A 60-year-old male complaining of fever and dyspnea came to the hospital. The CT scan suggested esophageal perforation, pyothorax, and pneumothorax due to advanced esophageal cancer. When he was transferred to our hospital, he caused a state of shock, and laboratory tests showed both severe renal dysfunction and inflammation. Additional CT scan showed numerous enlarged lymph nodes and mesenteric nodules. We decided to perform palliative surgery including right lower lobectomy, esophagectomy(R2 resection), esophagostomy, gastrostomy, and tube enterostomy. Because postoperative air leakage persisted due to a bronchial segmental leak at the transection site, a fenestration operation was performed on day 41. He gradually recovered after the operation, and systemic chemotherapy started on day 54. Finally, he died of the primary disease approximately 10 months after the operation. He was saved by palliative surgery as conservative treatment was deemed ineffective. After postoperative systemic chemotherapy, he could spend valuable time at home with his family.

An 81-year-old woman with right lower abdominal pain was referred to our hospital. She was diagnosed as ascending colon cancer with duodenal invasion by CT and colonoscopy. Eight courses of FOLFOX+Bev, 3 courses of 5-FU/LV+Bev and 3 courses of IRI+P-mab were performed, tumor was reduced. Right hemicolectomy and partial duodenectomy were performed. Histopathological findings showed ypTis, N0, M0, ypStage 0, Grade 2. One year after surgery, the patient was alive without recurrence. This result suggests that preoperative chemotherapy may be an option for locally advanced colon cancer with other organ invasion in elderly patients.

The patient was an 83-year-old woman who underwent surgery at our orthopedic department for a lumbar compression fracture. On the second postoperative day, she developed fever and massive lower gastrointestinal bleeding. CT imaging revealed wall thickening of the descending colon, an abscess extending from the surrounding area to the spleen, and portal venous gas. The diagnosis was perforation of the descending colon, retroperitoneal abscess, and splenic abscess, leading to emergency surgery. Intraoperative findings suggested that the descending colon had perforated into the retroperitoneal space, forming an abscess, which had penetrated the spleen, creating a fistula. A hard mass was palpable at the perforation site of the descending colon, raising suspicion of cancer. Partial colectomy with combined resection of spleen and intra- abdominal irrigation and drainage were performed. Pathological findings confirmed the diagnosis of perforation due to descending colon cancer. No obvious splenic infiltration was observed, and it was considered that gas produced by gas-producing bacteria in the splenic abscess had migrated into the portal vein. Postoperatively, the patient developed disseminated intravascular coagulation(DIC), but improved with treatment. The patient was transferred to a rehabilitation facility on the 41st postoperative day. Three months postoperatively, multiple liver metastases and peritoneal metastases were detected, and palliative care was initiated at the transfer facility.

The patient was a 51-year-old woman who underwent surgery for bilateral breast cancer in 2021. In 2023, 2 years after surgery, multiple liver metastases were detected. Although she was treated with paclitaxel(PTX)plus bevacizumab(Bev), followed by pembrolizumab(Pemb)in combination with carboplatin(CBDCA)and gemcitabine(GEM), the liver metastases showed progressive disease. Sacituzumab govitecan was initiated as a third-line therapy in December 2024. At that time, a scalp cooling system was used, resulting in hair loss equivalent to CTCAE Grade 1. The patient did not require a wig, and the scalp cooling system demonstrated a favorable hair preservation effect. Further case accumulation is necessary to evaluate the hair loss prevention effect of the scalp cooling system during sacituzumab govitecan administration.

A 40s woman visited her previous physician with a complaint of bloody stools, and a colonoscopy revealed lower rectal cancer. A close examination by our department revealed an advanced rectal cancer 1 cm to the dentate line, and a diagnosis of cT3N1M0, cStage Ⅲb was made. The circumferential resection margin(CRM)and distal margin(DM)were extremely close, making upfront surgery challenging in securing a surgical resection margin while also preserving the anus. This situation posed a high risk of local recurrence, leading to the decision for neoadjuvant therapy. After chemoradiation therapy (CRT), the patient showed a response of ycT3N0M0, ycStage Ⅱa and subsequently underwent robotic very low anterior resection. The anastomosis was performed using double stapling technique(DST)in the anal canal during robotic surgery. The pathology results revealed no residual tumor and no lymph node metastasis. We report a case in which a pathological complete response(pCR)was achieved after preoperative CRT, while successfully preserving the anus through intra-anal DST under robotic surgery.

The patient was a 67-year-old woman who presented to our hospital with abdominal pain. She was diagnosed with transverse colon cancer with obstructive colitis, pancreatic head, and gastric invasion(cT4bN1bM0, cStage ⅢC). After the placement of a colonic stent to relieve the obstruction, 5 courses of preoperative chemotherapy(FOLFOXIRI+bevacizumab) were administered for local control. Tumor shrinking was observed, and the response was judged to be a partial response. Following a rest period, radical surgery(extended right hemicolectomy and pancreaticoduodenectomy)was performed. Pathological findings showed pT4b(panc)N1bM0, pStage ⅢC, and R0 resection was achieved. In cases of colon cancer invading other organs, long-term survival may be achievable with R0 resection, and we believe that extended surgery should be considered proactively.

According to the Japanese clinical practice guidelines, surgical resection is the first-line treatment for primary gastrointestinal stromal tumors(GISTs). However, neoadjuvant imatinib therapy is recommended for tumors >10 cm in size or those with a high risk of incomplete resection. We report a rare case of an invasive gastric GIST initially diagnosed as an unresectable tumor, in which a 12-day course of preoperative imatinib led to a marked tumor response, allowing curative surgery and achieving a pathological complete response(pCR). A 62-year-old man presented with appetite loss and a large GIST with a central ulcer in the upper gastric body. CT revealed a >15 cm mass with suspected invasion into the lateral liver segment, pancreas, spleen, and diaphragm. Neoadjuvant imatinib(400 mg/day)was administered. By day 7, CT showed significant tumor necrosis and shrinkage. However, on day 12, he developed massive bilateral pleural effusion and pneumonia, necessitating imatinib discontinuation and intensive care with mechanical ventilation. After clinical improvement, a curative resection involving proximal gastrectomy with distal pancreatectomy, splenectomy, or partial diaphragmatic resection was performed. Pathological examination showed complete disappearance of GIST cells, indicating pCR. The postoperative course was uneventful, and the patient remained recurrence-free. This extremely rare case highlights the potential of ultra- short-term imatinib therapy to induce pCR in GIST. Further molecular analyses, including mutational profiling, are required.

Pancreaticoduodenectomy(PD)has been increasingly performed as conversion surgery for advanced gastric cancer. We report 6 cases of gastric cancer in which PD was performed following chemotherapy. The reasons for requiring PD were pancreatic head invasion in 3 cases, common bile duct invasion in 1 case, and lymph node recurrence in the hepatic hilum after distal gastrectomy in 2 cases. Preoperative chemotherapy regimens included S-1+oxaliplatin in 3 cases, S-1+oxaliplatin+ trastuzumab in 1 case, capecitabine+oxaliplatin in 1 case, and S-1+cisplatin in 1 case. One patient died during hospitalization due to sepsis caused by postoperative cholangitis. A pancreatic fistula classified as Clavien-Dindo classification Grade Ⅲa occurred in 1 case. The 1-year and 2-year overall survival rates were 83.3% and 66.7%, respectively. The 1-year and 2- year recurrence-free survival rates were both 75.0%. Although the number of cases is limited, PD as conversion surgery for gastric cancer is considered an effective treatment option.

Primary small bowel adenocarcinoma(PSBA)is one of rare cancer, and the treatment method is not established. We analyzed 18 patients with PSBA in our hospital retrospectively, especially extent of lymph node dissection, effectiveness of treatment, prognosis. There are 11 cases of jejunal adenocarcinoma and 7 of ileal adenocarcinoma. Thirteen patients underwent surgical resection and lymph node dissection was performed for 10 patients. There is no metastasis of main lymph nodes. Peri-intestinal and intermediate nodes have high efficacy of lymphadenectomy from analysis of lymphadenectomy index. Peritoneum is the most common site of recurrence and metastasis. Some Stage Ⅳ patients with surgical resection and chemotherapy survived more than 5 years. It was assumed that the combination of resection of the primary tumor and metastatic treatment would improve the prognosis.

Paget's disease of the breast in young women is rare. We report a case of Paget's disease of the breast in a woman in her 30s. She had eczema on the right nipple since February 202X. Ointment application did not relieve the symptoms, and topical steroids were used, but there was no improvement. In April 202X+1, a skin biopsy was performed from the nipple erosions. Pathological examination confirmed the diagnosis of Paget's disease of the breast. Imaging studies showed no evidence of tumoral lesions. In July 202X+1, skin-sparing mastectomy with reconstruction using a tissue expander and sentinel node biopsy were performed. Pathology results of the excised specimen showed Paget's disease and a 3×2 cm noninvasive ductal carcinoma of the outer inferior area in the right breast. Eight months after surgery, a latissimus dorsi musculocutaneous flap reconstruction was performed. The diagnosis of Paget's disease should be considered in young patients with persistent nipple erosions. And it is difficult to accurately detect breast cancer lesion when Paget's disease is diagnosed, and mastectomy plus breast reconstruction is a good indication considering the patient's cosmetic appearance.

A 60-year-old woman who underwent mastectomy for right breast cancer 21 years ago was treated with endocrine therapy, chemotherapy and radiation therapy over a 13-year period following recurrence involving distant lymph nodes, bone, and lung metastases. She also underwent Lt. burr hole opening biopsy and Ommaya reservoir placement and gamma knife therapy for brain metastases at another hospital. She was referred to the university hospital for comprehensive genomic profiling test of the brain metastases specimen, which revealed PIK3CA and PTEN mutation. However, no targeted drugs were available through public health insurance at the time, and she continued treatment with other therapies. With progressive bilateral lung metastases, and following the insurance approval of capivasertib in Japan, she was started on combination therapy with capivasertib and fulvestrant. The treatment resulted in a partial response, with a progression-free survival of 8 months. In the CAPItello-291 trial, capivasertib and fulvestrant demonstrated efficacy in patients with up to two prior lines endocrine therapy, but its use in late-line settings has not yet been reported. In this article, we report a case of a woman with metastatic recurrent breast cancer who was treated with capivasertib and fulvestrant was used as the late-line treatment, resulting in a progression-free survival of 8 months.

A man in his 70s was incidentally found to have a pancreatic body tumor on an abdominal ultrasound. Tumor markers, including CEA, CA19-9, DUPAN-2, and SPan-1 were not elevated. Contrast-enhanced CT revealed a well-defined, hypovascular tumor measuring 25×20 mm diameter without dilatation of the distal pancreatic duct. These findings were atypical for a pancreatic ductal adenocarcinoma or a neuroendocrine tumor. A pathological examination obtained by EUS-FNA confirmed the tumor as a Grade 2 neuroendocrine tumor. Three months later, preoperative CT revealed a lobulated mass in his left kidney. FDG-PET showed mild uptake in the pancreatic tumor and high uptake in the renal mass, suggesting a primary renal malignancy rather than metastasis. High FDG uptake was also identified in enlarged para-aortic lymph nodes near the renal hilum. He underwent distal pancreatectomy and left nephrectomy after a multidisciplinary team discussion. Pathology confirmed a mixed ductal-neuroendocrine-acinar cell carcinoma in the pancreas and a diffuse large B-cell lymphoma in the kidney and lymph nodes. Pancreatic MiNEN is an extremely rare disease, accounting for only about 0.2% of all pancreatic tumors.

In the case of borderline resectable or unresectable locally advanced pancreatic cancer, the indication for surgical resection is considered after preoperative chemotherapy(radiation)and reevaluation of the patient's condition. During neoadjuvant chemotherapy, many patients show progressive hematocytopenia due to bone marrow suppression;hence, careful perioperative blood management has a significant impact on surgical resection procedures and outcomes regarding short-term or long-term prognoses. In this study, we report successful cases of transfusion-free surgery for initially borderline resectable and unresectable pancreatic cancer in 4 patients for whom transfusion was not an option, using the PBM treatment program.

An 80s man was diagnosed appendicitis and an incidental 33 mm cystic mass with a substantial component in the pancreatic body by contrast-enhanced CT. The enhancement component was stained early contrast. By MRI, component was pale high signal on diffusion-weighted images, and low signal ADC maps. The cyst was low signal on T1WI and slightly heterogeneous high signal on T2WI. Because of suspected mucinous cystic neoplasm(MCN), we performed laparoscopic distal pancreatectomy. By immunostaining, BCL-10 and trypsin were positive. Definite diagnosis was acinar cell carcinoma(ACC). He has been recurrence-free for 5 years without additional treatment. When a pancreatic mass with a mixture of cystic and enhancing components is found, ACC should be included int the differential diagnosis.

The patient was a 60-year-old male who underwent subtotal esophagectomy following 3 courses of DCF therapy as preoperative adjuvant chemotherapy for advanced esophageal cancer. The surgery resulted in R2 resection. The postoperative pathology indicated MtUt, CT-pT3, N2(5/26), and pStage ⅢB. The patient received nivolumab and RT(40 Gy)after surgery. After 2 courses of nivolumab therapy, the patient experienced frequent diarrhea and severe dehydration and was admitted to the hospital. CT revealed portal vein gasemia, which necessitated emergency surgery for NOMI. Extensive resection of the small intestine was performed, and the patient survived. The patient was subsequently treated with wPTX as a second-line therapy. After 1 course, the patient developed febrile neutropenia and severe pneumonia, necessitating hospitalization. During this period, the tumor recurred and reached approximately 10 cm in size, exerting pressure on the heart. Pembrolizumab and FP were administered as third-line therapies. After 3 courses, the patient developed irAE colitis, requiring steroid pulse therapy;however, the recurrent tumor shrank significantly, improving the patient's general condition. Follow-up continued without restarting pembrolizumab, and the patient remained relapse-free for 1 year. This case illustrates a successful ICI rechallenge in a patient with advanced esophageal cancer.

The patient was a man in his 80s. Endoscopic examination revealed gastric cancer located on the anterior wall of the lesser curvature of the upper body of the stomach. He underwent laparoscopic proximal gastrectomy with D1+ lymph node dissection and esophagogastrostomy using the double-flap technique. The pathological staging was pT2N0M0, pStage ⅠB. He did not receive adjuvant chemotherapy. Eighteen months after surgery, follow-up non-contrast CT and PET-CT revealed solitary splenic metastasis. Due to his advanced age, chemotherapy was deemed difficult, and laparoscopic splenectomy was scheduled. Intraoperative findings revealed that the splenic metastasis had directly invaded the pancreas and colon, so laparoscopic distal pancreatectomy and partial colectomy were performed. Pathological examination confirmed recurrent solitary splenic metastasis from gastric cancer. Recurrence was detected in the greater curvature lymph node after 6 months postoperatively. The patient remains alive 7 months after surgery. Isolated splenic recurrence after gastrectomy for gastric cancer has been reported to achieve long-term survival with resection, and minimally invasive laparoscopic surgery may be considered as a treatment option for oligometastasis.

An 82-year-old male patient underwent pancreatoduodenectomy for pStage Ⅱ distal bile duct cancer. During observation, after 5 years, a solitary metastasis in segment 6 of the liver was detected, and laparoscopic partial hepatectomy was planned. The patient was successfully treated without complications, and the resection margins were negative. The patient survived without recurrence for 6 months after the surgery. Although no consensus has been reached regarding the surgical indications for liver metastases in patients with biliary tract cancer, recent reports have highlighted the merits of surgery. Factors, such as good health status, expected curative resection, number of tumors, tumor diameter, and duration after the first surgery were considered good candidates for surgery. Generally, Pringle's maneuver is difficult after pancreatoduodenectomy because of severe adhesions;however, some cases are considered possible for laparoscopic resection depending on the location, such as segments 2-6.

A man in his 90s with a history of gastrectomy for gastric cancer was diagnosed in December of year X with a circumferential transverse colon carcinoma causing endoscopic obstruction. He underwent laparoscopic partial resection the following month. Pathology revealed a 65×35 mm tumor(tub1-pap>tub2), corresponding to pStage Ⅱa. His carcinoembryonic antigen(CEA)dropped from 11.0 ng/mL preoperatively to 2.9 ng/mL postoperatively. By August of the same year, CEA levels began to rise again. Magnetic resonance imaging detected three hepatic metastases. A 10 mm lesion in segments 5 lay adjacent to the right hepatic vein, predicting substantial surgical invasiveness. Because pre-existing pancytopenia contraindicated chemotherapy, which the patient also declined, radiotherapy was selected. Two months later, all 3 lesions were treated simultaneously with volumetric-modulated arc therapy(VMAT)(60 Gy/20 fr), completed without toxicity. CEA declined from 71.9 to 3.5 ng/mL within 2 months post-irradiation. One-year post-radiotherapy, a gradual CEA increase together with FDG-PET/CT and MRI findings suggested local recurrence;nevertheless, disease activity remained contained while the super-elderly patient retained independent activities of daily living.

We report a case of early rectal cancer mixed neuroendocrine tumor Grade 3(NET G3)that rapidly metastasized. A 76- year-old woman was diagnosed with a rectal tumor in the lower rectum and underwent endoscopic submucosal dissection. Pathology showed tub2>por2, pT1b(2,700μm)with NET G3 features in less than 30% of the lesion. Immunohistochemistry was positive for synaptophysin and chromogranin A, negative for CD56. Despite abdominoperineal resection with D3 dissection, a large liver metastasis appeared 6 months after surgery. Liver biopsy confirmed similarity to the rectal NET G3 component. The patient died 13 months postoperatively despite chemotherapy. This case highlights that even small NET G3 components in early rectal cancer may indicate poor prognosis.

The combination of endocrine therapy and cyclin-dependent kinase 4/6 inhibitor(CDK4/6 inhibitor)is recommended as primary treatment for hormone receptor-positive HER2-negative metastatic or recurrent breast cancer. In this study, we investigated the efficacy and adverse events of CDK4/6 inhibitors as late therapy in patients treated with palbociclib(PLB) and abemaciclib(ABM)2 sequentially. Nine patients were selected with a history of prescriptions for 2 PLB and ABM drugs from December 2017 to November 2024. Efficacy and adverse events were examined retrospectively from the database. As a result, all patients were female, with an average age of 56 years old. There were 8 recurrent cases and 1 case of de novo Stage Ⅳ. Seven cases were changed to ABM after PLB, and 2 cases were changed from ABM to PLB. Median progression- free survival(PFS)as the late therapy for ABM was 29.2 months vs 6.5 months for PLB. One PD and 6 adverse events were the reasons for switching to ABM after taking PLB. Although the number of patients was small, PFS with sequential CDK4/6 inhibitors could be expected to be longer than 6 months, suggesting that the treatment may be useful in extending the time to chemotherapy induction.