The patient was a 79-year-old male in whom a neoplastic lesion was found in the sigmoid colon diverticulum during a follow-up colonoscopy for colorectal adenoma. Endoscopic treatment was difficult, and the patient was referred to our department for surgery. The patient had many underlying diseases, including angina pectoris, interstitial pneumonia, and diabetic nephropathy, and the decision was made to perform local resection as a minimally invasive treatment. The patient was treated with laparoscopic excision of the sigmoid colon, followed by a small laparotomy and intraoperative endoscopy to open the colon for local resection. Pathology results showed a 5 mm pTis with R0 resection. Early-stage cancer of the diverticulum is often difficult to treat endoscopically due to the limited space available for manipulation. Local excision, as a minimally invasive treatment, is also a useful option when several underlying diseases are present, as in this patient.

A 51-year-old woman underwent sigmoidectomy and ileostomy for perforated sigmoid colon due to cancer 1 year and 9 months prior to being admitted to our hospital with a complaint of abdominal pain following chemotherapy. Abdominal computed tomography showed multiple small intestine obstructions owing to retro-peritoneal recurrence of colon cancer. It was the difficult that the improvement of multiple small intestine obstruction of with the ileus tube and underwent open surgery. Intraoperative findings showed that the small mesentery was difficult to elevate due to retroperitoneal infiltration. There was intestinal stenosis at multiple sites. The intestinal tract, including the stenosis sites, from approximately 60 cm from the Treitz ligament to the end of the ileum was removed, and jejunal transverse colon bypass was performed. The clinical course was orally ingested and she was discharged from the hospital 54 days after surgery. Multidisciplinary treatment, including palliative surgery, contributed to the improvement of the patient's quality of life.

A 62-year-old man was diagnosed with unresectable locally advanced pancreatic cancer and was treated with mFOLFIRINOX for 9 months. Despite the tumor remarkable shrinkage, the contact with the nerve plexus around the SMA was not diminished. After confirming no distant metastasis with staging laparoscopy, radiotherapy with S-1 was performed. However, even after chemoradiotherapy, CT findings around the SMA showed no significant changes. Eleven months after the initial treatment, conversion surgery was conducted. The nerve plexus was successfully separated from the artery, allowing for a curative resection via pancreaticoduodenectomy. The histopathological findings revealed no residual cancer cells, and post-treatment classification was complete response. The patient remained healthy with no recurrence for over 13 months since the surgical resection. Preoperative CT findings sometimes suggest residual cancer around the nerve plexus even after treatment. However, as this case shows, the suspicion of residual cancer on imaging sometimes reveals no residual cancer, and the final decision may be determined by surgical resection.

We have administered FOLFOXIRI plus bevacizumab as preoperative chemotherapy for patients with advanced rectal cancer and have experienced difficulties in securing circumferential resection margins(CRMs)of 1 mm. This study included 13 patients with advanced rectal cancer who underwent surgery after receiving preoperative chemotherapy(FOLFOXIRI plus bevacizumab)at our hospital between January 2018 and July 2023. Eight patients(61.5%)had neutropenia of CTCAE Grade 3 or higher. The response rate to preoperative chemotherapy was 92.3%(SD in 1 patient, and PR in 12 patients), and pathological evaluation revealed pCR in 2 patients(15.3%). Postoperative recurrence of distant metastasis was observed in 2 patients(1 in the lung and 1 in the liver), both of whom underwent resection of the metastatic sites and are currently alive. Preoperative FOLFOXIRI plus bevacizumab therapy for advanced rectal cancer is considered a useful treatment for patients with advanced rectal cancer who have difficulty achieving a CRM of 1 mm.

A 75-year-old female patient presented to our hospital with a chief complaint of anemia and leg edema caused by poor nutritional status because of difficulties in oral intake. Computed tomography imaging revealed no evidence of distant metastasis, and the tumor was considered to be curatively resectable. However, as the patient was malnourished owing to difficulty in oral intake caused by gastrointestinal stenosis, we used neoadjuvant chemotherapy to avoid the risk of perioperative complications. Six courses of S-1+cisplatin were administered. After initiating chemotherapy, the gastrointestinal obstruction of the patient improved rapidly. She was able to take oral feedings, and her nutrition status improved. Thereafter, distal gastrectomy(Roux-en-Y reconstruction)was performed. The patient had a good prognosis with no perioperative complications and was discharged on postoperative day 20.

The patient is a 41-year-old woman. She had been regularly visiting our hospital for follow-up of primary biliary cirrhosis and gallbladder polyps, but was referred to the Department of Surgery for surgery because the polyps tended to enlarge in size. Abdominal CT showed a 10 mm-sized polyp with early contrast in the body of the gallbladder, and T2-weighted abdominal MRI showed a signal defect in the gallbladder lumen consistent with a polyp, but a qualitative diagnosis was difficult. Laparoscopic cholecystectomy was performed for diagnostic and therapeutic purposes. The macroscopic findings of the resected specimen showed a 12 mm-sized papillary lesion in the body of the gallbladder, which was diagnosed as a low-grade intracystic papillary neoplasm (ICPN) on histopathologic examination. No invasion was observed and the margins were negative. ICPN is a recently defined disease that is considered similar to intraductal papillary neoplasm of bile duct (IPNB), which develops in the gallbladder. Although most of them are diagnosed with cancer, we report a rare case of IPNB without cancer.

A 66-year-old man referred to our department due to liver dysfunction, and a close examination revealed wall thickening of the common hepatic duct and a tumor localized in the hepatic S8. Bile duct and liver biopsies resulted in a diagnosis of duplicate perihilar cholangiocarcinoma and hepatocellular carcinoma. Based on the evaluation of the tumor progression, we judged that both tumors could be curatively resected by right hepatectomy plus extrahepatic bile duct resection, and the patient was decided to undergo a primary resection. The postoperative course has no complications, and the final pathology confirmed the above diagnosis. Although there have been many reports of duplicate cancers in patients with risk factors such as a history of hepatitis virus or pancreaticobiliary malunion, it is rare for multiple cancers to originate in the hepatobiliary tract without such risk factors as in this case. In addition, the diagnosis of duplicate cancers requires proof that each cancer did not metastasize from the other and that there is no continuity. In this case, there was no clear continuity and biopsy showed that the tumor was not metastatic lesion from the other, so we could make a preoperative diagnosis of duplicate cancers. When multiple lesions are found, it is important to perform a thorough examination with the possibility of duplicate cancers in mind, and to perform an appropriate surgical resection in consideration of invasiveness.

The 12th edition of the Management of Esophageal Cancer guidelines recommends a regimen that includes immune checkpoint inhibitor(ICI)therapy as the primary treatment for Stage ⅣB esophageal cancer, which increases the number of treatment options. Surgical intervention at the appropriate time may improve patient prognosis. Here, we describe 2 cases of conversion surgery for patients with Stage ⅣB esophageal cancer who were successfully treated with ICI therapy. The number of patients for whom ICI can be incorporated into multimodal treatments and conversion surgeries is expected to increase in the future.

Hepatectomy is recommended for colorectal liver metastases and repeat resection of recurrent lesions is an effective treatment for patients with recurrence. However, treatment outcomes are unclear in patients with aggressive tumor behavior.

We report 2 pathological complete response (pCR) cases of neoadjuvant UDON(5-fluorouracil, docetaxel, and nedaplatin)therapy without any adverse events in advanced esophageal squamous cell carcinoma. One patient was a 58-year-old man. He complained of dysphagia and was diagnosed with advanced mid-thoracic esophageal cancer (Mt, SCC, cT3rN1M0, cStage Ⅲ). After 3 courses of UDON therapy without any adverse events, mediastinoscopic radical esophagectomy was performed without any postoperative complications. The second patient was a 72-year-old man. Advanced esophageal cancer (Mt, SCC, cT3rN0M0, Stage Ⅱ)was detected during treatment for ischemic heart disease. After 2 courses of UDON therapy without any adverse events, including cardiac events, mediastinoscopic radical esophagectomy was performed without any postoperative complications. UDON therapy, which is similar to DCF(docetaxel, cisplatin, and 5-FU)therapy, comprises divided doses of docetaxel and nedaplatin, which minimizes adverse effects on the bone marrow, heart, and kidneys. UDON therapy may be a safe and effective regimen and a reasonable and recommended choice for older and high-risk patients with advanced esophageal cancer.

Primary bone marrow lymphoma (PBML) is a malignant lymphoma characterized by proliferation of lymphoma cells exclusively in the bone marrow without lymphadenopathy. Despite the dismal prognosis of PBML, it is a very rare lymphoma with limited evidence concerning its pathophysiology, making accumulation of cases important. We herein report three cases of PBML at our institution. The first patient was an 80-year-old man who presented with hemophagocytic syndrome and pancytopenia at admission, and died of septic shock during initial chemotherapy. The second patient was a 64-year-old man who achieved complete remission with intensive chemotherapies, but relapsed shortly after completing the final chemotherapy course. The third patient was a 66-year-old woman who underwent chemotherapies and allogeneic hematopoietic stem cell transplantation, only to relapse shortly after transplantation. Although early intervention with chemotherapy is essential for PBML treatment, diagnosis of PBML is very challenging due to the absence of lymph node involvement. Moreover, treatment outcomes of existing chemotherapy and transplantation therapies for PBML are still poor. Further accumulation of cases and development of new treatment strategies are desirable.

We report a case of testicular cancer after kidney transplantation in a 29-year-old man. Twenty-two years after the surgery, computed tomography (CT) showed a retroperitoneal mass 3 cm in diameter. Positron emission tomography (PET) -CT revealed high FDG uptake in both the right testis and retroperitoneal mass. Regarding serum tumor markers, α fetoprotein (AFP) was slightly elevated to 12.5 ng/ml. He underwent right radical orchiectomy, and pathological examination revealed pure seminoma. After surgery, the serum AFP level remained high (12. 9 ng/ml), and we initially considered this nonseminoma patient to have a good prognosis according to International Germ Cell Consensus Classification. During three cycles of a combination regimen including bleomycin, etoposide, and cisplatin (BEP), we performed adjustment of immunosuppressive therapy, treatment for Cytomegalovirus infection (valganciclovir hydrochloride), and that for other adverse events associated with systemic chemotherapy. The chemotherapy schedule was delayed, and bleomycin (third course, day 15) was skipped due to adverse effects. After 3 cycles of BEP, the retroperitoneal lymph node metastasis shrunk from 3.0 to 1.5 cm in diameter. In contrast to the good radiological response, the serum AFP level gradually increased during the treatment to 102.6 ng/ml. Therefore, we did not consider the AFP elevation to have derived from residual cancer, and decided to perform close follow-up. During the 3-year follow-up, AFP decreased to around 20 ng/ml, and PET-CT did not show any uptake in the retroperitoneal mass or other sites.

A 79-year-old woman underwent radical cystectomy after neoadjuvant chemotherapy for urothelial carcinoma of bladder (high grade, pT3aN0M0). Six months later, a computed tomography scan revealed multiple lung metastases. Salvage treatment with chemotherapy and pembrolizumab was administered, and a complete response was achieved. Two years after surgery, however, a left adrenal mass appeared, and positron emission tomography／computed tomography showed significant solitary uptake in the left adrenal gland. She underwent left adrenalectomy and histological findings revealed that the adrenal tumor was a metastatic urothelial carcinoma. No new lesion was observed over one year after surgery. Surgical resection should be considered in cases with solitary metastasis who responded systemic treatment.

Spinal extramedullary tumors are the most common types of schwannomas and meningiomas. Therefore, most spinal cord surgeons should safely perform surgeries for these tumors. The posterior approach with conventional laminectomy is sufficient for the safe resection of almost all spinal extramedullary tumors. However, for specific tumors, it is necessary to consider mechanical stress on the spinal cord during surgery, invasion of the surrounding tissues, and postoperative spinal instability. In addition, if part of the tumor is left behind, the risk of recurrence should be considered in the treatment strategy. This study aimed to understand the key anatomical features and surgical techniques to choose the optimal approach for spinal extramedullary tumors, including dumbbell-shaped schwannomas and ventral meningiomas, which require a safer and more secure surgical approach.

There are attempts to assess tumor heterogeneity by texture analysis. However, the ordered subsets-expectation maximization (OSEM) reconstruction method has problems depicting heterogeneities. The aim of this study was to identify image reconstruction parameters that improve the ability to depict internal tumor necrosis using a self-made phantom that simulates internal necrosis.

A 70-years-old man with metastatic hormone-sensitive prostate cancer received the apalutamide, an oral androgen receptor signaling inhibitor. On day10 after drug initiation, fever and skin rash appeared on his whole-body surface. He stopped taking the drug on day18 and skin symptoms temporarily improved about 7 days after discontinuation. However, on day 38, symptoms recurred, and the patient was admitted to the hospital as an emergency due to suspicion of Stevens-Johnson syndrome. Steroid pulse therapy was administered, and gradual improvement of the skin lesions was observed. With the widespread use of apalutamide in daily clinical settings, severe drug eruptions such as the present case may potentially increase, and further additive experiences are awaited.

A 35-year-old man visited a local doctor for continuing analysis of his infertility. Semen analysis revealed azoospermia while an ultrasonography detected a right testicular tumor with a diameter of 10 mm. A blood test was negative for tumor markers. Magnetic resonance imaging showed a 1-cm tumor in the right testis and atrophy of the left testis. A testicular tumor arising from a functional unilateral testis was discovered during infertility treatment for which the patient was referred to our hospital for fertility preservation. Right and left testicular volumes were 18 mL and 3 mL, respectively, and his serum testosterone level was 2.96 ng/mL. Noting the atrophy of the contralateral testicle, we proceeded with a rapid pathology diagnosis by partial testicular resection. If no evidence of tumor malignancy was found, the surgery would have been concluded with no further dissection. Since the patient was undergoing fertility treatment, the decision was made to take sperm from the extracted testicle to preserve his fertility, followed by orchiectomy. Because a seminoma was suspected through the rapid pathological diagnosis, the man eventually underwent higher orchiectomy and testicular sperm extraction. The final diagnosis was seminoma, followed by successful retrieval of a sufficient level of sperm. Post operative serum testosterone level was found to be 0.32 ng/mL, after which testosterone replacement therapy was introduced. Through rapid diagnosis of pathology, successful management and outcome were achieved in the case of testicular cancer combined with infertility.

We report the case of a 41-year-old man who presented with gross hematuria and a bladder tumor on ultrasonography. Magnetic resonance imaging indicated a possible muscle-invasive bladder cancer or urachal carcinoma. Following transurethral resection of the bladder tumor, histopathological findings revealed an adenocarcinoma similar to colorectal cancer. The patient was diagnosed with an urachal carcinoma in the urinary bladder dome. Since multiple lung metastases were observed on computed tomography, and his serum carcinoembryonic antigen level was 116 ng/dL, his final diagnosis was a stage IVb urachal carcinoma. He received 11 courses of mFOLOX6, and underwent a laparoscopy-assisted partial cystectomy and pelvic lymph node dissection. Pathological examination confirmed negative surgical margins, but remained tumor cells were confirmed. The patient continued mFOLFOX6 treatment for 12 months postoperatively, with no disease progression observed.

(Objective) This study aimed at evaluating the efficacy and safety of upfront docetaxel (DTX) treatment and androgen deprivation therapy (ADT) in male patients with high-volume metastatic castration-sensitive prostate cancer (HV-mCSPC). (Methods) This retrospective study was conducted using the medical records of 30 patients treated for HV-mCSPC by using upfront DTX treatment along with ADT at Atsugi City Hospital between December 2015 and December 2022. The patient characteristics, demographics, oncological outcomes, adverse events, and sequential therapy were evaluated. (Results) Thirty patients were included in the final analysis. The median patient age and prostate-specific antigen at diagnosis were 73 years (range, 53-83 years) and 250 mg/ml (range, 0.54-3,817 ng/ml), respectively. The completion rate of six cycles of upfront DTX treatment was 86.7%. The median progression-free survival was 24 months; the median overall survival was not reached, and the 5-year survival rate was 71.5%. Alopecia was the most frequent non-hematological adverse event (60%) followed by fatigue (53.3%). Overall, adverse events of grade 3 or higher occurred in 46.7% of the patients, with neutropenia being the most frequent. The incidence of neutropenia of grade 3 or higher was significantly lower in the group receiving primary prophylaxis with long-acting granulocyte colony-stimulating factor (7.7% vs. 75%, P = 0.009). Abiraterone was the most frequently administered sequential treatment in 12 patients (60%). (Conclusion) In the triplet combination treatment era, upfront DTX treatment and ADT for patients with HV-mCSPC was safe as primary prophylaxis for severe neutropenia and effective as an upfront treatment. However, it should be selected if its effectiveness is superior to triplet treatment considering adverse events, cost-effectiveness, and quality of life.

(Purpose) We performed a clinical retrospective study on the evaluation of pembrolizumab treatment results for advanced urothelial cancer in our hospital. (Materials and Methods) Twenty-seven patients diagnosed with advanced or metastatic urothelial carcinoma who received pembrolizumab between April 2018 and December 2021 were included. We retrospectively reviewed medical records to examine treatment outcomes, immune-related adverse event (irAE), and prognostic factors. (Results) The median age of patients was 76 years, and the median number of pembrolizumab doses was 6. The median overall survival was 8.8 months, and the best treatment response according to RECIST version 1.1 was complete response 1, partial response 7, stable disease 5, and progression disease 14. Pre-pembrolizumab risk factors related to overall survival include the presence of liver metastasis, LDH ≥200 IU/L, and TSH <4 μIU/mL in univariate analysis. Grade 3 irAE was type 1 diabetes in only 1 case, and grade 2 were hypothyroidism in 4 cases, type 1 diabetes in 1 case, interstitial pneumonia in 1 case, and skin disorder in 1 case. Nine patients had a TSH of 4 μIU/mL or higher at the start of pembrolizumab, and four of them had hypothyroidism requiring oral levothyroxine, and none of the patients in the low TSH group required hormone replacement (p =0.013). (Conclusion) High TSH level before pembrolizumab administration for advanced urothelial cancer was associated with hypothyroidism, suggesting the possibility of improved prognosis.