A 76-year-old man presented with a pancreatic cystic lesion on magnetic resonance imaging before surgery for bladder cancer. Endoscopic ultrasound(EUS)suggested a malignant tumor such as a neuroendocrine neoplasm, but EUS-fine-needle aspiration was not performed. In addition, a single tumor 10 mm in size was found in the liver(S5), and liver metastasis was suspected. We judged that surgery would be useful for treating the neuroendocrine neoplasm and liver metastasis, so we performed distal pancreatectomy, splenectomy, and partial hepatectomy. Histopathological examination revealed anaplastic carcinoma with osteoclast-like giant cells and liver metastasis. Four courses of modified FOLFIRINOX and 3 courses of liposomal irinotecan plus 5-fluorouracil/Leucovorin were administered as chemotherapy, but it was discontinued due to adverse events. Thereafter, S-1 monotherapy was performed for 7 months, and the patient was alive without recurrence as of 1 year and 8 months postoperatively. Anaplastic carcinoma of the pancreas often recurs early after surgery; thus, long-term survival is difficult to achieve, even after R0 resection. Here, we report this case of anaplastic carcinoma with osteoclast-like giant cells of the pancreas and synchronous liver metastasis that was successfully treated with surgery and chemotherapy.

A 77-year-old man presented to our hospital with anemia and was diagnosed with a high-risk gastrointestinal stromal tumor (GIST)of the stomach on abdominal CT scan and endoscopic ultrasound-guided fine-needle biopsy. One month after initiating the neoadjuvant imatinib therapy, the patient was admitted to our hospital for fever and was diagnosed with an intratumoral infection. Antibiotic therapy was immediately initiated, and upper gastrointestinal endoscopy revealed a fistula between the stomach and tumor; therefore, endoscopic drainage was performed through the fistula. A local gastrectomy was performed 6 days after draining the intratumoral abscess as the inflammatory findings improved rapidly. The patient was discharged on day 6 without any postoperative complications. Adjuvant therapy with imatinib was initiated 6 weeks after surgery and is ongoing without any recurrence 14 months later. Gastric GISTs rarely develop into intratumoral infections, and appropriate treatment has not been established. In this case, the infection was controlled using antibiotics and endoscopic drainage, and resection was performed immediately after controlling the infection. Here, we report the treatment of infectious GIST with a review of the literature.

We report a case of advanced breast cancer achieving a significant improvement on QOL by mastectomy followed by S-1 administration. The patient was a 50s female brought by an ambulance because of bleeding from huge right breast tumor. CT scan showed bilateral breast cancers with right axially lymph node metastasis. Bilateral total mastectomy with right axially lymph node dissection was performed. Postoperative PET-CT showed multiple bone metastasis. Histopathological findings showed right tumor was scirrhous carcinoma, pT4bpN1cM1, Stage Ⅳ, left tumor was papillotubular carcinoma, pT2NX, Stage ⅡA, both tumor was HR positive, HER2 negative. Postoperative oral tamoxifen therapy was not effective. Second regimen S-1 with denosumab was very effective. The patient is alive with no complaints for 9 years after mastectomy. The purpose of treatments for MBC is to maintain favorable QOL, as well as to improve survival. S-1 could be a valuable agent for breast cancer treatments, since it showed clinical efficacy and mild toxicity, and be given orally.

A 56-year-old man was referred to our institution with bloody stools. Colonoscopy revealed a type 3 tumor in the lower rectum. Histological analysis revealed moderately differentiated adenocarcinoma. Magnetic resonance imaging indicated that the tumor was confined to the rectal wall; however, enlarged lymph nodes were observed. Computed tomography revealed no signs of metastasis. The patient was diagnosed with rectal cancer(cT3N1aM0, cStage Ⅲb). The patient received neoadjuvant chemotherapy(NAC)consisting of capecitabine and oxaliplatin(CAPOX). After 4 courses of CAPOX, the diagnosis was revised to ycT2N0M0. The patient subsequently underwent robot-assisted intersphincteric resection, ileostomy, and bilateral lymphadenectomy. Pathological examination revealed a complete response. This case suggests that NAC may be a viable option for treating locally advanced rectal cancer.

A 68-year-old woman presented with an abdominal mass. Abdominal computed tomography(CT)revealed a tumor (167 mm in diameter)that originated from the posterior gastric wall, and was diagnosed as a gastric gastrointestinal stromal tumor(GIST)based on a fine-needle aspiration biopsy. Additionally, we observed a ground-glass opacity in the left upper lobe, which was suggestive of primary lung carcinoma. Positron emission tomography(PET)revealed no evidence of distant metastases. The patient received neoadjuvant imatinib therapy, causing a reduction in GIST size. Left upper lung lobectomy was performed following a 3 months imatinib administration, then an additional 4 months of imatinib therapy, which induced a partial response(reduction rate of 60%). Subsequently, the patient underwent partial gastrectomy, distal pancreatectomy, and splenectomy for elective complete tumor resection. Histopathological findings showed no viable tumor cells nor evidence of invasion of the surrounding organs. CT performed 17 months after tumor resection without adjuvant therapy(at the patient's request)revealed a single perineal metastatic lesion. Imatinib therapy was administered, and a PET-documented complete response was achieved at 10 months. The patient maintained a complete response for 65 months after imatinib reinitiation.

A 72-year-old man visited our hospital for evaluation of a liver tumor documented on abdominal ultrasonography. Computed tomography revealed a liver tumor measuring 13 cm and a tumor thrombus in the right branch of the portal vein. The patient was diagnosed with hepatocellular carcinoma(T4N0M0, Stage ⅢB, Union for International Cancer Control 8th edition), which was categorized as an advanced-stage malignancy based on the Barcelona Clinic Liver Cancer staging system, and the patient received atezolizumab and bevacizumab therapy. The tumor thrombus disappeared completely after 2 courses of chemotherapy, and the liver tumor shrank to 8 cm following 11 courses of chemotherapy. We performed right hemihepatectomy and R0 resection after 19 courses of chemotherapy, and the patient was recurrence-free at 6-month follow-up. This report highlights the usefulness of multimodal therapy for locally advanced hepatocellular carcinoma.

Here, we report a case of ovarian metastases from colorectal cancer. A 61-year-old woman who underwent colorectal cancer surgery showed elevated CEA levels 30 months later. Contrast-enhanced computed tomography(CT)showed no recurrence; however, positron emission tomography-CT revealed a right ovarian mass. Based on these findings, a single-incision laparoscopic surgery was performed to diagnose right ovarian metastasis, and the histopathological diagnosis confirmed ovarian metastasis of colorectal cancer. The patient was recurrence-free at her 12 months postoperative follow-up.

An 81-year-old man who presented at another hospital with a chief complaint of throat congestion underwent upper gastrointestinal endoscopy, which revealed an esophagogastric(EG)junction tumor. The tumor was a Type 3 lesion extending from the lower esophagus to the gastric cardia(cT3N2M0); the patient underwent surgery(left thoraco-laparotomic proximal gastrectomy+lower esophagectomy). The histological examination confirmed the tumor to be a type of adenocarcinoma. Immunostaining of tumor cells showed positive staining for SALL4 and AFP, indicating a diagnosis of adenocarcinoma with enteroblastic differentiation, comprising cells resembling the fetal gastrointestinal epithelium and testing positive for AFP, Glypican-3, or SALL4. Herein, we report a case of a patient with adenocarcinoma with enteroblastic differentiation at the EG junction and present current insights from a literature review.

The patient presented with a 38 mm-sized mass in the S3/4 of the liver on contrast-enhanced CT in his seventies. He underwent hepatic left lobectomy and cholecystectomy as hepatocellular carcinoma. Postoperative histopathology revealed a diagnosis of intermediate differentiated hepatocellular carcinoma, pT3, pN0, pM0, pStage Ⅲ. Ten months after surgery, a contrast-enhanced CT scan of the abdomen showed a recurrence in the caudate lobe, and a partial caudate lobe resection was performed. Nine months after reoperation, a peripancreatic lymph node recurrence was noted, and a lymphadenectomy was performed. Six months later, metastasis was detected in S3 of the right lung, and the patient was started on atezolizumab+bevacizumab therapy for 15 months. Five years and 2 months after the initial surgery, Abdominal CT showed enlarged peripancreatic lymph nodes and an elevated lesion in the duodenal bulb. The bulky lesion in the duodenum was diagnosed as recurrence of hepatocellular carcinoma. The raised lesion in the duodenum was diagnosed as recurrence of hepatocellular carcinoma on biopsy. Currently, drug therapy is being resumed.

We report a patient with left breast cancer who underwent total mastectomy and axillary dissection as primary surgery. The patient, a 78-year-old woman, noticed a tumor about 4 cm in the left breast. She was diagnosed with left breast cancer (cT2N2M0, cStage ⅢA). The pathology revealed invasive lobular carcinoma, 46×31 mm, ly(+), v(0), histological grade: 2, n2, hormone receptor positive, HER2 negative, and pStage ⅢA. We recommended adjuvant chemotherapy, but she did not desire. She started oral administration of an aromatase inhibitor and radiation therapy. When DFI was 3 years, an examination was carried out because the increase in CEA value, CT scan revealed a mass extending from the bladder. We suspected bladder cancer. She underwent a bladder biopsy. The result was bladder metastasis of breast cancer. Later, we introduced chemotherapy. Routine screening of the lower urinary tract is not necessary for all patients, but women with a history of breast cancer presenting with urinary symptoms should undergo a thorough examination of the urinary tract.

A 71-year-old woman was referred to our hospital for a right breast mass urgency. A CT scan revealed a large right breast tumor with skin involvement. Biopsy results confirmed the diagnosis of Luminal-HER2 type invasive ductal carcinoma. Chemotherapy was initiated with a regimen of paclitaxel, trastuzumab, and pertuzumab. Initially, the tumor flattened and significantly decreased in size. However, after 9 months of treatment, disease progression occurred, leading to sequential changes in the treatment regimen to T-DM1 and T-DXd. Despite these efforts, the tumor continued to grow rapidly. At 13 months after starting chemotherapy, the treatment effect was unsatisfactory, prompting a decision to perform a total mastectomy, including resection of the right breast tumor and the pectoralis major muscle, followed by skin grafting. The histopathological effect of the treatment was judged as Grade 1b, with intermediate tumor margins. Postoperatively, the patient received radiation therapy to the chest wall, followed by continued treatment with trastuzumab and pertuzumab. As of 2 years after surgery, no recurrence has been observed.

Regional recurrence after sentinel lymph node biopsy for breast cancer is rare, with an incidence rate of less than 1%. The rate of axillary lymph node metastasis is similar in T1a breast cancer and Tis breast cancer. In this report, we present 2 cases of axillary recurrence after sentinel lymph node biopsy for T1a breast cancer. None of the patients experienced distant recurrence, and both patients underwent axillary dissection, chemotherapy, endocrine therapy, and radiation therapy. A notable commonality between these cases was the presence of multiple invasive lesions at the time of the initial diagnosis. Currently, the extent of invasion is assessed by its maximum diameter, and the presence of multiple lesions does not influence staging. However, multiple lesions may serve as a poor prognostic marker, necessitating a judicious approach to the initial treatment. Following resection for regional recurrence, it is crucial to pursue a multidisciplinary curative approach similar to the initial management of early breast cancer with lymph node metastasis.

The patient is a 70-year-old woman who presented with a chief presentation of anal itching. Her previous physician diagnosed her with perianal extramammary Paget's disease, and she was referred to our hospital. Physical examination revealed a well-circumscribed red skin rash 6 cm in diameter centered on her anus. An anal skin biopsy showed adenocarcinoma, and immunostaining demonstrated CK7+,CK19+,CK20+,CDX2+, leading to the suspicion of pagetoid spread of anal adenocarcinoma. Lower gastrointestinal endoscopy revealed no obvious lesions; however, based on immunostaining results, she was diagnosed with small anal adenocarcinoma with Pagetoid spread. She underwent laparoscopic abdominoperineal rectal amputation(D1LD0)considering the circumferential circumference and possibility of a cure. A 1 cm margin of anal skin was removed, and pathological examination revealed an area filled with Paget cells in the duct near the transitional epithelium, which was considered the primary tumor and was diagnosed as anal adenocarcinoma(PE, pTisN0M0, pStage 0). The patient remains alive without recurrence for 6 months.

The prognosis for locally advanced unresectable pancreatic cancer(UR-LA PC)is extremely poor, surgical treatment is difficult, and chemoradiotherapy is recommended. Here, we report a case of a patient with UR-LA PC treated with chemoradiotherapy, resulting in a long-term survival of 3 years and 2 months without recurrence.

The prognosis of patients with gastric cancer and ovarian metastasis is extremely poor, with many studies reporting survival durations within 1-2 years after diagnosis. The patient in this study was a 64-year-old female who visited a local hospital with lower abdominal pain and was referred to our hospital's gynecology department for follow-up of uterine fibroids. MRI revealed a right ovarian tumor and upper gastrointestinal endoscopy revealed gastric cancer in the upper stomach. A total hysterectomy with bilateral adnexectomy was performed, and the pathological examination revealed that gastric cancer had metastasized to the uterus and right ovary. After SOX therapy, laparoscopic proximal gastrectomy with double-flap reconstruction was performed. Postoperative pathological diagnosis was U, Ant, pType 5, 38×21 mm, por-tub, ypT4a(SE), Ly1b, V0(VB), ypPM0, ypDM0, ypN0, P0, CY0, H0, M1(OTH), ypStage Ⅳ, R0. Two years and 10 months have passed since the surgery, and there have been no signs of recurrence. In this patient, both the ovarian metastasis and primary gastric lesion were completely resected, and chemotherapy was effective, resulting in a good prognosis. Considering that gastrectomy reduces chemotherapy tolerability, the timing of gastrectomy should be considered. In addition, avoiding total gastrectomy is important for postoperative adjuvant chemotherapy.

Breast cancer is a representative malignancy that is prone to brain metastasis. Recently, several studies have reported the efficacy of trastuzumab deruxtecan(T-DXd)in treating brain metastases. We have used T-DXd in 10 patients with brain metastases, and stereotactic or whole brain irradiation was performed in 9 of 10 patients. All patients had symptoms of brain metastases. Because T-DXd was administered in the late line in the early cases, symptoms due to brain metastases or meningeal dissemination worsened during T-DXd administration in a few cases. None of the four most recent cases showed worsening of brain metastasis or symptoms due to brain metastasis after T-DXd use. We would like to accumulate more cases and investigate whether T-DXd can be preferred over irradiation for asymptomatic patients with brain metastases.

The patient is a 46-year-old woman who previously underwent a partial mastectomy with sentinel lymph node biopsy for a 5.6 cm diameter noninvasive breast apocrine carcinoma in the upper, inner quadrant right breast at age 33. Thirteen years later, a 2.1 cm diameter tumor appeared in the same area, and core needle biopsy examination revealed invasive apocrine carcinoma(ER[-], PR[-], HER2[+]). Without distant metastasis, the patient received doxorubicin plus cyclophosphamide( AC)therapy followed by trastuzumab, pertuzumab, docetaxel(HPD)therapy as neoadjuvant chemotherapy. Subseqently, the tumor disappeared clinically. Mastectomy was performed, and complete response was confirmed pathologically.

A 74-year-old man was found to have 2 nodules with an enlarging tendency in the left lung 2 years 4 months after undergoing surgery for colon cancer(T4aN0M0, pStage Ⅱb). The patient had a history of prostate cancer 13 years prior (T3bN0M1)that was treated by hormone therapy after radiotherapy as well as post-myocardial infarction, post-parathyroid surgery, and type 2 diabetes. CEA, CA19-9, SCC, CYFRA, ProGRP, and PSA levels were within normal limits. Chest CT findings of the left lung revealed a 1.2 cm nodule in S3 and a 0.9 cm nodule in S9, with FDG uptake for both shown to be elevated in PET results. Based on examinations performed of frozen sections after performing a VATS wedge resection, the nodule in the left S3 was suspected to be primary lung cancer, while the left S9 nodule was considered to be metastasis from colon cancer. A VATS segmentectomy of the upper division was then performed. The diagnosis based on postoperative pathological results of the S3 and S9 nodules was metastatic lung tumor from prostate cancer and colon cancer, respectively. The patient is presently under observation without recurrence. Resection should be considered even when multiple lesions are present, as it is important to determine the primary tumor for deciding a treatment policy. Findings obtained in the present case indicate that an intraoperative rapid diagnosis procedure does not always provide accurate results for planning the best operative procedure.

The patient was a 56-year-old woman. At the age of 41, she underwent partial mastectomy and sentinel lymph node biopsy for right breast cancer. At the age of 55, she fell and bruised her left chest. An 8 cm subcutaneous hemorrhage and swelling was found in the left breast. We diagnosed intramammary hematoma and performed hemostasis and drainage of hematoma cavity. As she had undergone surgery for contralateral breast cancer, the possibility of a positive BRCA1/2 gene mutation was considered, and part of the inner wall of the hematoma cavity was removed during surgery and submitted for pathological tissue diagnosis. She was diagnosed with left breast cancer. Considering the possibility of HBOC, a BRCA1/2 genetic test was performed, which revealed a positive BRCA2 gene mutation. We performed an additional total mastectomy and sentinel lymph node biopsy. Breast cancer is often discovered during screening or when patients visit the hospital due to the feeling of a mass, but it is rare for it to be discovered through an intramammary hematoma. Here we report a case in which an intramammary hematoma following surgery for contralateral breast cancer was diagnosed as breast cancer based on histopathological examination of the inner wall of the hematoma cavity, in a patient who was highly likely to have a BRCA gene mutation.

The patient was a 79-year-old male in whom a neoplastic lesion was found in the sigmoid colon diverticulum during a follow-up colonoscopy for colorectal adenoma. Endoscopic treatment was difficult, and the patient was referred to our department for surgery. The patient had many underlying diseases, including angina pectoris, interstitial pneumonia, and diabetic nephropathy, and the decision was made to perform local resection as a minimally invasive treatment. The patient was treated with laparoscopic excision of the sigmoid colon, followed by a small laparotomy and intraoperative endoscopy to open the colon for local resection. Pathology results showed a 5 mm pTis with R0 resection. Early-stage cancer of the diverticulum is often difficult to treat endoscopically due to the limited space available for manipulation. Local excision, as a minimally invasive treatment, is also a useful option when several underlying diseases are present, as in this patient.