A 73-year-old man with a history of perianal abscess and anal fistula for approximately 40 years visited our outpatient clinic because of anal pain. An anal tumor was found at the initial visit. Colonoscopy also revealed a circumferential rectosigmoid tumor located 15 cm from the anal verge. The initial diagnosis was double primary cancer: Stage ⅡB anal fistula cancer(T3N0M0)and cStage Ⅱa rectosigmoid cancer(cT3N0M0). He underwent abdominoperineal resection with curative intent. Histopathological examination revealed that both tumors were moderately differentiated adenocarcinoma. In addition, genetic testing revealed that both tumors were KRAS G12V mutated, BRAFV600E wild, and microsatellite stable. The final diagnosis was metastatic carcinoma of anal fistula caused by implantation from rectal cancer.

A woman in her 60s was diagnosed with gallbladder cancer and pancreaticobiliary maljunction. Extended cholecystectomy and extrahepatic bile duct resection were performed. Macroscopically, the gallbladder cancer was identified as nodular infiltrating in type. The pathological diagnosis was well-differentiated tubular adenocarcinoma, including partially poorly differentiated adenocarcinoma, pT3aN1M0, Stage ⅢB. CT revealed multiple lung metastases 5 months after surgery, but a complete response was achieved with S-1 therapy. CT performed 2 years and 9 months after surgery revealed a left ovarian tumor. Primary or metastatic ovarian cancer was diagnosed. It was found to be histopathologically similar to the poorly differentiated adenocarcinoma component of gallbladder cancer, and ovarian metastasis of gallbladder cancer was diagnosed, together with immunohistochemical findings. Although the ovaries are susceptible to metastases from various primary lesions, ovarian metastases from gallbladder cancer are rare. The prognosis of metastatic ovarian cancer is generally poor. However, aggressive resection should be performed if metastasis is not detected beyond the ovaries.

We report the case of an 87-year-old woman with a long-term prognosis after resection of a recurrent mesenteric liposarcoma. She was diagnosed with mesenteric tumor and rectal cancer and underwent simultaneous resection. Postoperative pathological examination revealed Stage Ⅰ rectal cancer and the mesenteric tumor was found to be a liposarcoma with a mixture of dedifferentiated and well-differentiated types. A CT scan during follow-up showed a local recurrence of mesenteric liposarcoma. Thirty months after the initial surgery, the recurrent tumor was resected. Postoperative pathology showed positive margins with a diagnosis of only well-differentiated liposarcoma. Chemotherapy was not administered, but there was no evidence of recurrence 52 months after surgery. We considered that positive resection margins of well-differentiated liposarcoma in elderly patients suggested that strict follow-up may be acceptable.

Invasive lobular carcinoma of the breast is on the rise. Among lobular carcinomas, pleomorphic invasive lobular carcinoma is considered to be a highly malignant subgroup. The patient was a 38-year-old woman. A health check revealed a tumor in her left breast and she visited our department. On arrival, a mobile mass of about 20 mm in diameter was physically palpable in the AB area of the left breast. Mammography showed it as a focal asymmetric density. An ultrasonography showed it as a hypoechoic mass with an unclear border. A contrast-enhanced MRI showed it as a mass of about 20 mm with contrast. Core needle biopsy revealed the diagnosis of invasive lobular carcinoma. There was no distant metastasis, so muscle-sparing mastectomy and sentinel lymph node biopsy were performed. Pathological examination of the resected specimen revealed the diagnosis of pleomorphic invasive lobular carcinoma, tumor diameter 40 mm, resection margin negative, ER positive, PgR positive, HER2(1+), Ki-67 17.2%. After chemotherapy, the patient was followed up with LH-RH agonist and tamoxifen. At present, 1 year and 6 months after surgery, there has been no clear evidence of metastasis or recurrence.

In this study, we sought to evaluate the prognostic impact of Onodera's prognostic nutritional index(OPNI)in patients with pathological stage(pStage)Ⅲ colorectal cancer(CRC)following radical resection.

This study aimed to assess predictive value of the modified controlling nutritional status(mCONUT)score in patients with pathological Stage(pStage)Ⅰ-Ⅱ-Ⅲ colorectal cancer(CRC)following radical surgery. Patients were classified into 2 groups based on the mCONUT score: those with the mCONUT score of ≤4 as mCONUT-Low group and those with that of ≥5 as mCONUT-High group. Association between the mCONUT score and clinicopathological features was examined. Survival curves of both the 2 groups for overall survival(OS), relapse-free survival(RFS)and disease-specific survival(DSS)were generated using Kaplan-Meier method and compared using the log-rank test, respectively. Multivariate analyses using the Cox proportional hazards model were performed to determine factors related to OS, RFS and DSS, respectively. High mCONUT score was significantly related to female gender, older age, emergency operation, colon cancer, right-sided disease, presence of venous invasion, advanced pStage, relapse and death. Survival curves showed that the mCONUT-High group had significantly worse prognosis than the mCONUT-Low group for OS, RFS and DSS, respectively. Multivariate analyses showed that high mCONUT score was a significantly independent risk factor for worse outcome of OS, RFS and DSS, respectively. In conclusion, the mCONUT score is useful to predict outcome of patients with pStage Ⅰ-Ⅱ-Ⅲ CRC following radical surgery.

A 57-year-old woman underwent left breast conserving surgery(Bp+Ax)for breast cancer at 46 years of age. Histopathological findings were invasive ductal carcinoma(tubule forming type), pN0(0/17), Ly0, V0, NG1, HG1, pT1aN0M0, Stage Ⅰ, ER 100%, HER2 score 0. Postoperatively, only radiotherapy to the preserved breast was performed and no adjuvant drug therapy was administered. This time, a 45 mm liver tumor in segment 4/3 was found by abdominal ultrasound for health checkup. Enhanced ultrasonography showed poor contrast, CT showed a low density tumor with calcification, MRI showed no diffusion reduction, and PET showed no FDG uptake. Although the findings were not typical for suspecting malignancy, but cholangiocellular carcinoma or metastatic liver cancer could not be ruled out. Laparoscopic liver resection was performed. Histopathological findings revealed liver metastasis of breast cancer. We report a rare case, a late-stage solitary hepatic metastasis from very early breast cancer. Although the concept of breast cancer as a systemic disease is well-established, in this case there is a possibility that recurrence would not have occurred if postoperative adjuvant drug therapy had been performed. The importance of postoperative adjuvant drug therapy for breast cancer was suggested. At present, she remains disease-free after hepatectomy.

An 81-year-old woman was referred to our hospital with sigmoid colon cancer 2 years ago. The patient underwent laparoscopic sigmoidectomy. According to the ninth edition of the TNM classification, the pathological diagnosis was pStage Ⅲa (pT1bN1bM0). However, adjuvant chemotherapy was not administered, in compliance with the patient's wishes. Thoracoabdominal computed tomography(CT)performed 2 years after the surgery revealed numerous enlarged lymph nodes in the neck and mediastinum and around the upper abdominal aorta, with no evidence of liver metastasis, lung metastasis, or peritoneal dissemination. The serum carcinoembryonic antigen level was elevated at 5.1 ng/mL. A CT scan obtained 6 months ago showed no obvious signs of recurrence, and the disease progressed rapidly, with only enlarged lymph nodes. Therefore, we considered possibilities other than colorectal cancer recurrence, such as malignant lymphoma or small-cell lung cancer. Cervical lymph node biopsy detected adenocarcinoma, and the immunohistochemical examination results were consistent with lymph node recurrence of colorectal cancer. Although the patient received systemic chemotherapy, she died approximately 9 months after recurrence. Herein, we report a case of postoperative recurrence of sigmoid colon cancer diagnosed as a result of cervical and mediastinal lymph node metastasis, which is a relatively rare form of colorectal cancer recurrence.

A 66-year-old woman visited a local hospital complaining of abdominal pain and fever. Blood tests and abdominal computed tomography revealed perforation of the gastrointestinal tract due to sigmoid colon cancer and generalized peritonitis. The patient was referred to our hospital for emergency surgery. Preoperative computed tomography revealed a mass shadow in the left mammary gland and right lung fields. Breast ultrasonography revealed an 8 mm irregular mass in the left mammary gland; the mass was diagnosed as primary breast cancer through a needle biopsy. The lung tumor was diagnosed as primary lung cancer by bronchoscopic biopsy. 18F-fluorodeoxyglucose positron emission tomography revealed aortic lymph node metastasis of sigmoid colon cancer, peritoneal dissemination, liver metastasis, and splenic metastasis. Based on these findings, we diagnosed the patient with highly advanced simultaneous triple carcinoma with distant metastasis. This report describes a rare case of simultaneous cancers of the sigmoid colon, breast, and lung.

An 80-year-old woman with left breast cancer was treated with breast-conserving surgery. After 22 years, she visited our hospital with a chief complaint of bloody secretion from left nipple. A biopsy showed ductal carcinoma, and she was diagnosed with nipple recurrence of breast cancer. She underwent total mastectomy of left breast, and final pathological examination diagnosed ductal carcinoma in situ. Adjuvant therapy was not performed, and the she is currently recurrence-free 6 months after surgery. A single recurrence in the nipple area more than 20 years after breast-conserving surgery is rare, but a good prognosis is expected. Adequate treatment strategies for late recurrence are important.

This report describes the case of a 99-year-old woman with abnormal bowel movements and bloody stools. The patient had visited her previous doctor and was diagnosed with rectal cancer. Lower gastrointestinal endoscopy revealed a semi-peripheral type 2 tumor of the Rb. The patient was diagnosed with Stage Ⅰ rectal cancer(cT2N0M0)and underwent robot-assisted low anterior resection(Hartmann's procedure). The patient had a good postoperative course and was discharged on postoperative day 9. Elderly persons are often high-risk candidates for surgery due to preoperative frailty and comorbidities. Therefore, the indications for surgery and the choice of surgical procedure should be determined based on a comprehensive evaluation of the patient's operational tolerance, risk of complications, postoperative quality of life, and curative potential. Here, we describe the case of a super-elderly patient with rectal cancer who underwent robot-assisted surgery.

A 70-year-old woman was admitted to the hospital with incomplete defecation. Colonoscopy and abdominal computed tomography revealed a submucosal tumor of >50 mm in diameter in the lower rectum. The biopsy specimen was positive for CD34 and c-kit. Based on these findings, the tumor was diagnosed as a gastrointestinal stromal tumor(GIST). We decided to administer neoadjuvant therapy with imatinib mesylate(IM)because we considered that the tumor was too large to remove without tumor perforation. After 28 weeks of administering neoadjuvant therapy, the tumor size was reduced by 40%. Robot-assisted intersphincteric resection and temporary ileostomy were performed without tumor perforation. The patient survived without recurrence for 8 months after the operation, followed by treatment with IM as adjuvant therapy. The present case suggests that neoadjuvant therapy with IM may be useful for locally advanced GIST.

A 35-year-old woman was diagnosed as triple-negative breast cancer(TNBC)by a core needle biopsy and referred to our hospital. She was diagnosed as cT2N3M1, cStage Ⅳ TNBC because of metastasis in the right axilla, supraclavicular and internal mammary lymph node, and the contralateral supraclavicular lymph node in addition to the primary tumor. No obvious visceral metastasis was observed. Immunohistochemical assay showed SP142 PD-L1-positive and CPS 10 or more by 22C3. The patient was started on atezolizumab+nab-paclitaxel(PTX)therapy, but progression disease(PD)was observed without obvious effect. Pembrolizumab+carboplatin+gemcitabine was started as second-line therapy, and the tumor achieved partial response(PR)but developed PD within 6 months. After that, she was administrated olaparib, but PD was observed, and after the therapy with PTX+bevacizumab, she is now treated with eribulin.

Breast cancer therapy based on the pathogenic variants of BRCA is entering a new era with the expanded use of olaparib in adjuvant chemotherapy. This study examined the timing of olaparib administration in patients with BRCA pathogenic sequence variant (PSV).

A 76-year-old man presented to our hospital with a chief complaint of pain in the right quadriceps. Various imaging tests revealed suspected peritoneal dissemination in gallbladder carcinoma. In October 2021, the patient underwent laparoscopy and a disseminated nodule was sampled. The patient was diagnosed with Stage Ⅳ gallbladder cancer. Histopathological examination revealed an adenocarcinoma classified as clear cell carcinoma. No neoplastic lesions were found in other organs, consistent with a primary gallbladder origin. The patient had received chemotherapy(GEM+CDDP)for approximately 1 year. Although computed tomography(CT)showed marked shrinkage of the lesion, positron emission tomography/CT revealed distant metastasis to the xiphoid process. The treatment regimen was switched to GEM+S-1. Despite this adjustment, the disease worsened, and the patient succumbed to the illness 1 year and 8 months after surgery. We report this case along with a literature review owing to the rarity of clear cell carcinoma of the gallbladder.

A man in his 60s was referred to us because of weight loss and epigastric distress. Computed tomography revealed a 100 mm tumor in the pancreatic body and tail, which directly invaded the celiac, common hepatic, splenic, and left gastric arteries. Metastatic lymph nodes and peritoneal dissemination were also observed. The tumor had invaded the gastric wall, and an endoscopic biopsy of the stomach tumor was performed. Histologically, the tumor was diagnosed as a signet ring cell carcinoma with a poorly differentiated adenocarcinoma component. The patient was diagnosed with advanced pancreatic cancer(cT4N1bM1, Stage Ⅳ). Radical excision was not possible; therefore, chemotherapy was planned. He initially received 6 cycles of mFOLFIRINOX, followed by 6 cycles of GnP. Post-therapeutic imaging showed a reduction in the size of the primary pancreatic tumor, and the levels of tumor markers had markedly decreased. However, the tumor progressed again, and the patient died 14 months later. Signet ring cell carcinoma is a rare type of pancreatic cancer, with few reported cases worldwide. Here, we report a case of signet ring cell carcinoma with long-term survival in a patient with pancreatic cancer.

We report a case of conversion surgery after nivolumab treatment and chemotherapy for metastatic gastric cancer. An 81-year-old man was diagnosed with advanced gastric cancer with enlarged para-aortic lymph nodes and FDG uptake on positron emission tomography. The patient was diagnosed with unresectable gastric cancer and received nivolumab and SOX therapy. After 7 courses of chemotherapy, the primary lesion disappeared with scarring and the para-aortic lymph nodes were reduced. Consequently, we performed a radical gastrectomy with D2 and para-aortic lymph node dissection as a conversion surgery. Histopathological results revealed a complete pathological response in both the primary lesion and lymph nodes, including the para-aortic lymph nodes. The patient did not receive any postoperative adjuvant chemotherapy and has been recurrence-free for 8 months.

The patient, a 70-year-old post-menopausal woman diagnosed with cT2N0M0, Stage ⅡA, triple-negative breast cancer (TNBC), received neoadjuvant chemotherapy consisting of carboplatin, paclitaxel, and pembrolizumab. After 3 courses of chemotherapy, the patient experienced diarrhea over 10 times per day. The stool culture was negative for CD and cytomegalovirus antigens. A histological examination of the sigmoid colon and rectum using needle biopsy revealed lymphocytic infiltration of epithelial cells, apoptosis, and collagen band thickening, consistent with irAE-induced enteritis. We diagnosed diarrhea and colitis due to irAE and treated the patient with high-dose steroids according to the NCCN treatment guidelines. The diarrhea and fever resolved rapidly following steroid administration. Lymphocytic infiltration, apoptosis, and collagen bands in the epithelial cells of the biopsied mucosa are critical for diagnosing irAE-induced enteritis. PD-1-associated enterocolitis is rare, with laboratory findings often revealing only minor changes in the early disease stages. Diarrhea worsens if treatment is delayed, underscoring the importance of early diagnosis and prompt initiation of steroid therapy.

The patient was a 38-year-old premenopausal woman. Under the diagnosis of left breast cancer with cT2N3cM1(OSS), Stage Ⅳ, Luminal B like, we started treatment with anastrozole, leuprorelin, abemaciclib and denosumab. Two months after starting treatment, headache and nausea were observed. A contrast-enhanced MR scan of the head showed 2 brain metastases measuring 3 mm in the right frontal lobe and 7 mm in the left frontal cortex. Radiotherapy and surgical resection were considered for the brain metastases. However, due to the possibility of neurological complications and the short time since abemaciclib was administered, the patient was continued on the same treatment until the efficacy of the treatment was determined. Three months after restarting treatment, an MRI of the head showed that the brain metastases had disappeared. The primary tumor had shrunk and some of the lymph nodes were obscured. Fifteen months has passed since the brain metastases disappeared, but no new lesions have been observed and the patient continues to receive abemaciclib therapy. Abemaciclib has been shown to cross the blood-brain barrier. It also has a longer intracerebral retention time than other CDK4/6 inhibitors. Combination therapy with abemaciclib may be a useful treatment option for HR-positive, HER2-negative breast cancer with brain metastases.

The patient was a woman in her 80s with a history of atrial fibrillation at age 80, and catheter ablation and pacemaker implantation for sinus bradycardia. Her chief complaint is a left lateral breast mass. A pacemaker was implanted subcutaneously in the caudal left subclavian region, and palpation revealed a 20 mm-sized elastic hard mass in the left D area. On close examination, she was diagnosed as HER2-enriched invasive ductal carcinoma of the breast, T1cN0M0, cStage Ⅰ. The surrounding fatty tissue was preserved without exposing the pacemaker, and a subtotal left breast resection plus sentinel lymph node biopsy was performed, with additional axillary lymph node dissection due to positive metastasis. Intraoperative pacemaker monitoring was performed and no trouble was observed. The patient was discharged on the 6th postoperative day without complications. Pathology results showed pT2pN2aM0(7/16), pStage ⅢA. Postoperatively, the patient is scheduled to receive radiation to the chest wall without a pacemaker and chemotherapy.