A 93-year-old woman was emergently admitted to our hospital diagnosed with femoral neck fracture. She had a previous history of undergoing laparoscopic right hemicolectomy for ascending colon cancer 2 years and 4 months ago, and blood examination showed severe anemia. Detailed inspection was then performed, and she was diagnosed as having local recurrence of previous ascending colon cancer. To prevent further bleeding, she underwent laparoscopic surgery. The tumor was located nearby hepatic flexure, and direct invasion to the duodenum and the Gerota's fascia was suspected. The region including recurrent tumor was carefully dissected from the surroundings enough to exteriorize, and the involved specimen was excised and reconstructed extracorporeally. She was discharged 16 days after surgery. Her performance status(PS)had been kept as same as preoperative condition since she died of progression of liver metastases. Although there are no definite treatment guidelines for local recurrence of colon cancer, surgery might be selected in technically resectable cases accompanied by some kind of symptoms. Laparoscopic surgery could be performed with low invasiveness, and afford big advantage even for patients with poor PS. Since surgeons can perform sophisticated dissection process by the magnified view provided by a laparoscope, safe laparoscopic surgery might be one of the candidates of effective approaches for the treatment of local recurrence of colon cancer.

An 83-year-old female was referred to our hospital because of bilateral lower extremity edema. Contrast-enhanced computed tomography(CT)showed an irregular mass, 7 cm in diameter, with central necrosis at the left renal hilum, infiltrating the left renal pelvis and ureteral junction with hydronephrosis. Magnetic resonance imaging(MRI)showed restricted diffusion at the tumor margin. Retroperitoneal tumor resection and left renal resection were performed. Although the tumor was close to the jejunum and the pancreas body and tail and spleen it could be separated from the tumor. The histopathological diagnosis was a solid tumor of spindle and polyrhomboidal cells with necrosis extending from the renal vein wall to the vascular lumen and adventitia. Immunohistochemical staining was positive for α-SMA and weakly positive for desmin. The diagnosis of leiomyosarcoma originating from the renal vein was made because of its continuity with the renal vein. Leiomyosarcoma accounts for 5-7% of soft tissue sarcomas and is the second most common retroperitoneal sarcoma liposarcoma. Sixty percent of vascular leiomyosarcomas originate from the inferior vena cava, while originating from the renal vein are rare. The patient has been free from recurrence and metastasis 1 year after surgery.

An 85-year-old man underwent robot-assisted total pelvic organ resection for advanced lower rectal cancer suspected infiltration of the prostate. The pathological diagnosis results were pT4b(prostate)N0M0, pStage Ⅱc. Post-operative complications included the onset of aspiration pneumonia on the fifth day after surgery, but the hospital stay of the patient was 43 days after surgery. With the recent trend of an aging society, the proportion of cancer patients over 85 years old has been steadily increasing. By examining the characteristics of colorectal cancer surgeries performed on patients aged 85 and older at our hospital, we confirmed that radical resection is beneficial even for older adults. We experienced a case of robot- assisted total pelvic organ resection for locally advanced rectal cancer in an elderly patient, and we will report this case with a literary discussion.

An 83-year-old man with a history of radical cystectomy and ileal conduit construction for bladder cancer, high anterior resection for rectal cancer, and partial hepatectomy for metastatic liver tumors presented with purulent discharge from the perineal region. Abdominal CT revealed gastrointestinal perforation and a pelvic abscess extending continuously to the perineum. Considering his poor general condition and terminal cancer status, a transverse colostomy and transperineal drainage were performed for symptom relief. His postoperative course was favorable, and he was discharged home on postoperative day 33. Transperineal drainage can be considered a feasible palliative treatment for pelvic abscesses extending to the perineum in patients with terminal cancer.

An 80-year-old woman with a history of lobectomy for small cell lung carcinoma(SCLC)presented with melena 2 years after surgery. Contrast-enhanced abdominal CT and enteroscopy revealed a bleeding tumor at the proximal jejunum. Partial small bowel resection was performed for hemostasis and diagnosis. Histopathology confirmed jejunal metastasis from SCLC. Due to advanced age and ongoing hemodialysis, no adjuvant therapy was administered. She remains recurrence-free 7 months postoperatively. Small intestinal metastasis from SCLC is rare, but long-term survival after resection has been reported. We report this rare surgical case of jejunal metastasis from SCLC with gastrointestinal bleeding.

An 81-year-old man was admitted with heart failure and severe anemia. He had undergone a right nephrectomy for renal cell carcinoma 25 years earlier. Abdominal CT revealed a transverse colon tumor. Colonoscopy showed a nearly circumferential lesion with submucosal tumor-like features. Laparoscopic transverse colectomy was performed, and the tumor was completely resected. Histopathological examination revealed a clear cell carcinoma consistent with recurrence of renal cell carcinoma. We report this rare case of late mesenteric recurrence 25 years after nephrectomy, along with a brief literature review.

A 70s-year-old woman was diagnosed with left breast cancer and underwent a left mastectomy(pT2N0M0, pStage ⅡA, estrogen-receptor negative and human epidermal growth factor-2 positive and BRCA negative). After surgery, adjuvant chemotherapy with trastuzumab and pertuzumab was administered. At 17 months postoperatively, multiple lung metastases and abnormal uptake in the pancreatic head on PET were detected. EUS-FNA was performed, and biopsy revealed a suspected invasive pancreatic ductal carcinoma. A diagnosis of primary pancreatic carcinoma was made, and subtotal stomach- preserving pancreaticoduodenectomy was performed. However, pathological examination revealed pancreatic metastasis from breast cancer. After surgery, chemotherapy with trastuzumab deruxtecan was administered. Eight months later, the lung metastases have disappeared, and the patient is currently under observation. We report a case of pancreatic metastasis following breast cancer surgery.

The patient is a woman in her 70s. Seven years after surgery for right breast cancer, she developed a recurrence in the mediastinal lymph nodes and started chemotherapy. However, the treatment was discontinued due to trastuzumab-induced cardiac dysfunction. During follow-up, cardiac function improved, but pericardial effusion was observed. Pericardiocentesis diagnosed pericardial metastasis of breast cancer. Approximately 1 month after the initial pericardiocentesis, reaccumulation of pericardial effusion was observed, necessitating a second procedure. However, the effusion recurred again within a short period. Due to the short time reaccumulation of pericardial effusion, surgical intervention or adhesion therapy was deemed necessary for the prevention of recurrence. Given the risk of further cardiac dysfunction from constrictive pericarditis associated with adhesion therapy, a thoracoscopic pericardial window procedure was selected. Postoperatively, no recurrence of pericardial or pleural effusion has been observed. We report a case of pericardial metastasis from breast cancer successfully managed with thoracoscopic pericardial window creation, achieving good control for over 1 year.

The patient was a female in her 80s. She had undergone Bp+SN for left breast cancer 18 years ago. This time, she was referred to our department because of suspicion of ipsilateral breast tumor recurrence. Breast ultrasound revealed a 15 mm mass in the CA area of left breast, and biopsy revealed IDC, ER+, PgR+, HER2-. The diagnosis was cT1cN0M0, Stage Ⅰ, and the treatment plan was Bt+SN. Preoperative lymphoscintigraphy revealed a single accumulation in the contralateral axillary lymph node. Surgery was performed using the dye method, and the ipsilateral axilla was searched, but no sentinel lymph node was found. However, 1 sentinel lymph node in the contralateral axilla that only had RI uptake was found. Rapid diagnosis was negative for metastasis, so axillary dissection was omitted. Contralateral axillary lymph node metastasis is classified as distant lymph node metastasis according to the breast cancer treatment guidelines. However, contralateral axillary lymph node metastasis observed at the same time as ipsilateral breast tumor recurrence may be treated as regional lymph node metastasis if it is considered to be the result of changes in lymphatic flow caused by the initial surgery.

Case 1:An 80-year-old man underwent laparoscopic low anterior resection and subtotal stomach-preserving pancreaticoduodenectomy with portal vein resection for rectal cancer and cholangiocarcinoma, respectively. After the operation, he complained of pain around his left shoulder and was pathologically diagnosed as cervical spine metastasis(C6)from cholangiocarcinoma. He requested only pain relief rather than aggressive medication and died 5 months after surgery. Case 2:A 66-year-old woman was diagnosed as initially unresectable locally advanced gallbladder cancer. She received 3 courses of chemotherapy with gemcitabine+cisplatin and underwent conversion surgery(S4a+S5 hepatic resection with extrahepatic bile duct resection, lymph node dissection and partial resection of duodenum). After the operation, she complained of lower limb paralysis and was diagnosed as thoracic spine metastasis(Th6)from gallbladder cancer. Her general condition was worsened rapidly due to the pain and she died 5 months after surgery. Since the prognosis is extremely poor, pain management is the essential of treatment to improve the QOL of patients with bone metastasis from biliary tract cancer.

The patient was a 64-year-old woman. She complained of intermittent right hypochondriac pain, and imaging tests showed that she had cholelithiasis and adenomyomatosis of the gallbladder. We decided to treat her surgically, and laparoscopic cholecystectomy was underwent. The removed gallbladder specimen showed a 2-3 mm elevated lesion in the mucosa of the gallbladder body. Histologically, the elevated lesion contained lymphoid follicle-like lymphocytes, with atrophic germinal centers inside and lymphocyte proliferation around the lesion. The proliferating cells were mainly positive for CD20 and CD79a, and positive for B cell markers. Based on the above, she was diagnosed with MALT lymphoma. She underwent resection alone, and has been free of recurrence or metastasis for 2 years since surgery. MALT lymphoma of the gallbladder is rare, does not have typical imaging findings, and preoperative diagnosis is difficult. This case reaffirms the importance of pathological examination of cholecystectomy specimens, as detailed pathological evaluation of the postoperative specimens leads to a diagnosis.

Port-site recurrence is a rare manner of recurrence specific to laparoscopic surgery. Herein, we report 2 cases of port-site recurrence after laparoscopic and robot-assisted surgeries for colorectal cancer at our institution. Case 1: A 57-year-old woman underwent laparoscopic ileocecal resection for cancer of the ascending colon. Thirty-seven months after the surgery, the patient presented to our hospital with a mass in the right lower abdomen. It was observed in the abdominal wall, corresponding to a port-insertion scar on the right lower abdomen. As no metastases to other organs were detected, en bloc excision of the abdominal wall tumor was performed. Pathological examination revealed metastatic adenocarcinoma from colon cancer; therefore, we diagnosed port-site recurrence. Case 2: A 74-year-old woman underwent robot-assisted lower anterior resection for rectal cancer. Eight months after surgery, liver metastasis was detected, and the patient underwent laparoscopic hepatectomy 14 months after the initial surgery, following chemotherapy. Twenty months later, contrast- enhanced CT revealed a mass in the abdominal wall corresponding to a port-insertion scar in the right abdomen. As no metastases to other organs were detected, en bloc excision of the abdominal wall tumor was performed. Pathological examination revealed metastatic adenocarcinoma from the rectal cancer; therefore, we diagnosed port-site recurrence.

An 75-year-old man was diagnosed with a 4-mm branch-duct type intraductal papillary mucinous neoplasm(IPMN)in the pancreatic tail and placed under observation. After 3 years and 6 months, endoscopic ultrasound(EUS)revealed a suspected pancreatic mass, prompting referral. Contrast-enhanced CT showed a 7-mm dilation of the main pancreatic duct without clear enhancing nodules. ERCP detected a 2-cm region with poor visualization of the branch ducts and ductal narrowing. MRCP revealed a faint high-intensity signal on diffusion-weighted imaging. EUS identified a 7-mm hypoechoic mass with irregular margins, and fine-needle aspiration(FNA)suggested atypical glands. The patient underwent a distal pancreatectomy with lymph node dissection. Histopathological examination revealed an IPMN extending 81 mm, with an invasive IPMN(IPMC)measuring 5 mm located 2 cm from the surgical margin. Three years and 4 months postoperatively, the patient remained recurrence-free. Recurrence is common when an IPMN progresses to invasive IPMC. This case underscores the challenges of preoperative diagnosis and is reported along with a brief literature review.

An 80-year-old man presented with fever and vomiting. Abdominal CT and upper and lower gastrointestinal endoscopy revealed ascending colon cancer with duodenal invasion, resulting in the formation of a duodenocolic fistula. The patient's general condition was poor, with an Eastern Cooperative Oncology Group-performance status(ECOG-PS)of 3, rendering the patient unsuitable for radical resection and chemotherapy. However, the patient strongly desired to resume oral intake and was discharged from the hospital. As a palliative measure, gastrojejunostomy and"separation surgery of the right-sided colon"were performed. No severe post-operative complications were observed. The patient was able to resume oral intake in combination with enteral nutrition via a feeding tube and was discharged 1 month after surgery. Gastrojejunostomy combined with"separation surgery of the right-sided colon"is considered a safe and effective palliative surgical option for managing duodenocolic fistula, providing symptom relief and improving the quality of life.

An 82-year-old female received a diagnosis of an ascending colon tumor with duodenal invasion. A right hemicolectomy and partial duodenectomy were performed. Histopathological examination confirmed a diagnosis of medullary carcinoma of the colon, classified as adenocarcinoma(med>>muc), type 2, 8.3×5.7 cm, T4b(SI:duodenum), N0, M0, Stage ⅡC. The patient was discharged from the hospital on postoperative day 16 without any complications and has shown no recurrence after 2 years of follow-up. Medullary carcinoma of the colon is a relatively new concept with favorable prognosis. In the present case, although invasive surgery was required, the procedure was performed safely, resulting in a curative resection.

A 74-year-old male was referred to our Department of Urology with a chief complaint of gross hematuria. Pelvic MRI revealed a protruding lesion within the bladder and a mural thickening of the anterior wall of the lower rectum. Based on these findings and the subsequent diagnostic workup, the patient was diagnosed with advanced rectal cancer and muscle- invasive bladder cancer. The patient underwent robotic-assisted total pelvic exenteration, right lateral lymph node dissection, and ileal conduit diversion. The postoperative course was uneventful, and the patient was discharged in an optimal general condition on postoperative day 31. Histopathological examination confirmed metastasis of the rectal cancer to the right lateral lymph node. Six months after surgery, the patient underwent adjuvant chemotherapy.

Goblet cell adenocarcinoma(GCA)of the appendix is a rare neoplasm with histological features of both neuroendocrine tumors and adenocarcinomas. Compared to classical carcinoid tumors, GCA reveal a higher frequency of lymph node metastasis and generally have a poorer prognosis. Here, we report 2 cases of appendiceal GCA. The first case involved a 70-year- old woman who underwent elective appendectomy following management for acute perforated appendicitis. Pathology revealed a GCA with subserosal invasion(pT3), prompting additional laparoscopic ileocecal resection with D3 lymphadenectomy. The postoperative course was uneventful, and no residual tumor or nodal metastasis was observed(pStage Ⅱa). No recurrence was noted at 1-year follow-up. The second case involved a 46-year-old man with terminal ileal stenosis identified on computed tomography during an evaluation for nausea and vomiting. Colonoscopy revealed a narrowed and inflamed ileal segment;however, biopsy was non-diagnostic. Surgery was indicated after failure of conservative management. Intraoperatively, peritoneal nodules suggestive of dissemination and a tumor mass in the ileocecal region were observed. Laparoscopic ileocecal resection was conducted to preserve adjacent structures. Pathology confirmed GCA (pT4bN2aM1c1, pStage Ⅳc). The patient is currently undergoing systemic chemotherapy with CAPOX and bevacizumab. Although treatment often follows colorectal cancer protocols, no standardized regimen has been established, and further case accumulation is needed.

Drug therapy including pembrolizumab is expected to improve treatment outcomes for triple-negative breast cancer (TNBC). We experienced a case of early-stage TNBC with high Ki-67 expression and a high risk of recurrence, in which neoadjuvant pembrolizumab therapy was effective. A 72-year-old woman with TNBC who developed secondary adrenal insufficiency due to hypopituitarism during pembrolizumab treatment. Symptoms rapidly improved with steroid replacement therapy, pembrolizumab was discontinued. Later, the patient had experienced severe infections during subsequent chemotherapy but recovered, and underwent partial mastectomy. Pathological findings showed treatment effect Grade 1a with negative margins. Seven months later, she has shown no signs of recurrence. We report a case of TNBC with high Ki-67 expression that responded well to neoadjuvant pembrolizumab therapy.

Metaplastic breast carcinoma, a rare subtype(<1% of breast cancers), is typically triple-negative with a poor prognosis. The KEYNOTE-522 trial established pembrolizumab plus chemotherapy as a standard treatment for early-stage, high-risk triple-negative breast cancer. We report a case of metaplastic carcinoma with squamous differentiation achieving pathological complete response after neoadjuvant pembrolizumab-based chemoimmunotherapy. This case suggests that pembrolizumab-based chemoimmunotherapy may be a promising option for chemoresistant metaplastic carcinoma.

The efficacy of perioperative treatment with pembrolizumab for early-stage triple-negative breast cancer(TNBC)at high risk of recurrence was demonstrated in the KEYNOTE-522 trial, and it's indication was expanded in Japan as of September 2022. We report a case in which transient elevation of CEA was observed following treatment with the pembrolizumab. The patient was a 41-year-old woman who presented to a local clinic with a mass in the right breast. She was diagnosed with right breast cancer and referred to our department for further treatment. The clinical stage was T2N0M0, and the tumor was ER-negative, PgR-negative, and HER2-negative, confirming a diagnosis of TNBC. We initiated perioperative treatment in accordance with the KEYNOTE-522 regimen. She underwent a total mastectomy of the right breast with sentinel lymph node biopsy, achieving a pathological complete response. Postoperatively, she was scheduled to receive 9 courses of pembrolizumab. During postoperative therapy, an elevation in CEA was observed. Although recurrence was suspected, further evaluation revealed no evidence of recurrence. Instead, thymic enlargement was noted. As follow-up continued, CEA levels began to decline and the thymic enlargement showed a tendency to regress. These findings suggest a potential association between immune checkpoint inhibitor and thymic enlargement, as well as a possible link to the observed CEA elevation.