We report a case of breast bleeding caused by breast cancer without skin invasion. A woman in her 70s was aware of a mass in her right breast but left it untreated. About 6 months after noticing the mass, she visited our hospital due to bleeding from the right breast. Although needle biopsy did not reveal a diagnosis of breast cancer, we diagnosed her as having breast cancer based on clinical findings and recommended her to have surgery. Her consent was not obtained. Approximately 1 year later, she experienced bleeding from her right breast and visited our hospital. A tumor was identified, a biopsy was performed, and a diagnosis of breast cancer was made. A right lumpectomy and sentinel lymph node biopsy was carried out. Pathological diagnosis was invasive ductal carcinoma. No skin invasion was observed. The final diagnosis was pT1c, pN0 (sn), M0, pStageⅠ. After surgery, the patient was treated with tamoxifen and radiation therapy, and is currently free of recurrence.

A 77-year-old woman with a diagnosis of transverse colon cance(r cT2N0M0, cStage Ⅰ), who presented with significant weight loss, underwent a planned laparoscopic colectomy. Intraoperative findings revealed multiple small white nodules suggestive of peritoneal dissemination. Due to the absence of a pathologist, rapid intraoperative pathology could not be performed, and only a biopsy of the peritoneal nodules was obtained. Subsequent pathological examination identified granulomatous tissue with caseous necrosis, leading to a diagnosis of tuberculous peritonitis. Standard 4-drug anti-tuberculosis therapy was initiated on postoperative day 7. A laparoscopic transverse colon resection with D3 lymphadenectomy was performed on postoperative day 73. This case emphasizes the importance of differentiating tuberculous peritonitis from carcinomatous peritonitis, as well as the need for appropriate infection control measures in managing Mycobacterium tuberculosis during surgery. The laparoscopic procedure was safely completed with successful management of tuberculous peritonitis.

We report a 72-year-old man who developed secondary rectal cancer 17 years after receiving brachytherapy for prostate cancer. The patient had undergone gastrectomy for gastric cancer 4 years earlier. Elevated tumor markers during follow-up prompted further investigation, revealing a rectal tumor invading the prostate. Robot-assisted total pelvic exenteration was performed after neoadjuvant chemotherapy. Histopathological examination confirmed advanced rectal adenocarcinoma invading the bladde(r ypT4bN3M0, ypStage Ⅲc). Although secondary malignancies following prostate radiotherapy are rare, our case met the established criteria for radiation-induced cancer;history of radiation exposure, latency period >4 years, histological differences from the primary tumor, and origin in previously normal tissue. Literature review indicates that, although uncommon, the incidence of secondary pelvic malignancies increases 15-20 years after radiotherapy, with a higher frequency reported following brachytherapy compared to radical prostatectomy. Our case highlights the importance of long- term follow-up in patients treated with pelvic radiotherapy because secondary cancers may emerge after decades. Ongoing surveillance may help detect such malignancies at earlier and more treatable stages, thereby improving patient outcomes.

Late recurrence of colorectal cancer, especially more than 5 years after curative resection, is rare, accounting for less than 0.5% of all cases. We report a valuable case of a 72-year-old female who was diagnosed multiple metastases 22 years after undergoing surgery for rectal cancer in her 50s. Initial examination revealed elevated CEA and various metastatic lesions including a right iliopsoas muscle tumor, multiple pulmonary nodules, and widespread multiple lymphadenopathy. Biopsy of the iliopsoas mass confirmed adenocarcinoma, consistent with her previous rectal cancer. Systemic chemotherapy was initiated, starting with FOLFIRI plus panitumumab(Pmab), which achieved a partial response. Due to skin toxicity from Pmab, it was switched to cetuximab(Cmab), and FOLFIRI was continued for 71 courses. Subsequently, the patient experienced disease progression and received second-line FOLFOX plus bevacizumab(Bmab)and third-line FTD/TPI plus Bmab. Furthermore, FOLFIRI plus Pmab was rechallenged. Ultimately, the patient died of the original disease 6 years and 1 month after the initiation of chemotherapy, and 28 years after the initial surgery. The recurrence of colorectal cancer 22 years post-surgery was the longest reported case in Japan. This case demonstrates that long-term survival can be achieved even in unresectable late-onset recurrent rectal cancer through persistent and multidisciplinary chemotherapy.

We report the case of an 80-year-old man who presented with acute abdominal pain and was emergently hospitalized. Contrast-enhanced computed tomography revealed a tumor in the ascending colon with free intraperitoneal air and ascites, without evidence of distant metastasis. A diagnosis of acute generalized peritonitis due to perforation of an ascending colon tumor was made, and the patient underwent emergency surgery consisting of primary closure of the perforation and creation of a diverting ileostomy. Postoperative colonoscopy identified a tumor in the ascending colon. Histopathological examination of biopsy specimens confirmed adenocarcinoma with HER2 positivity, RAS mutation, and microsatellite instability- high(MSI-high). The clinical stage was cT4bN1bM0(duodenum), Stage Ⅲc. Pembrolizumab therapy was initiated 1 month after surgery. Progressive tumor regression was observed during treatment, and after 14 courses, colonoscopy demonstrated marked tumor shrinkage with persistent severe luminal stenosis. After 17 courses in total, laparoscopic right hemicolectomy and ileostomy closure were performed. Histopathological examination of the resected specimen showed no residual carcinoma. The histological response was classified as Grade 3 corresponding to a pathological complete response(pCR). No adjuvant chemotherapy was administered. At 5 months after the operation, the patient is alive without any recurrence. This case suggests the potential efficacy of pembrolizumab for MSI-high locally advanced colorectal cancer.

A 76-year-old man underwent laparoscopic partial resection of the descending colon for descending colon cancer. The common trunk of the left colic artery and the first branch of the sigmoid artery was ligated, while the inferior mesenteric artery(IMA)was preserved and the inferior mesenteric vein(IMV)was divided. The pathological diagnosis was pT3pN0M0, pStage ⅡA, and no adjuvant chemotherapy was administered. At 6 months postoperatively, CT showed inflammatory changes extending from the anastomosis to the rectum, but observation was continued as the patient was asymptomatic. At 8 months postoperatively, he developed abdominal pain and frequent defecation. Based on CT and endoscopic findings, ischemic colitis was diagnosed. Conservative treatment was ineffective, and a double-barrel ileostomy was performed. Although the inflammation improved postoperatively, progressive stenosis occurred, and 11 months after ileostomy, a high anterior resection including the anastomosis and stoma closure was performed. It was considered that preservation of the IMA and division of the IMV led to relatively increased venous congestion, resulting in delayed-onset ischemic colitis.

A woman in her seventies presented with mucous hematochezia. Colonoscopy revealed a poorly differentiated adenocarcinoma in the upper rectum. Immunohistochemical staining showed CK7 positivity and CK20/CDX2 negativity, findings atypical for primary colorectal carcinoma. Contrast-enhanced CT and pelvic MRI demonstrated circumferential thickening of the rectal wall with an adjacent multilocular cystic lesion, raising suspicion of an endometriosis-associated intestinal tumor (EAIT). Laparoscopic low anterior resection with D3 lymphadenectomy was performed along with total hysterectomy and bilateral salpingo-oophorectomy. Histopathological examination revealed submucosal adenocarcinoma with CD10-positive endometrial stromal cells surrounding the tumor, consistent with EAIT. The patient received 6 courses of adjuvant chemotherapy with docetaxel and carboplatin. No recurrence has been detected during 3 years and 9 months of postoperative follow-up. This case may provide valuable insight into the diagnosis and multidisciplinary management of this uncommon disease.

The patient is a woman in her 70s. She came to our hospital because of constipation and abdominal pain. An abdominal CT scan showed a sigmoid colon mass and air in the surrounding mesentery, and an ileostomy was constructed based on the diagnosis of intramesenteric perforation of sigmoid colon cancer. Tumor biopsy by colonoscopy revealed a diagnosis of signet-ring-cell carcinoma. After 6 courses of mFOLFOX6 neoadjuvant chemotherapy, the patient underwent laparoscopic sigmoid colon resection and closure of the ileostomy. The final pathological diagnosis was pT4aN2aM0, pStage Ⅲc, RM1, microsatellite instability-high(MSI-H). Six courses of pembrolizumab chemotherapy were administered as adjuvant chemotherapy. Tumor markers have normalized and there are no signs of recurrence. MSI-H colorectal cancer is reported to account for about 10% of all colorectal cancers and signet-ring-cell carcinoma for only 1%. We report this case because it is a rare combination of both and a valuable case of successful multidisciplinary treatment.

We reported a case of sigmoid colon cancer with rectal intussusception. An 82-year-old woman had anal prolapse. Results of the examination, it was a diagnosis of sigmoid colon cancer with rectal intussusception. The tumor was then repositioned. Based on the above, robotic sigmoidectomy with D3 dissection of lymph nodes was performed. The histopathological diagnosis demonstrated double sigmoid colon cancers and no ischemic change of colon. She has not recurred 16 months later after operation.

The patient was a woman in her 70s who presented to our hospital for further examination and treatment after a palpable mass was noted in the upper right area of the umbilicus. Contrast-enhanced CT revealed a 52 mm heterogeneously enhancing mass located ventral to the horizontal part of the duodenum. MRI showed a mass with heterogeneous signal intensity in the right upper abdomen. Due to the discrepancy in tumor location between CT and MRI, a non-epithelial tumor originating from the bowel or mesentery was suspected;however, the exact site of origin could not be determined. Given the presence of well-developed feeding vessels, a biopsy was avoided, and surgical resection was performed for diagnostic and therapeutic purposes. Intraoperatively, the tumor was found within the transverse mesocolon and showed portal vein invasion. Therefore, resection of the transverse mesocolon tumor, partial colectomy of the transverse colon, and combined resection of the portal vein were performed. Gross examination of the resected specimen revealed a well-demarcated, white-colored tumor measuring 60 mm in maximum diameter within the transverse mesocolon. Immunohistochemical analysis showed positivity for SMA and desmin, and negativity for c-kit, CD34, and S-100. The Ki-67 labeling index was approximately 30%. Based on these findings, the tumor was diagnosed as a primary leiomyosarcoma of the transverse mesocolon. The patient has been followed postoperatively without adjuvant therapy, and no signs of recurrence have been observed during the 10 months since surgery.

A 50-year-old woman was diagnosed with left-sided breast cancer 1 decade previously. The patient underwent left partial mastectomy and sentinel lymph node biopsy, which necessitated axillary dissection. The cancer was classified as cT1cN0M0, indicating Stage Ⅰ, ER-positive, and HER2-negative breast cancer, with no metastatic findings on imaging. The final stages were pT1cN1aM0 and pStage ⅡA. Postoperatively, the patient received TC(docetaxel+cyclophosphamide) chemotherapy, total breast irradiation, and tamoxifen for 10 years. Positron emission tomography/computed tomography conducted 10 years postoperatively revealed an enlarged right axillary lymph node with an SUVmax of 1.3. A Class Ⅴ diagnosis was made via US-guided fine-needle aspiration cytology. No additional metastases were suspected and magnetic resonance imaging revealed no bilateral mass lesions in the breasts. Consequently, a histological diagnosis was required to ascertain whether the lesion was recurrent, which led to right axillary lymph node dissection. The specimen was identified as a metastatic carcinoma(GATA-3-positive, ER-positive, and HER2-positive). Considering the different subtypes and absence of other lesions, the patient was considered to have latent breast cancer as a new lesion. Chemotherapy, including anti- HER2 therapy, radiotherapy, and endocrine therapy, was administered as adjuvant treatment.

Encapsulated papillary carcinoma(EPC)is a rare malignant papillary lesion newly classified as ⅠB by the World Health Organization in 2012. We report 6 cases of EPC experienced at our hospital. The median age of the patients was 71.5 years. The main complaint was mass in 4 cases. Mammography was category 3 or higher in all cases. Ultrasound revealed 4 cases of solid mass and 2 cases of mixed mass. Fine needle aspiration biopsies were performed in 2 cases, one of which was malignant. Excisional biopsies were performed in 3 cases, all of which were diagnosed with EPC. Mastectomy was performed in 2 patients and partial mastectomy was performed in 4 patients. Pathological findings revealed invasion in 1 patient and 4 patients were hormone receptor-positive. Human epidermal growth factor receptor 2 of invasive case was negative. Partial resections were treated with radiation:only invasive case was treated with endocrine therapy. Rapid growth and high proliferative activity was noted in patients with invasive EPC;this suggests the need to carefully monitor the prognosis of such patients.

The patient was a 54-year-old woman diagnosed with right breast cancer at the age of 49 with cT4bN1M0, cStage ⅢB, and underwent radical surgery after preoperative chemotherapy. The histopathologic diagnosis was invasive ductal carcinoma, histological treatment effect Grade 1a, HR positive HER2 negative, chest wall irradiation and hormone therapy as postoperative treatment. At 5 years after surgery, there were no signs of recurrence on the imaging, but at a routine checkup 4 months later, left back pain and hip joint pain were observed, and bone metastases were diagnosed by MRI. PET- CT revealed multiple liver, lung, bone and lymph node metastases, and the course of recurrence was rapid in a short period of time. To re-evaluate the subtype, a liver biopsy was performed in combination with TAE to prevent bleeding for liver tumors with abundant blood flow. As a result, PgR turned negative, but there was no change in subtype. After irradiation to the pain area, paclitaxel and bevacizumab therapy was administered, and a marked reduction of pulmonary and liver metastases, and the disappearance of pain were observed. Local hepatic therapy with TAE followed by chemotherapy was thought to have helped the patient overcome the rapid tumor growth.

A 41-year-old woman presented with persistent dizziness. A neurological exam revealed rapid, multidirectional saccades, suggestive of opsoclonus-myoclonus syndrome(OMS). CT incidentally revealed a right breast mass, and further evaluation confirmed Stage ⅢC(cT2N3aM0), HR-positive/HER2-negative breast cancer, considered the underlying cause of OMS. Neoadjuvant chemotherapy with AC followed by weekly paclitaxel improved OMS and achieved partial tumor response. She underwent breast-conserving surgery with axillary dissection. Postoperatively, tamoxifen, a CDK4/6 inhibitor, and radiotherapy were administered. Five months after surgery, multiple liver metastases developed. Despite initiating weekly paclitaxel plus bevacizumab, the disease progressed rapidly, and she died 4 months later. Notably, OMS symptoms did not recur. This case highlights paraneoplastic OMS as an initial manifestation of breast cancer, with neurological improvement following systemic therapy.

Breast cancer(BC)is the most common cancer among Japanese women aged 30-39 years. In recent years, the impact of oncofertility has become an important issue. In Gifu prefecture, the oncofertility network was established to provide information regarding cancer treatment and fertility preservation. We retrospectively analyzed 42 BC patients(mean age 34.5) who received treatment at Gifu University Hospital and consulted the oncofertility clinic between May 2013 and December 2023. The clinical stages were as follows:Stage 0 in 1 patient(2%), Stage Ⅰ in 14(33%), Stage Ⅱ in 23(56%), Stage Ⅲ in 3(7%), and Stage Ⅳ in 1(2%). The molecular subtypes were:Luminal A in 13 patients(31%), Luminal B in 14 (33%), Luminal/HER2 in 8(19%), HER2-enriched in 2(5%), and triple-negative BC in 5(12%). Fertility preservation was performed in 15 patients, including embryo cryopreservation in 10, oocyte cryopreservation in 4, and ovarian tissue cryopreservation in 1. Among them, 12 patients(80%)were either unmarried or married without children. Offering fertility preservation options and providing appropriate information are essential in supporting the treatment of young BC patients.

A woman in her 50s visited the emergency department in May 20XX for abdominal pain and was diagnosed with hemorrhagic cholecystitis. Laparoscopic cholecystectomy was performed on the same day, and postoperative pathology results showed adenocarcinoma, pT3a(SE). The additional resection was attempted in June of the same year. However, metastasis was found in the para-aortic lymph node, and the tumor was determined unresectable. In July of the same year, we started a chemotherapy with a combination of gemcitabine, cisplatin, and durvalumab, and the lymph node metastasis was reduced by contrast-enhanced CT every 3 months. In January(20XX+1), we changed the chemotherapy only with durvalumab. As of 22 months after the start of chemotherapy, imaging has not revealed any re-progressive disease of lymph node metastases or new distant metastases.

A 75-year-old man was serendipitously found to have a splenic mass during a routine abdominal ultrasound screening for chronic kidney disease. He was subsequently referred to the gastroenterology department for further evaluation. Contrast- enhanced CT scans revealed multiple splenic lesions with heterogeneous enhancement, while MRI demonstrated low T1 and high T2 signal intensities. The initial diagnostic impression favored either hemangiosarcoma or malignant lymphoma; however, the patient opted for conservative management with regular follow-up. After a 6-month period, the largest splenic mass had increased in size from 77 mm to 110 mm, prompting a referral to the surgical department. With a preoperative diagnosis of hemangiosarcoma, the patient underwent laparoscopic splenectomy along with combined diaphragmatic resection and reconstruction. Postoperative histopathological examination revealed diffuse large B-cell lymphoma. Splenic malignancy is a rare disease, and a definitive diagnosis cannot often be established through imaging alone. When a splenic malignant tumor is suspected, surgical resection should be considered, as it serves both diagnostic and therapeutic purposes.

The patient was a 94-year-old woman. She had been previously diagnosed with main pancreatic duct dilatation and was under observation at a previous hospital. However, she was referred to our hospital due to progression of main pancreatic duct dilatation and the identification of a pancreatic head tumour on imaging. Further examination led to a diagnosis of pancreatic carcinoma. Preoperative evaluations included cardiac ultrasound, nutritional assessment, and NCD calculator to assess surgical tolerance. The patient's performance status(PS)was 0, and no cognitive impairment was noted. After thorough informed consent was obtained from the patient and family, surgery was planned. The procedure consisted of subtotal gastrectomy with pancreaticoduodenectomy and regional lymph node dissection. The pathological diagnosis was pT1bN1bM0, pStage ⅡB. Postoperative course:mild delirium was noted, but no other postoperative complications were observed. The patient was discharged on postoperative day 31, including preparations for discharge to home. At 12 months postoperatively, the patient remains in follow-up with no evidence of recurrence.

The patient was a woman in her 60s who was referred to our hospital for further evaluation and treatment of a pancreatic body mass. Endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)suggested a diagnosis of solid pseudopapillary neoplasm, and she subsequently underwent a spleen-preserving distal pancreatectomy. Twenty-seven months after the initial surgery, a solitary hepatic lesion was detected in S3 of the liver, which was considered a metastatic recurrence. Laparoscopic partial hepatectomy of S3 was performed. Histopathological examination of the resected hepatic tumor was consistent with pancreatic acinar cell carcinoma(ACC), prompting a re-evaluation of the primary pancreatic lesion, which also led to a revised diagnosis of ACC. Thirty-six months after the initial pancreatectomy, another solitary hepatic lesion appeared in S2/3, and was diagnosed as a second hepatic recurrence of ACC. Although chemotherapy was initiated, the response was classified as progressive disease. However, as the lesion remained localized to S2/3 and no new lesions were observed, surgical resection was considered appropriate. A laparoscopic left lateral segmentectomy of the liver was performed. Histopathological examination confirmed that the lesion was a hepatic metastasis of ACC. The patient has since been followed up without adjuvant therapy, and remains recurrence-free 22 months after the second hepatectomy.

We report a rare case of pancreatic adenosquamous carcinoma(PASC)associated with pancreaticobiliary maljunction (PBM). An elderly woman in her 80s presented with epigastric pain and anorexia. CT revealed a mass at the distal bile duct and pancreatic head, with a nodular lesion in the gallbladder fundus. Endoscopic retrograde cholangiopancreatography (ERCP)revealed a distal bile duct stricture and a common channel between the pancreatic and bile ducts, suggesting distal cholangiocarcinoma or pancreatic cancer with PBM. PET-CT demonstrated FDG accumulation around the distal bile duct- pancreatic head region and the gallbladder fundus, raising the possibility of synchronous double cancer. She underwent subtotal stomach-preserving pancreaticoduodenectomy(SSPPD)with gallbladder bed, portal vein(PV), and right hepatic artery (RHA)resection. Pathology confirmed pancreatic adenosquamous carcinoma(Stage ⅡB)and gallbladder carcinoma(Stage ⅢB). Postoperative pancreatic fistula occurred, but she was discharged on postoperative day 35. Despite initial recovery, she developed multiple liver metastases and peritoneal dissemination, and died 6 months later. While PBM is known to increase the risk of biliary cancer, co-occurrence with PASC is extremely rare. We report this case with a literature review.