[A Case of Jejunal Ectopic Pancreatic Cancer with Intestinal Perforation].

This patient was a 96-year-old woman. She was referred to our hospital with abdominal pain and vomiting. The levels of the tumor markers CEA and CA19-9 were elevated, at 39.47 ng/mL and 918.5 U/mL, respectively. She was diagnosed with peritonitis with digestive tract perforation by abdominal CT and an emergency operation was performed. At laparotomy, dirty ascites was observed in the peritoneal cavity. A perforation, 1 cm in diameter was found in the jejunum 15 cm from the Treitz ligament, and a mass, 2 cm in diameter was also palpated on the mesentery side. We performed jejunectomy including the tumor. The submucosal tumor was 2 cm in size and the mucosal surface of the perforation was ulcerated. Pathohistological inspection of the extracted sample revealed no heteromorphism in the small intestine mucosal plane. A moderately differentiated adenocarcinoma was diagnosed in the submucosal layer of the heterotopic pancreas of Heinrich typeⅡ. No tumor cells were found in the perforation. Thirteen previous cases of ectopic pancreatic cancer have been reported and this was the 14th case.

[Risk factors for tumor recurrence after curative resection in patients with Stage IIIa colon and rectosigmoid cancer].

PURPOSE: The aim of this study was to elucidate the risk factors for recurrence of Stage IIIa colon and rectosigmoid cancer. PATIENTS AND METHODS: The subjects were 93 patients with Stage IIIa colon and rectosigmoid cancer who underwent radical colectomy in this department between 2001 and 2011. Various risk factors for recurrence were examined. RESULTS: The overall recurrence rate was 18% (17/93 cases). Univariate analysis identified a risk factor for recurrence: depth of tumor invasion( ≥serosa exposed[ SE])(hazard ratio[ HR] 10.04, 95% confidence interva[l CI] 3.26-30.89, p<0.0001). The rate of 1, 2, and 3-year relapse-free survival of patients with respect to the depth of tumor invasion( ≥SE) were 76%, 61%, and 56%, respectively. CONCLUSION: Tumor depth SE or serosa infiltrating( SI) was a risk factor for the recurrence of Stage IIIa colon and rectosigmoid cancer.

[A case of lethal interstitial pneumonia after neoadjuvant chemotherapy for advanced gastric cancer].

We report a case of lethal interstitial pneumonia that occurred after neoadjuvant chemotherapy for advanced gastric cancer. A 76-year-old man with no history of interstitial pneumonia received 2 courses of S-1 (100 mg/body) following 1 course of S-1 plus cisplatin( CDDP) from June 2012. He complained of dyspnea on exertion 6 days after completion of the treatment. Chest radiography and computed tomography (CT) revealed diffuse interstitial lesions in bilateral lung fields. Bronchoalveolar lavage( BAL) revealed an increased number of lymphocytes and leukocytes. Transbronchial lung biopsy (TBLB) revealed interstitial pneumonia with fibrous thickening in the alveolar septum. The drug lymphocyte stimulation test (DLST) was positive for S-1 and negative for CDDP. These results suggested that S-1 had induced interstitial pneumonia. Steroid therapy( 40 mg/day prednisolone following 500 mg methylprednisolone pulse therapy) and an antibiotic agent were administered but were ineffective. He rapidly developed respiratory failure and required tracheal intubation and mechanical ventilation on hospital day 24, and died on hospital day 38.

[Radiofrequency (RF) ablation for liver metastases of colorectal cancer].

PURPOSE: To evaluate the effectiveness of radiofrequency ablation (RFA) for liver metastases of colorectal cancer. METHODS: RFA was used to treat 31 tumors (median diameter 1.5 cm, range 0.5-3.9 cm) in 13 patients of liver metastases of colorectal cancer. The median number of tumors treated per patient was 2. 9 (range, 1-10). RESULTS: Two patients had complications; bleeding and liver dysfunction. Four (12.9%) of 31 lesions developed a local recurrence after the treatment. We achieved a local control in 2 (92.6%) of 27 lesions <3.0 cm in diameter. In 4 (30.8%) of 13 patients, new metastases were observed at follow-up. One year survival rate from the initial ablation was 92.3% and 2-year was 46.2%. One year total local recurrence rate from the initial ablation was 55.6%. CONCLUSION: In the case of tumor greater than 3 cm, RF ablation is an effective method to treat hepatic metastases from colorectal carcinoma.

[A case of unresectable type 4 gastric cancer which has kept a long-term partial response with adjuvant systemic chemotherapy].

A 69-year-old woman was admitted to our hospital with complaint of epigastric discomfort in February 2006. The detailed examination had revealed type 4 advanced gastric cancer. An exploratory laparotomy was performed for the unresectable case due to peritonitis cartinomatoza. Postoperative S-1 monotherapy (100 mg/body, 4 weeks on, 2 weeks off) was started as an outpatient in April 2006. After 3-course, partial response (PR) was observed for the primary lesion by gastrointestinal endoscopy. In April 2007, the regimen was changed to S-1 (100 mg/body, 3 weeks on, 2 weeks off)+CDDP (60 mg/m2, days 8) combined chemotherapy, then the primary lesion showed a slight increase. Thereafter, the regimen was changed to S-1 monotherapy in March 2008, and S-1+CDDP combined therapy in July 2008 again. PR was kept observed for three years successfully after the exploratory laparotomy. A case of type 4 unresectable gastric cancer was reported that the postoperative chemotherapy of S-1 was effective.

[Two cases of advanced gastric cancer with postoperative severe complications after neo-adjuvant chemotherapy].

We report two cases of advanced gastric cancer with severe postoperative complications after neo-adjuvant chemotherapy (NAC). The first case is a 60-year-old man who was diagnosed as a type 2 advanced gastric cancer with paraaortic lymph node metastases and the elevation of serum CA19-9 level. NAC was started, but no reductions were noted after 3 courses. Palliative total gastrectomy with distal pancreatectomy, splenectomy, cholecystectomy, and partial hepatectomy for T4 gastric cancer exhibiting obstruction were performed in June 2007. On postoperative day 10, abdominal CT scan revealed left subphrenic abscess, then CT-guided percutaneous drainage was performed. A culture of the abscess yielded Candida albicans and Candida glabrata. The second case is a 58-year-old man who was diagnosed as a type 2 advanced gastric cancer with multiple lymph node metastases and the elevation of serum CA19-9 level. NAC were performed, but no reductions were noted. A distal gastrectomy was performed in January 2008. On the first postoperative day, a severe abdominal distension was appeared suddenly and increasingly. An emergency laparotomy was undergone, but no findings of the bowel obstruction were observed. On postoperative day 2, a rise of serum beta-D-glucan level was recognized. Both cases were improved by an antifungal drug therapy.