[A Case of Long-Term Survival Following Two-Stage Surgery for Perforated Advanced Gastric Cancer Caused by Chemotherapy].

A 74-year-old man with bloody vomit was diagnosed as having clinical Stage Ⅳ advanced gastric cancer with lymph node metastasis around the abdominal aorta. Initially, for curative surgery, he was administered neoadjuvant chemotherapy. On day 32, in the second course of chemotherapy containing S-1 after 12 courses of chemotherapy containing S-1 and cisplatin, he developed pan-peritonitis owing to the perforation of gastric cancer caused by chemotherapy, and thus, we performed emergency omental implantation and peritoneal drainage. He was discharged from the hospital after 14 days with no trouble. His gastric cancer was judged to be resectable without retaining metastatic lymph nodes based on intraoperative findings and abdominal computed tomography. Therefore, 3 months after the emergency surgery, he underwent total gastrectomy with D1+(+No. 11d)lymphadenectomy. The postoperative course was uneventful. He rejected adjuvant chemotherapy despite our recommendation. Regrettably, intraabdominal dissemination was observed 15 months after total gastrectomy, and he then received chemotherapy again. He has remained alive for 57 months after the first visit to our hospital.

Expression of GLUT-1 and GLUT-3 in xanthogranulomatous cholecystitis induced a positive result on ¹8F-FDG PET: report of a case.

Although several reports have revealed that fluorine-18 fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) is useful for differentiating between benign and malignant lesions in the gallbladder, the positive results of (18)F-FDG PET are not specific for malignancy because (18)F-FDG is also accumulated in inflammatory lesions. It is known that the most important pathway for (18)F-FDG to enter the cell body is mediated by the facilitative glucose transporter-1 (GLUT-1) through GLUT-3. We herein present a case of xanthogranulomatous cholecystitis (XGC) with a positive result on (18)F-FDG PET. In this case, GLUT-1 and GLUT-3 were both positively expressed in inflammatory cells at the gallbladder wall of XGC and this is the first report to reveal GLUT expression in XGC. This report reveals that surgeons should carefully consider the appropriate treatment of gallbladder tumor, even with a positive result on (18)F-FDG PET.

[A successfully resected case of colorectal cancer with multiple liver metastases treated with FOLFIRI after failure of mFOLFOX6].

A sixty-year-old man was admitted with anorexia and abdominal mass. Colonoscopy revealed type 2 tumor at sigmoid colon. Computed tomography (CT) demonstrated multiple liver metastases. The patient was diagnosed as sigmoid colon cancer with multiple liver metastases. The patient was treated with mFOLFOX6 as neoadjuvant chemotherapy because the liver metastases were unresectable. However, after 2 cycles of mFOLFOX6, the level of CEA and CA19-9 much increased. The regimen was replaced by FOLFIRI. The level of CEA and CA19-9 decreased after 2 cycles of FOLFIRI. CEA and CA19-9 further decreased and colonoscopy and CT revealed a partial response after 5 cycles of FOLFIRI. The patient was subjected to curative resection. Sigmoidectomy and liver resection were performed. Histological response was Grade 1b at liver metastasis. The patient was discharged and had an uneventful recovery. Six months after surgery, CEA and CA19-9 decreased to normal level, and the patient is free of recurrence. Neoadjuvant chemotherapy for metastatic colorectal cancer may render some unresectable patients resectable, affording these patients the possibility of prolonged survival. However, the optimal approach is unknown.

Localized malignant mesenteric mesothelioma causing small bowel obstruction.

Malignant mesothelioma is an uncommon lethal neoplasm in the serous membrane in which peritoneal mesothelioma is a rarer form. Herein is reported a case of malignant mesothelioma presenting as a localized mass inside the mesentery causing focal luminal obstruction of the small intestine. The diagnosis of malignant mesothelioma was obtained on repeat double balloon endoscopic biopsy. Partial resection of the small intestine along with the mesentery was performed, followed by a course of chemotherapy. No relapse of the disease has been found in the 8 months' follow up radiologically. To the best of the authors' knowledge this is the first reported case of localized malignant mesothelioma arising inside the mesentery. Mesothelioma should be considered as the differential diagnosis when small bowel obstruction occurs with unknown primary neoplasm.

A case of congenital midline cervical cleft with congenital heart disease.

A congenital midline cervical cleft (CMCC) is a rare developmental anomaly. It may represent failure of the branchial arches to fuse in the midline and presents at birth with a ventral midline defect of the skin of the neck. Congenital heart disease along with CMCC is rarer, and most of the cases reported are associated with chest wall defects or thoracic ectopia cordis. The authors report a case of a 5-month-old girl with CMCC and an atrial septal defect (ASD) and discuss the clinical presentation, embryologic development, and treatment.