[Rectal Mucinous Cancer with Submucosal Tumor-Like Morphology Preoperatively Diagnosed Using EUS-FNAB - A Case Report].

A man in his 70s presented with a chiefcomplaint ofbleeding during bowel movements. Subsequent colonoscopy revealed a submucosal tumor-like elevated lesion ofapproximately 4 cm situated in the sigmoid section ofthe rectum. EUS-FNAB was performed, and the lesion was identified as mucinous cancer. Based on a diagnosis of rectal cancer(cT4a, cN0, cM0, cStage II), a low anterior resection was performed. Histopathological analysis of the resected specimen revealed a well-differentiated mucinous cancer. The tumor had ruptured the proper muscular layer and was developing in a submucosal tumor-like manner, protruding from the wall within a fibrous capsule. In Japan, only 15 cases of submucosal tumor-like colorectal mucinous cancer have been reported to date. It is rare for such cases to be preoperatively diagnosed as mucinous cancer using EUS-FNAB and then to undergo radical resection.

[A Case of Anal Canal Squamous Cell Carcinoma Detected with Anal Stenosis Eight Years Following Resection for Rectal Adenocarcinoma].

An 89-year-old woman underwent low anterior resection for rectal adenocarcinoma(Ra, pT3N0M0, pStage II , Cur A)in 2008. In February 2016, she underwent an outpatient examination because of a defecation disturbance. Lower gastrointestinal endoscopy was performed and the stenotic region was biopsied. However, no malignancy was detected and the stenotic site expanded. However, the patient experienced recurrence of the same symptoms, developed severe anal stenosis, and underwent another examination in December 2016. Magnetic resonance imaging indicated a neoplastic lesion around the entire circumference of the anal canal. Transperineal needle biopsy results indicated squamous cell carcinoma. The patient was diagnosed with postoperative rectal cancer and metachronous anal canal squamous cell carcinoma(P, cT4bN2M0, cStage III b). Laparoscopic artificial anus construction was performed with the aim of unblocking the anal canal stenosis. Considering the patient's age and performance status, radiation therapy was administered. Two months after administering radiation therapy, the tumor decreased in size, and anal pain reduced.

Capsule Endoscope Aspiration after Repeated Attempts for Ingesting a Patency Capsule.

Capsule endoscope aspiration into the respiratory tract is a rare complication of capsule endoscopy. Despite the potential seriousness of this complication, no accepted methods exist to accurately predict and therefore prevent it. We describe the case of an 85-year-old male who presented for evaluation of iron deficiency anemia. He complained of dysphagia while ingesting a patency capsule, with several attempts over a period of 5 min before he was successful. Five days later, he underwent capsule endoscopy, where he experienced similar symptoms in swallowing the capsule. The rest of the examination proceeded uneventfully. On reviewing the captured images, the capsule endoscope was revealed to be aspirated, remaining in the respiratory tract for approximately 220 s before images of the esophagus and stomach appeared. To our knowledge, this is the first documented case of a patient who experienced capsule endoscope aspiration after ingestion of a patency capsule. This case suggests that repeated attempts required for ingesting the patency capsule can predict capsule endoscope aspiration. We presume that paying sufficient attention to the symptoms of a patient who ingests a patency capsule could help us prevent serious complications such as aspiration of the capsule endoscope. In addition, this experience implies the potential risk for ingesting the patency capsule. We must be aware that the patency capsule could also be aspirated and there may be more unrecognized aspiration cases.

[HER2-Positive Advanced Gastric Cancer with Disseminated Intravascular Coagulation and Diffuse Bone Marrow Carcinomatosis Successfully Treated with S-1/Trastuzumab Chemotherapy--A Case Report].

Trastuzumab, a humanized monoclonal antibody against human epidermal growth factor receptor 2 (HER2), has been proven to result in a survival benefit for the treatment of patients with HER2-positive advanced gastric cancer (AGC). However, data are lacking for the treatment of those with disseminated intravascular coagulation (DIC) and diffuse bone marrow carcinomatosis. A 77-year-old woman presented with back pain and fatigue since 2 months. Esophagogastroduodenoscopy showed a scirrhous lesion in the gastric corpus, which was biopsied and identified as signet-ring cell carcinoma with HER2 overexpression on immunohistochemistry. Laboratory testing, bone scintigraphy, and bone marrow biopsy were conducted, and she was diagnosed with HER2-positive AGC with DIC and diffuse bone marrow carcinomatosis. She underwent chemotherapy with the following regimen: oral administration of 80 mg/m2 S-1 for 2 weeks and 6 mg/kg trastuzumab infusion on day 6 every 3 weeks, which significantly improved the DIC. She was discharged from the hospital 73 days after admission and survived for 438 days after diagnosis. To the best of our knowledge, this is the first case report in which HER2-positive AGC complicated by DIC with diffuse bone marrow carcinomatosis was successfully treated with combined chemotherapy consisting of S-1 plus trastuzumab.

[A study on nine cases of mucocele of the appendix].

A clinicopathological study was made on 9 cases of mucocele (8 cases of adenoma and 1 case of adenocarcinoma) of the appendix treated at the hospital in the recent 12 years. With abdominal CT, correct preoperative diagnosis was successfully made in 7 out of 9 cases of mucocele of the appendix. Two cases of mucocele of the appendix were diagnosed as peritoneal pseudomyxoma before surgery. The most common operative procedure was ileocecal resection in 4 cases including 2 cases undergone irrigation of the abdominal cavity, and partial cecectomy in 5 cases including 2 cases undergone irrigation in the abdominal cavity. For a patient with adenocarcinoma, we repeated intraperitoneal chemotherapy with cisplatin after surgery. Eight patients with adenoma are doing well, but one patient with adenocarcinoma died 48 months after surgery. Therapeutic approaches based on homogeneous pathologic entities can now be considered rationally.

Antitumor effect of intratumoral administration of bone marrow-derived dendritic cells transduced with wild-type p53 gene.

PURPOSE: Dendritic cells (DCs) are attractive effectors for cancer immunotherapy because of their potential to function as professional antigen-presenting cells for initiating cellular immune responses. The tumor suppressor gene p53 is pivotal in the regulation of apoptosis, and approximately 50% of human malignancies exhibit mutation and aberrant expression of p53. We investigated the antitumor effect of intratumoral administration of bone marrow-derived dendritic cells transduced with wild-type p53 gene. EXPERIMENTAL DESIGN: We examined whether intratumoral administration of DCs infected with recombinant adenovirus expressing murine wild-type p53 (Ad-mp53) could induce systemic antitumor responses against mutant p53-expressing tumors, highly immunogenic MethA, or weakly immunogenic MCA-207 implanted in syngeneic mice. RESULTS: Accumulation of wild-type p53 protein in bone marrow-derived murine DCs could be successfully achieved by Ad-mp53 infection. Treatment with intratumoral injection of Ad-mp53-transduced DCs caused a marked reduction in the in vivo growth of established MethA and MCA-207 tumors with massive cellular infiltrates. Administration of p53-expressing DCs suppressed the growth of both injected MCA-207 tumors and untreated distant MCA-207 tumors, but not unrelated Lewis lung carcinoma tumors, suggesting the augmentation of systemic immunogenicity against MCA-207 tumor cells. Moreover, intratumoral injection of p53-expressing DCs had a greater antitumor effect than did s.c. immunization. CONCLUSIONS: Our results indicate that intratumoral administration of DCs expressing murine wild-type p53 leads to significant systemic immune responses and potent antitumor effects in mutant p53-expressing murine cancer models. These findings raise the possibility of using this strategy of intratumoral injection of p53-expressing DCs for human cancer treatment.