A 65-year-old man was diagnosed with gallbladder cancer during a medical checkup that revealed liver dysfunction. He was referred to our hospital seeking bloodless treatment due to religious beliefs. Blood tests revealed elevated hepatobiliary enzyme levels, and abdominal echocardiography revealed a broad nodular protuberant lesion in the body of the gallbladder and marked dilatation of the common bile duct. PET revealed marked abnormal accumulation of FDG in the gallbladder mass and duodenal papilla. Based on the imaging findings, double cancers of the gallbladder and duodenal papilla were diagnosed. A subtotal gastric-sparing pancreaticoduodenectomy was performed along with resection of the liver bed, gallbladder, and bile ducts, and D2 regional lymph node dissection. Both of postoperative histopathologic diagnosis were papillotubular adenocarcinoma. The patient has remained recurrence-free for 5 years postoperatively. Double cancers of the gallbladder and duodenal papilla are rare, and we report this case based on a review of the literature.

A 70-year-old man presented with anorexia and cough, and CT showed an infiltrative shadow in the right upper lobe. Bronchoscopy revealed unresectable advanced lung carcinoma(cT4N2M1a, cStage ⅣA). The patient had chronic renal failure due to type 2 diabetes mellitus and had been undergoing hemodialysis for 6 years. Four courses of primary chemotherapy( atezolizumab+carboplatin[CBDCA]+nab-paclitaxel[nab-PTX][atezolizumab 1,200 mg/body weight, CBDCA target AUC=5, nab-PTX 100 mg/m2 every 3 weeks])were administered. Thereafter, 3 courses of maintenance treatment with atezolizumab alone(1,200 mg/body weight every 3 weeks)were administered. At this point, the primary tumor was enlarged, and the patient was diagnosed with progressive disease(PD). After 4 courses of second-line chemotherapy with docetaxel(DTX)+ramucirumab(RAM)(DTX 60 mg/m2 day 1, RAM 8 mg/kg day 1, 15, every 4 weeks), the primary tumor temporarily shrank but then re-expanded; therefore, the patient remained in a state of PD. The general condition deteriorated, and he was referred to the palliative care department where he died peacefully.

An 80-year-old woman presented with lower abdominal distension for the past 3 days. Abdominal contrast-enhanced CT revealed an irregularly shaped mass measuring 80×50 mm in the right lower abdomen, with a contrast effect. The final diagnosis was locally advanced appendiceal cancer with multiple invasions into the adjacent ileum and retroperitoneum. After 7 courses of preoperative chemotherapy with mFOLFOX6 plus bevacizumab, the tumor reduced in size, and laparoscopic ileocecal resection with D3 lymph node dissection was performed 4 months after diagnosis. Histopathological examination revealed appendiceal cancer, tub1-tub2, ypT4aN0M0, pStage ⅡB, with a histological Grade of 2 and a curative degree of A. The patient had no signs of recurrence 2 years and 6 months after surgery without receiving adjuvant chemotherapy. We reported a case of locally advanced appendiceal cancer that was successfully treated with mFOLFOX6 plus bevacizumab as preoperative chemotherapy and was curatively resected without combined resection of surrounding organs, with a discussion of the relevant literature.

In this case report, we explored the effectiveness of chemoradiotherapy(CRT)for an unresectable large HER2-positive advanced gastric cancer in a 67-year-old male patient. The patient presented with upper abdominal distension and severe anemia. Contrast-enhanced CT scan revealed a 13 cm large tumor in the stomach, with multiple metastases to the liver and lungs. The patient was treated with CRT, combining radiotherapy with FOLFOX chemotherapy to manage persistent massive bleeding. Bleeding was successfully controlled within approximately 2 weeks, eliminating the need for further transfusions and allowing the patient to resume oral intake. Following CRT, trastuzumab-based chemotherapy resulted in significant tumor shrinkage, enabling continued treatment. This case highlights the potential of CRT as an effective treatment option for unresectable HER2-positive advanced gastric cancer complicated by massive bleeding. The successful control of bleeding using CRT might improve both the prognosis and quality of life(QOL)for such patients. We present this case to highlight the therapeutic benefits of CRT in similar clinical scenarios.

Recent advancements of surgery including robotic surgery have improved the clinical outcomes of resectable solid tumors. Although preoperative chemotherapy is often performed for high-risk cancers, the risk of postoperative recurrence remains a critical issue. So far, recurrence has been monitored through periodic imaging tests; however, molecular residual disease (MRD)has caught much attention as the means to detect minimal cancerous lesions at an earlier stage. With the rapid advancements in circulating tumor DNA(ctDNA)analysis using next-generation sequencing, MRD testing is emerging as a promising tool for predicting recurrence in multiple types of cancer. Thus, in this article, we discuss the current status of MRD testing in urogenital cancers and its potential impact on future treatment strategies.

We report a case of a patient with squamous cell carcinoma metastasis confined to a mediastinal lymph node, with no identifiable primary tumor. The patient remains cancer-free 2 years after diagnosis. Although various theories exist regarding the etiology of lymph node carcinoma of unknown primary origin, advances in elucidating its pathogenesis and integrating treatment strategies based on genetic profiling are expected to form the foundation of future clinical practice.

A 70s-year-old woman with a history of Lynch syndrome had ovarian, colon, and right renal pelvic cancers, all of which were detected early and surgically treated with no recurrence. Ten years have passed since the most recent surgical procedure. In September 2020, she developed hematuria and underwent an examination, which revealed left renal pelvic cancer with liver and lung metastases. Chemotherapy(GEM+CBDCA)was initiated in October 2020; however, imaging in April 2021 revealed disease progression. Treatment with an immune checkpoint inhibitor(ICI: pembrolizumab 240 mg/body)was initiated, but after 4 months, the disease progressed and the treatment was discontinued. The patient was then referred to our hospital. Immunological testing revealed a decrease in T cells; therefore, immune-cell therapy(αβT cell therapy)was initiated to improve this condition. After 4 sessions of αβT cell therapy at 2-week intervals, a CT scan in November 2021 revealed shrinkage of the liver metastases and renal pelvis tumor, and the patient was assessed as having a partial response. By February 2022, after a total of 7 sessions of αβT cell therapy, further tumor shrinkage was observed, and the tumor was almost completely resolved on imaging. Although further immunotherapy is rarely administered in patients for whom ICI is ineffective, our findings suggest the potential for significant immune-cell therapy efficacy even after ICI failure.

A 78-year-old male was under follow-up after gallbladder cancer surgery when CT imaging revealed thickening of the rectal wall, along with enlarged mesenteric and left-sided lymph nodes. Colonoscopy identified a semi-circumferential, tumor-like lesion in the lower rectum, and biopsy results confirmed a diagnosis of poorly differentiated adenocarcinoma. Pelvic MRI further revealed a separate tumor in the prostate, leading to a diagnosis of concurrent rectal and prostate cancer. The prostate cancer was managed with endocrine therapy following rectal resection. For the rectal cancer, neoadjuvant chemoradiotherapy(NACRT)was administered prior to surgical treatment. The resected specimen was evaluated for potential lymphatic metastasis of prostate cancer to the rectum. The patient is currently undergoing endocrine therapy and has remained recurrence-free for 2 years.

A 39-year-old man patient was admitted to a nearby clinic with bloody stool. Digital rectal examination revealed a mass lesion in the lower rectum. The patient was referred to our hospital and finally diagnosed with cT4a, N1b, M0, and c-Stage Ⅲb locally advanced rectal cancer. Neoadjuvant chemotherapy(NAC)with CAPOX and bevacizumab was administered to facilitate R0 resection, permitting anal preservation. When the chemotherapeutic regimen was evaluated to have achieved a complete clinical response, the patient underwent laparoscopic low anterior resection. He was shortly discharged without complications. No residual cancer was revealed upon histopathological examination, demonstrating a complete pathological response. Although NAC for rectal cancer has not been recommended by the Japanese guidelines, high response rates have recently been reported. Herein, we present the utility of NAC in the treatment of rectal cancer.

A 60-year-old female presented at our hospital with a mass in her left breast. Needle biopsy of the breast mass confirmed a diagnosis of invasive lobular carcinoma, and the patient underwent left mastectomy and axillary lymph node dissection. The patient received adjuvant chemotherapy and was started on continuous endocrine therapy. Three years post-surgery, she experienced recurrence of multiple bone metastases and received a combination of hormone therapy and selective cyclin-dependent kinases 4/6 inhibitors. Therapeutic efficacy was poor, allowing bone metastases to spread. Four months post-recurrence, blood tests revealed moderate thrombocytopenia. Despite the switch to chemotherapy, the patient's platelet count did not recover. CT revealed splenomegaly, which was not present three months earlier. Bone marrow biopsy revealed severe myelofibrosis with infiltration of small dysplastic cells into dense fibrotic tissue. The patient developed microangiopathic hemolytic anemia, but DIC was not observed during the course of the disease. Ten months after recurrence, a brain metastasis was detected, and the patient died the following month.

The prognosis for unresectable or recurrent biliary tract cancer is generally unfavorable. However, recent reports suggest that combination therapy with immune checkpoint inhibitors may improve outcomes. We report the case of a 79-year-old woman with intrahepatic cholangiocarcinoma who underwent radical resection. Three months post-surgery, she developed a recurrence in an intra-abdominal lymph node. Treatment with 4 courses of gemcitabine+cisplatin+durvalumab(GCD)resulted in a complete response, with no measurable lesions detected on imaging. The patient continued treatment and was subsequently transitioned to durvalumab monotherapy. Although treatment was discontinued due to drug-induced pneumonia, she has remained relapse-free since. To our knowledge, this is the first reported case of a complete response to GCD therapy in biliary tract cancer.

Intracystic papillary neoplasms(ICPN)are very rare. Pancreaticoduodenectomy was performed in patients with a history of cholecystectomy for ICPN. A 76-year-old woman with no complaints was referred to our hospital and was diagnosed with adenomyomatosis preoperatively. Laparoscopic cholecystectomy was performed, and the patient was diagnosed with ICPN based on pathological findings. A follow-up CT performed 6 months after the surgery showed dilated CBD and MPD. Cholangiography revealed a filling defect in the distal bile duct, with a positive cytology test. A pancreaticoduodenectomy was performed, and the patient was discharged on postoperative day 28. The pathological findings revealed the presence of ampullary cancer. Patients with ICPN may require sufficient follow-up and further detailed examinations, if necessary.

Preoperative chemotherapy for gastric cancer with obstructive symptoms traditionally requires bypass surgery.

A 67-year-old male presented with severe epigastric pain in May 2023 and was diagnosed with Stage Ⅲ advanced gastric cancer(cStage Ⅲ)in June. Due to indistinct boundaries between lymph node #8a and the pancreas, non-resectional chemotherapy and enterostomy were performed during a diagnostic laparotomy. The diagnosis was updated to sStage Ⅳ with cy1. Beginning in July, the patient was administered SOX and nivolumab. Following 6 courses, CT scans in December revealed clearer boundaries, allowing for conversion surgery in January 2024. This surgery resulted in a pathological complete response(pCR), with no detectable malignant cells. Despite postoperative complications, the patient was discharged on day 34 and is currently receiving outpatient S-1 therapy. This case suggests that enterostomy may facilitate conversion surgery to achieve pCR, thereby providing a new treatment strategy for advanced gastric cancer.

A 61-year-old female presented with dyspnea. CT scan revealed an esophageal tumor with airway stenosis, and she was referred to our hospital. During endoscopy, oxygen desaturation necessitated emergency endotracheal intubation and mechanical ventilation. Following tracheostomy placement, a diagnosis of NEC cStage ⅣB was established. IP chemotherapy was initiated. The patient was successfully weaned from mechanical ventilation on hospital day 14. Follow-up CT demonstrated tumor shrinkage, and she was discharged home on day 52. After that, IP therapy was continued and the tracheotomy tube was removed on an outpatient visit. Although the patient underwent up to fourth-line treatment, she died of the underlying disease 1 year and 2 months after the starts of treatment.

A 67-year-old female was admitted to our hospital for the diagnosis of gastric cancer with pyloric stenosis. Upper gastrointestinal endoscopy and computed tomography(CT)revealed a type 3 tumor in the prepyloric region without evidence of distant metastasis. Laparoscopic-assisted distal gastrectomy with D2 lymph node dissection was performed, and the final diagnosis was T4(SE)N1M0, Stage ⅢA. Adjuvant therapy was not administered because the patient suffers from schizophrenia. Twelve months after the initial resection, a mass was palpated at the trocar site in the right hypochondriac region. A core needle biopsy was performed, revealing adenocarcinoma. Abdominal CT showed the mass to be localized above the fascia of the abdominal wall, with no evidence of distant metastasis or peritoneal dissemination. The mass was surgically resected, and the final pathology report confirmed port-site recurrence of gastric cancer. Nine months after the second resection, there were no signs of recurrence.

A 30s-year-old male complaining of abdominal distension and pain was referred to our hospital. The support by palliative care team was initiated soon after emergency admission. Colonoscopic examination revealed a circumferential ulcerated tumor of rectosigmoid and the tumor was diagnosed as an adenocarcinoma. Contrast-enhanced CT revealed multiple enlarged lymph nodes, diffuse peritoneal nodules and massive ascites, which led us to the diagnosis of advanced rectosigmoid cancer. Because bowel obstruction was not observed, early initiation of systemic therapy was planned. Although abdominal pain was alleviated with analgesics including opioids, discomfort from abdominal distension remained. So, we decided to perform cell-free and concentrated ascites reinfusion therapy(CART). To avoid the delay in the initiation of systemic chemotherapy due the adverse effects of CART, the first systemic chemotherapy was followed by CART. After single CART, the abdominal distention resolved without relapse, and seamless transition to outpatient treatment was made. Although the prognosis of colorectal cancer with diffuse peritoneal dissemination is poor, aggressive adoption of palliative therapy including CART may enable the introduction of systemic chemotherapy and the following alleviation of cancer-related symptoms.

A 56-year-old female received the low anterior resection for RS rectal cancer(T4aN1M0)in June 2010. In February 2011, abdominal CT showed paraaortic lymph node swelling, we resected it, because of lymphatic metastasis from rectal cancer suspected. The resected specimen showed the histological feature similar with ovarian cancer rather than rectal cancer. But uterus and adnexa were not unremarkable on gynecologic examination. She received FOLFOX therapy. In December 2012, abdominal CT revealed a growing mass lesion at posterior to the rectosigmoidal anastomosis. We suspected local recurrence of rectal cancer, chemoradiotherapy(S-1+39 Gy)was administrated, a recurrent lesion was reduced and was followed up. In September 2014, abdominal CT showed the local recurrent lesion enlarged, then we started FOLFIRI+cetuximab. However, tumor progressed with no effect of chemotherapy. In May 2015, we performed the low anterior resection with excision of the local recurrent lesion. Histopathological evaluation of the resected specimen revealed a serous adenocarcinoma, like an origin of ovarium on immunohistochemical examination, highly suspected primary peritoneal cancer. Systemic chemotherapy with 4 courses of carboplatin and docetaxel(DC)therapy was administrated as adjuvant chemotherapy. In December 2016, CA125 level increased, PET-CT showed FDG accumulation in the local recurrent lesion, so we started DC therapy again. The recurrent lesion was disappeared rapidly, followed by 9 courses. She is still alive without recurrence 7 years after DC therapy.

A 77-year-old woman was diagnosed with advanced transverse colon cancer(poorly differentiated adenocarcinoma)cT3N3H0P0, cStage Ⅲc and underwent extended left hemicolectomy in April 2020. The tumor tissue revealed RAS: wild type, BRAF: mutant type, dMMR(MLH1 deficiency)by immunochemical staining, and MSI-H by CDx. She received CAPOX as adjuvant chemotherapy after surgery. At the end of the 3 courses, she developed abdominal aortic lymph nodes recurrence( diameter 32×18 mm)and began to receive pembrolizumab therapy in August 2020. But the tumor re-grew 6 months after the start of this regimen. However the recurrent lesion was localized, radiation therapy(IMRT: 54 Gy/27 Fr) was added in combination with pembrolizumab. Two months later the tumor had shrunk significantly. As of June 2024, the patient has remained recurrence-free, suggesting that the abscopal effect may have been involved by immuno-radiotherapy in this case.

The patient was a 51-year-old woman. A left breast tumor was detected during a health checkup and the patient was referred to our hospital. Upon arrival, a mobile mass measuring 17 mm in diameter was palpable in the CD region of the left breast. The mammogram showed a sawtooth mass. Ultrasonography revealed a hypoechoic mass with abundant blood flow. Needle biopsy revealed invasive ductal carcinoma. Systemic examination revealed masses in both thyroid lobes, and a fine-needle aspiration cytology diagnosis showed it to be benign. A left circular mastectomy and sentinel lymph node biopsy were performed. Pathological examination revealed a resection margin negative, ER negative, PgR negative, HER2 negative invasive ductal carcinoma, with a tumor diameter of 20 mm and 17.2% Ki-67 positivity. Thirty months after surgery, the left thyroid tumor showed a tendency to grow, and fine-needle aspiration cytology was performed again, which revealed a papillary carcinoma. A left thyroid lobectomy and lymph node dissection were performed. Pathological examination revealed that the patient had papillary thyroid cancer, T1aN0M0=Stage Ⅰ(<55y). Currently, 3 years after surgery, there is no evidence of metastasis or recurrence of either cancer.