[A Case of Central Venous Catheter Fracture after Its Implantation for Liver Metastasis of Rectal and Appendiceal Cancers].

This is the case of a 72-year-old man in whom multiple colorectal cancers including rectal and appendiceal cancers and synchronous S3 liver metastases were observed in 2014, and resection was performed in 2 stages. In 2017, a single recurrence was found in the liver S8, and he underwent a liver S8 sub-segmental resection. Implantation of a CV port for postoperative chemotherapy was planned. At the time of insertion, the catheter was punctured from the exterior portion of the left subclavian vein to avoid the pinch-off syndrome wherein the catheter is crushed between the clavicle and the first rib. Subsequently, FOLFOX therapy was started, but it was discontinued because of allergic symptoms, which appeared during the third course. Two years after the CV port was implanted, a catheter fracture was found on a chest X-ray performed during a regular visit. Since the detached catheter did not fall into the vein, it was possible to remove the port under fluoroscopy. When a catheter is implanted, even under ultrasound guidance, it is considered important to always keep in mind the possibility of a catheter fracture and to detect and respond to it early.

[A Case of Laparoscopic Gastrojejunal Bypass Surgery for Malignant Stenosis after Chemoradiotherapy for Esophageal Cancer].

We report a case of malignant stenosis due to recurrence of lymph node metastasis treated with laparoscopic gastrojejunal bypass. A 83-year-old man who underwent chemoradiotherapy for esophageal cancer(cT3N2M0). About 3 and half years after chemoradiotherapy, he was referred to hospital for vomiting. As a result of the examination, we diagnosed malignant stenosis of descending part of duodenum due to retroperitoneum lymph node recurrence of esophageal cancer. We performed laparoscopic gastrojejunal bypass operation because we suggested self-expandable metallic stent make easy to migrate into anal side of the duodenum. The postoperative course was good. He was enrolled in oncology department on the 21 days after the operation. Gastroduodenal stenosis is common pathology by malignant tumor. Gastrojejunostomy and placement of self-expandable metallic stent is commonly performed for malignant gastroduodenal obstruction. Endoscopic metallic stent placement is minimally invasive treatment for malignant stenosis of the intestine, however sometime the stent placement will make easy to migrate by extra compression. Gastrojejunostomy mat be more safety than endoscopic stent placement for the malignant gastroduodenal obstruction.

[A Case of Synchronous Colorectal Cancer Successfully Treated by Laparoscopic Surgery with Two Segmental Anastomoses].

A 63-year-old man was admitted for the evaluation of Hb 4.8 g/dL anemia. He underwent colon fiberscopy and was subsequently diagnosed with synchronous cancers of the ascending colon and rectum. He underwent laparoscopic ileocecal resection and low anterior resection with 2 segmental anastomoses. The histopathological diagnosis of A/C and rectal cancer was Stage Ⅱ and Stage Ⅲa, respectively. His treatment was completed after 6months of adjuvant chemotherapy with oral TS-1, which was followed by a subsequent 2 year follow-up study, without disease recurrence. Operations of synchronous cancers with 2 segmental anastomoses usually require longer surgical time and are associated with more postoperative complications compared with a single segmental anastomosis. We report a case of synchronous colorectal cancer successfully treated by laparoscopic surgery with 2 segmental anastomoses.

[A Case of Laparoscopic Gastrojejunostomy for Duodenal Obstruction Caused by Unresectable Locally Advanced Pancreatic Cancer].

The patient was an 85-year-old man who received chemotherapy with gemcitabine for 2 years 9 months under the diagnosis of unresectable locally advanced pancreatic body and tail cancer. He visited our hospital because of anorexia, upper abdominal fullness, and vomiting. A CT scan showed severe stenosis in the third portion of the duodenum, which was associated with the direct invasion of the advanced pancreatic cancer. Upper gastrointestinal fiberscopy revealed a severe duodenal obstruction; however, pancreatic cancer exposure within the duodenal mucosa was not observed. As the stenosis of the duodenum was relatively smooth because of the cancer invasion into only the submucosa, deviation of the metallic stent was possible, so we performed laparoscopic gastrojejunostomy. We started the surgery with 5-port settings. A slit was made in the gastric body by using ENDO-GIA®, and bypass surgery with a Roux-en-Y anastomosis was performed. The postoperative course was good, and oral intake resumed on the third postoperative day. Thereafter, he could leave the hospital with good progress and received systemic chemotherapy using gemcitabine. In the present case, an extramural gastrointestinal stenosis without cancer that was not exposed in the gastrointestinal mucosa was poorly fixed with gastrointestinal metallic stents and use of a deviating metallic stent was reported, so we chose laparoscopic gastrojejunostomy. In addition, after undergoing laparoscopic surgery, which is a minimally invasive treatment, he recovered quickly and shifted early to systemic chemotherapy. Herein, the usefulness of laparoscopic gastrojejunostomy for extramural stenosis is reported with a review of related literature.

[A Case of Extraosteosarcoma in the Omentum].

A 51-year-old female presented to our hospital with a chief complaint of abdominal pain. A blood test showed high ALP value(7,001 IU/L), and the abdominal CT showed a mass lesion of 20 cm in diameter with calcification and infiltrated surroundings. From these findings, we diagnosed the patient with peritonealcancer pre-operatively. The intraoperative findings showed an advanced tumor infiltrated into the sigmoid, transverse colon, small intestine and uterus. There were multiple suspected metastasis tumors in the peritonealcavity. Therefore, we resected the tumor as much as possible without curative surgery. Pathologically, the spindle cells were growing with bone formation. Immunostaining showed negative epithelial markers. The tumor protruded out of the intestinal wall, and the patient was diagnosed with extraskeletal osteosarcoma in the omentum. Chemotherapy with doxorubicin and cisplatin was initiated. Because of the disease progression and the presence of side effects, the patient discontinued chemotherapy and died 4 months after the operation. Extraskeletal osteosarcoma is a very rare tumor with poor prognosis. We reported a case of extraskeletal osteosarcoma in the omentum and review the literature.

[A Case Report of Needle-Tract Implantation on the Thoracic Wall after Radiofrequency Ablation for Hepatocellular Carcinoma Treated with Surgical Resection].

A 71-year-old man with hepatocellular carcinoma(HCC)underwent hepatectomy at another hospital in 200X. In 200X+ 7, +9, and +10, radiofrequency ablation(RFA)was performed for HCC recurrence. In 200X+11, he complained of a mass at the right site of the thoracic wall. After further examination, he was diagnosed with needle-tract implantation after RFA. We performed tumorectomy via a thoracotomy. Twelve months after the operation, he is alive with no recurrence. In case of needle-tract implantation after RFA, it is important to consider the possibility of surgical resection for local control.

[A Case of Locally Recurrent Tumor Resected by Left Hemicolectomy with Left Nephrectomy Six Years after Curative Operation for Sigmoid Colon Cancer].

A 65-year-old woman underwent high anterior resection for sigmoid colon cancer in 2011. The histopathological diagnosis was type 2, 25×27 mm, tub2, SE, N2, ly2, v1, and Stage Ⅲb. Her treatment was completed after 6months of adjuvant chemotherapy with UFT plus UZEL followed by a 5-year follow-up study, without recurrence. However, 6years after the initial operation, a routine chest and abdominal CT scan showed a 24mm local recurrence involving the left urinary tract and bilateral lung lesions. Eight courses of systemic chemotherapy using FOLFOX plus panitumumab regimen was administered immediately. CT scan after chemotherapy showed that all masses were downsized and no new lesions were identified. We resected the recurrent tumor after considering it feasible by left hemicolectomy with left nephrectomy. Histopathological examination of the recurrent tumor revealed adenocarcinoma, consistent with that of the previous primary sigmoid colon cancer. She is currently undergoing systemic chemotherapy using the FOLFOX regimen. There has been no change in the lung lesions and no new lesions have developed. This is a very rare case of recurrence more than 5 years after curative resection of Stage Ⅲ colon cancer. This paper presents the case considering that keeping the patient under surveillance for more than 5 years enabled the disclosure of recurrence without subjective symptoms.

[Two Cases of Hepatocellular Carcinoma Skin Metastasis].

Case 1: A7 2-year-old man, during diabetes medical treatment, was introduced at our hospital for liver cancer treatment. He had a subcutaneous mass 4 cm in size in the right precordial region, and subsequently underwent an operation. Histopathological findings indicated subcutaneous metastasis of hepatocellular carcinoma. Case 2: A6 0-year-old man presented with a subcutaneous mass noted in the right shoulder during hepatocellular carcinoma treatment. It was diagnosed as metastasis of the hepatocellular carcinoma to the dermis. Metastasis to the skin of internal organ-related tumors is relatively rare and is reported with approximately a 1.4-6.7%frequency of all dissection cases. Hepatocellular carcinoma is infrequent and it is reported that hypodermal and skin metastasis is 0.3-0.7% in autopsy cases. In addition, metastasis of hepatocellular carcinoma to the skin is a relatively terminal symptom.

[Lung metastasis of basaloid-squamous cell carcinoma of the esophagus; report of a case].

A 69-year-old woman had undergone a subtotal esophagectomy for basaloid-squamous cell carcinoma of the esophagus 2 years before (pT3, ly1, v2, pN0, pStage II). Right lung metastasis was detected by follow up chest computed tomography( CT). A partial resection of the right lung was performed. Histopathological diagnosis was basaloid-squamous cell carcinoma. She is doing well 17 months after surgery for metastasis.To our knowledge, no case of radical surgery for the lung metastasis of basaloid-squamous cell carcinoma has not been reported in the Japanese literature to date.