A 74-year-oldwoman hadconsultedthe department of urology in our hospital because of microscopic hematuria. Cystoscopy revealeda urinary bladder tumor, suspectedas an adenocarcinoma basedon biopsy. MRI showeda cystic tumor of the appendix with vesical fistula; therefore, she underwent an operation with a diagnosis of appendiceal cancer invading the urinary bladder. During the operation, we found that the appendix sunk into the urinary bladder with right adnexa. Therefore, we performed ileocecal resection, partial resection of the urinary bladder, and right adnexectomy. Macroscopically, the bladder was filled with a large number of mucus lumps. A papillary tumor, 4 cm in size, growing in the lumen of the bladder was detectedat the invasion site. Microscopically, proliferating carcinoma cells in a papillary form were observedin the lumen of the appendix with mucus production, invading the wall of the urinary bladder at the fundus of the appendix. Thus, the patient was diagnosed with mucinous adenocarcinoma of the appendix(V, type 1, 45×30 mm, muc, pT4b[SI, urinary bladder], int, INF c, ly0, v0, pN0, cM0, pStage II ). Primary appendiceal cancer invading the urinary bladder is very rare; herein, we report a rare case of appendiceal mucinous adenocarcinoma detected with a bladder tumor and present a literature review.

The patient was a man in his early 30s. He underwent sigmoidectomy with D3+ #216 for advanced sigmoid colon cancer with metastatic para-aortic lymph nodes. The pathological diagnosis was colon cancer(S), type 2, moderately differentiated, pT4a(SE), pN3(19/33), pM1a(LYM), pStage IV , KRAS wild-type, EGFR(+). He received FOLFOX plus bevacizumab(Bmab) as adjuvant chemotherapy. One year postoperatively, he experienced recurrence as multiple lung metastases. FOLFIRI plus panitumumab, SOX plus Bmab, CapeOX, nivolumab and FOLFIRI plus ramucirumab were then administered. The patient has survived for 4 years and 11 months from operation.

A 55-year-old man was admitted to our hospital for rectosigmoid(RS)cancer. We performed high anterior resection in the patient. Pathological findings showed mucinous adenocarcinoma, pT3(SS), pN1, sM0, sP0, pCy0, fStage III a. Two years and 3 months after the first operation, the patient visited our hospital due to lumbago, and we conducted a detailed abdominal examination. CT images showed the bladder tumor expanding into the vesical trigon and invading the prostate and mesorectum. Cystoscopy revealed the tumor, and tumor biopsy indicated poorly differentiated adenocarcinoma. These findings were consistent with metastasis of RS cancer; therefore, we performed total cystectomy, prostatectomy, and partial resection of the rectum. We performed a change of the ileum conduit to the urinary tract. Pathological findings showed many poorly differentiated adenocarcinomas in the lymph ducts ofthe bladder and prostate. Therefore, we diagnosed the condition as bladder cancer lymphogenous metastasis. The patient continues to do well without signs ofrecurrence 6 months later.

We describe 4 cases of locally advanced colorectal cancer resected successfully after neoadjuvant chemotherapy(NAC) conducted between April 2015 and August 2016. The NAC with mFOLFOX6 plus bevacizumab was performed after ileostomy for prevention of obstruction, because of tumor invasion into other organs. After chemotherapy, we could perform resection and avoid invasive surgery in either cases.

Solitary splenic metastasis from cancer is known as a rare disorder in cancer patients. In the present study, we report our experience regarding pathophysiology and treatment tactics of the splenic metastasis caused by ovarian cancer after perioperative chemotherapy. A 50s female presented to our clinic complaining of growing solitary splenic hilar node in CT. Hysterectomy, bilateral oophorectomy, omentectomy and adjuvant therapy was performed after neoadjuvant therapy with TC regimen. Five years and 3 months after surgery, she presented growing solitary splenic hilar nodule in CT. After staging laparoscopy, this lesion is judged to be able to be resected absolutely. Splenectomy and pancreas tail resection was performed. She has survived 39 months after 2nd surgery without recurrence. She recieved a diagnosis of solitary splenic metastasis from past ovarian cancer with whitch pattern of immunostaining was accord closely. Therapeutic tactics for solitary splenic metastasis is splenectomy because of the prognosis after complete resection is thought to be well.

A 67-year-oldman underwent lower anterior resection for rectal cancer andresection of liver metastatic tumor 5 years later. Seven years and 2 months after the initial surgery, a soft tissue mass was detected in the left diaphragm. Further retrospective review of CT scan images showedthat the diaphragmatic tumor was present just before the hepatectomy. Partial resection of the left diaphragm was performed, and no relapse has occurred since then for 2 years. Most cases of diaphragmatic metastasis are considered to arise from dissemination, but we considered this case as more likely to be hematogenous. When surgery is chosen to treat metastatic tumors of colorectal cancer, checking for other metastasis via preoperative imaging andperforming curative resection is important.

A 74-year-old male had undergone laparoscopic abdominoperineal resection for lower rectal cancer in July 2009. The pathological diagnosis was T2, N0, M0, pStage I (TNM 7th). Because of pathological venous invasion, adjuvant chemotherapy with Tegafur-uracil(UFT)plus Leucovorin for a year was performed. A CT examination revealed slowly growing peripheral right internal iliaclymph node. PET-CT demonstrated a 20mm right lateral lymph node(LLN)metastasis without other distant metastases. On diagnosis of solitary LLN metastasis of rectal cancer, the patient underwent surgical lymph node resection in September 2014. The pathological diagnosis was lymph node metastasis from rectal cancer. Subsequently, the patient received mFOLFOX6 adjuvant chemotherapy for 6 months. The patient remains alive without any recurrence 31 months after the second surgical treatment. lt is important to consider that LLN metastasis of Stage I rectal cancer might still occur a long time after the curative operation.

We report a case of a 79-year-old man who developed severe therapy-related pancytopenia from tegafur uracil(UFT)and Leucovorin(LV)as adjuvant chemotherapy for ascending colon cancer. Laparoscopic right hemicolectomy resection was performed for the ascending colon cancer. Pathohistological analysis revealed that the ascending colon tumor was moderately differentiated tubular adenocarcinoma(T3, N1, M0, and Stage III a). Postoperative adjuvant chemotherapy with UFT and LV was administered. After 2 courses of chemotherapies, severe thrombocytopenia(Grade 4)and neutropenia(Grade 4)were noted. Platelet and granulocyte-colony stimulating factor(G-CSF)were transfused. Furthermore, red blood cell transfusions were given for anemia(Grade 3). Dihydropyrimidine dehydrogenase(DPD)deficiency was suspected as the cause of the pancytopenia, and the ratio of dihydrouracil(DHU)and uracil(URA)was measured. However, the result was negative for DPD deficiency. Bone marrowaspiration revealed that therapy-related leukemia(TRL)and therapy-related myelodysplastic syndrome(T-MDS)were not the causes of the pancytopenia either. A total of 230 units of platelet transfusions and 20 units of red blood cell transfusions have been given for 32 weeks, and the patient currently requires routine blood transfusions. Fortunately, infection and bleeding never occurred. Subsequently, the patient should be monitored carefully.

A 65-year-old female received distal gastrectomy for gastric cancer.The pathological diagnosis was well differentiated adenocarcinoma(tub1), type 2, pT3, ly: 1, v: 1, N0, H0, P0, M0, CY0, pStage II A.She had been observed without adjuvant chemotherapy.Five years after the resection, umbilical tumor and intraperitoneal nodules were detected by computed tomography. Needle biopsy cytology of umbilical tumor revealed metastasis from gastric cancer.Based on the diagnosis of umbilical metastasis and peritoneal dissemination, S-1(80mg/m / 2, day 1-21)and CDDP(60mg/m2, day 8)were administered for 7 courses.Because of diarrhea(Grade 3), chemotherapy was changed to paclitaxel(80mg/m2, day 1, 8, 15).To date, the patient has undergone 33 courses of paclitaxel.The response evaluation is complete response and no other metastases are detected.She has survived more than 3 years from recurrence of gastric cancer.We report a long-surviving case of umbilical metastasis from post operative gastric cancer with chemotherapy.

We report a case of a 42-year-old woman with bone marrow carcinomatosis in the course of metastatic breast cancer who responded well to paclitaxel plus bevacizumab(PTX plus Bev)combination therapy. Four years after initial breast conserving surgery, she was admitted to our hospital with back pain and general malaise and was diagnosed as multiple bone metastases with bone marrow carcinomatosis originating from previous breast cancer(ER+/HER2-). While administering denosumab, we initiated systemic chemotherapy with PTX plus Bev. There has been no sign of progression at 1 year after beginning the treatment. Therefore, we conclude that PTX plus Bev combination therapy could be effective and sustainable treatment for bone marrow carcinomatosis arising from metastatic breast cancer.

We report a rare long-surviving case of solitary brain metastasis from colon cancer. The patient was a 64-year-old female. She had undergone laparoscopic right hemicolectomy for ascending colon cancer in October 2012(pStage III b). She was discharged from the hospitalin a satisfactory state, but 26 days after the operation, she was transported to the emergency department for systemic tonic-clonic convulsions. Magnetic resonance imaging revealed solitary metastatic tumor in the brain, but there were no metastatic lesions in other organs. Metastatic lesion was small and complete removal was considered to be difficult. Thus, we planned stereotactic radiosurgery for the metastases, and then regimen of mFOLFOX6 plus Bmab, tegafur-uracil plus Leucovorin were administered. As a means of evaluating recurrence of brain metastasis, methionine positron emission tomography(methionine PET)was also performed, and the patient has survived for 54 months since the surgery, to date, without recurrence. Cases with brain metastasis of colorectal cancer often have metastases involving other organs and are considered to have a poor prognosis. For solitary brain metastasis, long-term survival can be obtained with multidisciplinary treatments, and methionine PET is considered to be usefulfor recurrence evaluation after radiation treatment.

We report a case of advanced sigmoid colon cancer resected via laparoscopic surgery after preoperative chemotherapy. A- 55-year-old man visited our hospital with diarrhea. CTrevealed a giant tumor in the sigmoid colon, and surrounding lymph node enlargement was also noted. The tumor appeared to be locally advanced; thus, preoperative chemotherapy was started. Due to the possibility of obstruction, we constructed an ileostomy laparoscopically. The tumor was found to be RAS wild, and 4 courses of mFOLFOX6 plus panitumumab were given. Follow-up CTshowed remarkable tumor reduction allowing laparoscopic resection; as such, laparoscopic sigmoidectomy was performed successfully. Chemotherapy with molecular-targeted drugs is a promising method to make laparoscopic surgery possible for advanced colorectal cancer.

A 60's male patient underwent laparoscopic left hemicolectomy with D3 lymph node dissection for transverse colon cancer. Adjuvant chemotherapy with tegafur-uracil and leucovorin was administered.Thirty -four months later, MRI scan revealed a mass with sacrum invasion.Radiation therapy(39 Gy/13 Fr)was performed followed by chemotherapy(modified oxaliplatin, leucovorin, and 5-fluorouracil plus bevacizumab).Two weeks after the completion of radiation therapy, staging laparoscopy and tissue biopsy was performed in the hard tumor, which was located at the caudal end of the incisional scar of the retroperitoneum, in front of the sacrum.The pathological diagnosis revealed metastasis from transverse colon cancer.Radiographic examination showed partial response to radiochemotherapy, and buttock pain decreased.CT review before pain developed showed a small tumor located mainly in the mesorectum slightly adjacent to the sacrum, suggesting the implantation of cancer cells to the stripped plane behind the mesorectum during the surgery.

We report a case oftwo -stage right hemicolectomy in which the first surgery performed was laparoscopic ileocecal resection based on the preoperative diagnosis ofacute appendicitis. The second surgery was performed based on pathological diagnosis ofadvanced cecal cancer accompanied by appendicitis. A 49-year-old woman came to our hospital with a chief complaint of abdominal pain in the lower quadrant for 1 week. Blood test results indicated an inflammatory response, with white blood cells at 10,000/mL and C-reactive protein of1 7.5mg/dL. Abdominal computed tomography showed a swollen appendix and increased uptake in adipose tissue around the appendix. The patient was diagnosed with acute appendicitis, and emergency laparoscopic surgery was performed. Because the cecum wall was thickened and formed an inflammatory mass, ileocecal resection was performed. The pathological diagnosis was advanced cecal cancer accompanied by appendicitis, with metastasis to lymph node No. 201; thus, right hemicolectomy and D3 dissection were performed 14 days after the first surgery. No tumor was found in additional resected tissues. The final diagnosis was cecal cancer: adenocarcinoma tub1, SE, N1, M0, Stage III a. The patient received adjuvant chemotherapy with XELOX and remains relapse free. Acute appendicitis is induced by certain mechanisms that cause appendiceal obstruction. Unlike young patients, middle-aged and elderly patients rarely develop acute appendicitis because ofa tumor causing appendiceal obstruction, which often makes preoperative or perioperative diagnosis difficult. The presence of cancer, such as cecal cancer, should be considered when appendicitis is accompanied by severe inflammation in elderly patients.

The patient was a 50-year-old man who complained of bloody stool and proctal discomfort. After hospitalization, he was diagnosed bearing advanced lower rectal cancer with lateral lymph nodes and bilateral pulmonary metastases(cT3N3M1a, Stage IV ). He was treated with irinotecan, Leucovorin and 5-fluorouracil(FOLFIRI)plus cetuximab because of RAS wild type. After 11 courses of the chemotherapy, all pulmonary metastases were disappeared(CR). Six months after the initialtreatment, laparoscopic abdominoperineal resection with lateral lymph node resection was performed with curative intent. After the operation, additional1 2 courses of the same chemotherapy were carried out. One year after operation, there is no sign of recurrence. Though used to be considered non-curative, advanced rectal cancer with distant metastases could be potentially cured by multidisciplinary treatments.

A 60-year-old man underwent low anterior resection for rectal cancer. Histological findings indicated well-differentiated adenocarcinoma(T3[SS]N1M0, ly3, v2, Stage III a). Two years and 1 month later, right adrenalectomy was performed for solitary adrenal metastasis. Three months thereafter, left partial pulmonary resection was performed for a metastatic lung tumor. All resected specimens showed metastatic adenocarcinoma derived from the rectal cancer. The patient is alive and well without recurrence for more than 10years after lung resection. Given that adrenal metastasis is usually found as widespread metastasis, aggressive resection of well-controlled metastatic lesions including those in the adrenal glands is recommended.

A 76-year-old male visited a clinic and the images incidentally revealed a tumor in the tail of pancreas. Pancreatic ductal adenocarcinoma was diagnosed by the following examination, indicating that the tumor invasion to spleen, left adrenal gland and left kidney(cT3N0M0, cStage II A), requiring heminephrectomy for radical resection. Enhanced preoperative treatments were performed while taking into account a possibility of any restrictions for the age and the standard adjuvant chemotherapies after heminephrectomy. Although the direct tumor invasion to other organs still remained, we found the significant reductions of tumor size and FDG uptake level with the decrease of serum tumor marker levels without an appearance of distant metastasis and another disease, so a radical surgery was performed. We performed distal pancreatectomy with left heminephrectomy and left adrenalectomy. The histopathological findings showed pathological stage was ypT3N1aM0, fStage II B with the direct invasion to the spleen and left adrenal gland with the effect of preoperative therapy as Grade II b in Evans classification. He has survived so far without recurrence for 11 months after surgery without operative complications.

Anal metastasis of colorectal cancer is rare, and no standardized effective therapeutic strategy exists. We report a case of abdominoperineal resection for anal metastasis of rectal cancer. A 65-year-old man underwent laparoscopic low anterior resection for rectal cancer in August 2013. Histopathological examination revealed a moderately differentiated adenocarcinoma( tub2, pSS, ly3, v2, pN1, H0, P0, M0, Stage III a, Cur A). In February 2015, he complained of anal discomfort, and tumor markers were elevated. Enhanced CT revealed a 15-mm high-density solid tumor in the anal canal. The results of needle biopsy indicated a moderately differentiated adenocarcinoma. This tumor was suspected to be metastasis from rectal cancer, and we performed abdominoperineal resection. Histopathological examination revealed a moderately differentiated adenocarcinoma, which was the same histological type as the primary rectal cancer and was covered with normal anal epithelium. Collectively, the findings indicated anal metastasis from rectal cancer. The patient is alive without recurrence for 18 months after resection. Anal metastasis should be considered as a differential diagnosis in patients with anal discomfort who have a history of colon/rectal cancer. Abdominoperineal resection may be an effective treatment modality for this condition.

A 54-year-old woman underwent high anterior resection with D3 lymphadenectomy for rectal cancer at another hospital. She was diagnosed with well-differentiated adenocarcinoma of rectal cancer, pT3, N1, H0, P0, M0, fStage III a. She did not receive adjuvant chemotherapy. Eighteen months after surgery, abdominal CT at our hospital showed a 19mm-sized mass in S7 of the liver. EOB-MRI also showed a mass in the same location. The mass was a ring contrast-enhanced lesion on dynamic phase, had a low signal pattern on liver cell phase, and had high signal pattern on diffusion-weighted imaging. As such, it was diagnosed as liver metastasis of rectal cancer, and surgery was performed. During surgery, the tumor was found to be located between the liver and diaphragm. Thus, we performed partial resection of the liver diaphragm. Histopathologically, the tumor was the same well-differentiated adenocarcinoma as the primary tumor. In addition, the tumor existed only in the diaphragm and was pumping out the liver. Therefore, we diagnosed the tumor as a diaphragm metastasis of rectal cancer. On literature review, only 8 reports of colorectal metastatic tumors involving the diaphragm were found.

We evaluate the feasibility and efficacy of combination chemotherapy including single intraperitoneal( IP)administration of paclitaxel(PTX), followed by triplet chemotherapy(PTX, cisplatin[CDDP]and S-1: PCS)for CY1P0 gastric cancer.