[Three Cases of Conversion Surgery Resulted in Pathological Complete Response for Unresectable Pancreatic Cancer].

Conversion surgery(CS)post chemotherapy for unresectable pancreatic cancer is often reported recently. Although it is still controversial about adaptation of CS, it could possibly be one of the useful choices of treatment for unresectable pancreatic cancer. We report 3 cases of CS which eventually turned out to be pathological complete response.

[A Case of Meningeal Carcinomatosis of Gastric Cancer Successfully Controlled with Nab-Paclitaxel].

We report a 76-year-old woman with meningeal carcinomatosis after gastric cancer surgery. During adjuvant chemotherapy, metastasis to the left axillary and Virchow's lymph node was suspected. A resection biopsy revealed gastric cancer metastasis, and PTX plus RAM therapy was started. Due to RAM adverse events, the treatment was changed to weekly nab- PTX, which was continued for about 6 months. During the 8th course, she was hospitalized due to worsening headache and lightheadedness. Meningeal carcinomatosis was diagnosed by cytology of CSF examination and MRI findings. She died on the 16th day after admission. Meningeal carcinomatosis has a rapidly progressive course with poor prognosis. This case shows nab-PTX may have been able to control the progression.

[A Case of Descending Colon Cancer with Virchow and Axillary Lymph Node Metastasis].

A 72-year-old man was referred to our department with suspected intestinal obstruction. CT showed irregular descending colon wall thickening. Lower endoscopy showed severe descending colon stenosis. Biopsy results were group 1. FDG accumulation of significant SUV was found in the lymph nodes on the left supraclavicular region, left axilla, right mediastinum, posterior part of the right diaphragmatic leg, around the abdominal aorta, and in the liver. The accumulation in the descending colon was not definitely neoplastic. Consequently of left axillary lymph node biopsy, axillary lymph node metastasis of colorectal cancer was suspected, and laparoscopic left semicolon resection was performed. Among the simultaneous distant colorectal cancer metastases, Virchow's and left axillary lymph node metastases are extremely rare(0.1%). We report a case of descending colon cancer with simultaneous Virchow's and left axillary lymph node metastases, with some literature discussion.

An ectopic thymoma arising in the middle mediastinum that was difficult to distinguish from a lymph node metastasis.

BACKGROUND: Ectopic thymomas often occur in the upper mediastinum; however, they rarely arise in the middle mediastinum, especially on the dorsal side of the innominate vein and superior vena cava in the peribronchial region. CASE PRESENTATION: Six years prior, a 27-year-old female presented to our department and was diagnosed with locally advanced left breast cancer. First, we administered chemotherapy including an anti-human epidermal growth factor receptor 2 antibody. The size of the tumor was markedly reduced, and a radical operation involving mastectomy and axillary lymph node dissection was then performed. The patient underwent radiotherapy after the mastectomy, followed by trastuzumab therapy; she continued to receive endocrine therapy thereafter. She underwent computed tomography once a year after the surgery, and a nodule in the middle mediastinum on the dorsal side of the innominate vein and superior vena cava in the parabronchial region was detected at 4 years. We speculated that the nodule was a solitary mediastinal lymph node metastasis from her breast cancer; therefore, we performed thoracoscopic resection of the tumor. We diagnosed the tumor as a thymoma. Currently, the patient visits our hospital to receive continuous hormone therapy for her breast cancer, and the latest computed tomography scan demonstrated no metastases from or recurrence of her breast cancer or thymoma. CONCLUSIONS: We report a case of ectopic thymoma in the middle mediastinum. The tumor, which was detected during systemic therapy for locally advanced breast cancer, was located on the dorsal side of the innominate vein and superior vena cava in the parabronchial region and was indistinguishable from a lymph node metastasis from breast cancer.

[A Case Report of Carcinoma of the Appendix Which Was Diagnosed with Ascites One Year after Appendicitis Operation].

A 68-year-old man visited our hospital in October 201X, giving abdominal bloating as his primary symptom. We found tenderness at McBurney's point, high WBC values from a blood test, and swelling of the appendix in a CT scan, so he was diagnosed with acute appendicitis. On the same day, he had an emergency laparoscopic appendectomy, and he made good progress and was discharged from the hospital on the fourth day after the surgery. In the histopathological examination, he was diagnosed with acute gangrenous appendicitis and examination was concluded. August of the following year, ascites accumulation was found by CT scan, and he was introduced to the department of gastroenterology of this hospital for further testing. Lower endoscopy showed swelling of the appendix root, and he was diagnosed with adenocarcinoma in the biopsy. A CT scan found increased granular concentration in the omentum. Because of a diagnosis of appendix cancer/peritoneal dissemination, he underwent laparoscopic examination in October. Nodules were found scattered in the small intestinal mesentery and the omentum, and peritoneal dissemination was suspected during intraoperative rapid diagnosis. The operation was concluded with only laparoscopic examination. Because of the diagnosis of appendix cancer/peritoneal dissemination, mFOLFOX6 plus bevacizumab was implemented. Primary appendix cancer is a relatively rare disease, often diagnosed after surgery for appendicitis, reported of here 0.03% to 0.5% of cases undergoing appendectomy. We report a case of primary appendix cancer diagnosed 1 year after appendectomy, with the discussion of the literature.

[A Case of Neuroendocrine Tumor of the Second Part of the Duodenum].

A 69-year-old woman was referred to our hospital when the upper gastrointestinal endoscopy performed by the previous physician for detailed examination of upper abdominal discomfort indicated a duodenal tumor. Upper gastrointestinal endoscopy revealed a submucosal tumor with a central depression in the descending part of the duodenum. Contrast- enhanced computed tomography of the abdomen revealed a 23 mm tumor with contrast effect in the descending part of the duodenum contralateral to the Vater papilla. There was no lymphadenopathy or distant metastasis. Duodenal gastrointestinal stromal tumor was suspected, and localized duodenectomy was planned. Intraoperative findings showed that the tumor was located in the descending part contralateral to the Vater papilla with no evidence of surrounding invasion. Localized duodenectomy was performed, and on intraoperative rapid histopathological examination, an adenocarcinoma was suspected. As a result, the surgery was changed into pancreaticoduodenectomy. Based on the results of immunostaining, neuroendocrine tumor grade 2 was diagnosed. No lymph node metastasis was observed. The patient did not have recurrence of lesion 7 months after surgery.

[A Case of Long-Term Survival in a Patient with Advanced Gastric Cancer with Virchow's Lymph Node Metastasis Which Received Multidisciplinary Treatment].

We report a case of long-term survival in a 75-year-old male with advanced gastric cancer and Virchow's lymph node metastasis[cT3N3M1(LYM)H0P0, cStage Ⅳ]which received multidisciplinary treatment. Over 1 year and 6 months, 5 courses of S-1 plus CDDP, 14 courses of S-1 plus docetaxel, and 3 courses of S-1 plus CPT-11 were administered. Following chemotherapy, FDG-PET/CT showed FDG uptake only in the primary tumor and regional lymph nodes. Total gastrectomy and D2 dissection were performed. The pathological diagnosis was Type 5, 55×50 mm, L, Less, tub1>tub2, T3, int, INF b, ly2, v1, pPM0, pDM0, pN2(3/29), HER2(-). S-1 was used as adjuvant chemotherapy. Four years and 7 months after resection, cervical lymph node swelling was detected. The cervical lymph node was resected, followed by radiotherapy administration(56 Gy/28 Fr). No relapse occurred, and the patient has survived more than 7 years and 1 month and 8 years and 11 months after conversion surgery and diagnosis, respectively.

[A Case Report of Accessory Breast Cancer in the Right Axillary Region].

An 80-year-old woman visited a previous hospital complaining of a lump in the right axillary region. Because it was suspected of accessory breast cancer from the findings of image inspection, she was referred for surgery. Based on mammography and ultrasonography, both bilateral mammary glands were reported normal, but an irregular mass was found in the right axillary region. Resection biopsy showed adenocarcinoma like invasive ductal carcinoma. In addition, ER and PgR were positive. With a preoperative diagnosis of accessory breast cancer, she underwent wide local resection of the right axillary region with lymph-node dissection(Level Ⅰ), and local pedicle flap formation. Histopathological findings revealed that the tumor was composed of invasive ductal carcinoma. The center of tumor was consisted of ductal tissue discontinuous with normal mammary gland. So, a diagnosis of accessory breast cancer in the right axillary region was confirmed. She is currently in recurrence-free survival. Accessory breast cancer is relatively rare. We report a case of accessory breast cancer in the axillary region with some review of the literature.