Oncotype DX is performed to predict prognosis and the added benefit of chemotherapy in hormone receptor-positive, HER2-negative breast cancer, with the goal of individualizing chemotherapy decisions. Here, we report 2 cases of early- stage hormone receptor-positive, HER2-negative breast cancer with lymph node metastases in which the oncotype DX test was performed but yielded inconclusive results. Case 1:A 53-year-old woman was diagnosed with left breast cancer following bloody nipple discharge. She underwent total mastectomy and axillary lymph node dissection. Two positive lymph nodes were identified;however, it was difficult to assess the invasive component of the primary tumor. When oncotype DX was performed, it was deemed inconclusive due to insufficient tumor tissue. Case 2:A 46-year-old woman was diagnosed with right breast cancer during routine follow-up at our department. She underwent total mastectomy and axillary lymph node dissection. Although the primary tumor was widely spread within the breast, assessment of the invasive component was challenging. Three lymph node metastases were identified. Oncotype DX was performed but was judged inconclusive due to insufficient tumor tissue.

Esophageal metastasis from breast cancer is rare and seldom diagnosed before death, with no established standard treatment. We report 3 cases managed at our institution. Case 1:A 78-year-old woman previously underwent surgery for invasive ductal carcinoma(ER+, PgR+, HER2-)at the age of 65. Eight years postoperatively, the first recurrence occurred, followed by progressive dysphagia 5 years later, leading to the diagnosis of esophageal metastasis. Case 2:A 63-year-old woman had surgery at age 48 for invasive ductal carcinoma(ER+, PgR+, HER2-). Fourteen years postoperatively, she experienced a recurrence, and 1 month later, rapidly progressive dysphagia developed, resulting in the diagnosis of esophageal metastasis. Case 3:An 81-year-old woman was diagnosed with stage Ⅳ(bone)invasive ductal carcinoma(ER+, PgR+, HER2-)at age 73. After 8 years of systemic treatment, esophageal metastasis was diagnosed. In Cases 1 and 3, radiation therapy was selected, leading to symptomatic improvement and maintenance of oral intake until death. In contrast, Case 2, complicated by interstitial pneumonia, was treated with chemotherapy, but symptoms did not improve, and the patient remained unable to take food orally until death.

This report describes 2 cases of breast cancer complicated by immune thrombocytopenia(ITP), both developing severe myelosuppression during adjuvant chemotherapy. Case 1 involved a 72-year-old woman(cT3N3M0, Stage ⅢC, ER-negative, HER2-negative)who underwent mastectomy with axillary dissection. Following completion of weekly paclitaxel(PTX), initiation of epirubicin plus cyclophosphamide(EC)resulted in a marked platelet decrease to 1.3×104/μL on day 7, necessitating repeated platelet transfusions. Case 2 involved a 65-year-old woman(cT2N0M0, Stage ⅡA, ER-negative, HER2- positive)treated with mastectomy and sentinel node biopsy. After completing PTX plus anti-HER2 therapy, EC administration similarly led to severe thrombocytopenia(1.7×104/μL). In both cases, neoadjuvant chemotherapy was considered, but due to underlying ITP, primary surgery was selected. Severe thrombocytopenia during the first EC cycle led to treatment discontinuation. These findings suggest that in breast cancer patients with ITP, neoadjuvant chemotherapy may not be feasible, and primary surgical intervention should be considered. Furthermore, when administering EC, vigilant hematological monitoring is imperative.

A 69-year-old man underwent chemotherapy for bladder recurrence after right ureteral cancer surgery, and blood tests showed CA19-9 levels of 7,700 U/mL. Abdominal plain CT scans showed wall thickening at the fundus of the gallbladder. MRCP, endoscopic ultrasound(EUS), and contrast CT scans were performed, and the patient was diagnosed with adenomyomatosis of the gallbladder and underwent laparoscopic cholecystectomy with full-thickness dissection. Postoperative pathological examinations showed adenocarcinoma cells in the Rokitansky-Aschoff sinus(RAS), and the patient was diagnosed with gallbladder cancer(pT2, N0, M0, INF b, ly0, v0, n0, CM0, EM0, Stage Ⅱ). The postoperative course was uneventful, and the patient was discharged 2 days after surgery. A second stage operation was planned, but FDG-PET/CT scans performed 5 weeks after surgery showed ascites and abnormal accumulation suggestive of peritoneal dissemination. The patient subsequently died 4 months after surgery due to progression of the primary disease.

The patient is a 66-year-old man. He underwent posterior and antero-dorsal segmentectomy for hepatocellular carcinoma(HCC)detected at physical examination. Early postoperatively, he developed a single S3 metastasis in the left lung and started combination therapy with atezolizumab plus bevacizumab. During the ninth course of treatment, recurrence was also observed in S2 of the remaining liver. A partial resection of the left upper lobe of the left lung was performed by open thoracotomy and partial resection of the outer hepatic segment through a diaphragmatic approach. Histopathological analysis suggested that the lung metastasis was distant metastasis from the first posterior segment tumor and that the liver S2 was multicentric carcinoma. He was treated with lenvatinib for a short period of time postoperatively, but recurred multiple metastases in both lungs on CT scan 3 months later. He has been treated with a combination of durvalumab plus tremelimumab while submitting to cancer genome testing, which revealed TMB-high and MSI-high. Tissue sampling is essential for the diagnosis of inter-hepatic metastasis or multicentric occurrence, and in the case of ipsilateral hepatopulmonary metastasis, trans-diaphragmatic approach surgery is effective for less incision surgery. Combined immunoadjuvant therapy for resected HCC has shown efficacy in short-term results.

The patient was a 79-year-old man diagnosed with thoracic esophageal cancer(cT4[aorta]N1M0, Stage ⅣA)and received preoperative chemoradiotherapy(2 courses of fluorouracil and cisplatin and 40 Gy of radiation). Despite treatment, the aortic invasion did not improve, and an additional 20 Gy of radical radiation was administered. Ten days after treatment completion, the patient presented with hematemesis. An upper gastrointestinal endoscopy demonstrated a suspected aorto- esophageal fistula(AEF). The patient underwent thoracic endovascular aortic repair(TEVAR)urgently. Thirty-five days later, the general condition improved, and he underwent thoracoscope-assisted subtotal esophagectomy, omental patch to the mediastinum, esophagostomy, and gastrostomy. The pathological diagnoses were CRT-pT4b(aorta and trachea), RM1, pN1, M0, and pStage ⅣA. Postoperatively, the patient developed a persistent mediastinal abscess that was relieved with drainage and antibacterial treatment. Chemotherapy was initiated as the residual disease increased, and multiple pulmonary metastases appeared. Ten months after the TEVAR, the patient remained alive. We suggest that TEVAR followed by esophagectomy is effective in treating AEF associated with locally advanced esophageal cancer.

An 82-year-old woman under follow-up for a pancreatic cyst was found to have an approximately 2 cm hypoechoic mass with irregular margins and a heterogeneous internal structure on the dorsal side of the uterus on abdominal ultrasonography. Abdominal CT and MRI was conducted, and rectal GIST was suspected. Due to the patient's strong desire to preserve anal function, transanal minimally invasive surger(y TAMIS)was planned. The procedure was performed in the prone position and the anal was dilated with the Lone Star® RETRACTOR SYSTEM, and the GelPOINT® Path was inserted. Indigo carmine and MucoUp® were injected into the submucosa on both sides of the tumor, followed by mucosal incision. The tumor was partially adhered to the vaginal wall and was resected by shaving off the vaginal wall. The mucosal defect was closed together with the muscular layer using 3-0 V-Loc®, and the surgery was completed. The operative time was 3 h 14 min, with minimal blood loss. The postoperative course was uneventful, and the patient was discharged on postoperative day 10. Imatinib(400 mg/day)was initiated 1 month after discharge but was discontinued after 2 months due to Grade 3 edema. Two years after the surgery, the patient remained recurrence-free.

A 74-year-old man underwent resection of descending colon cancer and was diagnosed with T4aN0M0, Stage Ⅱb. Isolated splenic metastasis was observed 6 months after radical colectomy. Tumor marker levels gradually increased despite chemotherapy with IRIS plus bevacizumab as first-line treatment and CAPOX plus bevacizumab as second-line treatment. A splenectomy was performed without metastasis. Histopathological examination demonstrated a moderately differentiated adenocarcinoma of the spleen that had metastasized from the colon cancer, and the histological response was Grade 1a. Although tumor marker levels markedly declined after splenectomy, multiple liver metastases were observed 6 months after surgery. Because splenic metastases are clinically rare and generally systemic, resectable splenic metastases are relatively uncommon. Resection for isolated splenic metastasis should be considered as a multidisciplinary treatment option, along with adjuvant chemotherapy and timing of surgery.

In cases of colorectal cancer diagnosed as pT1 after endoscopic resection, surgical additional resection is considered due to the potential risk of lymph node metastasis. However, approximately 90% of such cases do not exhibit lymph node metastasis. Recently, the increase in the elderly population has led to a rise in patients with poor performance statu(s PS), complicating the decision-making process for additional resection. In this study, we retrospectively reviewed 35 cases that underwent surgical additional resection following endoscopic resection between January 2019 and December 2024 at our institution. Lymph node metastasis was observed in 3 cases(8.6%). Among 20 cases with multiple indications for additional resection, 3 cases(15.0%)had lymph node metastasis. Additionally, among the 8 cases with positive resection margins, 2 cases (25.0%)had lymph node metastasis. No recurrences were observed during the follow-up period. Given the higher incidence of lymph node metastasis in cases with multiple risk factors or positive resection margins, surgical additional resection is considered advisable in such cases.

We report a case of resectable port site recurrence after laparoscopic surgery for transverse colon cancer. A 70-year-old woman was diagnosed as transverse colon cancer and performed laparoscopic right hemicolectomy with D3 lymphadenectomy. Histopathological findings revealed that the tumor was resected curatively and the staging was T4a, N1a, M0. As adjuvant chemotherapy, 2 courses of capecitabine and 3 courses of UFT/LV were administered. Fifteen months after surgery, elevated CA19-9 level was noted, and CT scan showed a mass corresponding to the left lower abdominal port site. Based on these findings, surgical resection of the abdominal wall tumor was performed, and complete resection was achieved. Based on histopathological findings, the lesion was diagnosed as a port site recurrence originating from the primary transverse colon cancer.

A 60's man was admitted with melena. A colonoscopy was detected lower rectal cancer, and a enhanced CT scan revealed invasion of the prostate and enlarged left lateral lymph node. Total neoadjuvant therapy(TNT)considered of preoperative 7 courses of CAPOX followed by 5 Gy×5 short course RT, after treatment PET-MRI showed shrinkage of the tumor and left lateral lymph node, but invasion of the prostate was remained, preoperative diagnosis was ycT4b(AI:prostate) N3M0, ycStage Ⅲc. In collaboration with urologists, robot-assisted abdominoperineal resection with en bloc prostatec t omy and left lateral lymph dissection was performed. He exhibited a good post operative course and was discharged on the 17th postoperative day. Pathological examination revealed no tumor invasion into prostate and any lymph node metastasis, ypT3N0M0, ypStage Ⅱa.

A man in his 40s presented with fever and right lower abdominal pain. Laboratory data showed elevated inflammatory markers. Abdominal CT showed a 3 cm mass in the mid-lower abdomen with fluid retention and gas continuity with the small bowel, consistent with diverticulitis. Multiple hepatic nodules were also noted. After antibiotic therapy, laparoscopic surgery was performed on hospital day 3. Intraoperatively, a firm mass was found approximately 30 cm proximal to the ileocecal valve, with extensive adhesions to the mesentery and omentum. Multiple white nodules were observed in both hepatic lobes. We performed partial small bowel resection(approximately 60 cm)and partial liver resection for liver biopsy. The pathological diagnosis was adenocarcinoma arising from Meckel's diverticulum with multiple liver metastases(pT3pN1bpM 1a, pStage Ⅳa). We decided to introduce systemic chemotherapy similar to that used for colorectal cancer in small bowel cancer, and we started systemic chemotherapy with mFOLFOX6 at 8 weeks after surgery. Bevacizumab was added from the fourth course due to progressive liver metastasis on CT imaging. After 15 courses, a partial response(PR)of the liver metastases was achieved with no local recurrence or new lesions. Meckel's diverticular adenocarcinoma is extremely rare, and no standard chemotherapy has been established. We have observed relatively good results with mFOLFOX6 plus bevacizumab in this setting.

Colorectal cancer liver metastasis(CRLM)is commonly managed with surgery or systemic chemotherapy. However, alternative treatments are needed for patients who are not candidates for these standard therapies. Stereotactic body radiation therapy (SBRT) has shown promising results in terms of local control.

The patient was a 74-year-old man. Three years ago, he underwent laparoscopic ileocecal resection for ascending colon cancer and was followed up on an outpatient basis. Three years after surgery, tumor marker levels were elevated, and a full- body examination suggested duodenal recurrence after ascending colon cancer surgery, so a pancreaticoduodenectomy was performed. The postoperative course was uneventful, and the patient was discharged on the 16th day. He is currently undergoing outpatient follow-up without recurrence. A compilation of similar reports has shown that small intestinal and duodenal metastases after colon cancer surgery are rare, and resection results in a relatively good prognosis. When recurrence of colon cancer is suspected after surgery, a full-body examination should be performed, including duodenal and small intestinal metastases.

A 76-year-old man presented to our hospital with a chief complaint of abdominal pain. Cholecystitis or cholecystic carcinoma was suspected on computed tomography(CT);however, no malignant findings were found on endoscopic ultrasonography(EUS), and a diagnosis of acute cholecystitis was established. An upper gastrointestinal endoscopy(GS)was performed, which revealed a type 3 lesion on the posterior wall of the upper gastric body. Cholecystitis did not improve, and emergency surgery was performed. The gallbladder was found to have metastatic involvement originating from gastric cancer.

The patient is an 83-year-old woman who underwent a right mastectomy with axillary lymph node dissection in 2009. The histological type was invasive lobular carcinoma, and the pathological stage was diagnosed as pStage Ⅲc. She received chemotherapy, radiotherapy, and 5 years of endocrine therapy. In 2019, a tumor in the ascending colon was discovered during a routine check-up. Laparoscopic right hemicolectomy was performed, and pathological examination confirmed the tumor was a metastasis from breast cancer. she was undergoing endocrine therapy(letrozole)at the time. In 2024, the patient presented with loss of appetite and epigastric pain after meals. Upper gastrointestinal endoscopy suggested type 4 advanced gastric cancer, and biopsy confirmed poorly to undifferentiated adenocarcinoma. While metastasis from breast cancer was considered, biopsy findings alone made it difficult to differentiate from primary gastric cancer. Therefore, a laparoscopic distal gastrectomy was performed for oral intake management. Pathological examination confirmed gastric metastasis from breast cancer. In patients with a history of breast cancer, the possibility of metastasis should be considered. Comparative histological analysis and immunohistochemical studies are essential for accurate diagnosis.

A 78-year-old man was referred to our institution with bloody stools. Colonoscopy revealed advanced rectal cancer with stenosis at the lower rectum(anal verge 4-12 cm). Biopsy findings revealed highly differentiated adenocarcinoma. Magnetic resonance imaging(MRI)/computed tomography(CT)/positron emission tomography(PET)showed the tumor on the rectal wall, mesenteric lymph nodes, and an enlarged left lateral lymph nod(e No. 283), but no metastasis was detected. The patient was diagnosed with rectal cancer(cT4aN3M0, cStgae Ⅲc)and received neoadjuvant chemoradiotherapy(CRT) (50.4 Gy irradiation of the primary tumor and small pelvis, including the lateral lymph nodes, and oral capecitabine). After CRT, the diagnosis was revised to ycT2N3M0, ycStage Ⅲb. He subsequently underwent robot-assisted abdominoperineal resection and D3+ltLD2 dissection. Lymph node metastasis was detected in No. 283-lt and No. 241, and the pathological diagnosis was ypT2N3M0, ypStage Ⅲb. Histological evaluation of response to treatment was Grade 2. He showed a favorable postoperative course and was discharged on postoperative day 18. He received 8 courses of adjuvant chemotherapy with CAPOX from postoperative day 32 and is alive with recurrence-free 9 months after surgery. This case suggests that CRT is a viable option for treating locally advanced rectal cancer.

We report a case of T4b breast cancer that developed 17 years after radiofrequency ablation(RFA). The patient was a 64- year-old woman. She had been diagnosed with left breast cancer 17 years ago and had undergone RFA. After radiation therapy, she had been administered AI drugs for 5 years. She was diagnosed with a mass in her left breast and visited our department. At the time of admission, a mass measuring 7 cm in diameter was palpable in her left breast. A needle biopsy revealed the diagnosis of invasive ductal carcinoma. A systemic examination revealed no obvious distant metastasis. A pectoral muscle-sparing mastectomy+partial pectoralis major muscle resection+axillary lymph node dissection+reconstruction using a rhomboid flap was performed. Histopathological findings of the resected specimen showed invasive ductal carcinoma, tumor diameter 53 mm, negative resection margin, and no lymph node metastasis. ER positive, PgR positive, HER2 positive, Ki-67 30%, and the diagnosis was T4bN0M0, Stage ⅢB. After postoperative chemotherapy, radiation therapy was performed. After that, trastuzumab+pertuzumab was administered 17 times. Currently, the patient is being followed up with fulvestrant. Two years after surgery, there has been no obvious metastasis or recurrence.

A 61-year-old female patient was diagnosed with stage ⅡB squamous cell carcinoma of the uterine cervix. She underwent chemoradiotherapy, which included whole pelvic irradiation(50 Gy), intracavitary irradiation(24 Gy), and 6 cycles of nedaplatin therapy at the gynecology department. After chemoradiotherapy, a biopsy of the uterine cervix was performed, and pathological examination showed evidence of remission. Six months later, a CT scan and MRI scan revealed a 23 mm mass in the S3 region of the liver, which was diagnosed as a solitary, metachronous liver metastasis. The patient was referred to our department for surgery and underwent laparoscopic hepatic lateral segmentectomy. Pathological findings confirmed that the metastasis was from squamous cell carcinoma of the uterine cervix. Postoperatively, the patient was followed up without chemotherapy. However, 3 months after surgery, a CT scan revealed multiple liver metastases and lymph node metastases. The patient is currently receiving chemotherapy at another hospital. While liver metastasis in cervical cancer is not uncommon, isolated, metachronous liver metastasis is rare. Including our case, there have been only 8 such reports in Japan, making this a rare case.

The patient was a 68-year-old man. The diagnosis was Bismuth type 1 hilar cholangiocarcinoma with right hepatic arterial infiltration. Right hepatectomy with extra hepatic bile duct resection was planned. Computed tomography(CT)volumetry using SYNAPSE VINCENT revealed the volume of entire liver to be 1,417 mL, future liver remnant volume(FLR-V)to be 390 mL(28%), and estimated indocyanine green clearance rate of future liver remnant(ICG-Krem)to be 0.043. It was too small, so portal vein embolization(PVE)was performed, and 4 days after PVE, hepatic vein embolization(HVE)was done. Fourteen days after PVE, FLR-V increased by 472 mL(34%), and future liver remnant function(FLR-f)assessed by single- photon emission computed tomography(SPECT)increased by 563 mL(41%). Twenty-eight days after PVE, FLR-V increased by 573 mL(41.8%), FLR-f 648 mL(47%), ICG-Krem 0.064, and functional ICG-Krem assessed by SPECT 0.073. Thirty- two days after PVE, right hepatectomy with extra hepatic bile duct resection was performed. Surgery time was 764 min, and blood loss was 1,900 mL. The cancer was pathologically diagnosed as moderately differentiated adenocarcinoma, pT2a, pN0, pM0, pStageⅡ, R0 resected. The patient's postoperative course was uneventful, and he discharged 23 days after surgery. He started to receive adjuvant S-1(120 mg)chemotherapy 28 days after surgery, and there has been no evidence of recurrence for 4 months.