Two notable cases of bowel obstruction caused by diffuse large B-cell lymphoma(DLBCL)of the ileum were encountered. The first case, a 73-year-old man, presented with intussusception into the ascending colon, originating from an ileal tumor. He underwent ileocecal resection with lymph node dissection and later received R-CHOP chemotherapy, remaining recurrence- free for 1 year. The second case, a 75-year-old woman, had a large tumor infiltrating the abdominal wall in the right pelvis. She underwent right colectomy combined with abdominal wall and lymph node resection. However, rapid tumor progression post-surgery left no opportunity for chemotherapy, and she passed away 67 days later. These cases underscore the critical need to carefully evaluate the extent of surgical intervention for patients who may benefit from chemotherapy.

The patient was a 47-year-old woman who underwent partial colon resection and medial segmentectomy of the liver via laparotomy for descending colon cancer with a metastatic liver tumor. Postoperative chemotherapy was administered. Six months later, she developed pelvic recurrence and subsequently underwent bilateral adnexectomy, hysterectomy, and lymph node dissection, which confirmed colorectal metastasis. Two years and 6 months after the initial surgery, a gradually enlarging abdominal wall mass was detected. As the mass rapidly increased in size and became painful, an abdominal wall metastasis from colorectal cancer was suspected. Surgical intervention was deemed necessary to prevent deterioration in the patient's quality of life due to potential tumor ulceration. The tumor was resected under general anesthesia, including partial resection of the rectus abdominis muscle. Histopathological examination confirmed metastasis from colorectal cancer. Postoperatively, the patient's abdominal wall pain resolved. At the time of reporting, the patient had died of pulmonary metastasis, although there was no local recurrence at 1 year and 2 months postoperatively.

The patient was a man in his 70s who presented with epigastric pain and was referred to our department with a suspected diagnosis of gallbladder cancer. He was diagnosed with gallbladder cancer and metastasis to the paraaortic lymph nodes, and underwent 8 courses of gemcitabine, cisplatin, durvalumab(GCD)therapy. Following a favorable tumor response, he underwent gallbladder bed resection, extrahepatic bile duct resection, and lymphadenectomy. Postoperative pathological examination confirmed the presence of intraepithelial carcinoma, with a therapeutic effect graded as Grade 4, indicating a pathological near-complete response(near-pCR). Postoperative immune-related adverse event(irAE)enteritis and hypothyroidism were noted, highlighting the importance of perioperative management of irAEs.

Malignant lymphoma(ML)occurring in the oral cavity are often difficult to diagnose, as their clinical presentation is non- specific and may resemble that of other malignancies or inflammatory conditions. We report a case of diffuse large B-cell lymphoma(DLBCL)detected as a result of ill-fitting dentures. The patient was an 80-year-old man. He had a medical history of chronic heart failure(NYHA class Ⅲ, after CABG), COPD, and benign prostatic hyperplasia. In the middle of February 2018, he visited a dental clinic with a chief complaint of ill-fitting dentures and was subsequently referred to our department for further examination and treatment. At the initial examination, the patient exhibited bilateral facial asymmetry and swelling extending from the right cheek to the right submandibular region, with palpable induration. These findings strongly suggested that the patient had a malignant tumor, and we clinically diagnosed him as having ML(Ann Arbor staging, Stage Ⅳ)based on various imaging studies. Histopathological examination confirmed the diagnosis of DLBCL. In consultation with the hematology department, the patient began treatment with R-CEOP therapy(administered at 50% dose due to severe cardiac dysfunction): rituximab 375 mg/m2, etoposide 50 mg/m2, vincristine 1.4 mg/m2, and cyclophosphamide 750 mg/ m2), and the patient underwent 6 courses of this therapy. However, the tumor continued to increase in size, and radical treatment was deemed difficult. In late August 2019, the patient developed ventricular tachycardia, followed by ventricular fibrillation, and subsequently died from cardiopulmonary arrest. Although oral ML are rare, it is critical for oral surgeons to promptly recognize suspicious clinical signs and initiate appropriate diagnostic procedures, including imaging and biopsy, to ensure early diagnosis and treatment.

An 89-year-old woman was referred to our department for surgery of subobstructed transverse colon cancer. She was operated on by Pfannenstiel incision and intracorporeal anastomosis after 3 days of preoperative fasting and mechanical bowel preparation with Tokakujokito. The postoperative course was good, and the patient was discharged on the seventh postoperative day. It has been reported that intracorporeal anastomosis leads to faster recovery of peristalsis after surgery and shorter postoperative hospital stay. In addition, the Pfannenstiel incision is associated with less complaints of wound pain, and the patient is weaned off the bed more quickly, so the combination with intracorporeal anastomosis is expected to result in an even faster postoperative recovery. Intracorporeal anastomosis for advanced cancer with stenosis is currently under discussion, but there is no significant difference in postoperative abscess formation or recurrence of seeding compared to extracorporeal anastomosis in normal cases, and it may be considered if the mechanical bowel preparation is well performed. We believe that mechanical bowel preparation with Tokakujokito may lead to better evacuation of stools in advanced cancer with stenosis, and thus expand the indications for intracorporeal anastomosis. We report this case and the innovations we have made in mechanical bowel preparation with Tokakujokito in our department.

A comprehensive treatment(COMPT)composed of macroscopic complete removal of peritoneal metastasis(PM)and perioperative chemotherapy has been performed to cure patients with PM. The present article shows the theoretical basis to cure patients with low grade mucinous carcinoma peritonei(LGMCP)from appendiceal mucinous neoplasm(AMN)by COMPT. When the micrometastasis(MM)does not exist outside the surgical field, complete cytoreductive surgery/complete cytoreduction(CRS, CCR-0)alone can cure the patients(Scenario A). If the MM burden left after CCR-0 resection(Scenario C)or neoadjuvant chemotherapy(NAC)+CCR-0(Scenario D)is less than the threshold level that could be completely eliminated by IOHIPEC, patients will be cured by CRS+IOHIPEC. Scenario F shows the status where MM can be completely eliminated by NAC, resulting in cure by NAC+CRS without IOHIPEC. In trying to cure patients with PM, our aim is to induce patients to follow Scenarios A, C, D or F. Between 2009 and 2023, 509 patients with LGMCP from AMN received CCR-0. Of these patients, 142 patients were treated with neoadjuvant laparoscopic(NLHIPEC)and CRS, neoadjuvant intraperitoneal chemotherapy(NIPC), and 101 patients were treated with neoadjuvant systemic chemotherapy(NSC)NIPC was performed 5 cycles, before CRS. Five-year, and 10-year overall survival rates of these patients after CCR-0 resection were 88.7%, and 77.6%, respectively. Recurrence was found in 158 patients, and peritoneal, pleural, and lung recurrence were found in 143, 6 and 3 patients. Treatment options related to the cure were inspected. To define cure, patients who survived without recurrence longer than 5 years were cured(n=202), and 43.2%(19/44)of patients were cured after CCR-0 alone(Scenario A). Patients treated with CRS+IOHIPEC were cured in 54.3%(132/243), and those treated by NIPC+CCR-0 were cured in 53.5%(38/71). Cured rates after treatment by NIPC and NSC were 53.5%(38/71), and 38.5%(35/91)(p=0.056, χ2 =3.65). Cure rate after non NIPC+CCR-0+IOHIPEC(68/117; 58.1%), and NIPC+CCR-0+IOHIPEC(34/54; 63.0%) were significantly higher than those after CRS alone(19/44; 43.2%). The PCI scores of patients treated with IOHIPEC and non IOHIPEC were 15.1±10.4 and 13.7±9.7(NS). In contrast, PCI scores for patients treated with NIPC and with NSC were 10.7±8.2 and 16.8±10.6(p<0.0001). Grade 3, 4 and 5 postoperative complications after CRS were encountered in 43 (9.2%), 43(9.2%)and 5(0.9%)patients, respectively. Conclusions: CCR-0 with IOHIPEC and NIPC may improve the cure rate of patients with LGMCP. According to our theory, this improvement is due to the elimination of MM by IOHIPEC and reduction of MM burden within threshold levels, that can be completely eliminated by IOHIPEC. We await more effective options for the elimination of MM.

We aimed to examine outcomes and predictors of survival in elderly patients with colorectal cancer(CRC)following radical surgery. A total of 508 patients with pStage Ⅱ-Ⅲ CRC who underwent radical surgery between June 2007 and December 2019 at our hospital were retrospectively reviewed. The patients were classified into those aged ≥80 years as an E group and those aged <80 years as an NE group. The association between clinicopathological features and age were evaluated. Overall survival(OS), relapse-free survival(RFS), disease-specific survival(DSS)and non-disease-specific survival(NDSS) based on age were assessed using the logrank test. Then, we sought to determine predictors of OS, RFS and NDSS in the E group using the Cox proportional hazards regression model. No significant differences were found for the rate of postoperative complications between the E and NE groups. The E group had similar RFS and DSS, but significantly worse OS and NDSS compared to the NE group. Preoperative prognostic nutritional index(PNI)was identified as a predictor of unfavorable OS, RFS and NDSS in the E group. In conclusion, radical surgery for CRC is safe and feasible, and PNI is useful to predict the outcomes in elderly patients.

A 63-year-old man was diagnosed with ulcerative colitis of the proctitis type 12 years ago. Three years ago, his symptoms worsened and he was diagnosed with pancolitis type. Recently, a colonoscopy revealed a stenotic lesion with a submucosal tumor-like protrusion in the rectum. Biopsy of the same area did not reveal any neoplastic lesion. However, because 18F-fluorodeoxyglucose accumulation was observed in the stenotic lesion and the value of carcinoembryonic antigen increased over time, the patient was diagnosed with rectal cancer(cT3N0M0)associated with ulcerative colitis. Robot-assisted low anterior resection was performed. Postoperative histopathological examination revealed a submucosal tumor-like invasive carcinoma in the stenotic lesion with intramucosal lesion corresponding to UC-Ⅲ. Currently, 2 years after surgery, the patient shows no evidence of disease recurrence.

A female patient in her 70s. She was referred to our hospital with a huge left breast tumor. She was diagnosed with locally advanced Stage Ⅳ triple negative breast cancer. She refused chemotherapy that caused hair loss. Locoregional surgery and S-1 made it possible to continue treatment while maintaining a good quality of life.

The patient is a 54-year-old woman who underwent abdominal ultrasonography, which revealed a 13×10 mm submucosal tumor in the gastric antrum. The patient was initially advised to undergo follow-up observation. Over time, the gastric submucosal tumor showed slight enlargement, but histopathological analysis via endoscopic ultrasonography with fine-needle aspiration(EUS-FNA)did not reveal any obvious malignant findings. Due to the progressive increase in tumor size, the patient was referred to our department for surgical treatment. Laparoscopic local gastrectomy was performed, during which an extramural protruding mass measuring approximately 20 mm was identified on the anterior wall of the gastric antrum. The mass was resected using an automated suturing device, with excision extending from the serosa to include the muscularis mucosae. The patient had an uneventful postoperative recovery and was discharged on the 7th postoperative day. Histopathological examination of the resected specimen revealed spindle-shaped tumor cells. Immunohistochemical staining showed the tumor cells were positive for S-100, but negative for desmin, CD34, and c-kit. In this report, we present a case of gastric Schwannoma that demonstrated a tendency to increase in size and was successfully treated with laparoscopic local resection. We also include a discussion of relevant literature.

An 82-year-old female was referred of vomiting and diagnosed with advanced gastric cancer accompanied by pyloric stenosis, with enlarged lymph nodes below the pylorus. After undergoing laparoscopic gastrojejunostomy, 3 courses of S-1 plus L-OHP was administered. Both the lymph nodes and the primary tumor shrank. The patient was diagnosed as ycT4aN2M0, ycStage Ⅲ. Laparoscopic distal gastrectomy were performed. The pathological diagnosis was ypT4aN1M0, ypStage ⅢA. Four courses of S-1 plus L-OHP were administered as postoperative adjuvant chemotherapy, but multiple liver metastases were detected. Because of HER2 negative, 2 courses of ramucirumab plus paclitaxel was administered, but lung metastasis, increased liver metastasis, and ascites were detected. Nivolumab was administered, leading to a reduction in pulmonary nodules, liver metastasis, and ascites. Sixty-five months post-surgery, radiation therapy was administered for recurrent mediastinal lymph node metastasis, achieving significant shrinkage. Nivolumab treatment was continued, and there has been no further disease progression at 83 months post-surgery. This case shows that disease control was achieved with nivolumab for liver, lung, and lymph node metastases following gastric cancer surgery, and long-term survival was attained with multimodal therapy.

A 67-year-old woman presented to a local clinic with right lower abdominal pain. Abdominal ultrasonography revealed an enlarged appendix, and the patient was referred to our surgical department for further evaluation and treatment. The patient was diagnosed with acute appendicitis based on an abdominal plain CT scan, and laparoscopic appendectomy was performed. Histopathological examination of resected appendix revealed sessile serrated adenoma/polyp(SSA/P), and the patient is under careful follow-up in our hospital. Eight months after surgery, the patient did not show any obvious signs of recurrence. SSA/P is classified as serrated lesions of the colon. Appendiceal SSA/P are rare.

51-year-old man underwent pancreatoduodenectomy(PD)for pancreatic head cancer, followed by 6 months of adjuvant chemotherapy with S-1. At 20 months postoperatively, 3 pulmonary metastases were detected. S-1 chemotherapy was administered for 16 months and no new lesions or disease progression was observed. Based on the sustained response, the patient was diagnosed with oligometastatic pancreatic cancer and staged bilateral pulmonary resections were conducted. Histopathological analysis confirmed that all the nodules were lung metastases from pancreatic cancer. At 24 months after pulmonary resection, the patient remains alive without evidence of recurrence. Currently, there are no standardized criteria for the indication or timing of surgical resection in patients with isolated pulmonary metastases from pancreatic cancer. Additionally, the definition of oligometastatic disease in pancreatic cancer remains unclear. This case suggests that pulmonary resection can lead to long-term survival in selected patients with lung metastases from pancreatic cancer. Chemotherapy for lung metastases may help identify optimal candidates for pulmonary resection.

Blast crisis (BC) in chronic myelocytic leukemia (CML) typically presents with increased blasts in the bone marrow, showing either myeloid or B-lymphoid phenotypes. We report a rare case of CML-BC with a T/myeloid mixed phenotype localized to the lymph nodes. An 80-year-old woman presented with right axillary lymphadenopathy. PET-CT revealed multiple enlarged lymph nodes. Axillary node biopsy showed proliferation of medium-sized atypical lymphoid-like cells expressing both T-cell and myeloid markers. Both bone marrow and peripheral blood showed no abnormalities. The BCR::ABL1 translocation was detected in both bone marrow and lymph node tissue. Fluorescence in situ hybridization showed positive staining for BCR/ABL1 gene rearrangement. Based on these findings, blast crisis of CML with a T/myeloid mixed phenotype was diagnosed. Following dasatinib therapy, the enlarged nodes regressed. Despite the patient's advanced age, no significant adverse events have been observed during the course of treatment.

A 50-year-old man with cerebral palsy presented to our department complaining of pollakiuria and macrohematuria. Although urinary cytology revealed no positive findings, computed tomography (CT) showed muscle-invasive bladder carcinoma and right intrapelvic lymphadenopathy (cT3bN1M0). Cystoscopy revealed a large non-papillary bladder tumor. Radical cystectomy and urinary diversion were performed. Verrucous carcinoma (VC) of the bladder without intrapelvic lymph node metastasis (pT3bN0) was diagnosed histopathologically. VC is often locally invasive and is a non-metastasising well-differentiated variant of squamous cell carcinoma. Patients with cerebral palsy have a high incidence of urinary incontinence, dysuria, and urinary tract infections. VC of the bladder is associated with chronic bladder irritation due to various causes, including chronic cystitis, dysuria, and bladder stones. VC is frequently detected as locally invasive disease of stage T3 or higher ; the only effective treatment is radical cystectomy. Therefore, early detection and surgery are necessary to improve prognosis. Clinical evaluation, including urodynamic studies, is recommended for patients with cerebral palsy, and in cases of persistent pollakiuria, dysuria, and macrohematuria, abdominal CT and cystoscopy should be considered for the early detection of squamous cell carcinoma and VC of the bladder.

We report a case of small bowel metastasis from renal cell carcinoma (RCC) in a woman in her 70s. In 20XX, she underwent a laparoscopic left nephrectomy for left-sided RCC (pT3bN0M0). Three and a half years later, she presented to the emergency department with recurrent vomiting. Contrast-enhanced computed tomography (CT) revealed a suspected small bowel tumor with intussusception and associated lymphadenopathy. Laparoscopic partial resection of the small intestine was performed, and pathological examination confirmed metastatic RCC in both the small bowel and regional lymph nodes. One month later, positron emission tomography-computed tomography (PET-CT) showed increased uptake in the mesenteric lymph nodes, suggesting residual disease. As a result, systemic therapy with ipilimumab and nivolumab was initiated. After four cycles of treatment, follow-up imaging demonstrated complete resolution of the residual lesions. Isolated small bowel metastasis from RCC, which was observed in this case, is relatively rare.

Diagnosis of upper urinary tract urothelial carcinoma (UTUC), based on imaging findings and urine cytology is often difficult. In this study, we have evaluated the preoperative imaging findings, voided urine cytology, and selective urine cytology in patients with suspected UTUC, who underwent laparoscopic radical nephroureterectomy (LRN). Cases of benign postoperative pathological findings are also reported. Among the 195 patients who underwent LRN between October 2010 and November 2023, 182 patients were included in this study. Simultaneous radical cystectomies and malignant tumors other than urothelial carcinoma were excluded. Most of the cases (137 cases (75.3%)) were classified as class III or less, based on voided urine cytology and 88 cases (48.4%) were classified as class IV or more based on either voided urine cytology or selective urine cytology. Ureteroscopy was performed in 40 cases (22.0%). The four patients who had undergone LRN without malignant findings had not undergone ureteroscopy. Pathological findings indicated normal urothelium in two patients, inflammatory scar in one patient, and amyloidosis in one patient. Accurate preoperative diagnosis requires pathological examinations such as natural urine cytology and selective urine cytology, computed tomographic urography, retrograde pyelography, and ureteroscopy if necessary.

An 86-year-old woman was referred from another hospital for gemcitabine monotherapy for locally advanced pancreatic head cancer. After 8 courses of gemcitabine monotherapy, follow CT showed partial response, and biliary metallic stent which had been placed 8 months ago displaced into the duodenum. An upper gastrointestinal endoscopy was performed and the stent was retrieved. There has been no subsequent elevation in hepatic and biliary enzymes, and she is currently under observation without re-stenting. There have been reports of displaced biliary stents causing gastrointestinal perforation and intestinal obstruction. For cases where chemotherapy is effective and the placement duration of the bile duct stent is prolonged, it is necessary to increase the frequency of abdominal X-rays to monitor the dislocation of the bile duct stent carefully.

A 62-year-old man presented at our hospital with a 30 mm-sized black tumor in the middle esophagus detected by upper gastrointestinal endoscopy. Biopsy confirmed a diagnosis of malignant melanoma. Computed tomography and positron emission tomography revealed no evidence of distant or lymph node metastases. The patient underwent a thoracoscopic subtotal esophagectomy, gastric tube reconstruction, and 2-area lymph node dissection. Based on the Japanese Classification of Esophageal Cancer(11th edition), the diagnosis was pT2(MP)N1M0, Stage Ⅱ. Post-operative chemotherapy with nivolumab(240 mg)was initiated in the fourth post-operative week. However, liver metastasis was detected in the third post-operative month. The patient was subsequently treated with nivolumab and ipilimumab, but there was no response. The patient died of the primary disease 8 months post-operatively.

A woman in her 50s was referred to our hospital after a health checkup revealed a large liver tumor on abdominal ultrasonography. Colonoscopy revealed a Type 3 lesion occupying half of the rectosigmoid colon, and a biopsy confirmed a diagnosis of well-differentiated tubular adenocarcinoma. Contrast-enhanced computed tomography revealed multiple liver metastases in both lobes, and laparoscopic high anterior resection was performed(pT3N0M1a, Stage Ⅳ). Post-operatively, chemotherapy was initiated with a single course of mFOLFOX6, followed by 11 courses of mFOLFOX6+bevacizumab. Due to worsening peripheral neuropathy, the regimen was switched to FOLFIRI+bevacizumab, which was administered over 43 courses. Although the liver metastases steadily reduced in size, the response remained as a partial response. Two years and 6 months after the initiation of chemotherapy, the patient elected to discontinue treatment, and follow-up observation was continued thereafter. Three years and 4 months after discontinuation of chemotherapy, the liver metastases continued to regress, suggesting a clinical complete response.