[A Case of Diffuse Large B Cell Lymphoma of the Extrahepatic Bile Duct Cholangiocarcinoma].

The patient was an 81-year-old man who was hospitalized with poor appetite and obstructive jaundice. An abdominal CT scan showed remarkable thickening of the wall from the cystic duct to extrahepatic bile duct. Endoscopic retrograde cholangiopancreatography( ERCP)revealed stricture at the extrahepatic bile duct. Cholangiocarcinoma was diagnosed and pancreaticoduodenectomy was performed. The histopathological diagnosis was diffuse large B cell lymphoma (DLBCL). The patient was stable after the operation. We present a case report describing the resection of DLBCL of the extrahepatic bile duct along with a review of the literature.

[A Case of Disseminated Myelocarcinoma with Bone Metastasis 15 Years after Mastectomy and Relatively Long-Term Survival through Multidisciplinary Treatment].

The patient was a 62-year-old woman who had undergone mastectomy in August 2003 for cancer of the right breast. In addition to radiation therapy in the remaining breast, chemotherapy and endocrine therapy were subsequently performed. The patient had a 10-year recurrence-free postoperative course followed by annual surveillance. Beginning in 2016, an elevation in the serum level of tumor markers was detected; however, no accumulations were found in PET-CT over 2 consecutive years(2016 and 2017). Thereafter, serum levels of tumor markers continued to rise, and a PET-CT in 2018 revealed costal accumulations leading to a diagnosis of late-stage bone metastasis in postoperative year 15. Although hormone therapy was resumed, a continuing rise in the serum level of tumor markers led to a diagnosis of diffuse bone metastasis by MRI in 2019. Treatment with abemaciclib was initiated, and with effective radiotherapy, the PS was maintained at 0-1, serum levels of tumor markers decreased, and the lesions themselves continued at SD. However, in June 2020, multiple liver metastases appeared in an abdominothoracic CT scan. The patient refused chemotherapy; this, a BSC policy was adopted. Acute hemolytic anemia occurred immediately thereafter, and the PS gradually deteriorated. The patient died in September 2020, 17 years and 1 month after surgery.

[A Case of Gastric Endocrine Carcinoma].

The patient was an 80-year-old man, hospitalized with poor appetite, light-headedness, and black stool. Esophagogastroduodenoscopy showed an ulcerative lesion in cardia, and the tumor was diagnosed as gastric cancer using the biopsy specimens. The patient underwent a gastrectomy with D1-node dissection. Pathologically, the small tumor cells infiltrated the muscularis propria of the gastric wall, and these tumor cells immunohistochemically showed a positive reaction for synaptophysin. Therefore, the tumor was diagnosed as small cell-neuroendocrine carcinoma of the stomach. Metastasis was not observed in regional lymph nodes, and the TNM classification was defined as pStage ⅠB. After surgery, adjuvant chemotherapy was not performed. The patient is well without recurrence for more than 7 months after the surgery. We experienced and report a case of gastric endocrine cell carcinoma that underwent resection and provide a review of the literature.

[A Case of Fatal Interstitial Pneumonia during FOLFIRI plus Cetuximab Therapy for Liver Metastasis of Colon Cancer].

The patient was a 76-year-old woman who underwent sigmoidectomy in April 2011 for sigmoid colon cancer with multiple concurrent liver metastases. She was treated postoperatively with mFOLFOX6 plus cetuximab but was diagnosed with the progressive disease at the end of course 14. The patient started receiving FOLFIRI plus cetuximab therapy in May 2012. Later in August 2012, she was examined for respiratory distress on the scheduled date of receiving course 7 and was diagnosed with drug-induced interstitial pneumonia resulting from systemic chemotherapy. The patient was administered oxygen, and her symptoms improved temporarily with steroid half-pulse and endotoxin adsorption therapy, but on inpatient day 10, her respiratory condition deteriorated. She was treated with steroid pulse therapy, but died of respiratory failure on inpatient day 17. The main adverse events associated with FOLFIRI plus cetuximab therapy are gastrointestinal symptoms, hematotoxicity, peripheral nerve damage, and dermatological symptoms. However, reports of respiratory conditions such as interstitial pneumonia are rare. Although the incidence is low, interstitial pneumonia can be severe and fatal and therefore requires close attention.

[A Case of Stage â £ Rectal Cancer with No Evidence of Disease after Neoadjuvant Chemotherapy and Surgery].

A 46-year-old man presented with hematochezia in October 2012. A circumferential type 2 rectal cancer was detected with colonoscopy. Contrast-enhanced CT showed multiple liver and lung metastases. Chemotherapy was administered after the diagnosis of cStage Ⅳ rectal cancer. After 1 course of XELOX plus Bmab, the treatment was changed to XELOX plus Cmab for 21 courses. An infusion reaction occurred during the 21st course. Because a complete response of the liver metastases and a reduction in size of the primary tumor had been achieved, we performed a low anterior resection in April 2014. The final pathological diagnosis was type 2, 10×25 mm, tub1, pMP, int, INF b, pN1 (251). There was no evidence of disease (NED) after the surgery. We are closely following up this patient with no postoperative chemotherapy, and as of July 2015, there is no sign of recurrence. We describe a case of a Stage Ⅳ rectal cancer that was resected with radical surgery after neoadjuvant chemotherapy. We also include a brief review of the literature.

[A case of hepatic metastases from colorectal cancer in a long-term survivor undergoing local combined modality therapy for repeated local recurrences].

Herein, we report of a long-term survivor who underwent local combined modality therapy for local hepatic recurrences detected 10 years after initial surgery for colorectal cancer and 7 years after metachronous liver metastasis. In the third year after surgery for colorectal cancer, a solitary liver metastasis was detected, and curative surgical resection was performed. However, because local recurrence developed 3 years later, curative resection was repeated. When local recurrence developed again 1.5 years later, the patient declined surgery and systemic chemotherapy, and radiofrequency ablation was performed. However, because of the development of another local recurrence 6 months later, hepatic arterial infusion chemotherapy was initiated. This therapy has been continued for 1.5 years to date, with successful local disease control and no adverse events. Although surgical resection is the first choice for resectable liver metastases of colorectal cancer, thermocoagulation and hepatic arterial infusion chemotherapy can also be valid options for patients who are inoperable or refuse surgery as well as for those who are not suitable for or refuse systemic chemotherapy. Notwithstanding, the guidelines for the treatment of colorectal cancer (2014 edition) now include the following statement: thermocoagulation is not recommended as an alternative to surgical resection. Hepatic arterial infusion chemotherapy appears to be a promising treatment strategy associated with antitumor effects with few adverse events. It is also relatively less expensive than systemic chemotherapy.

[A case of locally advanced breast cancer that responded to preoperative chemotherapy].

A 51-year-old woman presented with a huge tumor in the left breast. The tumor occupied the whole breast, accompanied with a 10-cm wide red discoloration of the skin, subsequently followed by a massive axillary lymph node metastasis. The patient was diagnosed with locally advanced breast cancer, graded as T4cN2aM0, StageIIIB. After preoperative chemotherapy, even though the tumor could not be observed on a CT scan, it was assumed to persist in the skin as discoloration was observed. Bt+Ax+Mj+Mi(level 1+2) and a full-thickness skin graft transplantation were performed. Pathological findings revealed a benign remnant of the active cancer in the skin. Four months after the operation, local recurrence was observed in the skin of the chest wall. Therefore, radiotherapy was performed.

[A case of intrahepatic hematoma from hepatocellular carcinoma].

Spontaneous intrahepatic hematoma caused by hepatocellular carcinoma is a rare condition since usually the circumference shows liver cirrhosis. We report a case of hepatocellular carcinoma with an intrahepatic hematoma. A 79-year-old man was admitted to our hospital with sudden onset upper abdominal pain and high fever. Laboratory data showed that the patient had liver dysfunction but was not anemic. Abdominal computed tomography( CT) revealed an intrahepatic tumor with a hematoma measuring 8.5 cm in diameter in the right lobe of the liver. An enhancing lesion and pooling of contrast media inside the tumor was observed. Angiography also revealed a microaneurysm in the tumor. The patient underwent right hepatic lobectomy, and histopathological examination showed hepatocellular carcinoma.

[A case in which XELOX plus bevacizumab chemotherapy was effective in an elderly patient with heart failure and multiple liver metastases after sigmoidectomy].

A 75-year-old woman with a chief complain of anal pain visited the emergency department. She was diagnosed as having S-colon cancer perforation accompanied by an intra-abdominal abscess. Computed tomography (CT)-guided drainage was applied to the intra-abdominal abscess. Six days after drainage, the patient's condition progressed to acute respiratory failure due to heart failure, and ventilator support was provided temporarily. The patient's cardiopulmonary function improved with conservative management. S-colon cancer was detected during colonoscopy examination, and biopsy indicated a tub2 tumor. Next, S-colon resection with D3 lymph node dissection was performed. The postoperative course was uncomplicated. Two months after surgery, liver metastases were detected on CT. Since the patient's performance status (PS) was 3, it was impossible for her to undergo chemotherapy. Four months after surgery, her PS was restored to 2 and the liver metastases were exacerbated, as seen on CT. The patient began chemotherapy (XELOX plus bevacizumab, 30% reduced dose). Eight months after the start of chemotherapy, 9 courses had been administered, the carcinoembryonic antigen (CEA)/carbohydrate antigen (CA) 19-9 level had decreased to the reference value, and the decrease in size of the liver metastases indicated a partial response (PR), as assessed by CT.

[An effective treatment by chemotherapy with CDDP+CPT-11 for recurrent gastric cancer which S-1 cannot be used owing to adverse effects].

We report a case of a 64-year-old man with multiple lung metastases after gastric cancer surgery. This patient was initially treated with S-1. However, he experienced adverse effects, and subsequently, he was effectively treated with cisplatin (CDDP) and irinotecan (CPT-11). In July 2010, the patient experienced a decrease in appetite and underwent a detailed examination. He also underwent distal gastrectomy in the same month. The postoperative diagnosis was T4a( SE), N2, M0, Stage IIIB. In November 2010, adjuvant chemotherapy with S-1 was initiated. In February 2011, the patient developed a skin disorder( grade 3) and generalized edema along with walking difficulty, which were identified as adverse effects of S-1. Evidently, S-1 was contraindicated for this patient, and adjuvant therapy was discontinued. In September 2011, contrast -enhanced thoracoabdominal computed tomography( CT) was performed and para-aortic lymph node metastasis and multiple lung metastases were detected. CDDP+CPT-11 therapy was initiated. By June 2012, 8 courses had been administered, and the patient had a good partial response. With regard to chemotherapy for advanced or recurrent gastric cancer, there is no consensus on a treatment policy for cases in which S-1 cannot be used owing to adverse effects. CDDP+CPT-11 therapy is considered a safe and effective choice.

[A case of chest wall recurrence after mastectomy for breast cancer that showed response to chemotherapy].

We report a case of a 55-year-old woman who underwent mastectomy and axillary lymph node dissection for right breast cancer( T2N1cM0) 7 years previously. She had been experiencing chest pain for 1 year. Ultrasonography( US) showed a low echoic mass, 1 cm in diameter, near the rib in the right breast (class 5).Magnetic resonance imaging (MRI) and positron emission tomography( PET)-computed tomography( CT) scans revealed an 8-cm wide, segmentally enhancing soft tissue lesion and enhanced lymph nodes at the right edge of the sternum. Under the diagnosis of local recurrence, the patient received chemotherapy consisting of adriamycin and cyclophosphamide( AC) and docetaxel. Definite improvement in chest wall metastasis was observed following this treatment. By changing the treatment to endocrine therapy, the disease has been effectively controlled.

[A case of iatrogenic immunodeficiency-associated lymphoproliferative disease in a patient treated with methotrexate for rheumatoid arthritis for 9 consecutive years, which Showed natural remission after discontinuation of MTX therapy].

We report our experience with a case of iatrogenic immunodeficiency-associated lymphoproliferative disease in a patient who had been treated with methotrexate (MTX) for rheumatoid arthritis for 9 consecutive years, which showed natural remission after discontinuation of the MTX therapy. The patient was a 64-year-old woman who was admitted emergently to our hospital with hematemesis and melena. She presented with multiple gastric ulcers and bilateral tonsillitis with a central ulcer. Biopsy of these lesions raised the suspicion of diffuse large B-cell lymphoma. Positron emission tomography (PET)- computed tomography( CT) showed increased fluorodeoxyglucose( FDG) accumulation in the pharynx, cervical lymph nodes, liver, spleen, stomach, distal part of the ileum, and para-aortic lymph nodes, with a maximum standard uptake value of 26.85. Blood test showed elevated lactate dehydrogenase( LDH)( 321 U/L) and interleukin( IL)-2R( 3,531 U/mL) levels. After discontinuation of MTX, the sore throat subsided, and the tonsillitis, lymph node enlargement, and ulcers were resolved. The levels of LDH and IL-2R returned to within the normal range. The patient could be categorized into a regressive disease group with relatively favorable prognosis among patients with MTX-induced lymphoproliferative disease. However, she should continue to be followed up regularly because there remains a possibility that lymphoproliferative disease may relapse after the discontinuation of MTX.

[Long-surviving patient with hilar cholangiocarcinoma by gemcitabine monotherapy].

An 80-year-old woman visited our department with the complaint of icterus and brown urine. After detailed examination, she was diagnosed with cT4N0M (-), cStage IVa, hilar cholangiocarcinoma. We believed that she could be cured with surgery, but she and her family did not agree to the surgical procedure. Chemotherapy was scheduled, and gemcitabine (GEM) therapy was started in April 2011. GEM therapy reduced significantly the level of the CA 19-9 tumor marker, and diagnostic imaging allowed a judgment of partial response or stable disease after 18 months. In the present report, we describe a case of a patient with hilar cholangiocarcinoma who achieved long-term survival with GEM therapy. We also include a brief literature review.

[A patient with sigmoid colon cancer( cStage IV) who responded to preoperative chemotherapy with mFOLFOX6 plus bevacizumab and was subsequently able to undergo a radical operation].

There are a growing number of reports of unresectable, advanced colorectal cancer and multiorgan invasive colorectal cancer for which extended surgery was avoided or a radical operation was performed after down-staging, or tumor size reduction, was achieved by chemotherapy. Here we describe a case of sigmoid colon cancer (cStage IV) for which preoperative chemotherapy improved the outcome of surgery. The patient was a 57-year-old man with sigmoid colon cancer of sufficient size to block the passage of the endoscope. The cancer was found to be widely infiltrated and adherent to the peritoneum over the bladder, with effusion around the tumor that made peritoneal disseminated metastasis a strong possibility. Moreover, many regional and periaortic lymph nodes were swollen. Sigmoid colon cancer at Stage IV was diagnosed. After preoperative chemotherapy [mFOLFOX6+bevacizumab (Bev)] was administered, tumor size decreased sufficiently to allow the endoscope to pass through. The effusion around the tumor disappeared, and lymph node swellings were reduced. The surgical findings revealed no evidence of peritoneal metastasis, and tumor adhesion to the peritoneum over the bladder was small, which limited the extent of combined peritonectomy. Ultimately, the histopathological diagnosis was Stage II,and histological evaluation of the drug therapy effects was that the tumor was then Grade 1b. Although clinical studies are currently conducted on preoperative chemotherapy for locally advanced colorectal cancer, preoperative chemotherapy is not established as standard treatment due to lack of clear evidence. The evaluation of the usefulness of preoperative chemotherapy is warrants future clinical studies.

[A case of recurrent gastric cancer responding to CPT-11].

A 68-year-old man underwent total gastrectomy for gastric cancer(Stage II). Adjuvant chemotherapy with S-1 was administered. At 21 months after the operation, he received a nephron catheter because of hydronephrosis caused by para-aortic lymph node metastases. Then, weekly paclitaxel was given as a second-line treatment. However, his tumor marker level increased and he therefore received CPT-11 (160 mg/m2) as a third-line treatment at 28 months after the operation. At 7 days after the first CPT-11 administration, he was hospitalized because of a severe adverse event involving nausea and general fatigue, which caused a continuous fever of 39°C and renal failure at 14 days after administration. However, hydration enabled him to recover several days later. Computed tomography scan revealed the lymph node metastases to be partial remission.

[A case of primary malignant lymphoma of the spleen which was difficult to be diagnosed].

A 55-year-old woman who had a chief complaint of left abdominal and back pain. She was diagnosed with pancreatic cancer associated with splenic metastasis (Stage IVb) by CT and MRI study and was treated with chemotherapy of gemcitabine (GEM). Chemotherapy was discontinued due to adverse event (grade 3). CT study at this point reveals the effectiveness of GEM. The tumor was localized, and an operation was performed. The tumor was diagnosed as primary malignant lymphoma (diffuse large B-cell lymphoma) of the spleen. The splentic tumor is extremely rare, so a surgical treatment was indicated for making a correct diagnosis. This was an interesting case of malignant lymphoma that GEM revealed a cytoreductive result.

[A case of locally advanced pancreas cancer effectively treated by multidisciplinary strategy].

A 64-year-old female with a primary complaint of abdominal and back pain was diagnosed as locoregionally advanced pancreas cancer. She underwent distal pancreatectomy and received postoperative adjuvant chemotherapy of gemcitabine (GEM). Abdominal CT after 14 months showed a local recurrence without far organ metastasis. She was treated with radiation and the chemotherapy of S-1, which resulted in a stable control by a follow up CT. Then she is undergoing the combination chemotherapy of GEM and S-1. The patient is alive for 26 months after the operation.

[A case of unresectable multiple hepatic metastases from colorectal cancer successfully treated with panitumumab therapy on third-line].

In a patient with multiple liver metastases of colorectal cancer in whom tumor response had been achieved by 5-FU hepatic arterial infusion, the catheter for arterial infusion chemotherapy was occluded resulting in re-elevation of tumor marker levels. Second-line IRIS therapy using S-1 and CPT-11 was started. IRIS therapy reduced tumor marker levels to a degree greater than that previously achieved with 5-FU hepatic arterial infusion, and diagnostic imaging allowed a judgment of partial response. But tumor marker levels increased gradually. After all, diagnostic imaging allowed a judgment of progressive disease and an eminent elevation of tumor marker levels in one year. Third-line panitumumab therapy was started. Panitumumab therapy reduced tumor marker levels to a degree greater than that previously achieved with 5-FU hepatic arterial infusion and IRIS therapy, and diagnostic imaging allowed a judgment of partial response. We report herein a successful case. Hepatic arterial infusion therapy is one of the treatment methods characterized by a lower incidence of adverse reactions, relatively low cost, and expectation of high anti-tumor efficacy as compared to chemotherapy such as FOLFIRI. IRIS therapy does not require a port insertion and pump carrying, and its cost is about half of FOLFIRI therapy. When used as second-line therapy for unresectable colorectal cancer, non-inferiority of IRIS therapy to FOLFIRI therapy has been demonstrated in a phase II/III clinica (l FIRIS) study. We may say that IRIS therapy is promising as an equivalent to hepatic arterial infusion therapy in the treatment of liver metastases of colorectal cancer. In addition, we may say that panitumumab therapy is promising as an equivalent to hepatic arterial infusion therapy and IRIS therapy.

[Multidisciplinary treatment including pneumonectomy for squamous cell carcinoma of the anal canal-a case report].

In August 2008, a 52-year-old woman presented to our hospital with a complaint of bleeding upon defecation. The patient underwent lower gastrointestinal endoscopy with biopsy. PRb indicated a type 2 lesion in one-third of the circumference. The patient was diagnosed with squamous cell carcinoma by biopsy. Imaging did not reveal any metastasis to other organs. In September, she underwent an abdominoperineal resection of the rectum. Postoperative histopathological findings were PRb, type 2, A, N3, H0, P0, M0, and Stage III b. Adjuvant chemotherapy of oral S-1 was started. In January 2009, contrast-enhanced abdominal CT revealed a pelvic recurrence, and the patient underwent chemoradiotherapy. In October, chest CT showed a 5-mm solitary pulmonary metastasis in the right apex of the lung. In March 2010, chest CT showed a slight enlargement of the tumor in the right apex, but no other metastatic lesion was observed. In April, the patient underwent a thoracoscopic partial pneumonectomy. It has been 16 months postoperatively, and no recurrence has been observed. In the present report, we describe a case of squamous cell carcinoma of the anal canal that underwent multidisciplinary treatment including pneumonectomy. We also include a brief literature review.

[A case of locally advanced gastric cancer responding to preoperative S-1/CDDP combination chemotherapy].

A 59-year-old man visited our department with the complaint of an abdominal mass. After detailed examination, he was diagnosed with cT3 (SE) N2M0, cStage III C gastric cancer and underwent a 3 course preoperative S-1/CDDP combination chemotherapy. After tumor down-staging was achieved after the 3 course combination chemotherapy, a surgery was scheduled. The patient underwent distal gastrectomy with D2 lymph node dissection. Histopathological diagnosis was M, type 1, 75 × 35 mm, papillary>moderately-differentiated tubular adenocarcinoma [pT2 (MP), ly3, v0, pN2, Stage IIB]. The patient is now treated with oral S-1 as postoperative adjuvant chemotherapy on an outpatient basis, and there are no signs of recurrence as of 1 year after the surgery. Preoperative chemotherapy appears to be a promising treatment option for gastric cancer with extensive lymph node metastasis.