[A Case of Five Years Recurrence-Free Survival after Successful Multidisciplinary Treatment for Simultaneous Brain Metastasis and Heterochronic Small Intestinal Metastasis from Lung Cancer].

The patient was a 54-year-old male at the time of initial examination. He was aware of numbness and weakness in the left hemisphere of his body and came to see the hospital. He was diagnosed with brain metastasis of lung cancer and started treatment(cT2N0M1[Brain]). He underwent gamma knife for the head lesion and nivolumab for the lung lesion. The patient's lesions shrank with the success of the medical treatment, but recurred with small intestinal metastasis. He underwent a partial resection of the small intestine and was treated again with nivolumab, which resulted in a complete response. He is currently alive without recurrence. We have experienced a very rare case of recurrence-free survival after treatment for brain metastasis and small intestinal metastasis of lung cancer.

[Liver Resection after Chemotherapy for Simultaneous Liver Metastasis of Cecal Cancer-A Case Report].

A 78-year-old male patient was referred to another hospital for cecal cancer and metastatic liver tumor. After open ileocecal resection, he was referred to our hospital for treatment of liver lesions. CT scan showed a lesion with contrast effect of approximately 60 mm in S8, and the patient was judged to be resectable by right lobe resection. However, considering his age and the possibility of latent disease, it was decided to introduce preoperative chemotherapy. After 4 courses of XELOX, although the ICG worsened from 9% to 18% after chemotherapy, the tumor was reduced to approximately 30 mm. The patient underwent an open anterior segment resection of the liver. Colorectal cancer guidelines recommend that surgical resection is the first-line treatment for resectable liver metastases and that preoperative adjuvant chemotherapy should not be given to patients. In this report, we describe a case in which a liver metastasis was safely resected with chemotherapy.

Long-term surgical outcomes of gastric neuroendocrine carcinoma and mixed neuroendocrine-non-neuroendocrine neoplasms.

BACKGROUND: Neuroendocrine carcinoma (NEC) and mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) are extremely rare subtypes of gastric cancer. MiNEN is a mix of carcinomatous components and neuroendocrine neoplasm in the same lesion. NEC and MiNEN have a poor prognosis, are difficult to diagnose, and have no established treatment. Herein, we assessed the clinicopathological characteristics and long-term surgical outcomes of gastric NEC and MiNEN patients in our hospital. METHODS: We retrospectively assessed 1538 patients pathologically diagnosed with gastric cancer and who underwent curative surgical resection at our institution between January 1999 and October 2021. Of these patients, 25 (1.6%) were pathologically diagnosed with neuroendocrine neoplasms. From these 25 patients, we retrospectively analyzed the clinicopathological characteristics and surgical outcomes of 13 (0.8%) patients pathologically diagnosed with NEC or MiNEN. RESULTS: The NEC and MiNEN patients consisted of 11 men and 2 women [mean age, 74 (62-84) years]. The preoperative histological diagnoses were NEC (n = 4) and adenocarcinoma (n = 9). The final pathological diagnoses were large cell neuroendocrine carcinoma (LCNEC; n = 7) and MiNEN (n = 6). Total gastrectomy was the most common surgical procedure (9/13, 69.2%), followed by distal gastrectomy (3/13, 23.1%) and proximal gastrectomy (1/13, 7.7%). Immunohistochemical staining showed 8 CD56-positive patients. All 13 patients were positive for chromogranin A and synaptophysin. The mean Ki-67 value was 64.8 (0-95)%, and the mean mitotic score was 107.9 (0-400). Nine patients survived without recurrence postresection. The median postresection overall survival time was 68.7 (8.0-129) months. The 5-year survival rate was 0.75 ([95% CI] 0.408-0.912). CONCLUSION: The surgical treatment outcomes of NEC and MiNEN patients were relatively favorable. Although evidence concerning the effectiveness of surgery alone is meager, radical resection as part of multidisciplinary treatment including chemotherapy can potentially improve prognosis.

[Duodenal Stent Placement against Anastomotic Stenosis after Esophageal Cancer Resection-A Case Report].

A 53-year-old man was diagnosed as esophageal cancer, and esophagectomy was performed. Anastomotic stenosis was caused due to lymphorrhea and anastomotic leakage after surgery. Dilation was performed, though stenosis did not improved, we placed esophageal stent across the stenotic lesion. Pharyngitis occurred after indwelling esophageal stent, we hence removed the stent. Passage disorder was developed, we placed duodeneal stent which is more flexible. Stenosis is now palliated after placing duodeneal stent. Duodeneal stent could be an option for the tratment of anastomotic stenosis after esophageal surgery.

[Combined Modality Therapy for HER2-Positive Progressive Stomach Cancer Metastasis Achieving Treatment Response-A Case Report].

The patient was a 73-year-old man whose chief complaint was a 1-month history of anorexia and weight loss. Pyloric stenosis due to a circumferential type 2 lesion was detected on the pylorus ring from the gastric angle. Close inspection revealed a diagnosis of progressive stomach cancer cT3N+M0, stage Ⅲ. We judged that perioperative radical excision would be impossible and performed gastrojejunal bypass surgery. Postoperatively, the patient was treated with 2 courses of SOX plus trastuzumab and 7 courses of S-1. PR was identified, and a distal-side gastrectomy plus D2 lymph node dissection were performed as conversion surgery. The patient was discharged on postoperative day 9. For 1 year postoperative, no recurrence was noted. The prognosis of the unresectable gastric cancer is poor, but chemotherapy and conversion surgery in this case resulted in a favorable prognosis.

[A Case of Esophageal Malignant Melanoma during Follow-Up of Esophageal Melanosis Metastasis].

Man 62-years-old as for the case. In 2019, he was diagnosed with right hypopharyngeal cancer, and esophageal melanosis was noted on upper gastrointestinal endoscopy before treatment. We did a follow-up upper gastrointestinal endoscopy every year. At a follow-up upper gastrointestinal endoscopy performed in February 2021, he was histologically diagnosed with an esophageal primary malignant melanoma. Computed tomography showed no metastatic lesions. He underwent esophagectomy. He is currently being followed on an outpatient basis and has had no recurrence. Careful follow-up for esophageal melanocytosis is important for early diagnosis of esophageal primary malignant melanoma.

[A Case of Diffuse Large B-Cell Lymphoma of the Testis, Which Also Developed in the Rectum after Resection of a Large B-Cell Lymphoma].

A man aged 65 years had undergone high orchidectomy of the right testis for diffuse large B-cell lymphoma(DLBCL) occurring primarily in the testis 11 months before. Although he was referred to another hospital for postoperative chemotherapy, he refused the treatment by self-judgement. For 1 month, he had been experiencing melena and anal pain, so he visited our department in June. Rectal palpation revealed a sub-circumference tumor palpable from the anal margin, in which a part protruded outside the anus. CT revealed a sub-circumference hypertrophic wall from the rectal Ra to the anus and intramural enlarged lymph nodes, without metastases to the other organs. Systemic gallium scintigraphy detected a strong concentration in the rectum. The endoscopic examination of the inferior region revealed a circumference type 2 tumor at Rb, and biopsy revealed DLBCL. Clinically, this case was considered a testoid DLBCL with rectal metastasis. Therefore, we performed laparoscopic rectal amputation in July, XX. sT3N1b, cM0. The postoperative course was uneventful. After the patient was discharged from our department, he received chemotherapy at another hospital. At present, 4 years 0 month postoperatively, the patient condition is favorable without recurrence. When perforation occurs in gastrointestinal DLBCL, the start of chemotherapy is delayed and the primary lesion worsen. Therefore, we performed surgical therapy first. Such cases must be evaluated for metastases or new lesions carefully.

[A Case of Performed Right Colectomy with Pancreato-Duodenectomy for Transverse Colon Cancer Invased to Duodenum].

There is a clear consensus regarding the combined resection of organs with cancer invasion, patients with colon cancer. However, there are very few reports to our knowledge regarding the use of pancreato-duodenectomy(PD)for colon cancer patients with cancer invasion in the duodenum. We here report a colon cancer patient in whom we performed PD and right hemicolectomy, who showed favorable results with no recurrence. The patient was a 69-year-old woman. Her chief complaint was hypogastric pain. Her previous doctor performed colonoscopy and a colonoscopic biopsy, and detected a type 2 lesion, throughout the entire circumference of the transverse colon near the liver, and she was diagnosed with adenocarcinoma. From further imaging analyses, she was diagnosed as having transverse colon cancer with invasion into the superior mesenteric vein(SMV), duodenum, and pancreatic head, and No. 223 lymph node metastasis. The patient's cancer was concluded to be unresectable, and she underwent chemotherapy, namely mFOLFOX6 with cetuxiumab(Cmab). One course of mFOLFOX with Cmab, the patient decided to consult our hospital for a second opinion. We concluded that her cancer was resectable, so we performed PD, right hemicolectomy, and resection and reconstruction of a part of the SMV. The operation time was 5 hours 17 minutes, and total blood loss was 190 mL. The histopathological diagnosis was tub2, T4b(duodenum and, tissue surrounding the SMV), int, INF b, ly1, v2, PN1b, EX(+)/ND(PN+, v+), PM0(25 cm), DM0(14.3 cm), N1(1/ 20), H0, P0, M0, pStage III a. She was discharged 15 days after surgery with no complications, and thereafter received ajduvant chemotherapy(capecitabine with oxaliplatin)as an outpatient. After 3 courses, capecitabine with oxaliplatin was changed to capecitabine because she developed a nervous system disorder, and she was further treated for approximately about 6 months. She is doing well at the time of writing, with no recurrences for 2 years. We suggest that PD should be performed on colon cancer patients in which the colon cancer has invaded other organs and has been evaluated as being unresectable.