We performed robot-assisted radical prostatectomy (RARP) for 221 patients from December 2015 to May 2023. In 218 patients, the prostatic anterior fat pad was submitted separately for histopathological evaluation. Fourteen patients (6.4%) had lymph nodes in the prostatic anterior fat pad, and three (1.4%) had lymph node metastasis in the prostatic anterior fat pad. The details of three cases are presented here.Case 1 was a 63-year-old patient who underwent RARP for prostate cancer (cT2aN0M0), with an initial prostate-specific antigen (PSA) concentration of 24.522 ng/ml and a Gleason score of 3+4. The pathological results indicated adenocarcinoma, pT3a, Gleason score: 3+4. The postoperative PSA nadir was 0.205 ng/ml, and the patient was diagnosed with biochemical recurrence. Subsequently, the patient underwent hormone therapy and salvage radiation therapy, with no recurrence to date.Case 2 was a 62-year-old patient who underwent RARP for prostate cancer (cT2aN0M0), with an initial PSA of 10.418 ng/ml and a Gleason score of 4+4. The pathological results indicated adenocarcinoma, pT2c, Gleason score: 4+4. The postoperative PSA nadir was 0.401 ng/ml, and the patient was diagnosed with biochemical recurrence. The patient subsequently underwent hormone therapy.Case 3 was a 76-year-old patient who underwent RARP for prostate cancer (cT2aN0M0), with an initial PSA of 4.676 ng/ml and a Gleason score of 4+3. The pathological results indicated adenocarcinoma, pT2c, Gleason score: 3+4. The postoperative PSA nadir was 0.031 ng/ml, and the patient has not experienced recurrence to date.

(Objective) Patient characteristics and treatment outcomes of a rare histologic type of bladder neuroendocrine carcinoma were evaluated. (Methods) 2,133 cases of bladder cancer treated by transurethral resection of bladder tumor from August 2005 to August 2022 were histopathologically reevaluated, and clinicopathological factors, treatment methods, and prognosis of cases with a confirmed diagnosis of bladder neuroendocrine cancer were analyzed. (Results) Of 2,133 cases, 12 (0.56%) were diagnosed as neuroendocrine carcinoma. Immunohistochemical staining revealed small cell carcinoma in 10 cases (83.3%) and large cell carcinoma in 2 cases (16.7%). The median age was 79 years, and performance status 2 or higher was reported in 3 cases. Seven cases had localized cancer at the time of diagnosis, five cases had distant metastasis, and radical cystectomy was performed in four cases. Of the 3 cases who received chemotherapy, first-line platinum-based chemotherapy achieved disease control in two cases. After second-line treatment, no cases responded to pembrolizumab or enfortumab vedotin. The median overall survival (OS) of all cases was 12.5 months. The median OS of cases who underwent total cystectomy was 26 months, and that of cases who did not undergo total cystectomy was 8.2 months, showing a significant difference (p=0.05). (Conclusion) Neuroendocrine carcinoma of the urinary bladder often develops in older patients and has a poor prognosis. In cases of localized cancer, total cystectomy should be performed if possible.

A 62-year-old woman was admitted and underwent endoscopic mucosal resection for sigmoid colon cancer.Histopathological examination revealed submucosal invasion of 3,000 μm with positive tumor budding(Grade 2).Subsequently, she underwent laparoscopic sigmoidectomy with D2 lymphadenectomy.Postoperative pathology showed no regional lymph node metastasis, and the disease was staged as pStage Ⅰ.Chest CT scans revealed small nodules in the right middle lobe and left lower lobe that had been noted preoperatively and demonstrated gradual enlargement.Twenty four months after the initial surgery, these were diagnosed as synchronous pulmonary metastases, and she underwent thoracoscopic partial resections of both lungs.Nonetheless, the patient remains alive, with no recurrence 10 years after the resection of the pulmonary metastases.

Adrenal metastasis from gastric cancer is often found as part of systemic metastasis, and is rarely an isolated tumor that requires resection.The patient was a 73-year-old man.Contrast CT scan performed to investigate anemia and positive stool for occult blood revealed a 5 cm mass in the left adrenal gland.Upper gastrointestinal endoscopy revealed gastric cancer in the lesser curvature of the gastric angle, and lower gastrointestinal endoscopy revealed rectal cancer.Laparoscopic left adrenalectomy was performed for the left adrenal mass, and a histopathological examination revealed that the tumor was adrenal metastasis from gastric cancer.After 3 courses of SOX therapy, robot-assisted distal gastrectomy, with D2 lymph node dissection, and Roux-en-Y reconstruction were performed.Postoperative pathological diagnosis was M, Less, ypType 4, 48×43 mm, por2>tub2>sig, ypT3(SS), INF c, Ly0, V0, ypPM0, ypDM0, ypN0, P0, CY0, H0, M1(ADR), ypStage Ⅳ.By appropriately combining systemic therapy(chemotherapy)and local therapy(surgical resection), it is expected that the prognosis can be improved even for isolated adrenal metastasis of gastric cancer.

The purpose of this study was to clarify the prognostic factors of locally advanced colorectal cancer cases without distant metastasis successfully resected after chemotherapy.We investigated the association between prognosis and clinicopathological factors in 25 cases of locally advanced colorectal cancer without distance metastasis that underwent curative resection after chemotherapy between 2008 and 2021.The association between clinicopathological factors and DFS showed no difference in the use of molecular targeted drugs, response criteria, depth of tumor invasion, lymph node metastasis, but the prognosis was better in cases with a histological response Grade 1b or higher(p=0.039)and the cases underwent postoperative adjuvant chemotherapy(p=0.021), and both of these factors were extracted as independent prognostic factors for DFS in multivariate analysis.These results suggest that the histological response grade may be a useful prognostic factor in locally advanced colorectal cancer cases without distant metastasis successfully resected after chemotherapy.

The patient was a 63-year-old woman.In 2014, she underwent surgery for metastatic ovarian cancer, but intraoperative findings revealed peritoneal dissemination.A colonoscopy after surgery revealed a type 2 tumor in the ascending colon, and a biopsy revealed a diagnosis of tub2.After chemotherapy, an ileocecal resection was performed for ascending colon cancer.She subsequently developed multiple lung, liver, and right rib metastases, and in December 2023, FOLFIRI plus RAM therapy was started.In May 2024, a CT scan showed an increase in the right pleural effusion, and she was diagnosed with malignant pleurisy.She underwent thoracic drainage and pleurodesis.FOLFIRI plus RAM therapy was continued, but in August of the same year, she developed nausea and difficulty breathing, and a CT scan revealed a right pneumothorax.The collapse of the right lung was mild, and the patient was admitted to the hospital on an emergency basis and placed on rest.There was no worsening of the pneumothorax, and she was discharged on the 9th day after admission.The mechanism by which the pneumothorax developed in this case was thought to be that intrathoracic pressure increased with nausea and vomiting caused by chemotherapy and increased opioid dosage, leading to the rupture of the pleural dissemination lesion, causing the pneumothorax.

We report 2 cases in which skin grafting was avoided by utilizing thoracoepigastric following mastectomy with extensive skin defects due to advanced breast cancer extensively involving the breast.Case 1: A 53-year-old woman was diagnosed with right breast cancer extending to the midline of the chest.She underwent total mastectomy of the right breast, resection of the midline chest skin, and sentinel lymph node biopsy.Intraoperative frozen section analysis revealed positive sentinel nodes, prompting additional axillary lymph node dissection.Due to the extensive skin defect caused by resection of the midline chest skin, a thoracoepigastric flap was created to achieve wound closure.The postoperative course was uneventful.Case 2: A 64-year-old woman developed an intramammary recurrence of right breast cancer during follow-up after prior surgery.The recurrent tumor had extensively spread throughout the breast, with widespread erythema noted on the overlying skin.Multiple axillary lymph node metastases were also present, and neoadjuvant chemotherapy was initiated.Following chemotherapy, she underwent right total mastectomy and axillary lymph node dissection.A thoracoepigastric flap was used for wound closure.Her postoperative course was free of complications.

Although systemic chemotherapy is the mainstay of treatment for metastatic recurrence of pancreatic cancer, in recent years, with the improvement of chemotherapy, some cases have been reported as long-term survival by multidisciplinary.We report a case of pancreatic cancer with superior mesenteric artery invasion treated with chemotherapy and carbon-ion radiotherapy(CIRT)followed by conversion surgery(CS).CIRT was successfully re-introduced for hepatic oligometastatic recurrence that appeared 1 year after CS.Disease control was obtained and continued at 6 months after CIRT for the liver, suggesting that multidisciplinary treatment including CIRT might be promising strategy for hepatic oligometastases if the primary tumor is under control.

Skin-related adverse events(AEs)are a major adverse effect of anti-EGFR antibody therapy in metastatic colorectal cancer.While various preventive skincare strategies have been reported, few studies have examined the relationship between skin-related AEs and seasonal variations.We retrospectively analyzed 73 patients who received anti-EGFR antibody therapy at Hyogo Medical University Hospital from January 2020 to August 2023.The primary endpoint was the incidence of Grade≥2 skin-related AEs at weeks 8 and 12 after treatment initiation in the summer(Su group)and winter(Wi group)groups, compared to the spring/autumn(Control group).At week 12, the Wi group had a significantly higher incidence of skin-related AEs than the Control group(94.4% vs 61.1%, p=0.011).No significant differences were observed for rash acneiform or paronychia, but Grade≥2 dry skin was significantly more frequent in the Wi group(83.3% vs 50.0%, p=0.021).Younger age(<65 years)(HR: 1.94, 95%CI: 1.18-3.21, p=0.009)and treatment initiation in winter(HR: 2.04, 95%CI: 1.11-3.76, p=0.022)were identified as risk factors.These findings suggest that patients initiating treatment in winter may be at increased risk of severe dry skin, necessitating enhanced skincare measures.

In 2024, enfortumab vedotin plus pembrolizumab(EV+P)and nivolumab plus gemcitabine/cisplatin(Nivo+GC)were approved as first-line therapies for metastatic urothelial carcinoma(mUC), marking a major shift in treatment strategy.EV+P, in particular, demonstrated remarkable efficacy and has been assigned the highest level of recommendation in both the 2025 European Association of Urology(EAU)and National Comprehensive Cancer Network(NCCN)guidelines.By contrast, avelumab maintenance therapy following platinum-based chemotherapy-established since its approval in 2021-has long been practiced as a standard approach in Japan.Its major strength lies in the robust real-world evidence accumulated domestically, confirming both efficacy and safety across various patient populations.In the 2025 update of the Japanese Urological Association(JUA)bladder cancer guidelines lists EV+P, Nivo+GC, and avelumab maintenance therapy are all listed as Grade 1, Level A recommendations.However, there are no head-to-head trials directly comparing ICI-based combinations with sequential therapy, and no reliable biomarkers exist to predict treatment response to either platinum-based chemotherapy or subsequent avelumab maintenance.Therefore, careful consideration of efficacy, safety, and extensive real-world evidence available is required to guide optimal, individualized treatment selection for patients with mUC.

Muscle-invasive bladder cancer(MIBC)carries a high risk of recurrence.The standard treatment has been cisplatin-based neoadjuvant chemotherapy(NAC)followed by radical cystectomy(RC), but nearly half of patients are cisplatin-ineligible and unable to receive optimal NAC.Furthermore, recurrence after NAC plus RC remains common, highlighting the need for effective adjuvant strategies.Recent advances in immune checkpoint inhibitors(ICIs)have revolutionized perioperative treatment paradigms.The phase Ⅲ CheckMate 274 trial demonstrated that adjuvant nivolumab significantly prolonged disease-free survival(DFS), particularly in PD-L1-positive patients.In the IMvigor010 trial, adjuvant atezolizumab did not improve DFS in the overall population, but a biomarker-driven subanalysis revealed marked benefit in patients with postoperative circulating tumor DNA(ctDNA)positivity.Based on these findings, the ongoing IMvigor011 trial restricts adjuvant atezolizumab to ctDNA-positive patients.The NIAGARA trial evaluated a comprehensive perioperative approach using neoadjuvant gemcitabine-cisplatin plus durvalumab followed by adjuvant durvalumab for 1 year.This regimen significantly improved DFS, overall survival(OS), and pathological complete response(pCR)rates without increasing Grade ≥3 toxicities.ctDNA has emerged as a promising biomarker for risk stratification and treatment monitoring, potentially enabling precision perioperative immunotherapy.This review summarizes pivotal phase Ⅲ trials of perioperative ICI therapy in MIBC and discusses the role of ctDNA-guided strategies, envisioning a shift from universal ICI administration to biomarker-driven, individualized perioperative approaches.

Bladder cancer is a common malignancy in the elderly, with approximately 75% of cases diagnosed as non-muscle-invasive bladder cancer(NMIBC).Although transurethral resection of bladder tumor(TURBT)is the standard initial treatment, recurrence rates remain high, and intravesical Bacillus Calmette-Guérin(BCG)instillation has long been used as an adjuvant therapy.However, about 30% of patients develop BCG-unresponsive disease despite adequate BCG administration.Radical cystectomy is recommended in such cases, but its invasiveness and impact on quality of life(QOL)often make it impractical in real-world settings.Thus, the development of novel bladder-preserving treatments is urgently needed.In recent years, diverse approaches including immune checkpoint inhibitors(ICI), gene therapy, drug delivery systems(DDS), and oncolytic virus-based therapies have been actively investigated, with numerous clinical trials ongoing worldwide.Importantly, pembrolizumab, nadofaragene firadenovec, and N-803 in combination with BCG have received FDA approval, representing major advances in the management of BCG-unresponsive NMIBC.In addition, promising agents such as TAR-200, cretostimogene grenadenorepvec, and detalimogene voraplasmid are under clinical evaluation.These advances indicate the potential for novel strategies that enable bladder preservation while achieving tumor control.Future challenges include validation of long-term outcomes, establishment of evidence through randomized controlled trials, and regulatory approval and reimbursement in Japan.Expansion of therapeutic options is expected to improve both prognosis and QOL in this high-risk population.

Non-muscle invasive bladder cancer(NMIBC)accounts for about 70% of bladder cancers, with most patients treated by TURBT followed by intravesical therapy according to recurrence risk.BCG is effective but BCG-unresponsive cases often require cystectomy.Recently, novel therapies including immune checkpoint inhibitors, drug-delivery devices, and gene therapy have emerged.This chapter reviews recent and ongoing phase Ⅲ trials in BCG-naïve NMIBC.

Portal vein embolization(PVE)is a preoperative procedure that requires contrast media, making it contraindicated in patients with a history of contrast-induced anaphylaxis. We report a case of intrahepatic cholangiocarcinoma (ICC)in which laparoscopic right portal vein ligation(PVL)was performed as an alternative to PVE due to this contraindication.

A 50-year-old woman underwent distal pancreatectomy for pancreatic neuroendocrine neoplasm(NEN). Pathological analysis showed that the pancreatic tumor was composed of neuroendocrine tumors(NETs)G2 and G3, along with neuroendocrine cancer (NEC), and was accompanied by NET G2 and G3 lymph node metastasis around the pancreas. The primary tumor exhibited neural invasion with NET G3, vascular invasion with NET G2, splenic vein invasion with NET G3, lymphatic duct invasion with NEC, anterior surrounding tissue invasion with NET G2, and posterior surrounding tissue invasion with NET G2, G3, and NEC. The patient was not given adjuvant chemotherapy. Fifteen months postoperatively, computed tomography( CT)and positron emission tomography(PET)detected para-aortic lymph node metastasis, which was treated with 50 Gy radiation therapy. PET-CT imaging showed reduced viability of the metastatic lymph nodes 3 months after radiation, with complete remission observed on CT 6 months after radiation. Fifty-two months postoperatively, a solitary liver metastasis was identified and resected laparoscopically, revealing NET G2. The patient has remained recurrence-free for 27 months after the liver resection. This case emphasizes the efficacy of radiation therapy in achieving remission and long-term survival of patients with lymph node metastasis from NEN, despite the lack of histological differentiation between NET and NEC.

A 72-year-old woman with liver cirrhosis, diabetes, and parkinsonism was treated with atezolizumab plus bevacizumab (Atezo/Bev)for hepatic cancer and multiple lymph node metastases around the duodenum. After 2 doses of this treatment, alpha-fetoprotein(AFP)levels decreased, and the vascularity and size of the tumors were reduced on computed tomography. Eighteen days after the fourth dose of Atezo/Bev, the patient experienced shock due to bleeding from a duodenal ulcer and required hospitalization. Despite treatment with proton pump inhibitors, the duodenal ulcer did not show signs of healing and refractory duodenal ulcer bleeding occurred 102 days after the initial bleeding. AFP levels remained low and most of the tumors shrank, although new lymph node metastases were noted. Owing to the intractable duodenal ulcer and the intent for curative treatment of the hepatic cancer, resection of the liver, pancreatoduodenectomy with partial resection of the transverse colon, which was invaded by metastatic lymph nodes around the pancreatic head, and extirpation of the metastatic lymph nodes were performed. Pathological findings revealed that over 90% of the liver tumor was necrotic, and the residual viable lesion was adenocarcinoma, with a differential diagnosis of cholangiocarcinoma or cholangiolocellular carcinoma. The necrotic lesion possibly had a hepatocellular carcinoma component, and the liver cancer before Atezo/Bev treatment was possibly a combined hepatocellular-cholangiocarcinoma or cholangiolocellular carcinoma. The patient died of parkinsonism 1 year after surgery, without recurrence of liver cancer.

A 70s-year-old woman was diagnosed with advanced transverse colon cancer with an invasion of the duodenum, pancreas and liver. Pre-operative diagnosis was cT4b(the duodenum, pancreas and liver), N1b, M0, cStage Ⅲc. Neoadjuvant chemotherapy was performed for R0 resection. Since the tumor shrank, radical resection(R0)was performed. The standard treatment for resectable advanced colon cancer is surgical therapy in JSCCR Guidelines 2024 for the Treatment of Colorectal Cancer. On the other hand, neoadjuvant chemotherapy for locally advanced colon cancer is reported to contribute to prolong prognosis by increasing the proportion of R0 resection. Our hospital has a policy of neoadjuvant chemotherapy followed by surgical treatment for T4b cases, and the same policy was applied to this case. A successful case of R0 resection after neoadjuvant chemotherapy for advanced transverse colon cancer with invasion of the duodenum, pancreas and liver is reported.

Lipoma and well-differentiated liposarcoma are clinically differentiated by site of origin and length, and pathologically differentiated by immunostaining with MDM2 and CDK4. An 82-year-old male patient. A retroperitoneal lipomatous tumor which compressed intraabdominal organs was found on CT and MRI scan. Laparotomy for retroperitoneal tumor resection was performed. Lipomatous tumor more than 10 cm was extirpated. The pathological diagnosis was retroperitoneal intramuscular lipoma. One year after surgery, there is no sign of tumor recurrence.

Malignant melanoma is a rare and highly aggressive neoplasm originating from melanocytes, typically occurring on the skin and exhibiting early lymphatic and hematogenous metastases. Despite advancements in chemotherapy, immunotherapy, and radiotherapy, a definitive standard treatment has yet to be established;surgical excision remains the most effective modality. We present a case of primary malignant melanoma of the left palate. A 64-year-old man was referred to our department with a chief complaint of a black pigmented lesion on the palate. Clinical examination revealed a 20×25 mm exophytic black mass with an irregular margin and induration, extending from the left hard palate to the maxillary gingiva. Based on clinical findings, imaging, and excisional biopsy, the lesion was diagnosed as primary malignant melanoma of the left palate(cT3aN1M0, Stage Ⅲ), and curative surgical resection was performed. The postoperative pathological diagnosis was pT3aN0M0, Stage ⅡA. Immunotherapy with a checkpoint inhibitor was initiated 2 months after surgery. The patient has remained free of recurrence or metastasis for 1 year postoperatively and has demonstrated favorable oral function and clinical outcome.

Primary intraosseous carcinoma(IOC)is a rare malignancy originating from the epithelial lining of odontogenic cysts. We present a case of IOC arising from an odontogenic cyst in the mandible.