Some patients with advanced colorectal cancer present with bowel obstruction at diagnosis, requiring palliative stoma creation to relieve symptoms. However, the clinical course following this intervention remains poorly characterized, particularly in patients with limited tolerance for systemic therapy. We retrospectively analyzed 31 patients with metastatic colorectal cancer who underwent palliative stoma creation between 2018 and 2023. Patients were categorized into 3 groups:best supportive care(BSC, n=5), short-term chemotherapy(<3 months;ST-C, n=4), and long-term chemotherapy (≥3 months;LT-C, n=22). Significant differences in baseline performance status(PS), Glasgow prognostic score(GPS), and peritoneal dissemination were observed among the groups, with more favorable profiles in the LT-C group. Median overall survival was 2.4 months in the BSC group, 3.9 months in ST-C, and 27.2 months in LT-C. Curative resection was achieved in 4 LT-C patients. PS and GPS may help identify patients suitable for sustained chemotherapy. Given the comparable survival between the ST-C and BSC groups, the introduction of chemotherapy should be carefully considered in patients with poor baseline status.

A 76-year-old man with a history of chronic obstructive pulmonary disease(COPD)presented with exertional dyspnea and melena. Detailed examination revealed a 10-cm heterogeneous, contrast-enhancing mass on the posterior wall of the upper gastric body. Endoscopy showed a submucosal tumor-like elevation with ulceration. Biopsy of the ulcerative lesion indicated well-differentiated adenocarcinoma. Based on these findings, the coexistence of gastric gastrointestinal stromal tumor(GIST)and gastric cancer was clinically suspected. Considering the patient's poor general condition, partial gastrectomy of the upper gastric body was performed. Intraoperatively, a 12-mm white nodule was also found on the anterior wall of the lower gastric body and was enucleated simultaneously. Histopathological examination revealed discontinuous high- and low-grade GISTs, a 5-mm intramucosal well-differentiated adenocarcinoma, and the white nodule was diagnosed as a leiomyoma. Although adjuvant imatinib was initiated postoperatively, it was discontinued due to adverse effects. Peritoneal dissemination and liver metastases developed 4 years and 8 months after surgery, and the patient passed away 5 years and 6 months postoperatively. The coexistence of multiple gastric GISTs with early gastric cancer and gastric leiomyoma is extremely rare. We report this case with a brief review of the literature.

A 52-year-old man was diagnosed with unresectable advanced gastric cancer, staged as cT4a(SE), N+, M1(H0, P0, CY1), Stage ⅣB. First-line chemotherapy with SOX plus nivolumab was initiated. Nivolumab was added from the second course. Six days after the first nivolumab dose, the patient developed a pruritic skin rash, diagnosed as Grade 2 drug eruption. Chemotherapy was continued with topical steroids and antihistamines. However, at the start of the 3 course, the rash worsened and was diagnosed as toxic epidermal necrolysis(TEN), prompting emergency hospitalization under dermatology care. At admission, approximately 80% of the body surface area showed epidermal detachment and erosions. The patient was treated with steroid pulse therapy, intravenous immunoglobulin(IVIg), and subsequent prednisolone therapy. Skin re- epithelialization was achieved after approximately 3 weeks. Cutaneous immune-related adverse events(irAEs)from immune checkpoint inhibitors(ICIs)are usually mild and manageable, but in rare cases, severe conditions such as TEN or Stevens- Johnson syndrome can occur. Prompt diagnosis and treatment in collaboration with dermatologists are crucial. We report this case with a literature review.

Case 1:A 75-year-old woman with a history of Lynch syndrome developed a new ileocolic anastomotic tumor after prior surgeries for colorectal and ovarian cancers. Pembrolizumab led to clinical complete response after 5 courses, confirmed by endoscopy and PET-CT. Treatment was stopped after 15 courses at the patient's request, with no recurrence at 4 months. Case 2:A 69-year-old man underwent resection for descending colon stenosis, diagnosed as endocrine cell carcinoma (pStage Ⅲc, MSI-H). Postoperative PET-CT revealed lymph node metastasis. Pembrolizumab achieved clinical complete response after 10 courses;therapy was stopped after 18 courses, with response maintained at 9 months.

Radiation-induced angiosarcoma(RIAS)of the breast is a rare malignant tumor occurring after breast-conserving therapy. A 70-year-old woman underwent breast-conserving surgery followed by radiation therapy for right breast cancer at the age of 66. Four years and 10 months after surgery, she noticed a mass with skin redness in her right breast. A biopsy revealed angiosarcoma, and she was subsequently referred to our hospital. Physical examination demonstrated a 55 mm ulcerated mass. Ultrasound, CT, and MRI examinations showed a poorly demarcated tumor invading the skin without evidence of distant metastasis. Wide surgical resection, including affected skin, was performed along with reconstruction using a latissimus dorsi flap. Histopathological examination confirmed a 65 mm angiosarcoma with negative surgical margins. Postoperatively, delayed wound healing occurred, necessitating hyperbaric oxygen therapy. The patient was discharged 35 days after surgery; no recurrence was observed at the 6-month follow-up. Early diagnosis, extensive surgical resection, and coordinated multidisciplinary care involving reconstructive procedures are essential for achieving favorable clinical outcomes in patients with RIAS.

We report a case of metastatic breast cancer in the bones effectively treated with locoregional surgery. The patient was a 52-year-old woman who presented with an increasing right breast lump. A mass accompanied by skin redness 5 cm in diameter was palpable in the AC area of the right breast. Ultrasonography revealed multiple other masses in the bilateral breasts that were suspected to be malignant. Core needle biopsy led to the diagnosis of invasive ductal carcinoma in both breasts. Tumor marker 1-CTP was elevated, and bone scintigraphy showed multiple abnormal accumulations in the thoracic and lumbar spine, indicating multiple bone metastases. Bilateral mastectomy was first performed for local control. Histopathological diagnosis was invasive ductal carcinoma(scirrhous type)in both breasts, with multiple lesions, hormone receptor positive, and HER2 negative. After surgery, chemotherapy followed by endocrine therapy was administered, and tumor markers decreased, and bone metastases remained stable disease(SD). Two years and 2 months after surgery, no local recurrence or appearance of new lesions have been observed.

We report a case of tubular breast carcinoma discovered during an ultrasound examination during an opportunistic breast cancer screening. The patient was a 71-year-old woman. An ultrasound examination during an optional health check revealed a mass lesion in her left breast and she visited our department. Mammography revealed no abnormal findings. Ultrasonography revealed a hypoechoic mass measuring 5 mm in diameter in the AC area of the left breast. Core needle biopsy revealed tubular carcinoma. Systemic examination revealed no obvious distant metastasis. A circular lumpectomy and sentinel lymph node biopsy was performed. Histopathological findings showed tubular breast carcinoma, tumor diameter 7 mm, negative resection margins, and no lymph node metastasis. Ki-67 6.2%, ER positive, PgR positive, HER2 negative. After postoperative radiation therapy, the patient is being followed up with an aromatase inhibitor. One year after surgery, there has been no obvious metastasis or recurrence. Tubular carcinoma is pathologically characterized by a high amount of fibrous stroma surrounding the lumen, and ultrasound findings often show a hypoechoic mass with unclear boundaries and attenuation of posterior echoes. In this case, ultrasound examination was also useful in estimating the histological type.

Solid papillary carcinoma(SPC)is a rare histological type of breast cancer, accounting for only 1% of all breast cancer. We report a patient with right breast SPC who underwent total mastectomy. An 88-year-old Japanese woman presented with bloody nipple discharge and a palpable right breast mass. Mammography revealed a well defined high-concentration mass. Core needle biopsy revealed a diagnosis of suspicious of SPC, ER(+)[>95%], PgR(+)[>95%], HER2(1+). A right mastectomy and sentinel lymph node biopsy were performed. The patient was diagnosed with pathological stage 0(Tis, N0M0)breast carcinoma, SPC in situ type with neuroendocrine markers. The patient has survived without any recurrence for 4 years.

We present the case of a 54-year-old woman who was treated with preoperative chemotherapy, surgery, postoperative radiotherapy, and endocrine therapy for estrogen receptor(ER)-positive HER2-negative breast cancer. Positron emission tomography(PET)-computed tomography(CT)performed 10 years post-surgery revealed accumulation in the cervical and mediastinal lymph nodes and right chest wall. Endocrine therapy was initiated for the treatment of recurrent ER-positive and HER2-negative breast cancer but was unsuccessful. Despite initiation of chemotherapy, the patient developed bilateral recurrent nerve palsy and underwent tracheotomy. At the time of tracheotomy, biopsy evaluation revealed that the metastatic left supraclavicular lymph nodes were ER- and HER2-positive; therefore, the treatment was switched to a trastuzumab, pertuzumab, and docetaxel(TPD)combination for HER2-positive recurrent breast cancer. However, PET-CT revealed increased accumulation in the recurrent lesions, and the treatment was switched to trastuzumab deruxtecan (T-DXd). The accumulation of recurrent foci became less pronounced and the patient continued to progress without further deterioration.

The patient was a 67-year-old woman. She was referred to our gastroenterology department after pancreatic duct dilatation was found on abdominal ultrasound by her family doctor. After detailed examination, she was diagnosed with neuroendocrine neoplasm(NEN)of the minor papilla of duodenum, and pancreaticoduodenectomy with lymph node dissection was performed. Histopathological examination revealed invasive tumor growing from the mucosal epithelium to the muscularis propria of the duodenum. The tumor was composed of cells with small, round nuclei. The tumor cells were positive for synaptophysin, chromogranin A, and CD56, and the Ki-67 index was less than 1%. Based on the above, we diagnosed the tumor as neuroendocrine tumor(Grade 1)of the minor papilla of duodenum. In addition, metastasis to the anterior lymph nodes of the pancreatic head was observed. The patient is currently alive and free of recurrence 4 years after surgery. NEN is a tumor that occurs throughout the body, but those that occur in the minor papilla are rare. Because NEN arising from the minor papilla of duodenum has a high rate of lymph node metastasis, pancreaticoduodenectomy with lymph node dissection is recommended.

The patient was a woman in her 40s. Because epigastric pain was observed, an upper gastrointestinal endoscopy was performed, which revealed a submucosal tumor-like protrusion with 2 delles, of approximately 5 cm, near the posterior wall of the greater antral curvature. A definitive diagnosis could not be made using conventional biopsy or EUS-FNA;therefore, surgery was performed to facilitate a diagnosis. The tumor was semicircular beyond the pylorus ring, which made local resection difficult. In addition, considering the possibility of malignancy, we performed lymph node dissection(D1+7, 8, 9, and 12a)in addition to a distal gastrectomy. The postoperative diagnosis was pT4aN1M0, pStage ⅢA. The postoperative course was good, and the patient remained alive and well 7 months after surgery. Cancer treatment should always be considered for atypical submucosal tumors that cannot be confirmed pathologically.

An elderly woman in her 80s with a medical history of rheumatoid arthritis and chronic hepatitis B was diagnosed with Stage Ⅳ, ER-negative, HER2-positive invasive ductal carcinoma of the left breast, with mediastinal lymph node metastases. She received chemotherapy combined with anti-HER2 therapy and achieved a complete remission after 12 months. Three years and 7 months later, FDG-PET/CT revealed enlargement of the left axillary lymph nodes, and they were suggested as recurrences. Radiotherapy was administered, resulting in temporary reduction in lymph node size. However, 10 months later, the lymph nodes re-enlarged and were subsequently surgically resected. Histopathological examination revealed that they were non-caseating granulomas without any evidence of malignancy, consistent with a diagnosis of sarcoid-like reaction. The patient has been followed up postoperatively without recurrence for 12 months.

Surgical resection is the standard treatment for resectable colorectal cancer; however, patients with locally advanced colorectal cancer may face challenges, such as difficulty for the surgeon to achieve R0 resection and a high risk of postoperative recurrence. Although, in the Japanese guidelines, neoadjuvant chemotherapy(NAC)is not recommended for patients with resectable colorectal cancer, clinical studies conducted in Western countries have suggested its clinical benefits. In the FOxTROT trial, NAC was reported to promote tumor regression, contributing to a higher R0 resection rate in patients with locally advanced colorectal cancer. In addition, some reports have indicated that NAC can be performed safely and is not associated with increased postoperative complications. In this case, a patient with sigmoid colon cancer with rectal invasion (cT4b, N1b, M0)received 2 courses of capecitabine-oxaliplatin(CapeOX)therapy as NAC and experienced tumor regression, which enabled the patient to undergo minimally invasive surgery. We report this case because the clinical course suggests the significance of considering the clinical benefits of NAC for locally advanced colorectal cancer, even though NAC is not recommended in Japan.

Low-grade appendiceal mucinous neoplasm(LAMN)is often difficult to diagnose preoperatively. We investigated the clinical features and treatment outcomes of LAMN cases experienced at our institution.

Gastrointestinal perforation during chemotherapy for gastric cancer is an infrequent but important adverse event. We report a case of ileal ulcer perforation induced S-1 chemotherapy for gastric cancer. A 73-year-old male underwent total gastrectomy in December 2020(palliative surgery)and S-1 chemotherapy was initiated in January 2021. The treatment was well tolerated until late March, when he presented with sudden abdominal pain and fever. He was diagnosed with perforation of the gastrointestinal tract and acute generalized peritonitis. Emergency laparotomy revealed a 2-mm perforation in the ileum, approximately 30 cm proximal to the terminal ileum. About 7 cm of ileum including the perforated area was partially resected. Histopathological analysis confirmed a Ul-Ⅳ ulcer with granulation tissue and severe inflammation. Based on clinical and pathological findings, the perforation was attributed to S-1-induced small intestinal ulceration. The patient subsequently received up to fourth-line chemotherapy. He survived for 15 months after the initial surgery.

With the aging of society, the number of cases with colorectal cancer aged 90 and over is increasing. We retrospectively reviewed short-term outcomes of laparoscopic surgery performed at our hospital from January 2019 to August 2024. Thirteen patients were included. Primary tumor locations were C/A/T/D/S/R=3/4/1/1/3/1. Pathological stages were Stage 1/2/3/4=3/2/6/2. All patients underwent primary tumor resection, with D2 lymphadenectomy in 2 cases and D3 in 11. Stoma creation was performed in 2 cases;anastomosis was performed in 11. Postoperative complications of Clavien-Dindo Grade ≥Ⅲ occurred in 2 patients. The median postoperative hospital stay was 20 days(range 9-56 days). All patients returned to their preoperative living conditions without becoming bedridden. We conclude that laparoscopic surgery allows safe recovery even in super-elderly patients.

We reviewed surgical outcomes of gastric cancer patients aged 90 or older at our institution. The median age was 91; there were 3 men and 7 women. Performance status was 1 in 4 cases and 2 in 6. All patients had comorbidities, and the median PNI was 37.5. Surgical procedures included distal gastrectomy(6), proximal gastrectomy(1), and total gastrectomy (3). Nine underwent open surgery, and 1 had laparoscopic surgery. Lymph node dissection was D1(4), D1+(4), and D2 (2). Tumor stages were Ⅰ(3), Ⅱ(4), Ⅲ(1), and Ⅳ(2). Median operation time and blood loss were 165 minutes and 155 mL, respectively. Complications of Clavien-Dindo grade Ⅱ or higher occurred in 60% within 30 days but were conservatively managed. All resumed oral intake. In-hospital mortality was 20%. Median postoperative survival was 175 days. One patient died of gastric cancer, 8 of other causes(eg, pneumonia, heart failure), and 1 was unknown. With careful patient selection, gastrectomy appears relatively safe even in patients aged 90 and above, though attention to complications is essential.

A 74-year-old man underwent total gastrectomy with Roux-en-Y reconstruction for gastric cancer in May 2019. Three years postoperatively, he developed epigastric discomfort, and imaging studies revealed peritoneal dissemination leading to jejunal stenosis. He was admitted for stent placement. Endoscopic examination revealed 2 stenotic sites with curvatures at 3 cm and 6 cm distal to the esophagojejunal anastomosis, making guidewire passage difficult using a standard-diameter endoscope. A small-caliber transnasal endoscope was employed, successfully passing through the stenotic sites and enabling proper stent placement. After stent insertion, the patient was able to maintain oral intake until shortly before death due to disease progression, contributing to improved quality of life.

An 81-year-old man with acute appendicitis was referred to our hospital. Abdominal computed tomography(CT)incidentally revealed a 53-mm mass in the left mesorectum. After a laparoscopic appendectomy, further investigation of the rectal mesenteric tumor was performed. Colonoscopy revealed an extrinsic compression of the lower rectum, and endoscopic ultrasound-guided fine-needle aspiration revealed a grade 2 neuroendocrine tumor(NET). A retrospective review of a CT scan performed 11 years earlier at another hospital revealed a solitary 13-mm mass in the same region of the left mesorectum, without continuity with the rectal wall. These findings therefore suggested that the primary rectal mesenteric NET had grown slowly over time. We performed laparoscopic low anterior resection, and the patient was recurrence-free at 6-month follow-up. Although primary mesenteric neuroendocrine tumors are rare, they should be considered in the differential diagnosis of primary mesenteric tumors.

We report the case of a 46-year-old female who initially underwent laparoscopic sigmoidectomy for sigmoid colon cancer (pathological Stage Ⅲb, RAS mutant type)1 year prior. Postoperative adjuvant chemotherapy with 4 courses of CAPOX was administered. In January 2021, contrast-enhanced abdominal computed tomography revealed 11 liver metastases. Systemic chemotherapy with FOLFIRI+bevacizumab(BEV)was initiated, resulting in a partial response. A partial hepatectomy involving segments 4, 6, 7, and 8 was performed in July of the same year. Two new hepatic lesions were detected 3 months postoperatively, necessitating a second hepatectomy. Four months later, a solitary liver metastasis was identified, and the patient underwent a third hepatectomy following additional chemotherapy. Another solitary liver lesion was detected 4 months later, prompting a fourth hepatectomy, again preceded by chemotherapy. Six months after the fourth hepatectomy, a new hepatic lesion was found. At the patient's request, she underwent radiofrequency ablation(RFA)combined with transarterial embolization(TAE)at another institution. Subsequently, a right ovarian metastasis was identified and surgically resected. Four months following the RFA and TAE, 2 new liver metastases were discovered, and a fifth hepatectomy was performed after further chemotherapy. Infiltration into the right Glisson's branch was observed, and the surgical margin was positive. Postoperatively, FOLFIRI+BEV therapy was resumed. As of the latest follow-up, 4 year and 3 months after the initial diagnosis of multiple liver metastases, the patient remains under outpatient management and continues systemic therapy.