Japanese Journal of Cancer and Chemotherapy最新文献

An 81-year-old man with acute appendicitis was referred to our hospital. Abdominal computed tomography(CT)incidentally revealed a 53-mm mass in the left mesorectum. After a laparoscopic appendectomy, further investigation of the rectal mesenteric tumor was performed. Colonoscopy revealed an extrinsic compression of the lower rectum, and endoscopic ultrasound-guided fine-needle aspiration revealed a grade 2 neuroendocrine tumor(NET). A retrospective review of a CT scan performed 11 years earlier at another hospital revealed a solitary 13-mm mass in the same region of the left mesorectum, without continuity with the rectal wall. These findings therefore suggested that the primary rectal mesenteric NET had grown slowly over time. We performed laparoscopic low anterior resection, and the patient was recurrence-free at 6-month follow-up. Although primary mesenteric neuroendocrine tumors are rare, they should be considered in the differential diagnosis of primary mesenteric tumors.

The patient was an 83-year-old woman who underwent surgery at our orthopedic department for a lumbar compression fracture. On the second postoperative day, she developed fever and massive lower gastrointestinal bleeding. CT imaging revealed wall thickening of the descending colon, an abscess extending from the surrounding area to the spleen, and portal venous gas. The diagnosis was perforation of the descending colon, retroperitoneal abscess, and splenic abscess, leading to emergency surgery. Intraoperative findings suggested that the descending colon had perforated into the retroperitoneal space, forming an abscess, which had penetrated the spleen, creating a fistula. A hard mass was palpable at the perforation site of the descending colon, raising suspicion of cancer. Partial colectomy with combined resection of spleen and intra- abdominal irrigation and drainage were performed. Pathological findings confirmed the diagnosis of perforation due to descending colon cancer. No obvious splenic infiltration was observed, and it was considered that gas produced by gas-producing bacteria in the splenic abscess had migrated into the portal vein. Postoperatively, the patient developed disseminated intravascular coagulation(DIC), but improved with treatment. The patient was transferred to a rehabilitation facility on the 41st postoperative day. Three months postoperatively, multiple liver metastases and peritoneal metastases were detected, and palliative care was initiated at the transfer facility.

We report a rare case of gastric cancer associated with immunoglobulin G4-related disease(IgG4-RD). A 79-year-old male was admitted to our hospital for evaluation of hepatic dysfunction. Laboratory investigations revealed elevated serum levels of AST, ALT, ALP, γ-GTP, and IgG4. Contrast-enhanced abdominal computed tomography(CT)showed diffuse wall thickening of the common bile duct(CBD), pancreatic enlargement with a capsule-like rim, and no dilatation of the main pancreatic duct. Additionally, a gastric tumor was identified. Upper gastrointestinal endoscopy revealed a type 2 tumor in the gastric antrum. The patient subsequently underwent laparoscopic distal gastrectomy with D1 lymphadenectomy and Billroth Ⅱ reconstruction. Histopathological examination confirmed the coexistence of gastric cancer and IgG4-RD. At 1-year postoperative follow-up, no evidence of tumor recurrence or progression of IgG4-RD was observed. This case underscores the importance of considering IgG4-RD in the differential diagnosis of patients presenting with both pancreaticobiliary abnormalities and gastric lesions.

We experienced 15 cases of obstructive colorectal cancer treated with chemotherapy after colonic stent placement. Fourteen cases were classified as cStage Ⅲ or Ⅳ, primarily involving distant metastases or extensive local invasion. Chemotherapy, mainly oxaliplatin-based and oral anticancer regimens, was administered for a median of 4 courses before primary tumor resection(median BTS duration:125 days). Although RECIST-defined partial response(PR)was observed in 3 cases, imaging revealed tumor shrinkage in 13 cases, facilitating easier surgical resection. No severe adverse events or stent-related complications were observed during chemotherapy. Compared with cases undergoing surgery without prior chemotherapy (median BTS duration:30 days), operative time, blood loss, and postoperative complication rates were similar, confirming the safety of surgery following stent placement and chemotherapy. Chemotherapy during stent placement and subsequent primary tumor resection was performed safely and may become a viable treatment option.

Introduction: Low-grade appendiceal mucinous neoplasm(LAMN)is often difficult to diagnose preoperatively. We investigated the clinical features and treatment outcomes of LAMN cases experienced at our institution.

Methods: We retrospectively reviewed 7 cases of LAMN that underwent surgical resection at our institution between October 2016 and December 2024.

Results: The median age of the patients was 59 year(s range:38-87), with 4 males and 3 females. The most common initial symptom was abdominal pain, observed in 5 cases. Only 1 case was diagnosed as LAMN preoperatively. The surgical procedures included 1 case of laparoscopic appendectomy, 2 case of laparoscopic cecal resection, 1 case of laparoscopic ileocecal resection, 2 cases of laparoscopic ileocecal resection with lymph node dissection, and 1 case of laparoscopic right hemicolectomy(due to ascending colon cancer). No recurrences were observed postoperatively.

Discussion: LAMN is challenging to diagnose preoperatively. In our study, only 1 case was diagnosed before surgery, and the surgical procedures varied. Further accumulation and analysis of cases are required.

An 82-year-old woman under follow-up for a pancreatic cyst was found to have an approximately 2 cm hypoechoic mass with irregular margins and a heterogeneous internal structure on the dorsal side of the uterus on abdominal ultrasonography. Abdominal CT and MRI was conducted, and rectal GIST was suspected. Due to the patient's strong desire to preserve anal function, transanal minimally invasive surger(y TAMIS)was planned. The procedure was performed in the prone position and the anal was dilated with the Lone Star® RETRACTOR SYSTEM, and the GelPOINT® Path was inserted. Indigo carmine and MucoUp® were injected into the submucosa on both sides of the tumor, followed by mucosal incision. The tumor was partially adhered to the vaginal wall and was resected by shaving off the vaginal wall. The mucosal defect was closed together with the muscular layer using 3-0 V-Loc®, and the surgery was completed. The operative time was 3 h 14 min, with minimal blood loss. The postoperative course was uneventful, and the patient was discharged on postoperative day 10. Imatinib(400 mg/day)was initiated 1 month after discharge but was discontinued after 2 months due to Grade 3 edema. Two years after the surgery, the patient remained recurrence-free.

Two notable cases of bowel obstruction caused by diffuse large B-cell lymphoma(DLBCL)of the ileum were encountered. The first case, a 73-year-old man, presented with intussusception into the ascending colon, originating from an ileal tumor. He underwent ileocecal resection with lymph node dissection and later received R-CHOP chemotherapy, remaining recurrence- free for 1 year. The second case, a 75-year-old woman, had a large tumor infiltrating the abdominal wall in the right pelvis. She underwent right colectomy combined with abdominal wall and lymph node resection. However, rapid tumor progression post-surgery left no opportunity for chemotherapy, and she passed away 67 days later. These cases underscore the critical need to carefully evaluate the extent of surgical intervention for patients who may benefit from chemotherapy.

An 80s man was diagnosed appendicitis and an incidental 33 mm cystic mass with a substantial component in the pancreatic body by contrast-enhanced CT. The enhancement component was stained early contrast. By MRI, component was pale high signal on diffusion-weighted images, and low signal ADC maps. The cyst was low signal on T1WI and slightly heterogeneous high signal on T2WI. Because of suspected mucinous cystic neoplasm(MCN), we performed laparoscopic distal pancreatectomy. By immunostaining, BCL-10 and trypsin were positive. Definite diagnosis was acinar cell carcinoma(ACC). He has been recurrence-free for 5 years without additional treatment. When a pancreatic mass with a mixture of cystic and enhancing components is found, ACC should be included int the differential diagnosis.

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.

Introduction: We examined the treatment outcomes of brain metastases from gastric cancer in our department.

Patients: Six cases of brain metastases were reported between June 2013 and August 2023.

Results: At the onset, 5 cases were undergoing chemotherapy for unresectable advanced or recurrent gastric cancer and 1 case was undergoing follow-up observation after gastrectomy. The median time to onset was 11.7 months after the start of chemotherapy and 30.5 months after the end of adjuvant chemotherapy, respectively. The diagnostic trigger was movement disorder in 5 cases, dementia- like symptoms in 1 case, and incidental discovery in 1 case. The tumor diameter and number of brain metastases were 1-3 lesions with <3 cm/17 lesions with <3 cm/2 lesions with ≥3 cm in 3/1/2 cases. Local therapy included stereotactic radiation/whole brain irradiation/operation plus stereotactic radiation, respectively, and systemic chemotherapy was continued in 4 cases. The overall survival was 14.9 months for all patients, 31.5 months for 3 patients, including 2 patients who had a history of nivolumab and 1 patient who was HER2 positive and had only brain and meningeal dissemination as distant metastases, and 3.0 months for the other 3 patients(p=0.025). In addition to local therapy, immune checkpoint inhibitors and molecular targeted drugs may be effective in treating gastric cancer with brain metastasis.