We report a case of urothelial cancer, gastric cancer, and cecal cancer that responded to pembrolizumab treatment. The patient was a 64-year-old man who was diagnosed with invasive urothelial carcinoma. CT scan showed a 9 cm large tumor in the pelvis. GC therapy was started immediately due to the rapid growth. Since the treatment resulted in PD after 6 courses of GC therapy, pembrolizumab chemotherapy was introduced as second-line. After 4 courses of chemotherapy, upper endoscopy showed remnant gastric cancer(0-Ⅱc, tub2)and cecum cancer(Type 1, tub1), but the urothelial cancer treatment was prioritized. After 7 courses of pembrolizumab treatment, pelvic tumor resection was performed. ESD of the residual gastric cancer was scheduled, however the lesion was unclear and could not be confirmed. Ileocecal resection was performed for cecum cancer. Pathology revealed only scars without any cancerous tissue. Based on multiple cancer history and family history, Lynch syndrome was suspected. The patient is still under treatment of pembrolizumab therapy and no recurrence is seen for 4 years.

We report a case of metachronous liver metastasis occurring 15 years after surgery for sigmoid colon cancer(SCC). The patient was a 76-year-old male who underwent sigmoid colectomy(D3 lymphadenectomy)for SCC 15 years ago. Pathological examination at that time revealed adenocarcinoma(tub1, pap), pT3, pN0, cM0, pStage Ⅱa. He received adjuvant chemotherapy with S-1 for approximately 1 year postoperatively and was under observation thereafter. After 15 years, the tumor markers CEA and CA19-9 showed elevated levels during follow-up visits with his primary care physician. A CT scan revealed a liver tumor in the lateral segment, and cytological examination via fine-needle aspiration was consistent with findings not contradicting colorectal cancer liver metastasis. Subsequent surgical resection of the liver tumor confirmed pathology consistent with metastasis from sigmoid colon cancer. Therefore, we diagnosed metachronous liver metastasis from sigmoid colon cancer occurring 15 years after surgery. Metachronous liver metastasis occurring more than 10 years postoperatively is rare, with only 8 reported cases including our own in Japan.

39-year-old woman with no significant medical history was found to have a pancreatic body tumor during abdominal ultrasound screening at our hospital. The ultrasound revealed a hypoechoic tumor with internal calcifications measuring 29×17 mm, displaying minimal internal vascularity. A contrast-enhanced CT scan characterized the lesion as a poorly enhancing solid tumor. Based on these findings, a suspicion of solid pseudopapillary neoplasm(SPN)of the pancreas was primary, leading to a laparoscopic spleen-preserving distal pancreatectomy. Pathologically, the tumor exhibited areas of solid and hemorrhagic necrosis, with irregularly interspersed hyaline stroma. Immunohistochemical staining showed diffuse positivity for vimentin, nuclear and cytoplasmic positivity for β-catenin, partial positivity for synaptophysin and CD10, and negativity for chromogranin A, bcl 10, and trypsin, confirming the diagnosis of SPN. This case report details the suspicion and successful laparoscopic surgical management of pancreatic SPN in a young female, reflecting on the radiological features and providing some brief literature review.

The patient is a 66-year-old man. He came to the hospital for chest and back pain, and a CT scan of the chest and abdomen showed the pancreatic tail cancer and multiple lung and liver metastases. Systemic chemotherapy was performed, but during the course of the treatment, he had difficulty in speaking, and a head MRI scan was performed, which led to suspicion of brain metastasis of pancreatic cancer. At this point, the primary tumor and lung liver metastases were well controlled by chemotherapy, so brain tumor resection was performed. Postoperatively, the patient had slight residual aphasia, tinnitus, and mild hearing loss, but the patient did not develop any other symptoms. After that, multiple bone metastases were discovered, and from then on, the patient received mainly palliative care, and died from the underlying disease 57 months after the initial diagnosis and 20 months after brain tumor surgery. No intracerebral recurrence was observed during the course of treatment. Pancreatic cancer with brain metastasis is rare, no treatment has been established, and its prognosis is extremely poor. Surgical resection of metastatic brain tumors in pancreatic cancer may improve the prognosis when the primary tumor and other metastases are well controlled.

The patient was a man in his 40s who sought medical attention due to a positive fecal occult blood test. Colonoscopy revealed a 15 mm 0-Is lesion in the rectum Rb. Endoscopic mucosal resection(EMR)was performed. Pathological diagnosis showed a 0-Is, 15×15 mm, adenocarcinoma(tub1>tub2)in an adenoma, staged as pT1a(SM, 500 μm), INF b, Ly0, V0, BD1, pHM0(1 mm), pVM0(1 mm), ER0, pCurEA. During follow-up, he experienced fatigue 11 months post-EMR. Contrast-enhanced chest and abdominal CT scans, along with a colonoscopy, revealed local recurrence, lymph node metastasis, multiple pulmonary metastases, and multiple hepatic metastases following early-stage rectal cancer EMR. Despite systemic drug therapy, hepatic arterial infusion therapy, and palliative radiotherapy, the patient passed away 1 year and 9 months after EMR(10 months after recurrence). Regular surveillance is considered necessary following endoscopic resection of early colorectal cancer, although further case accumulation is needed to determine the intervals.

We report a case of solitary splenic metastasis after surgery for colon cancer. 75-year-old woman who underwent sigmoidectomy for sigmoid colon cancer. After undergoing adjuvant CAPOX therapy, the splenic mass was identified 18 months postoperatively. Postoperative chemotherapy has been resumed, and the patient is under observation. Splenic metastasis of malignant tumors is considered relatively rare. There are scattered reports indicating the effectiveness of resection for isolated splenic metastasis, but adjuvant therapy postoperatively is considered necessary.

The patient was a 64-year-old man. In January 2018, laparoscopic low anterior resection and resection of peritoneal dissemination were performed for simultaneous liver metastasis and peritoneal dissemination of rectal cancer. Histologically, the tumor was moderately differentiated adenocarcinoma/mucinous carcinoma, pT4aN2aM1c2, Stage Ⅳc. Five courses of CapeOX+bevacizumab(Bmab)were administered postoperatively, and in June 2018, hepatectomy and resection of peritoneal dissemination were performed. Chemotherapy was restarted and 3 courses were performed, but splenic metastasis was observed, so the patient was changed to CapeIRI+Bmab and 11 courses were performed, followed by splenectomy and resection of peritoneal dissemination in October 2019. Chemotherapy was discontinued after 4 courses of Capecitabine postoperatively, but gastric intramural metastasis, recurrence of peritoneal dissemination, and transverse colon cancer were discovered, and local gastric resection, resection of peritoneal dissemination, and partial transverse colectomy were performed in July 2020. After that, capecitabine+Bmab was administered for 8 courses and discontinued. Six years and 6 months have passed since the initial surgery, and the patient is still alive without recurrence.

A 74-year-old man complaining of perianal pain was referred to our hospital. A contrast-enhanced computed tomography scan showed a giant mass measuring 10.3 cm between the rectum and the prostate. Magnetic resonance imaging showed contrast effect and decreased diffusion at the margins, with hemorrhage and necrosis inside the mass. We performed a transperineal needle biopsy, it was diagnosed as rectal gastrointestinal stromal tumor(GIST). Complete resection of the tumor was difficult, we started neoadjuvant chemotherapy with imatinib mesylate(400 mg/day)for reduced the diameter of the tumor. The tumor diameter(reduction rate)at 1, 3, and 5 months after treatment was 7.4 cm(28%), 7.0 cm(32%), and 6.2 cm(40%). We considered complete surgical resection possible and performed a robot-assisted rectal resection with no tumor damage. Pathological examination was consistent with a rectal GIST, and the resection margins were negative. We report a case of a giant rectal GIST markedly responsive to neoadjuvant chemotherapy with imatinib mesylate.

We report a case of pancreaticoduodenectomy for a giant duodenal gastrointestinal stromal tumor(GIST)that was safely resected without a blood transfusion using chemotherapy and arterial embolization preceded by perioperative management with patient blood management(PBM). The patient was a 73-year-old female Jehovah's Witness. The patient presented to her primary care physician 6 months earlier with a chief complaint of jaundice. A computed tomography scan revealed a tumor measuring 113.7×96.2 mm extending from the pancreatic head to the porta hepatis. Upper gastrointestinal endoscopy revealed SMT lesions in the duodenal bulb and descending leg, which were biopsied, and a diagnosis of duodenal GIST was reached. The patient underwent preoperative chemotherapy with Gleevec, and surgery was planned approximately 6 months after the start of treatment to reduce the tumor size. The tumor size was reduced to 87.5×56.0 mm. Iron and vitamin supplements were also administered for a set period as hemostatic therapy, and the hemoglobin concentration increased to 12.6 g/dL immediately before surgery. To control intraoperative bleeding, the gastroduodenal artery was embolized using celiac artery angiography, and pancreatoduodenectomy was performed 9 days later. In this case, we incorporated preoperative chemotherapy, and perioperative management consisted of tumor embolization and PBM to preserve the blood supply. This allowed us to complete the treatment without blood transfusion, respecting patient autonomy.

A 74-year-old male patient underwent laparoscopic left nephroureteral surgery for suspected left ureteral carcinoma on follow-up CT after sigmoid colon cancer surgery and lymph node recurrence surgery. Although primary ureteral adenocarcinoma or metastatic ureteral carcinoma was suspected, postoperative histopathological examination and clinical course led to the diagnosis of intraluminal ureteral dissemination of sigmoid colon cancer. Postoperative intraluminal ureteral recurrence of colorectal cancer is extremely rare. This symptom should be ruled out after sigmoid colon cancer surgery.

Metastatic breast tumors account for 0.5-2.0% of all malignant breast tumors; however, metastasis of renal cell carcinoma to the breast is extremely rare. Here, we report a case in which an isolated breast metastasis was found 28 years after total nephrectomy for renal cell carcinoma and resection was performed. The patient was a 52-year-old woman who had undergone right radical nephrectomy for right clear cell renal cell carcinoma at the age of 24 years. Twenty-eight years after the surgery, she noticed a mass in her right breast and visited a local hospital. Ultrasonography revealed a breast mass, sized approximately 1.5 cm, in the right C region; therefore, a needle biopsy was performed for a qualitative diagnosis. Histopathological findings were similar to those of primary renal cell carcinoma, and breast metastasis of renal cell carcinoma was considered. PET-CT did not reveal accumulation in other organs; therefore, the diagnosis was isolated breast metastasis, and surgical resection was decided. Right partial mastectomy was performed, and a histopathological examination of the resected specimen led to the diagnosis of metastatic renal cell carcinoma.

A 70s-year-old man with pancreatic body cancer underwent evaluation by endoscopic-ultrasound guided tissue acquisition(EUS-TA), followed by distal pancreatectomy. Histopathological findings showed a well differentiated pT3N0M0 adenocarcinoma. Adjuvant S-1 chemotherapy was completed, and annual upper gastrointestinal endoscopy was performed. Three years postoperatively, a type 0-Ⅱc lesion was detected at the posterior gastric wall, at the location where the EUS-TA was performed. The initial biopsy showed no obvious malignant findings, but a repeat biopsy 6 months later revealed a well-differentiated adenocarcinoma. Therefore, we performed 4 courses of gemcitabine+nab-paclitaxel, subsequently performed partial gastrectomy. Histopathological findings of the resected stomach specimen showed a well differentiated adenocarcinoma extending from the subserosa to the submucosa. Then, we diagnosed as needle tract seeding(NTS)of pancreatic cancer. Twelve months after partial gastrectomy, there were no signs of recurrence. EUS-TA is a useful method for diagnosing pancreatic tumor. However, knowledge regarding NTS of pancreatic cancer due to EUS-TA is limited by the fact that this is a rare event. We herein report a case of NTS due to EUS-TA, which was performed partial gastrectomy.

An 86-year-old man was referred to our hospital by his primary care physician because of epigastric pain. The patient was diagnosed with gastric cancer and underwent pyloric gastrectomy(D2 dissection and Roux-en-Y reconstruction)and partial hepatectomy. Based on the presence of squamous cell carcinoma and poorly differentiated adenocarcinoma components in postoperative pathological examination, a diagnosis of adenosquamous carcinoma(pT4bN2M0, pStage ⅢB)was made. Postoperative adjuvant chemotherapy with S-1+DTX was initiated; however, it was discontinued owing to severe general malaise. One year after surgery, the patient did not show any obvious signs of recurrence. Gastric adenosquamous carcinoma is a special type of gastric cancer with a relatively low incidence, accounting for approximately 0.4% of all gastric cancers. Here, we report a case of gastric adenosquamous carcinoma along with a review of the relevant literature.

A 67-year-old man was brought to our hospital by ambulance because of vomiting and lightheadedness. He was diagnosed with gastric cancer and multiple lymph node and left adrenal metastases. No other organ metastases were observed. Total gastrectomy and left adrenalectomy were performed. Combination therapy with S-1 and cisplatin(CDDP)for gastric cancer(pT4aN3bM1, pStage Ⅳ)was initiated but later discontinued because of diarrhea, acute renal failure, and pancytopenia. While hospitalized for chemotherapy side effects, he fell and was diagnosed with cerebellar infarction based on head computed tomography(CT)and magnetic resonance imaging(MRI)findings. Subsequently, an increase in carcinoembryonic antigen levels was observed, and combination therapy with ramucirumab(RAM)and paclitaxel(PTX)was initiated; however, chemotherapy was discontinued due to severe fatigue. On postoperative day 207, he was found to have impaired consciousness and was transported to the emergency department of the hospital. He was diagnosed with brain metastases using CT and MRI. The patient died in a coma on postoperative day 264. Adrenal and brain metastases from gastric cancer are relatively rare and their prognosis is poor. Hematogenous metastases to the whole body should be suspected when an adrenal metastasis is found, and a thorough examination of the head is also considered necessary.

We investigated the clinical outcomes of gastrectomy in 7 patients over 90 years of age. Four patients were male and 3 were female. The tumor was located in the U region in 1 patient, M region in 2, and L region in 4. Four patients had circumferential involvement, and 3 had obstruction of passage, 1 of which was caused by gastric perforation. The preoperative prognostic nutritional index(PNI)was low(<40)in 4 patients, and the clinical Stage was Ⅰ in 1 patient, ⅡB in 3, and Ⅲ in 3. The surgical approach was laparotomy in 4 patients and laparoscopy in 3, and the surgical procedure comprised distal gastrectomy in 6 patients and proximal gastrectomy in 1. Lymph node dissection was D1 in 2 patients, D1+in 2, and D2 in 3. Consequently, R0 resection was performed in 6 patients and R2 resection in 1. Postoperative complications were observed in 4 patients, all of whom were treated conservatively. The duration of postoperative hospital stay was 11(9-18)days, and 5 patients(71.4%)were discharged to their home. Postoperative chemotherapy was administered to only 1 patient who underwent R2 resection. The long-term outcomes were as follows: 1 patient died of gastric cancer and 2 died of other diseases. Although the postoperative complication rate is relatively high in very elderly patients over 90 years of age with poor nutritional status, gastrectomy can be performed relatively safely, considering the indications for surgery and adequate planning.

Case 1: A 49-year-old woman underwent NAC followed by surgery for left breast cancer. Two years later, she experienced recurrence with lymph node and liver metastases. Nine months after, multiple brain metastases appeared, which shrank after whole-brain radiation therapy. One year post-radiation, the tumors regrew, and T-DXd was administered, leading to a positive response. However, 22 months later, the disease progressed, and she died from carcinomatous meningitis 26.6 months after treatment. Case 2: A 48-year-old woman had NAC followed by surgery for right breast cancer. One year and 9 months post-surgery, she had a brain metastasis recurrence, treated with resection and Gamma Knife. Six months later, the tumors regrew and were resected again. One year after, multiple brain metastases appeared, treated with whole-brain radiation therapy. Initially, the tumors shrank but regrew, so T-DXd was administered, achieving a complete response. However, 19.1 months later, the disease progressed with lung metastases, and she died from carcinomatous meningitis 21.9 months post-treatment. Case 3: A 47-year-old woman with Stage Ⅳ left breast cancer(lung, liver, and bone metastases)continued chemotherapy. After multiple brain metastases appeared, whole-brain radiation therapy and T-DM1 led to tumor shrinkage. However, the tumors rapidly regrew, and T-DXd was started, resulting in a positive response. Ten months later, the disease progressed, and she died from carcinomatous meningitis 17.7 months after initial treatment.

A 79-year-old man presented with a painful palpable mass in his lower abdominal wall, measuring approximately 7 cm, that occurred 4 months after undergoing partial sigmoidectomy for sigmoid colon cancer perforation within the left inguinal hernia sac. The mass was diagnosed as a recurrent tumor of sigmoid colon cancer located in the left rectus abdominis muscle. Chemotherapy was initially considered for treatment; however, surgical resection of the tumor combined with abdominal wall reconstruction was ultimately selected because the tumor caused significant pain and impacted the quality of life of the patient. Metastases were not observed in other areas. Postoperative chemotherapy was administered, and the patient is currently alive without any signs of recurrence 1 year after surgery.

The case was a 75-year-old man. The patient had back pain and an abdominal CT scan was performed. The scan revealed an 8 cm mass in the left lower abdomen, containing both fatty and solid components. An abdominal MRI showed the mass had shifted position, with the solid component exhibiting high signal intensity on diffusion-weighted imaging, suggesting a liposarcoma originating from the small bowel mesentery. For diagnosis and treatment, laparoscopic-assisted surgery was performed. Laparoscopic observation revealed a mobile mass within the jejunal mesentery, and a small laparotomy was conducted to remove it. Histologically, the tumor was identified as a liposarcoma with both well-differentiated and dedifferentiated components. There was no recurrence for 6 years after the surgery.

The patient, a man in his 70s suffered 5 episodes of intestinal obstruction over the past year and had been under observation, however he remained undiagnosed. When he experiences another episode of lower abdominal pain and vomiting, the subsequent detailed examination revealed an intestinal obstruction caused by a suspected small intestinal tumor. A laparotomy was performed, and a tumorous lesion was identified in the ileum, approximately 20 cm oral to the ileocecal area. Then, a partial small intestinal resection with mesenteric lymph node dissection was performed. The subsequent pathological diagnosis was Type 2, 49×28 mm, tub1, pT3N0M0, pStage Ⅱa. There are multiple reported incidences of primary small intestinal cancers progressing to advanced cancer at the time of diagnosis. Hence, in the event of an idiopathic intestinal obstruction, small intestinal tumor must be considered.

A 75-year-old man presenting with dysphagia was referred to our hospital and diagnosed with advanced esophageal squamous cell carcinoma(ESCC)accompanied by an intramural metastasis in the gastric wall. Following completion of 3 courses of neoadjuvant chemotherapy(NAC)with docetaxel/cisplatin/5-fluorouracil(DCF), the patient underwent minimally invasive esophagectomy with 3-field lymph node dissection. Histopathological examination showed no viable cancer cells in the esophageal and gastric wall, confirming a complete response. The patient was alive with no evidence of disease as of the 5-year postoperative follow-up. According to the results of a clinical trial conducted by the Japan Clinical Oncology Group (JCOG1109), DCF has become the standard NAC regimen for clinical Stage Ⅱ/Ⅲ ESCC. Although ESCC with a gastric intramural metastasis is notorious for its dismal prognosis, multidisciplinary treatment with intensive NAC and radical surgery may provide a cure for even for patients with highly advanced disease.