A 72-year-old man was admitted to our hospital department in September 2014 because of a positive fecal occult blood test.Colonoscopy showed a type 2 tumor in half of the AV 15 cm rectosigmoid colon.Histology of the biopsy indicated a moderately differentiated adenocarcinoma, and the RAS gene test found wild type.On CT examination, there were multiple liver lung metastases and a 30mm diameter tumor with pancreatic duct extension to the pancreatic body.A PET-CT examination had a high SUVmax at the same site.Because of the location of the tumor EUS-FNA was not used.However, the possibility of pancreatic body cancer could not be denied after the CT examination.Treatment by radical resection was impossible because of the spread of the cancer so we selected chemotherapy.Undeniable pancreatic metastasis of rectal cancer, pancreatic cancer was used as a prognostic factor as double cancer of rectal cancer and pancreatic cancer, from that UGT1A1 test side effects appearance was a low-risk decision, was selected FOLFIRINOX in the treatment regimen.After 25 cycles, the pancreatic body tumor and liver metastases and also the primary tumor were reduced, the multiple lung metastases disappeared, and disease control was good.Side effects were diarrhea on the day of administration of irinotecan, but this was controllable by administering oral loperamide when starting the infusion.Grade 3 or more peripheral neuropathy has not developed, and this regimen is continuing.Pancreatic cancer is a solid cancer with a poor prognosis; if you do not reach the tissue diagnosis of metastatic pancreatic cancer, was a case in which no choice but to select a regimen to carcinoma of the prognostic.

A 65-year-old man had undergone high anterior resection for rectal cancer. Seven years after the surgery, a liver metastasis was identified, and the metastasis was surgically resected. A year after the liver surgery, blood testing showed high carcinoembryonic antigen(CEA). A fluorodeoxyglucose(FDG) / -positron emission tomography(PET)/CT examination showed a high FDG accumulation at the rectal anastomosis site, and we diagnosed local recurrence of rectal cancer and prostate invasion. Because there were no distant metastases, he underwent laparoscopic lower anterior resection, radical prostatectomy, and ileostomy. Histopathological examination of the tumor revealed adenocarcinoma and invasion to the right seminal vesicle, suggesting local recurrence of the primary rectal adenocarcinoma. The surgical margin was free of cancer. Operations for local recurrence of rectal cancer are difficult because of tumor invasion and tissue adhesions. In spite of the extended operation, the patient showed good postoperative recovery. Laparoscopic resection for local recurrence of rectal cancer is less invasive than open abdominal operations, and it may be the treatment of choice for local recurrences of rectal cancer.

A-77-year-old man presented to our hospital with high fever and lower abdominal pain. Enhanced CT of the abdomen revealed swelling of the appendix with wall thickening and fluid collection. We diagnosed appendicitis with abscess formation and performed transumbilical laparoscopic-assisted appendectomy after the inflammation improved in response to antibiotics. Operative findings revealed a cystic lesion ofthe appendix and strong adhesion ofthe appendix to the terminal ileum. Based on these operative findings, we changed the operative procedure to a single-incision laparoscopic assisted ileocecal resection because ofthe possibility ofhydrops processus vermiformis. Histopathological findings revealed hyperplasia ofthe glandular epithelium with nuclear enlargement. Mucinous cystadenocarcinoma ofthe appendix was diagnosed. Additional surgery was not performed due to the patient's request. The patient has been free from recurrent disease for approximately 6 months after the surgery. Transumbilical laparoscopic-assisted appendectomy is useful for preventing pseudomyxoma peritonei and easing changes in extended operations for suspected cases of hydrops processus vermiformis.

Pancreatic metastasis of colorectal cancer is uncommon and is often identified in later stages of cancer, thereby making resection more uncommon. We report a case oflong -term survival after resection of metachronous metastasis to the pancreas from primary sigmoid colon cancer. A 50-year-old female patient underwent a sigmoid colon resection and bilateral salpingo-oophorectomy for sigmoid colon cancer and metastatic ovarian cancer in 2007. She underwent partial lung resection for metastatic lung cancer twice. Four years and 11 months after the first operation, an isolated mass was identified in the pancreatic tail, and a distal pancreatectomy, splenectomy, left adrenal gland removal, and regional lymph node dissection were performed. The tumor stained negatively for cytokeratin 7 and positively for cytokeratin 20, resulting in a diagnosis of pancreatic metastatic cancer from sigmoid colon cancer. The patient is alive 3 years and 4 months after distal pancreatectomy. This suggests that curative resection is effective for metastasis of colorectal cancer to the pancreas, similarly to metastases to the liver and lung.

A 64-year-old woman with anorexia and anemia was diagnosed with ascending colon cancer invading the duodenum. Considering the difficulty of curative resection, we first performed gastrojejunostomy and ileostomy. After surgery, the patient received FOLFIRI with cetuximab as neoadjuvant chemotherapy. After 9 courses of the regimen, enhanced computed tomography revealed shrinkage of the lesion, with the efficacy evaluated as a partial response. The patient underwent right hemico- lectomy and partial resection of the duodenum. The pathological diagnosis was pT3(SS), pN0(0/30), ly1, v1, pPM0, pDM0, pRM0, fStage II . On histopathological examination, the efficacy of chemotherapy was evaluated as Grade 1a. The patient received adjuvant chemotherapy with FOLFIRI and remains well without any evidence of recurrence more than 6 months after surgery.

We report a case of a gastrointestinal stromal tumor(GIST)that originated in the anal canal. A 70's woman with a subcutaneous tumor reaching from the anal canal was referred to our hospital. After a thorough examination, the tumor was resected percutaneously in the jackknife position. Histopathological examination showed proliferation of spindle-shaped tumor cells arranged in irregular bundles. Immunohistochemical staining showed that the tumor was positive for c-kit and CD34, and negative for a-SMA and S-100, so the tumor was diagnosed as GIST. As a-SMA-positive smooth muscle cells were seen around the tumor, we suspected that this tumor originated from the internal sphincter muscle.

Familial adenomatous polyposis has an autosomal dominant pattern of inheritance. Colon cancer occurs frequently as a result of colorectal adenoma. The standard treatment is total proctocolectomy. However, it is reported that duodenal papilla cancer and desmoid tumors can also occur alongside colon cancer. We report a patient with duodenal papilla cancer who underwent total proctocolectomy 22 years previously. The patient was a 47-year-old man who had undergone a total proctocolectomy at the age of 25 years for familial adenomatous polyposis. On abdominal CT, duodenal papilla cancer that was suspected to be malignant was found. Using single-balloon enteroscopy, duodenal papilla cancer was diagnosed and pancreatoduodenectomy was performed. Seventeen months after surgery, liver and lung metastases were diagnosed. We began to provide palliative treatment, but the patient died 7 years 10 months after surgery.

We herein report the case of a patient with a cecal cancer with simultaneous liver, spleen, and ovarian metastases as well as peritoneal dissemination who achieved a long-term survival. The patient was a 67-year-old female. Ileocecal resection with partial hepatectomy, splenectomy, simple total hysterectomy, bilateral salpingo-oophorectomy, and resection of the peritoneal dissemination were performed. The final diagnosis was Stage IV (T4a, N1, M1b[H1, P3, OTH]). Adjuvant chemotherapy was administered, but abdominal computed tomography(CT)revealed a metachronous liver metastasis 41 months later. We performed partial hepatectomy, and the patient continued adjuvant chemotherapy. The patient is currently alive and disease-free 30 months after the last operation, 72 months after the initial surgery.

A 66-year-old woman underwent total pelvic exenteration for a pelvic tumor. The pathological diagnosis was sigmoid colon cancer T4b(in the small intestine, uterus, and vagina), N0, M0, Stage II . The patient was treated with XELOX for 6 months as adjuvant chemotherapy and was then treated with IRIS for another 6 months. Brain metastasis developed in the left occipital lobe after 12 months, and she underwent craniotomy and enucleation of the tumor. Liver metastasis and peritoneal dissemination metastasis developed 16 months after her initial diagnosis. The patient underwent re-craniotomy and radiotherapy for recurrence of the brain metastasis 18 months after diagnosis and started taking TAS-102 3 months later. She began treatment with CPT-11 plus panitumumab 24 months after diagnosis, and the dose was increased 9 months later(ie, 35 months after the initial diagnosis). The patient remains alive 42 months after surgery.

A 75-year-old man was admitted with abdominal pain and taken to our hospital. CT and MRI showed a tumor measuring 60mm in diameter in the pelvic cavity. Based on the imaging findings, we suspected a schwannoma and decided to perform surgery. As the tumor was found to be benign in intraoperative frozen section diagnosis, the tumor was enucleated. Histopathological findings showed no nuclear atypia, and the patient was diagnosed with a schwannoma. He complained of paresthesia in his right leg after surgery, and underwent walking training. Six months after surgery, no recurrence was found.

The case of a 78-year-old man with hormone-independent locally advanced prostatic cancer with liver metastases is reported. Standard systemic chemotherapy was not administered due to his poor general condition. At the initial consultation, rapidly growing liver metastases, multiple lymph node metastases, and extensive locally advanced prostatic lesions were found. Transcatheter arterial chemoembolization, low dose systemic chemotherapy, and thermotherapy were administered. After introduction of this combination therapy, marked regression of all of the lesions, including the liver metastases, lymph node metastases, and pelvic extension was observed. The patient's condition and prognosis were markedly improved without serious complications.

The patient, a 57-year-old man, observed an elastic hard tumor under his left areola. Ultrasonography showed a circular hypoechoic mass that was 1.5 cm in diameter with a moderately indistinct border. Using fine needle aspiration cytology, the tumor was diagnosed as a ductal carcinoma(T1N0M0, stage I ). The patient underwent a mastectomy and a sentinel lymph node biopsy. We omitted radical axillary lymph node dissection because there were no metastases in the sentinel lymph node according to intraoperative frozen section diagnosis. On histopathology, the patient was diagnosed with papillotubular carcinoma. The tumor was positive for ER and negative for PgR, and the HER2 score was 2+. Postoperatively, oral tamoxifen therapy was administered. There have been no signs of recurrence during 4 years of follow-up. We report the sentinel lymph node biopsy results for the 27 cases of male breast carcinoma in Japan.

Stromal sarcoma of the breast is a very rare disease accounting for 0.03%of primary breast malignant tumors. From 1995 to 2014, 384 patients with primary breast malignant tumors underwent resection at our institution, of which 2 cases(0.5%) were stromal sarcoma of the breast. Case 1: A woman aged in her 50's presented with a painful lump spanning the right breast identified 7-8 months previously by palpation. The patient first visited the outpatient department at our hospital when the lump gradually increased in size and bleeding from the breast was observed. The tumor measured 8 cm in its greatest dimension and it was elastic soft with a smooth surface, exhibited sphericity, and existed in combination with a partial skin ulcer. Biopsy indicated possibility of stromal sarcoma; therefore, simple mastectomy was performed and the patient was pathologically diagnosed with stromal sarcoma. Presently, the patient is alive and recurrence-free 3 years after the surgery. Case 2: A woman aged in her 80's presented with a left breast tumor identified 4-5 days previously via palpation. The patient visited a general practitioner who referred her to our hospital. The tumor measured 1.6 cm in its greatest dimension and it was elastic hard, irregular in shape, and exhibited dimpling. Biopsy indicated the possibility of malignancy; therefore, a partial resection was performed and the patient was pathologically diagnosed with stromal sarcoma. After 6 months, another lesion was detected and extirpation was performed. A recurrent lesion was detected after 7 months and extirpation was performed again. Presently, the patient is alive and recurrence-free 17 months after the third surgery. In stromal sarcoma of the breast, surgical resection with a negative margin is the only curative treatment. Tumor resection should be planned carefully and the possibility of sarcoma in breast tumors with atypical features as breast cancer should be considered.

A 67-year-old woman presented with a 3 cm palpable mass in the lower lateral quadrant of her right breast. Mammography and ultrasonography showed a mass with an irregular border. Using fine needle aspiration biopsy and cytology, we detected malignant cells with keratosis, and made a diagnosis of squamous cell carcinoma(SCC). We performed total mastectomy with axillary lymph node dissection. Histologically, the tumor was identified as SCC with keratinization and a component of scirrhous adenocarcinoma; estrogen and progesterone receptor expression were not elevated. The tumor tested negative for HER2. The patient did not receive any adjuvant chemotherapy and is alive with no recurrence 13 years after surgery.

We report 2 cases of lung metastasis from breast cancer that were successfully treated with endocrine therapy.Case 1 is a 69-year-old woman with cirrhosis of the liver caused by hepatitis C.She underwent surgery for left breast cancer at the age of 58, and surgery for right breast cancer at the age of 65.Four years later, she was diagnosed with lung metastasis of breast cancer.She received letrozole and the treatment was effective.Because the severity of the pleural effusion increased 3 years later, fulvestrant was subsequently administered.As a result, the patient remained in good health for 1 year.She died 5 years later.Case 2 is a 72-year-old woman who underwent right breast cancer surgery 12 years previously.She complained of respiratory discomfort as a result of right pleural effusion from lung metastasis.She was hospitalized for cancer lymphangitis that had deteriorated.The patient was immediately treated with fulvestrant and her symptoms improved significantly; the pleural effusion also disappeared.Sixteen months later, no recurrence has been observed.

A 78-year-old woman developed second, third, and fourth lung tumors at intervals of 1-3 years after left upper lobectomy for primary lung cancer. The tumors were controlled with radiofrequency ablation(RFA)or conventionalconformalradiotherapy for 9 years postoperatively. For the treatment of second primary lung cancer or lung metastasis after surgical resection of the primary lung cancer, reoperation is not recommended because of the impaired respiratory reserve. Thus, local therapy such as radiotherapy or RFA is applied in some cases. Among these, stereotactic body radiotherapy(SBRT)is a feasible option because of its good local control and safety, which is comparable with surgery. On the other hand, for cases of multiple lesions that are not suitable for radiotherapy or combination therapy, RFA could be an option because of its short-term local control, easiness, safety, and repeatability. After surgery for primary lung cancer, a second lung tumor could be controlled with highly effective and minimally invasive local therapy if it is recognized as a local disease but is medically inoperable. Therefore, longterm postoperative follow-up for primary lung cancer is beneficial.