapy indicated tumor 1 as PD and tumor 2 as PR, and surgery was subsequently performed(Bt plus SLN). Upon histopathological examination, the findings demonstrated a non-pCR invasive ductal carcinoma, featuring an ER(+)/PR(-)/HER2(-)profile. Depending on the specific subtype identified, post-operative treatment included HER2-targeted therapy or ER/PR-targeting hormone therapy in conjunction with chemotherapy.

[A Case of Splenectomy for Isolated Splenic Metastasis after Surgery for Gastric Cancer].

Splenic metastasis of gastric cancer is rare. Cases of long-term survival after the resection of metachronous solitary splenic metastasis have been reported, and proactive resection should be performed. A 77-year-old man was presented to our hospital with anorexia. Further investigation showed type 2 gastric cancer in the greater curvature of the stomach in the lower body. Subsequently distal gastrectomy was performed on October 2018. The pathological stage was T3N2M0, Stage ⅢA, and the patient was treated with S-1 as adjuvant chemotherapy for 1 year. Two years after surgery, enhanced computed tomography(CT)showed a solitary splenic tumor with a diameter of 10 mm. Six months later, the tumor had grown to 25 mm, and PET-CT revealed no other tumors. Thus we diagnosed the patient as metachronous solitary splenic metastasis of gastric cancer, and splenectomy was performed on June 2021. Histopathological diagnosis was a metastasis of gastric cancer. The patient was treated with S-1 and remains recurrence-free for 1 year after the second operation.