[A Case of Advanced Gastric Cancer Treated Effectively with Combination Chemotherapy of Paclitaxel plus Ramucirumab].

A 74-year-old man was referred to our hospital because of a gastric tumor. A Borrmann type 2 gastric tumor was found on upper gastrointestinal endoscopy, but tissue biopsy indicated only necrotic tissue and the preoperative diagnosis was difficult. Contrast CT and FDG-PET revealed lymphadenopathy at multiple sites accompanied by high accumulation of FDG in the perigastric lymph nodes, left upper collarbicular fossa, bilateral hilar ganglia, and longitudinal cauda. Because the tumor was strongly suspected to be gastric cancer or malignant lymphoma, distal gastrectomy was performed. The tumor was finally diagnosed as a poorly differentiated adenocarcinoma with multiple lymph node metastasis. S-1 plus cisplatin therapy was administered as first-line chemotherapy, and paclitaxel(PTX)plus ramucirumab(RAM)therapy was administered as secondline chemotherapy. PTX plus RAM therapy was effective, and the patient achieved complete remission(CR), as observed on imaging. However, because adverse events such as numbness in the periphery of the limbs were noted, PTX plus RAM therapy was discontinued per the patient's request. Currently, 13 months since the interruption of treatment, the CR has been maintained, as determined on imaging.

[A Case of Rectal Carcinoid with Liver and Lymph Node Metastases Treated by a Two-Stage Operation].

A 77-year-old woman was admitted to our hospital with the chief complaint of chest pain. CT showed a liver tumor that was 45 mm in diameter. A colonoscopic examination revealed a submucosal tumor in the lower rectum, which was diagnosed by histopathology as a neuroendocrine tumor (NET), grade 2. Liver biopsy confirmed the diagnosis of a liver metastasis from a rectal carcinoid. Considering surgical stress and possible complications, we first performed hepatectomy followed by low anterior rectal resection in a two-stage operation. Histopathological examination revealed that the rectal carcinoid was 14 mm in diameter with four lymph node metastases. After surgery, treatment with an octreotide LAR was initiated. The patient remained disease-free for 1 year 8 months after surgery.