[Two Cases of Advanced Gastric Cancer Treated with Palliative Radiotherapy].

We report 2 cases of gastric cancer treated with palliative radiotherapy. Case 1: A 74-year-old man presented with gastric cancer. He had severe anemia caused by tumor bleeding and needed frequent blood transfusions. Radiotherapy of 38.25 Gy in 15 fractions was administered to controlbl eeding. We confirmed hemostasis. Case 2: An 81-year-old man presented with peritonealrecurrence 41 months after operation for remnant gastric cancer. Systemic chemotherapy(S-1)was started, but gastrointestinalobstruction worsened. Radiotherapy of 44 Gy in 22 fractions was performed to improve obstruction. Conclusion: Palliative radiotherapy is minimally invasive and is therefore a treatment option for gastric cancer with bleeding and obstruction.

Ruptured mesenteric desmoid-type fibromatosis without emergency surgery: A rare case report.

INTRODUCTION: Desmoid-type fibromatosis (DF) is a rare tumor that develops in the limbs, abdominal wall, and abdominal cavity. It is accounting for less than 3% of soft-tissue sarcomas and less than 0.03% of all neoplasms. PRESENTATION OF CASE: A 57-year-old man was diagnosed as acute peritonitis due to intra-abdominal tumor rupture. Since his systematic symptoms were relatively stable, gastrointestinal perforation was ruled out, the differential diagnosis of the tumor itself was difficult, and it was unclear resectable by emergency surgery, we started conservative treatment. After examinations, ileocolectomy was performed. Histopathological examination revealed spindle cells with collagenous fiber hyperplasia and immunohistochemical staining for ß-catenin was positive, so we made a diagnosis of mesenteric desmoid-type fibromatosis (MDF). DISCUSSION: The mechanism of DF development is suggested to be associated with hereditary diseases, mechanical stimuli, and a history of exposure to radiation appear to be involved as pathogenetic factors in sporadic development. Surgical resection is the first-line treatment for MDF, but the postoperative high local recurrence rate is problematic. Drug therapy and radiation therapy are selected for cases in which radical resection is not possible or for recurrent cases. However, the number of examined cases is small and sufficient evidence has not been accumulated for most treatment strategies, it is expected that the optimal treatment at the time of recurrence will be further verified by the accumulation of MDF. CONCLUSION: There are few reports of peritonitis caused by MDF rupture; emergency surgery can be avoided.

Meckel's diverticulum adenocarcinoma accompanied with vitelline duct remnant and huge cystic lesion: A rare case report.

INTRODUCTION: Vitelline duct remnant (VDR) is a rare abnormality of the primitive yolk sac, and Meckel's diverticulum (MD) is the most common type. MD is a congenital small intestinal diverticulum that leaves the ileal side of vitelline duct, and MD adenocarcinoma is extremely rare. PRESENTATION OF CASE: A 49 year-old-man with abdominal mass was diagnosed as a huge pelvic tumor. We resected this tumor together with the invading ileum and the ileocecum. On histopathological and immunohistochemical analysis, tumor was diagnosed as adenocarcinoma and originated from the digestive tract. Considering that the cord extending from the umbilicus was connected to the tumor and that the tumor invaded the terminal ileum, we made a diagnosis of MD adenocarcinoma accompanied with the umbilical side of VDR and the huge cystic lesion bloated by tumor components filling up the duct due to cancer progression. DISCUSSION: The reported occurrence of MD tumors is 0.5%-3.2%. The incidence of adenocarcinoma is 21.7% for the malignant tumors in MD. It is likely that a highly advanced local invasion and lymph node metastases are involved and that the prognosis of this adenocarcinoma is poor. There is no recommended chemotherapeutic regimen for MD adenocarcinoma. It is expected that cases should be accumulated in the future for the development of a more optimally recommended regimen. CONCLUSION: Although the incidence of our case is extremely rare, the recognition of tumor development of the embryonic remnant origin is considered important for the treatment of this adenocarcinoma.

Preoperative diagnosis of an asymptomatic cancer restricted to the cystic duct.

INTRODUCTION: Even now, cystic duct cancer (CDC) as defined by Farrar is rare and has a better prognosis than gallbladder cancer, although CDC as defined by Ozden et al., the definition of which could apply to early and advanced cases of CDC, is not rare and has a poorer prognosis than the CDC defined by Farrar. PRESENTATION OF CASE: A 78-year-old woman with no complaints was found to have a tumor restricted to the cystic duct. Three cytology examinations of the patient's bile could not establish that the tumor was an adenocarcinoma. However, adenocarcinoma was suspected due to the hypervascularity shown on contrast-enhanced computed tomography. Cholecystectomy and extrahepatic bile duct resection with D2 lymph node dissection was performed. The pathological study revealed it to be CDC. Her postoperative course has been uneventful and without recurrence for 21 months. DISCUSSION: At their first medical examination, many CDC patients are found to have such advanced spread of the cancer to adjacent organs that an extended operation might be necessary. As in our case, better patient outcome results when no lymph node or remote metastasis is present. CONCLUSION: Diagnosing CDC as early as possible contributes to curative resections and favorable patient outcomes and also allows surgeons to recommend a mini-invasive procedure to their patients rather than extended resection including that of adjacent organs.