A 50s male was diagnosed with multiple hepatocellular carcinomas(HCCs), tumor thrombus in the right atrium, and multiple lung metastases. Because the HCCs were unresectable, chemotherapy was planned. However, the patient developed obstructive jaundice 20 days after the first visit, before chemotherapy could be initiated. Immediate treatment was thought necessary to prevent HCC progression. Because the Child-Pugh score was A(6 points)on the first visit, lenvatinib was administered without drainage. The jaundice improved after 10 days of treatment, and computed tomography revealed shrinkage of the HCC and improvement in intrahepatic bile duct dilatation 14 days later. The lenvatinib treatment was continued thereafter, and jaundice did not recur. The patient died 9 months later. This report highlights the usefulness of lenvatinib without drainage in patients with obstructive jaundice due to HCC when urgent treatment is necessary and liver function is well-preserved.

A 60s man presented with leukemia for an underlying disease, which had CR to chemotherapy. By medical examination, an INSM1-positive small cell carcinoma was found next to the right lung hilar region. The patient was diagnosed with cT2aN1M0. Radiation therapy was performed with 45 Gy at the hilum of the lung and mediastinum, and 4 courses of chemotherapy(CDDP 80 mg/m2+VP-16 100 mg/m2)was performed. Whole brain radiation therapy was also performed at 25 Gy. As a result, the lung cancer had CR. However, a small nodule remained in the right upper lobe, which was diagnosed as non-small cell lung cancer using a bronchoscope. There were not metastasis with lymph node or distant station by examination with PET. Right upper lobectomy and lymph node dissection were performed. Pleomorphic carcinoma was diagnosed, and there was no remain of small cell carcinoma. These findings suggest that early detection of the second cancer is important for long-term survival after small cell lung cancer treatment. Improvement of prognosis through surgical resection should be considered.

The patient was a 53-year-old female diagnosed with right breast cancer cT2N2bM0, cStage ⅢA, and the histopathological findings revelaed invasive ductal carcinoma, NG2, HG2, ER 90%, PgR 30%, HER2 3+, and Ki-67 50%. Cardiac function tests to assess suitability for neoadjuvant chemotherapy revealed a left ventricular ejection fraction of 39.7% and left ventricular hypokinesis. Trastuzumab was the preferred treatment for the breast cancer, and after consultation with the cardiologist, trastuzumab+pertuzumab+paclitaxel was initiated as neoadjuvant chemotherapy, in combination with an angiotensin Ⅱ receptor blocker and a beta-blocker. Post-surgery, histopathological examination revealed a non-pathological complete response, and treatment was continued with a T-DM1+aromatase inhibitor. The patient's cardiac function remained stable during anti-HER2 antibodies. We encountered a case in which anti-HER2 antibodies were administered to a patient with a HER2-positive breast cancer and markedly reduced cardiac function. With regular monitoring, appropriate cardiac care, and cardioprotective medications, anti-HER2 antibodies can be safely administered to patients with impaired cardiac function.

Gastric metastasis of breast cancer is clinically rare and its diagnosis is often delayed because of the difficulty in differentiating it from primary gastric cancer. Here, we report a case of gastric metastasis identified 12 years after surgery for left-sided breast cancer. Gastrointestinal symptoms prompted an upper gastrointestinal endoscopy, which revealed an elevated gastric lesion. Immunohistochemical staining of the lesion showed positivity for CK7, GATA-3, mammaglobin, and GCDFP-15, and negativity for CK20, leading to the diagnosis of gastric metastasis from breast cancer. When gastrointestinal symptoms occur in patients with a history of breast cancer, it is important to consider gastric metastasis in the differential diagnosis and perform a thorough evaluation, including immunohistochemical analysis.

A 36-year-old woman with a history of neurofibromatosis type 1 (NF1) presented with acute onset of left-hand weakness, numbness, and pain. Neurological examination revealed Horner's syndrome, distal weakness in the C8-T1 myotomes, and sensory disturbances in the corresponding dermatomes. The constellation of these signs was consistent with Pancoast syndrome, involving both the sympathetic trunk and the lower brachial plexus. Nerve conduction studies demonstrated reduced distal compound muscle action potentials and reduced or absent sensory nerve action potentials from multiple nerves in the C8-T1 territories, supporting involvement of the lower trunk. Chest X-ray revealed a large apical mass, and cervical MRI showed that the mass was compressing the brachial plexus at that level, accounting for her symptoms. Histopathological examination of a specimen obtained from the apical mass confirmed malignant peripheral nerve sheath tumor (MPNST). The patient underwent multimodal treatment including partial resection, embolization, radiotherapy, and chemotherapy, which controlled tumor growth and allowed her to maintain functional independence over a two-year follow-up. This case highlights the importance of early recognition of MPNST in NF1 patients presenting with new neurological symptoms. It also underscores the value of careful neurological examination and electrophysiological studies in accurately localizing the responsible lesion.

A 71-year-old woman with abnormal liver function was referred to another hospital. During follow-up, she developed refractory leg edema and ascites and was subsequently referred to our institute. Despite multiple imaging studies, including dynamic computed tomography (CT), Gd-EOB-DTPA magnetic resonance imaging (MRI), angiographic CT, and perflubutane-enhanced ultrasound, a definitive diagnosis could not be established. Liver biopsies from three sites with different imaging findings revealed adenocarcinoma of bile duct origin, and the patient was diagnosed with unresectable intrahepatic cholangiocarcinoma involving nearly the entire liver. She received gemcitabine/cisplatin, but treatment was discontinued early due to severe anorexia. Palliative care was provided, but she died approximately six months after diagnosis. This case highlights the diagnostic difficulty of imaging alone and underscores the value of liver biopsy when imaging findings are inconclusive.

Over the past decade, molecular biology techniques have identified numerous key genetic mutations in brain tumors. This has improved understanding of disease pathogenesis, and facilitated prognostic prediction, and the development of effective targeted molecular therapies. In 2021, the World Health Organization published the fifth edition of its classification of CNS tumors(WHO 5th), recommending a reporting format based on an integrated diagnosis combining histopathological and molecular genetic information. The classification of pediatric brain tumors has also advanced significantly, clarifying the disease backgrounds specific to childhood and differences in prevalence. The WHO 5th classification represents a significant advancement in selecting optimal treatments and recognizing patient groups that share similar clinical characteristics. However, some challenges remain for its implementation in routine clinical practice, including establishing access to molecular genetic testing. Herein, we reviewed the tumor types listed in the WHO 5th edition that predominantly affect children and adolescents, referring to recently published reports and concepts.

A 76-year-old woman was admitted to our hospital with an abnormal shadow on a chest computed tomography (CT) scan. A chest magnetic resonance imaging (MRI) revealed an anterior mediastinal cyst of 7 cm in diameter with an internal septal-like structure, leading to the differential diagnosis of mediastinal lymphangioma. After administering milk, we performed video-assisted thoracoscopic excision of the lesion. After excision of the cyst, no cloudy fluid leakage was observed from the excised margin. Immunohistochemical analysis showed that the cells lining the cyst walls were stained positive for D2-40, therefore the lesion was diagnosed as a mediastinal lymphangioma. Mediastinal lymphangioma is rare, and postoperative lymphatic leakage is common in surgical cases. In this case, mediastinal lymphangioma was selected as the differential diagnosis based on the preoperative MRI findings, and complete resection was achieved without complications by administering milk before surgery.

A 72-year-old man underwent bronchoscopy for an abnormal shadow on chest imaging, but no definitive diagnosis was made. The lesion was followed for four years as atelectasis, during which time it gradually increased in size. A computed tomography (CT)-guided biopsy suggested mucinous adenocarcinoma; however, a definitive diagnosis remained elusive. Surgical resection was ultimately performed for both diagnostic and therapeutic purposes, and the patient was diagnosed with invasive mucinous adenocarcinoma. Invasive mucinous adenocarcinoma, characterized by abundant mucus components, may be difficult to diagnose through preoperative biopsy. Even when atelectasis is suspected, the possibility of invasive mucinous adenocarcinoma should be considered. Prompt re-evaluation is warranted when an enlarging shadow is observed. In some cases, surgical resection may be necessary as part of the diagnostic strategy.

Primary cardiac malignant tumor is rare and is associated with poor survival. We report a case of primary cardiac intimal sarcoma. A 41-year-old man was admitted to our hospital with congestive heart failure. We performed tumor resection under emergency. The pathological diagnosis of the resected tumor was cardiac intimal sarcoma. There have been few reports of cardiac intimal sarcoma, and the frequency of its occurrence and prognosis are unknown. Surgery and postoperative radiation therapy may improve the prognosis.

We report two cases of metastatic cardiac tumors managed surgically. Case 1 involved a 52-year-old man with colorectal cancer and pulmonary metastases who developed respiratory distress during chemoradiotherapy. Imaging revealed a right atrial mass extending into the right ventricle. Mass reduction of the intracardiac tumor was surgically performed to reduce embolic risk and to enable subsequent chemotherapy. Postoperative chemotherapy resulted in complete remission without recurrence. Case 2 involved a 50-year-old woman with cervical cancer who experienced worsening dyspnea during treatment. Positron emission tomography (PET) and echocardiography identified a tumor extending from the right atrium to the pulmonary artery. As complete resection was unfeasible, mass reduction with tricuspid valve replacement was performed, followed by chemotherapy. The patient remains alive. Pathology confirmed metastatic cardiac tumors in both cases. These tumors present variably depending on the primary cancer and metastatic pattern, making diagnosis and treatment challenging. In symptomatic cases, especially with heart failure or embolism, prompt surgical intervention is critical. Mass reduction can relieve symptoms and improve survival. A focused literature review is also included to support clinical decision-making.

Secondary leukemia often occurs as acute myeloid leukemia (AML) and myelodysplastic neoplasms (MDS), but is rare in chronic myeloid leukemia (CML). A 50-year-old man was diagnosed with secondary CML in B-lymphoid blast phase 12 years after the onset of mucinous gland carcinoma of unknown origin. After resection of the carcinoma, he received chemotherapy and radiotherapy. He achieved a major molecular response with tyrosine kinase inhibitor and hyper CVAD/MA therapy, followed by allogeneic hematopoietic stem cell transplantation in deep molecular response (DMR) approximately 1 year after the start of treatment. Twenty-six months later, he continues to maintain DMR under treatment with asciminib. Although the development of secondary CML is very rare, CML incidence is higher in patients with a history of cancer treatment. Consequently, it is important to be aware the risk of not only MDS/AML but also CML in this group.

A man in his 50s with an intellectual disability underwent a cystostomy for neurogenic bladder, followed by regular catheter exchange. Eighteen years later, the patient developed hematuria. Computed tomography and cystoscopy revealed a bladder tumor despite negative urinary cytology. Transurethral resection of the tumor confirmed the diagnosis of squamous cell carcinoma. Radical cystectomy was performed due to muscle invasion. Histopathological analysis revealed a pT3aN1M0 squamous cell carcinoma. No adjuvant therapy was administered, and the patient has remained recurrence-free for seven years postoperatively.

The patient was a man in his 70s. He had undergone sigmoid colon resection and D3 dissection 10 years earlier for sigmoid colon cancer and liver metastases. The patient postoperatively received FOLFOX4+bevacizumab(BEV), followed by tegafur/uracil. Increased lymph node metastasis was observed 2 years prior, and treatment with tegafur/gimeracil/oteracil was initiated. However, the tumor continued to grow, and the treatment was switched to CAPOX+BEV. Urinary retention was noted after completing the first oxaliplatin(L-OHP)course. The speed of administration was halved, and a second dose was administered; however, urinary retention occurred again during L-OHP administration, which was therefore discontinued. The treatment was subsequently changed to CAPIRI+BEV, and the urinary retention symptoms resolved. The urinary retention was attributed to acute peripheral neuropathy caused by L-OHP. The absence of urinary retention during the postoperative administration of FOLFOX4+BEV and its onset during the current administration of CAPOX+BEV may have been due to benign prostatic hyperplasia, which developed 5 years prior. Benign prostatic hyperplasia may be a risk factor for urinary retention in patients with acute peripheral neuropathy caused by L-OHP.

A 54-year-old woman was diagnosed with breast cancer and underwent surgery. Postoperative histopathological examination revealed invasive ductal breast carcinoma, pT2pN0(sn)M0, Stage ⅡA, Luminal B, HER2 type. Although the patient underwent postoperative adjuvant therapy, the breast cancer relapsed 4 years post-surgery, and anti-HER2 therapy was initiated. The patient developed brain metastasis, and thus, stereotactic radiation was performed, and trastuzumab-deruxtecan was selected as the third-line treatment. However, on day 8 after the first administration of trastuzumab-deruxtecan, she was coughing and had dyspnea. The patient was diagnosed with trastuzumab-deruxtecan-induced interstitial lung disease. She required endotracheal intubation and steroid therapy during hospitalization, which led to improvement. Here, we describe a case study of complete clinical response to metastasis using post-discharge imaging studies. When administering trastuzumab-deruxtecan, consideration of the possibility of drug-induced lung injury is crucial early in the course of the treatment.

A 70-year-old woman was diagnosed with rectal cancer Ra, cT3N1bM0, cStage Ⅲa. The patient underwent laparoscopic colostomy. Panitumumab+FOLFOX therapy was initiated as preoperative chemotherapy. Four weeks after the administration of panitumumab, micro-ulcerations developed around the stoma, and panitumumab was withdrawn. Eight weeks after treatment, the patient reported redness, swelling, and pain around the stoma. An abscess was observed draining from the ulceration site, and a CT scan revealed extensive subcutaneous abscess formation around the stoma. Because the tumor had shrunk by 50%, chemotherapy was discontinued, and laparoscopic low anterior resection, colostomy closure, and debridement were performed. Postoperatively, the stoma wound was treated with local negative pressure closure. Regular outpatient visits should be encouraged when chemotherapy is administered to ostomates, particularly when anti-EGFR antibody drugs are administered. Because the area where the faceplate is applied can only be observed in detail during stoma care, it is important to identify skin lesions early. Additionally, it is important to collaborate closely with the WOCN, primary care physicians, and dermatologists.

Patients with Trousseau syndrome have been reported to have a poor prognosis when a malignant tumor is concurrently present. Moreover, biopsy can be difficult to perform due to hemorrhage during anticoagulant treatment. We present 2 cases of patients with Trousseau syndrome who were diagnosed with lung cancer using liquid biopsy and document their long-term survival following tyrosine kinase inhibitor treatment.

The patient was in her 50s, had received concurrent chemoradiotherapy for stage ⅢB cervical cancer approximately 19 years ago, and was in good health. She had an ileus 3 months earlier and underwent an experimental laparotomy 2 months before, which revealed cancerous peritonitis, as well as a biopsy of a tumor in the peritoneum. Histological examination revealed malignant peritoneal mesothelioma(MPM). The patient died 2 months postoperatively. Histological examination was the primary diagnostic method, supplemented by HE staining, immunostaining, and genetic testing, for establishing MPM diagnosis. MPM is an extremely rare secondary cancer following cervical cancer treatment.

Trastuzumab deruxtecan(T-DXd)is approved as a second-line treatment for HER2-positive advanced or recurrent breast cancer. Recently, its indication has been expanded to include advanced or recurrent breast cancer exhibiting low HER2 expression and a history of prior chemotherapy. Approximately 45-55% of all breast cancers fall into the HER2-low category, highlighting T-DXd as a promising therapeutic option in the subset. The DESTINY-Breast04 trial demonstrated the efficacy of T-DXd in patients with HER2-low metastatic breast cancer patients who had received one or two prior lines of chemotherapy for advanced or recurrent disease. Here, we present a case of recurrent breast cancer with low HER2 expression in which T-DXd was effective as a ninth-line treatment.

The patient is a 67-year-old female who visited a local clinic with a primary complaint of redness and swelling at the umbilicus. The patient was scheduled for surgical excision because of a suspected umbilical abscess caused by a remnant urachus. During this period, weight loss and elevated tumor marker levels were noted, and further investigation led to the diagnosis of pancreatic body and tail cancer with a Sister Mary Joseph's nodule. Systemic chemotherapy was administered, and initially, both the tumor size and tumor marker levels decreased. However, the tumor subsequently increased in size, and the patient died 7 months after treatment. When an umbilical mass is noted, the possibility of umbilical metastasis from visceral malignancies should be considered.