The aim of this study was to evaluate the outcome and efficacy of hepatic arterial infusion chemotherapy for liver metastasis. Nineteen patients with liver metastasis after esophagectomy for esophageal squamous cell carcinoma underwent hepatic arterial infusion chemotherapy. Six patients(32%)received hepatic arterial infusion chemotherapy as the initial treatment, and the remaining 13 patients(68%)received hepatic arterial infusion chemotherapy after systemic chemotherapy. Of the 13 patients, 3 responders to the first systemic chemotherapy received as maintenance therapy, and 10 non-responders to the first systemic chemotherapy received as a second-line therapy. Response ratio was 37%, and 6 patients(32%)had a toxicity of Grade 3 or more. The median overall survival after liver metastasis was 10.8 months, and the 1-year overall survival rate was 42%. No patient survived more than 3 years after liver metastasis. The 1-year overall survival rate in patients received as the initial and maintenance therapy was 67%, while that in patients received as a second-line therapy was 20%(p=0.0291). Our findings suggested that hepatic arterial infusion chemotherapy for liver metastasis may be effective treatment as the initial therapy or the maintenance therapy for responders to the first systemic chemotherapy.

A 63-year-old female patient was emergently admitted to our hospital with complaints of dyspnea and leg edema. She had a history of abdominal total hysterectomy and bilateral salpingo-oophorectomy for uterine leiomyoma 11 years ago. Computed tomography (CT) and echocardiography revealed a local recurrent tumor on the right side of the inferior vena cava in the retroperitoneal cavity, which extended to the right ovarian vein, inferior vena cava, and right atrium/ventricle. The patient suffered shock due to the tumor lodging in the tricuspid valve, so we performed an emergency intracardiac tumor resection under cardiopulmonary bypass, and two months later, we removed the locally recurrent tumor and the intravascular tumor below the diaphragm. The tumor in the inferior vena cava was removed entirely under hypothermic circulatory arrest. In cases such as this one, which is associated with hemodynamic instability before surgery, it is desirable to aim for a complete resection with a two-stage surgery.

Mediastinal teratomas are germ cell tumors that account for 15% of all adult anterior mediastinal tumors. Giant anterior mediastinal tumors sometimes require a median sternotomy and an additional approach or a clamshell approach. We present a case of a large mature teratoma occupying the left thoracic cavity that was treated by a thoracoscopic surgery with a lateral mini-thoracotomy. Preoperatively, we marked the lateral thoracic area near the largest cyst. In the right lateral recumbent position, a 4-cm incision was made in the left 6th intercostal space. Several large cysts were drained as much as possible. In the supine position, three 5-mm ports were placed in the 2nd, 5th, and 6th intercostal spaces. The left lobe of the thymus and the tumor were resected en block. Pathologically, the tumor was a mature teratoma. The patient had a good postoperative course and was discharged on the 8th postoperative day.

According to the guidelines for thymic tumors, surgical resection is recommended for clinical stage Ⅳ thymic epithelial tumors if completely resectable. A 38-year-old woman presented with fever, chest pain, and back pain. Computed tomography (CT) revealed a mediastinal tumor, which was diagnosed as thymoma type B3 through CT-guided biopsy. Intraoperatively, using 4K three-dimensional (3D) endoscopy, tumor invasion into the left upper lobe and pleural dissemination on the parietal pleura and diaphragm were observed. To preserve the possibility of future re-resection, operation was thoracoscopically performed and the tumor was removed, including partial resection of the left upper lobe. All visible pleural dissemination lesions were also resected, including part of the left diaphragm. The diaphragmatic defect was reconstructed using a Gore-Tex Patch. There is no established treatment strategy for thymoma with incidental pleural dissemination, and the 4K 3D endoscopy may contribute to the successful completion of such a complex operation.

A 67-year-old man was performed total thyroidectomy for stage ⅣC papillary thyroid carcinoma with multiple lymph node and lung metastases. Five years and two months later, treatment with lenvatinib was started. Chest computed tomography (CT) six years and four months after the start of treatment revealed left pleural effusion. A pleural biopsy was performed under thoracoscopy. Histopathological findings showed papillary thyroid carcinoma, and the patient was diagnosed with pleural dissemination of thyroid cancer. Genetic test showed a positive BRAF V600E gene mutation. Treatment with dabrafenib and trametinib was initiated nine days after lenvatinib was discontinued.

Cardiac hemangioma is a rare benign tumor, and the cavernous type accounts for 50~60% of all cardiac hemangiomas. Although most cases are asymptomatic, the risk of serious complications, such as embolism, arrhythmia, tumor rupture, coronary artery obstruction, or sudden death, is high, and surgical resection should be considered. In a 60-year-old woman, follow-up imaging studies after a left breast cancer operation incidentally revealed a cardiac tumor in the right atrium. Transthoracic echocardiography showed a poorly mobile, highly echogenic 12×16 mm mass with clear margins, and contrast-enhanced computed tomography (CT) showed a round tumor with no obvious enhancement. The tumor was resected with an atrial wall and diagnosed as a cavernous hemangioma on histopathological examination. Cardiac hemangiomas are enhanced using contrast medium; however, some cases have no contrast enhancement. Histopathological examination confirmed this diagnosis. The patient was discharged on postoperative day 11 in a good condition.

A 74-year-old male was admitted with acute cholecystitis, during which computed tomography( CT) revealed a 20 cm anterior mediastinal tumor. He developed septic shock requiring tracheostomy and mechanical ventilation, and was referred to our institution. Biopsy under local anesthesia excluded malignant lymphoma and germ cell tumor, leading to planned surgical resection. Due to the tumor's extensive bilateral spread and proximity to the tracheostomy site, clamshell thoracotomy with lower partial sternotomy was performed instead of median full sternotomy. The final diagnosis was well-differentiated liposarcoma. The sternum was closed with wires and plates, and prophylactic negative pressure wound therapy was applied. Postoperatively, there were no sternal complications. Laparoscopic cholecystectomy was later performed, and the tracheostomy cannula was removed successfully. In surgical resection of giant mediastinal tumors, the approach should be selected based on the tumor's location and its extent of invasion into surrounding tissues.

A 42-year-old woman was admitted to our hospital with nodular legions in the bilateral lung. Bilateral lung wedge resection was performed via subxiphoid uniportal approach, and the pathological diagnosis was uterine leiomyoma pulmonary metastasis. At six months after operation, no recurrence was observed.

A male patient in his 70s was admitted with bloody stool. Upper gastrointestinal endoscopy revealed active bleeding from a submucosal lesion located opposite the duodenal papilla. Hemostasis was difficult to achieve, and histopathological analysis of the biopsy specimen revealed only necrotic tissue and inflammatory changes. Endoscopic ultrasonography (EUS) revealed a 35-mm hypoechoic lesion within the submucosal layer. EUS-guided tissue acquisition suggested a poorly differentiated or undifferentiated tumor. Given these findings, the patient underwent pancreaticoduodenectomy. The final diagnosis was primary duodenal epithelioid angiosarcoma.

Small cell carcinoma (SCC) of the prostate has a poor prognosis. We present three cases of primary SCC of the prostate treated with amrubicin as second- or third-line chemotherapy. Case 1 : A 54-year-old male received cisplatin and irinotecan but showed metastatic progression. Amrubicin was initiated as second-line therapy, leading to tumor shrinkage. However, disease progression (PD) occurred in the ninth month, and he passed away 16 months after treatment initiation. Case 2 : An 82-year-old male treated with combined androgen blockade (CAB) later developed pelvic lymph node enlargement, and SCC was diagnosed. He received carboplatin-etoposide and then carboplatin-irinotecan. Amrubicin was given as third-line therapy but showed no significant response. He passed away 24 months after treatment initiation. Case 3 : A 68-year-old male treated with CAB developed M0CRPC and later distant lymph node metastases, confirmed as SCC. He received cisplatin-etoposide and then amrubicin as second-line therapy, achieving a partial response initially but experiencing PD in the fifth month. He passed away 36 months after starting treatment. Amrubicin may be a therapeutic option for primary SCC of the prostate, but achieving prolonged survival remains difficult.

Immune checkpoint inhibitors (ICIs) have shown remarkable efficacy in various malignancies, but their effectiveness in colorectal cancer is generally limited to MSI‒high tumors. We report a case of complete response in an MSI‒stable rectal cancer patient with para‒aortic lymph node metastasis treated with a sequential strategy involving targeted therapy and ICI. A 52‒year‒old woman underwent laparoscopic intersphincteric resection with bilateral lateral lymph node dissection for advanced lower rectal cancer, followed by adjuvant CAPOX. Two years postoperatively, para‒aortic lymph node metastasis was confirmed histologically. FOLFIRI plus cetuximab was initiated, resulting in marked regression of the nodes but without CEA normalization. Switching to FOLFIRI plus bevacizumab led to further CEA reduction. After 2 courses, nivolumab was added and CEA normalized. CEA levels rose again after completion of ICI, but continued FOLFIRI plus bevacizumab led to re‒normalization without radiologic progression. This case suggests that sequential treatment using cetuximab and bevacizumab may modulate the tumor microenvironment and enhance ICI response even in MSI‒stable colorectal cancer. Strategic immunomodulation could provide a promising option for ICI‒resistant tumors.

We report a case of a 51‒year‒old man who presented with right lower abdominal pain. On physical examination, a palpable, tender mass was detected in the right lower abdomen. Contrast‒enhanced computed tomography (CT) revealed a 15‒cm mass in the right lower abdominal wall, supplied by the right inferior epigastric artery, with internal hemorrhage and necrotic areas. Radiological findings were inconclusive for malignancy. As there was no evidence of distant metastasis or invasion into adjacent organs, the tumor was considered resectable, and surgical resection was performed. Histopathological examination confirmed the diagnosis of synovial sarcoma. Given the high risk of recurrence and metastasis associated with synovial sarcoma, adjuvant chemotherapy was administered postoperatively. The patient remains alive without recurrence 1 year after surgery.

We report a case of conversion surgery after nivolumab treatment and chemotherapy for metastatic gastric cancer. A 75‒year‒old man was diagnosed as advanced gastric cancer with peritoneal dissemination. The patient was judged as unresectable gastric cancer and received SOX+nivolumab treatment. After 8 courses of chemotherapy, the primary lesion and enlarged lymph nodes were reduced and abdominal small nodules were disappeared. Consequently, we performed staging laparoscopy followed by laparoscopic distal gastrectomy with D2 lymph node dissection as a conversion surgery. Histopathological diagnosis was ypT2N0M0CY0, and ypStage ⅠB. The patient has been recurrence‒free for 6 months.

We report a 58‒year‒old woman with Stage Ⅳb sigmoid colon cancer, presenting with hematochezia and lower abdominal pain, and diagnosed with over 15 liver metastases and para‒aortic lymph node (PALN) metastases. After laparoscopic sigmoid colectomy, FOLFOXIRI plus bevacizumab achieved marked liver tumor reduction and complete PALN response, enabling hepatic resection. Multiple recurrences were managed with repeated liver resections, PALN dissection, and chemoradiotherapy. Following fifth‒line of chemotherapy, oxaliplatin was reintroduced, and fruquintinib initiated, leading to 6 years and 3 months of survival. This case highlights multidisciplinary strategies for initially unresectable colorectal cancer.

We have experienced a case in which MSI‒high advanced cecum and ascending colon cancer was completely cured by surgery and immune checkpoint inhibitors (ICIs). CEA, which had been high before surgery, did not normalize after radical surgery and rose again 1 year later. Although no obvious relapse findings could be identified by imaging tests such as CT and PET and examination laparoscopy, an increase in CEA was observed, so it was judged that the residual tumor had a flare‒up, and pembrolizumab alone was started. After 3 cycles, CEA normalized and treatment was completed after a total of 9 doses. Currently, no recurrence has been observed and follow‒up is underway. If there is a high suspicion of a recurrence of MSI‒high colorectal cancer, ICI therapy was considered an option.

To effectively induce anti‒tumor immune responses, it is essential that tumor‒specific T cells are generated within the tumor microenvironment (TME), a process in which tumor‒draining lymph nodes (TDLNs) are thought to play a critical role. We have previously demonstrated that photoimmunotherapy targeting cancer‒associated fibroblasts (PIT‒CAF), which specifically targets the fibroblast activation protein (FAP), modulates the immune cell composition and function within the TME. In this study, we investigated the effects of CAFs and PIT‒CAF on tumor‒specific T cells in both the TME and TDLNs.

A female patient in her 70s, underwent laparoscopic right hemicolectomy for ascending colon cancer (pT4aN2aM0). Eight courses of post‒operative adjuvant chemotherapy with CapeOX were administered. However, 1 year and 5 months post‒surgery, liver metastasis was observed. Following 1 course of FOLFIRI therapy and 1 course of FOLFIRI+bevacizumab therapy, high‒frequency microsatellite instability (MSI‒H) was detected, and pembrolizumab therapy was initiated. CT imaging revealed necrotic changes in the metastatic lesion while stable disease (SD) was maintained. After completing 28 courses of pembrolizumab therapy over 1 year and 9 months, the treatment was temporarily discontinued. One year and 3 months after discontinuation, the CEA level was elevated and the tumor was enlarged. Pembrolizumab therapy was resumed, and 5 additional courses were administered. Subsequently, surgical resection of the liver metastasis revealed no residual tumor and pathological complete response was confirmed. The patient has remained recurrence‒free without further treatment.

Surgery is the basic treatment for oral cancer; however, post-operative oral function has a significant impact on daily life. Therefore, early detection of oral cancer during dental checkups is important. On remote islands without dentists, it is particularly desirable for oral surgeons to cooperate for the early detection of oral cancer, to perform surgery. The Kagawa Dental Association has been conducting remote island oral cancer examinations in cooperation with the Dept. of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, for the early detection of oral cancer on remote islands with no dentists in Kagawa Prefecture. In this report, we describe our experience with the early detection of a rare mucoepidermoid carcinoma of the floor of the mouth during remote island oral cancer screening in the Kagawa Prefecture, with the cooperation of the local government and others.

The patient was a 63-year-old man at initial consultation. After pre-operative chemotherapy for advanced gastric cancer, he underwent distal gastrectomy. Eight months later, liver metastases appeared in segments 6 and 7. First-line chemotherapy with capecitabine plus cisplatin was administered, but the liver lesions worsened, and a para-aortic lymph node metastasis was observed. Second-line ramucirumab plus paclitaxel shrank the metastatic lesions without new lesions. Because he could not tolerate further combined chemotherapy, third-line nivolumab monotherapy was started 12 months after chemotherapy initiation. After 6 courses, grade 4 adrenal insufficiency developed, and nivolumab was discontinued. Nevertheless, all metastatic lesions had shrunk and showed peripheral calcification. Ramucirumab monotherapy was resumed (43 courses) based on the patient's clinical status. During this period, the liver metastases continued to decrease and became completely calcified;the para-aortic lymph node resolved. PET-CT showed no FDG accumulation in the liver, consistent with organized, tumor-free lesions. The recurrent disease was judged equivalent to a complete response (CR), and no further treatment was given. Subsequent CT scans showed ongoing shrinkage and gradual decalcification of the organized liver lesions. Thirty-five months after discontinuing ramucirumab, the lesions are cystic and the CR persists. Given the high microsatellite instability status and the timing of lesion shrinkage and calcification, nivolumab likely played the dominant role in achieving CR. Our review of the limited number of reported cases suggests that discontinuing nivolumab after CR in gastric cancer can be a valid option.

A 34‒year‒old woman presented with a pelvic tumor in the Douglas pouch during her first pregnancy, initially suspected to be a desmoid tumor and managed subsequently. Biopsy during cesarean section in her second pregnancy confirmed aggressive angiomyxoma (AAM). Postpartum tumor growth prompted a 16‒month course of gonadotropin‒releasing hormone agonist therapy (leuprorelin acetate, 1.88 mg every 4 weeks), which reduced tumor size from 20×13 cm to 10×7.5 cm after 12 doses. However, adverse effects, such as fatigue and nausea occurred, and further tumor shrinkage was minimal, necessitating surgical intervention. A left posterior sacral approach allowed complete tumor resection while preserving the rectum, reproductive organs, and autonomic nerves. AAM is a rare tumor of the pelvis or external genitalia in young women. Although surgical excision remains the primary treatment, no standardized approach exists. This case demonstrates the role of preoperative hormone therapy in significantly reducing tumor size, thereby facilitating complete excision with organ preservation, and underscore its potential role in AAM management.