A 58-year-old man was treated with radical excision for rectal cancer. Pathological findings were pT3N1M0, Stage ⅢB, RAS: mutant, BRAF: mutant, MSS. The patient was followed up without adjuvant chemotherapy. Eight months after surgery, a CT scan showed recurrence of liver metastases, and chemotherapy was started. The patient was started on regorafenib as the fourth-line therapy for multiple liver metastases, distant lymph node metastases, and peritoneal dissemination. Twenty-three days after the first course, he developed severe abdominal pain and visited the emergency department on day 25. Suspecting generalized peritonitis due to perforation of the upper gastrointestinal tract, he was treated with emergency laparotomy and drainage. A perforation was found in the anterior wall of the lower gastrointestinal body and was sutured closed. There were no adverse events, and the patient was discharged on the 21st postoperative day. regorafenib is a multi-kinase inhibitor, and gastrointestinal perforation has been reported as a serious adverse event, although it is rare. We report a case of upper gastrointestinal perforation during regorafenib administration, with some discussion of the literature.

The patient was a 60-year-old woman. She was diagnosed with hypertension, symptomatic epilepsy, renal failure, and cerebral infarction. During follow-up, she was found to have a mass in her left breast and was referred to our department. An irregular mass measuring 5 cm in diameter was palpated in the C region of the left breast. Multiple enlarged lymph nodes, thought to be metastases, were also palpated in the ipsilateral axillary lymph nodes. A needle biopsy revealed invasive ductal carcinoma, ER positive, PgR positive, HER2 negative, Ki-67 12%. A systemic examination revealed bone metastasis. Surgery was not possible due to comorbidities, so fulvestrant(500 mg/month)+denosumab(120 mg/month)was started. Furthermore, as the tumor markers were elevated, abemaciclib(300 mg/day)was added, which resulted in a decrease in the tumor markers. After 1 month of administration, grade 3 neutropenia was observed, so the dosage was reduced to 200 mg/day. During the course of treatment, the tumor markers rose again, so the dose was increased to 250 mg/day, which resulted in a decrease in the tumor markers and good tolerability. At present, 36 months after the start of treatment, long SD has continued, no adverse events of grade 3 or higher have been observed, and the drug has been well tolerated.

We report 2 cases of early breast cancer treated with adjuvant S-1 plus endocrine therapy. In case 1, a 70-year-old woman was diagnosed with right breast cancer and underwent partial mastectomy. The histopathological diagnosis was invasive ductal carcinoma(solid type), positive for estrogen receptor(ER)and progesterone receptor(PgR), negative for HER2/neu. The Ki-67 labeling index was 14%. The diameter of invasion was 27 mm, no lymph node metastasis was observed, and we confirmed the diagnosis as pT2N0M0, Stage ⅡA. A venous invasion was observed and the histological grade was Ⅱ. In case 2, a 53-year-old woman was diagnosed with left breast cancer and underwent lumpectomy. The histopathological findings showed a solid-tubular carcinoma, characterized by ER-positive, PgR-positive, HER2-negative. The Ki-67 labeling index was 24%. The tumor had an invasion of 20 mm and was diagnosed as Stage Ⅰ early-stage cancer, but there were some venous invasions and the histological grade was Ⅲ. We judged that both patients were at intermediate risk of recurrence and administered S-1 in addition to endocrine therapy. Even in cases without axillary lymph node metastasis, this combination of S-1 with endocrine therapy was considered to be a useful treatment option if the criteria of the POTENT trial were met.

A 59-year-old man presented with abdominal mass and weight loss. Computed tomography revealed a 20 cm mass in the vicinity of the left kidney. A tumor biopsy was performed and diagnosed with leiomyosarcoma. We performed tumor resection. The tumor invaded the surrounding tissues, and a lumpectomy with resection of the left kidney and left adrenal gland was performed. Pathologically, there was a slight suspicion of tumor exposure, so radiotherapy was administered to the dissected surface. There was no evidence of local recurrence or metastasis after 12 months.

The patient was a 47-year-old woman. She had been aware of abdominal distension for several months and visited our hospital. Contrast CT revealed a 30 cm tumor with uneven contrast effect. MRI showed uniform low signal intensity on T1 weighted images and a mixture of low and high signal intensity on T2 weighted images. She was diagnosed with a giant ovarian tumor and underwent surgery at the gynecology department. Laparotomy revealed that the tumor originated in the small intestine mesentery rather than the ovary, and she was referred to our department during surgery. The tumor had involved the ileocolic artery and vein, and was removed by right hemicolectomy. The specimen was 32×32×27 cm and weighed approximately 8 kg. Histopathological examination showed proliferation of spindle cells. Immunohistochemistry showed negative staining for c-kit and positive staining for β-catenin. The tumor was diagnosed as an intra-abdominal desmoid tumor. Intra-abdominal desmoid is a rare disease, and diagnosis and surgical procedure are often difficult. We report a case of resection of a giant mesenteric desmoid tumor with a review of the literature.

[Objective]To clarify the effect of immunotherapy on unresectable gastric cancer. [Subjects and methods]The study included all 67 patients with gastric cancer cStage ⅣB treated with systemic chemotherapy at Yarita Hospital between January 2016 and December 2022. The following 2 groups were compared: early patients treated between 2016 and 2017 and late patients treated between 2018 and 2022. [Results]Nivolumab was used in 20 patients(30%), and there were no cases of discontinuation due to irAE. The median overall survival was 11 months(0-91 months), with a duration of 13 months in the early group and 8.5 months in the late group(p=0.02). The transition rate to the third-line or later treatments increased from 6 of 27 patients(22%)in the early group to 13 of 40 patients(33%)in the late group(p=0.02). [Discussion]For patients evaluated in this study, the first and second treatment courses were introduced in the short-term, with the hope of subsequent treatment, even for patients with large ascites, poor PS, or complications. In recent years, drugs for the fourth-line and later treatments have been introduced, and we have observed patients for whom the latter treatment was effective.[Conclusion]The transition rate to the third-line or later treatments of patients with unresectable gastric cancer is increasing.

A 66-year-old man underwent endoscopic mucosal resection(EMR)for a polyp located in the rectosigmoid(RS)region. The pathological findings was tub1, T1a, ly0, v0, HM0 and VM0, and there were no factors indicating the need for additional treatment. Four years following the EMR procedure, a contrast-enhanced CT scan revealed an enlarged lymph node exhibiting contrast enhancement in the area of #252 lymph nodes. The patient was diagnosed with recurrent cancer, and laparoscopic high anterior resection with D3 dissection was performed. The patient had a good postoperative course and was discharged from the hospital on the seventh day after the surgery. The pathological diagnosis was a recurrence of rectal cancer characterized by an extramural tumor nodule without involvement of lymph node structures. Four courses of CAPOX were administered as adjuvant chemotherapy, and there has been no recurrence observed 2 years and 6 months after the surgery. The recurrence rate for endoscopically resected pT1a rectal cancer with no additional treatment considerations is relatively high, at 6.3%. Therefore, we consider that it is important to follow up the patient closely.

An 80-year-old man underwent laparoscopic distal gastrectomy, D2 lymphadenectomy, and Billroth Ⅰ reconstruction for gastric cancer. The short gastric artery and vein were completely preserved. The patient developed a fever on the second postoperative day, and a blood test on the third day showed high inflammation findings, and contrast-enhanced CT scan revealed decreased gastric wall blood flow of the anal side of the remnant stomach. When contrast-enhanced CT was performed again 7 days after the surgery to re-evaluate the condition, there was no improvement in the decreased blood flow in the remnant stomach, so the diagnosis of remnant gastric necrosis was made. Total remnant gastrectomy, Roux-en-Y reconstruction were performed. Histopathologically, the remnant stomach was found to have full-thickness necrosis on the anal side. The stomach has a well-developed intramural blood flow network, so blood flow disorders in the remnant stomach is rare. However, there are individual differences in the blood flow network within the gastric wall, and if decreased blood flow is suspected, ICG fluorescence imaging should be performed and consideration should be given to changing the surgical method to additional gastrectomy or total gastrectomy.

We report encapsulated papillary carcinoma and mucinous carcinoma in a case of local advanced bilateral breast cancer. The patient was 78-year-old woman who had bilateral breast tumor. The right palpable tumor was 6 cm in diameter and left tumor was 7 cm in a diameter. Ultrasonography revealed a low echoic mass in both side breast. A core needle biopsy was performed for the bilateral tumor. Pathological diagnoses were suspicious of papillary carcinoma(right side), mucinous carcinoma(left side). She underwent a bilateral total mastectomy and sentinel lymph node biopsy. The final permanent pathological diagnoses were encapsulated papillary carcinoma(right side)and mixed type mucinous carcinoma(left side). After operation, she was administrated an aromatase inhibitor. The patient has been well and remained disease-free during a follow-up period of 1 years. The surgical excision was useful for locally advanced breast cancer patients who were possible to perform operation.

An 88-year-old man was referred to our hospital for further examination of an asymptomatic liver tumor. MRI showed low-intensity regions on T1-weighted images, high-intensity regions on T2-weighted images, high-intensity regions on diffusion-weighted images, and low-intensity regions in the arterial, portal, and hepatocyte phases of Gd-EOB-DTPA. PET scan of the tumor was positive, while endoscopy exhibited no malignant findings. The CT and MRI findings showed that the tumor could be a metastatic liver tumor, cholangiocellular carcinoma, or hepatic inflammatory pseudotumor. Considering the possibility of a malignant tumor, laparoscopic partial hepatectomy was performed as a diagnostic treatment. The patient was discharged on the 8th postoperative day. The histopathological diagnosis was diffuse large B-cell lymphoma. Since the lesion was localized to the liver, a diagnosis of malignant lymphoma originating from the liver was made. Six courses of R-THP-COP therapy were administered. No indication of recurrence was noted 18 months after surgery. Although primary hepatic lymphoma is difficult to diagnose, laparoscopic hepatectomy allows for an accurate diagnosis and early postoperative recovery, enabling rapid administration of chemotherapy.

A 77-year-old man underwent a right hemihepatectomy for hepatocellular carcinoma in 2002. The patient remained alive without recurrence for 17 years after surgery. In September 2019, he was diagnosed with a tumor in the lower lobe of the right lung by follow-up CT. A partial right lung resection was performed in February 2020. Histological and immunohistochemical staining confirmed the recurrence of a previous hepatocellular carcinoma. Late lung cancer recurrence after radical hepatectomy is rare. Here, we report a case of hepatocellular carcinoma relapse in the lungs 17 years after liver resection.

An 80-year-old woman presented to our hospital complaining of nausea and abdominal distention. An abdominal computed tomography scan revealed wall thickening of the small intestine, a dilated oral intestinal tract, swollen intra-abdominal lymph nodes, and splenomegaly. Moreover, the soluble interleukin-2 receptor level was increased at 2,120 U/mL. Accordingly, we diagnosed the patient with a small bowel obstruction due to malignant lymphoma of the small intestine, for which we performed a laparoscopy-assisted partial resection of the small intestine after decompression. The resected specimen was pathologically diagnosed as diffuse large B-cell lymphoma. The patient's general condition recovered rapidly after laparoscopic surgery, and her clinical course proceeded smoothly to the initiation of chemotherapy(R-CHOP)at the Department of Hematology. The tumor remains in remission now. Here, we report a case of laparoscopic surgery for malignant lymphoma of the small intestine that caused bowel obstruction due to luminal narrowing along with a relevant literature review.

An 82-year-old woman, who underwent a mastectomy for right breast cancer 35 years ago, presented to our hospital with a chief complaint of general malaise and dyspnea. A chest CT scan revealed a right pleural effusion and multiple bone metastases. Upper gastrointestinal endoscopy revealed a small bulge in the mid gastric fold, which was diagnosed as a metastatic breast cancer lesion, based on pathological diagnosis and immunostaining findings. The patient had triple-negative breast cancer and was started on docetaxel therapy despite her advanced age. The pleural effusion disappeared, tumor marker levels normalized, and treatment was continued. Here, we report a case of late recurrence of breast cancer with gastric metastasis 35 years postoperatively.

The patient was a 73-year-old man who had undergone surgery for gastric cancer in January 2020 and was subsequently attending an outpatient clinic. In May, he presented with right upper abdominal pain. A computed tomography (CT) scan revealed an intraparenchymal rupture of a pseudoaneurysm in a segmental branch of the hepatic artery, and a transcatheter arterial embolization was performed. A follow-up CT scan in August showed a tumor in the same area. Retrospectively, the pseudoaneurysm in the segmental branch of the hepatic artery, which had experienced intraparenchymal rupture, was identified as the feeding artery for the tumor. In October, a right hepatic lobectomy was performed. Pathological examination confirmed a diagnosis of poorly differentiated hepatocellular carcinoma (HCC). This case highlights a rare instance of HCC causing intraparenchymal rupture.

A 33-year-old man was diagnosed with acute myeloid leukemia (AML). He was treated with daunorubicin and cytarabine and achieved complete remission. He underwent consolidation therapy with three cycles of venetoclax and azacitidine (VEN+AZA). He received cord blood transplantation following a reduced-intensity conditioning (RIC) regimen. After 19 months, an extramedullary mass appeared in the paranasal sinuses along with vision loss, and relapsed AML was diagnosed based on a biopsy. Palliative irradiation was performed because the patient did not wish to receive a second transplantation. A painful extramedullary mass was found in the inguinal area, and radiation therapy was performed. Subsequently, extramedullary masses appeared in the submandibular region, but radiation therapy was not feasible because the irradiation field overlapped with that of the previous therapy. The extramedullary masses decreased after two cycles of VEN+AZA therapy. This is a rare report of VEN+AZA therapy for an extramedullary relapse of AML.

Primary central nervous system lymphoma (PCNSL) is a B-cell lymphoma confined to the CNS. In general, early initiation of treatment after diagnosis is considered to be associated with improved prognosis in patients with malignancy. However, the prognostic impact of the time from diagnostic brain biopsy to initiation of treatment in patients with PCNSL remains unclear. In this study, we retrospectively analyzed how time from diagnostic biopsy to rituximab-containing treatment correlated with prognosis in 19 patients with PCNSL. Patients with a better prognostic score defined by age and performance status at diagnosis tended to have a better prognosis if chemotherapy was initiated sooner after brain biopsy. In conclusion, earlier chemotherapy initiation after brain biopsy and definitive diagnosis should be considered in the treatment of PCNSL.

We report the case of a 46-year-old Japanese woman diagnosed with Stage Ⅳ right breast cancer, cT1cN1M1(ovarian and peritoneal metastases). We administered bevacizumab+paclitaxel as the first-line treatment. In the 13th course, the peritoneal dissemination progressed, and the regimen was changed to eribulin(1.4 mg/m2)as the second-line treatment. During the second course, abdominal distension developed and was resolved during follow-up. However, abdominal distension and pain were observed from day 9 of the fourth course. Based on the results of blood chemistry and CT scans, she was diagnosed with acute pancreatitis(CT Grade 1)and was admitted to the hospital. After fasting and fluid replacement therapy, her clinical symptoms and laboratory data improved, and was discharged from the hospital 8 days later. She had no history of excessive alcohol consumption and no evidence of biliary disease, and was considered having eribulin-induced pancreatitis.

A 57-year-old man visited our hospital due to abnormal chest X-ray findings. Chest computed tomography(CT)showed amalgamated beaded solid nodules in the right upper lobe of the lung. Lobectomy of the right upper lobe was performed and the nodule was histologically determined to be seminoma. Positron emission tomography(PET)-CT showed high 18F-fluorodeoxyglucose(FDG)uptake in the lung nodules and faint uptake in the left testicle. As ultrasound and palpation detected no tumor in the testes, consent to perform orchiectomy was not obtained. Considering the PET-CT findings, we diagnosed testicular seminoma with solitary pulmonary metastasis, which is extremely rare.

Colorectal villous tumors secrete large amounts of mucus that can cause electrolyte abnormalities and dehydration, a condition known as electrolyte depletion syndrome. A woman in her 70s, who had been underweight for 10 years with a body mass index(BMI)of 16, was admitted to our hospital with electrolyte abnormalities, renal disorders, and rectal tumors. The electrolyte abnormalities and renal disorders were corrected relatively quickly with supplemental fluid therapy. Notably, 1,000 g of mucus stool per day was observed; subsequently, a lower gastrointestinal endoscopy revealed a circumferential villous tumor in the Rb of the rectum, which was biopsied and diagnosed as rectal cancer and electrolyte depletion syndrome. The patient was temporarily discharged from the hospital; however, several days later, the electrolyte abnormalities and renal disorders recurred. The patient was readmitted to the hospital and underwent robot-assisted Hartmann's surgery after improvement of the general condition of the patient. Postoperative pathology revealed papillary adenocarcinoma with SM depth, and the patient progressed without recurrence or relapse of electrolyte depletion syndrome.

A 63-year-old woman was admitted to our hospital with suspected appendicitis. Abdominal CT revealed an enlarged appendix, and findings consistent with some small nodules. She was diagnosed with appendicitis and successfully treated with antibiotics. Contrast-enhanced CT performed 2 months after discharge revealed a reduction in small nodules, and tumor markers were not elevated. Therefore, we concluded that this case was unlikely to be an appendiceal tumor. Interval appendectomy was performed laparoscopically, and histopathological analysis revealed a low-grade appendiceal mucinous neoplasm(LAMN). Herein, we present this case and review the relevant literature.