[Solid serous cystic neoplasm of the pancreas showing a gradual tumor enlargement for over five years:a case report].

Serous cystic neoplasms (SCNs) of the pancreas are slow-growing benign tumors. They are mostly monitored without surgical management. Solid SCN is rare and differentiating it from hypervascular tumors of the pancreas using preoperative imaging may be difficult. A 69-year-old woman was referred to our department for surgical treatment of an enlarged pancreatic tail tumor with a size of 22mm based on the abdominal computed tomography (CT). At the age of 60, she underwent thyroidectomy for papillary thyroid carcinoma and mastectomy for breast cancer. Initially, consecutive annual CT examinations did not show signs of recurrence. However, after 9 years, a hypervascular pancreatic tumor was detected and assumed to be either a neuroendocrine tumor or metastasis. The patient underwent distal pancreatectomy, and the resected specimen was histopathologically diagnosed as solid SCN of the pancreas. Before being referred for pancreatic resection, this patient had been followed up with serial annual CT examinations for over 9 years after a previous malignant disease. Retrospectively, the abdominal CT scans showed that the pancreatic tumor already existed 5 years ago and had gradually increased in size thereafter. In this case report, we focused on the characteristics of solid SCN to address the difficulty in diagnosing this rare malignancy.

[Hepatic metastases from alpha-fetoprotein producing colorectal cancer that responded remarkably to transcatheter arterial chemo-embolization].

Although alpha-fetoprotein (AFP)-producing colorectal cancer is extremely rare, its potential for liver metastasis is high and the prognosis of the patient is very poor. We report a case of metastatic liver tumor from an AFP producing sigmoid colon cancer that was successfully treated with transcatheter arterial chemo-embolization (TACE). A 48-year-old female was admitted to our hospital complaining of anal bleeding, and was diagnosed as harboring a type 2 advanced tumor with two metastatic lesions in the lateral segment of the liver. Serum AFP measured 948.2 ng/ml before surgery. We performed sigmoidectomy and lateral segmentectomy of the liver. Pathological examination revealed moderately differentiated adenocarcinoma both in the primary and the metastatic lesions, and AFP-stain positive nests were seen on immunohistochemical staining. The serum AFP value returned to normal soon after the surgery. Five months later, a recurrent lesion was discovered in the right lobe of liver, and it was surgically removed. Another 4 months later, multiple liver metastases were recognized and the patient's serum AFP level was found to be 593.3 ng/ml. For the re-recurrent hepatic lesions of 5.5 cm in diameter, she underwent two courses of TACE using Lipiodol and epirubicin hydrochloride. Following the treatment, the tumor shrank rapidly and almost disappeared. The patient has been in good health for 24 months since the last TACE, and the serum AFP level has been within the normal range.