[A Case of Gastric Cancer Performed Curative Operation after Nivolumab].

A 69-year-old man was admitted for the severe anemia. Upper gastrointestinal endoscopy revealed type 3 gastric cancer (por1, HER2 negative)that spread from EG junction to the lesser curvature of lower gastric body. CT revealed LNs metastasis and the direct invasion to the diaphragm. We diagnosed the locally advanced gastric cancer(T4bN[+]M0, Stage ⅣA) and planed neoadjuvant chemotherapy. After 3 courses of S-1 plus CDDP therapy, serum CEA level increased. And the invasion to diaphragm was unclear although the tumor shrunk. After 3 courses of nab-PTX plus RAM therapy as the second- line, the tumor was PD. As the third-line chemotherapy, nivolumab therapy was repeated up to a total of 15 courses. As the tumor was PR, the patient underwent total gastrectomy with D2 lymphadenectomy. The histopathological examination revealed that the cancer invaded into the muscle layer without lymph nodes metastasis. The cancer was diagnosed as pT2 (MP)N0M0, Stage ⅠB. The cancer cells were EB virus positive and MSI-high. CD 8 positive T lymphocytes infiltrated into the stroma. The patient is alive 26 months without adjuvant chemotherapy. The curative operation was able to perform because the infiltrative CD8 positive T lymphocytes reactivated with nivolumab responded remarkably.

[A Case of Laparoscopically Resected Sigmoid Colon Cancer and Transverse Colon Mesentery Primary Solitary Fibrous Tumor].

The patient is a 52-year-old woman who visited the general practitioner because of positive fecal occult blood test by medical examination. The patient underwent colonoscopy at the hospital, which revealed sigmoid colon cancer. Therefore, the patient was referred to our hospital for surgery. Preoperative CT scan revealed a well-defined and lobulated 54 mm tumor on the caudal side of the duodenal third portion. On MRI, the tumor showed low T1-weighted image signal and high T2-weighted and diffusion-weighted images signal, with low ADC. For preoperative diagnosis, we diagnosed sigmoid colon cancer and transverse colon mesenteric and performed laparoscopic sigmoid colon and transverse colon mesenteric tumor resections. The histopathological tumor diagnoses were sigmoid colon cancer(S, type 2, 30×30 mm, 1/2 circumference, moderately differentiated adenocarcinoma, pT3[SS], INF b, Ly1a, V1a, pN1b[#252: 2/4], sM0, fStage Ⅲb)and transverse colon mesentery primary solitary fibrous tumor. The patient was treated with XELOX as the adjuvant chemotherapy and survived without recurrence until present.

[A Case of Giant Pancreatic Mucinous Cystic Neoplasm That Was Difficult to Preoperative Diagnosis].

A 43-year-old woman with about abdominal distension was referred to our hospital for a more detailed examination. Abdominal CT showed 27 cm-sized cystic lesion with the calcification along the partition wall and a nodular hyperplasia. We suspected pancreatic pseudocyst, primary retroperitoneal tumor and we performed tumorectomy. The resected specimen had a maximum diameter of 27 cm. The histopathological diagnosis was mucinous cystadenocarcinoma of the pancreas with ovarian-type stroma. The adjuvant chemotherapy treated with gemcitabine was selected for 3 courses. She continues to do well without any recurrences 7 months later.

[A Case of Laparoscopic Resection for a Primary Malignant Lymphoma of the Small Intestine Strongly Adhered to the Sigmoid Colon].

An 85-year-old man presented to our hospital for loss of consciousness. Blood test revealed anemia, and the fecal occult blood test was positive. Colonoscopy revealed an ileal ulcer located 10-14 cm from the ileal end on the proximal side. Pathological examination was indicative of diffuse large B-cell lymphoma(DLBCL), and laparoscopic resection was selected as the technique of choice. The ileal tumor was strongly adhered to the sigmoid colon, and laparoscopic partial resection of the ileum and sigmoid colon was performed. In general, primary gastrointestinal lymphomas may occur, for which perforate and surgical resection is recommended. It is rare for malignant lymphomas to involve other intestinal areas, and laparoscopic surgery is useful in such cases.

[A Case of Pancreatic Head Cancer Resected after Neoadjuvant Chemotherapy Followed by Pseudocyst].

A 41-year-old man with upper abdominal and back pain was admitted to another hospital. He had a history of recurring acute pancreatitis and pseudocyst. Six months later, abdominal CT revealed a pancreatic head tumor arising from the pseudocyst, and adenocarcinoma was suspected based on endoscopic ultrasound fine needle aspiration(EUS-FNA)findings. We selected neoadjuvant chemotherapy because resection was difficult due to severe inflammation and edema around the tumor. Chemotherapy(FOLFIRINOX followed by gemcitabine plus nab-paclitaxel)was effective, and the tumor almost disappeared on CT. Subtotal stomach-preserving pancreatoduodenectomy(SSPPD)was performed 12 months after starting chemotherapy, and curative resection was successful. The final Stage was ⅡA(T3[CH1]N0M0). Histopathological examination revealed no viable tumor cells. S-1 adjuvant chemotherapy was administered for 6 months. He was still alive 22 months postoperation without any recurrence. Neoadjuvant chemotherapy is effective in cases involving pancreatic cancer with severe inflammation, because pre-operative chemotherapy can reduce tumor size and alleviate the inflammation caused by acute pancreatitis and pseudocysts.

[A Case of Gastric Endocrine Carcinoma with a Huge Liver Metastasis].

A-67-year old man was diagnosed with gastric cancer and a liver tumor. Extended left hemihepatectomy combined with caudate lobectomy and distal gastrectomy with lymph node dissection were performed. Histological examination revealed synaptophysin and CD56positive tumor cells with a solid and rosette structure, which was diagnosed as endocrine carcinoma (EC). Additionally, a tubular adenocarcinoma was present in the stomach. The liver tumor presented as EC with tumor thrombus in the left portal vein. Finally, the patient was diagnosed with gastric EC(pT3[SS], pN0, P0, CY0, M1[HEP], Stage Ⅳ, R0). He received 6courses of the adjuvant chemotherapy with cisplatin(CDDP)plus irinotecan(CPT-11), and has been alive without recurrence for 21 months post-operation. Gastric EC is a rare subtype of gastric cancer. The resection of liver metastasis of gastric EC may improve patients' prognosis and QOL. CDDP-based chemotherapy is recommended, due to the regimen for small cell lung cancer.

Simple and practical nomograms for predicting the stone-free rate after shock wave lithotripsy in patients with a solitary upper ureteral stone.

PURPOSE: To develop practical nomograms for predicting the stone-free rate after shock wave lithotripsy (SWL) in patients with a solitary stone in the proximal ureter. METHODS: Between July 2006 and June 2015, 319 patients with a proximal ureteral stone who underwent preoperative non-contrast enhanced computed tomography (NCCT) and subsequently received SWL were identified. Patients' age, gender, laterality, stone size, mean and maximum Hounsfield Unit (HU) of the stone, and skin-to-stone distance (SSD) were assessed. The stone-free status was defined as no radiopacity detected on the 3-month follow-up plain radiography or NCCT. RESULTS: Mean stone size was 10 mm (range 3-20 mm). Mean and maximum HU of the stone ranged from 115 to 1447 (mean 701) and from 265 to 1881 (mean 1062), respectively. The overall stone-free rate was 70%. Multivariate analyses identified stone size (p < 0.001), maximum HU (p < 0.001), and SSD at 90° (p = 0.038) as independent predictive factors for the stone-free status after SWL. Nomograms could be constructed for predicting the probability of stone-free status after SWL corresponding to SSD of 8, 10, and 12 cm using maximum HU and stone size. CONCLUSIONS: This study demonstrated that stone size, maximum HU of the stone, and SSD at 90° are significant predictors of successful SWL outcome in patients with a proximal ureteral stone. We have developed simple and practical nomograms corresponding to three different SSDs for predicting the stone-free rate after SWL.

[A Case of Recurrent Breast Cancer with Bone Metastasis Successfully Treated with Everolimus and Exemestane Therapy].

We report a case of a patient treated with everolimus and exemestane combination therapy for bone metastasis after breast surgery.The patient, a 58-year-old woman, consulted our department for back pain in October 2014.S he was diagnosed with left breast cancer when she was 41 years old.She had received Bt+Ax for left breast cancer and administered tamoxifen for 5 years.We decided on everolimus and exemestane combination therapy after observing an abnormal uptake in the 7th to 8th thoracic vertebrae on a PET-CT scan.The pain was controlled using oxycodone and fentanyl orally disintegrating tablet with zoledronic acid.After receiving treatment, the patient experienced pruritus and a Grade 2 rash, but they were managed with antihistamine administration and the treatment was continued.Four months later, the abnormal uptake on the right thoracic vertebrae shrunk; the pain almost disappeared, and oxycodone and fentanyl orally disintegrating tablet were discontinued.Subsequently, exemestane was used alone.Six months later, the range of abnormal uptake on the thoracic vertebrae progressed, and the disease was evaluated as PD.Four months later, everolimus and exemestane combination therapy was resumed, and the abnormal uptake on the thoracic vertebrae almost disappeared as observed on a PET scan.The effectiveness of the treatment was evaluated as CR because other local recurrence and new metastases were not found. Everolimus might exhibit bone resorption inhibiting effects and bone protection effects, but the decision regarding the periods of suitable use and the effects of long-term continuation of treatment are controversial, and further discussion based on experience of increasing use is required.

[Solitary ectopic thymoma at ligamentum arteriosum; report of a case].

We report a case of solitary ectopic thymoma at the ligamentum arteriosum, which was resected with thoracoscopic surgery. A 62-year-old male patient received chemoradiation therapy for laryngeal cancer approximately 1 year before. The present computed tomography scan indicated a mass (diameter, 2 cm) at the ligamentum arteriosum. Furthermore, positron emission tomography showed an abnormal accumulation on the mass. Malignant lymphoma and laryngeal cancer with lymph node metastasis were suspected, and thoracoscopic surgery was performed. The tumor had a clear margin;therefore, it could be extirpated easily. The results of the postoperative pathological examination indicated that the tumor was an ectopic thymoma. The patient was discharged 3 days after the surgery because he showed good clinical course and was kept under careful observation.

[A case wherein bevacizumab/XELOX combination therapy was remarkably effective for the treatment of extensive dissemination in advanced colon cancer, and the primary lesion could be resected].

Here, we report a case wherein bevacizumab/XELOX combination therapy was remarkably effective for the treatment of a patient with unresectable advanced cecum cancer and carcinomatous peritonitis. A 52-year-old man was diagnosed with cecum cancer with extensive carcinomatous dissemination. He underwent open laparotomy, and the findings indicated a unresectable cecal tumor attached to the retroperitoneum; therefore, ileo-transverse colostomy was performed. After 6 courses of bevacizumab and XELOX therapy, the primary tumor as well as ascites and carcinomatous dissemination had disappeared, and a marked decrease in the serum carcinoembryonic antigen(CEA)level was noted. However, subsequently, positive emission tomography/computed tomography(PET/CT)indicated a recurrence of the primary tumor. Therefore, ileocecalectomy and D2 lymph node dissection were performed. Thus, we believe that bevacizumab/XELOX therapy may be useful as neoadjuvant chemotherapy for the treatment of advanced colon cancer with peritonitis carcinomatosa.

[Long-term survival of a case of juvenile colon cancer with multiple liver metastases successfully treated by multidisciplinary therapy].

A 35-year-old woman underwent hemicolectomy and RFA for ascending colon cancer with multiple liver metastases in February, 2005. She received postoperative hepaticarterial infusion chemotherapy with 5-FU, and systemic hemotherapy with UFT for 10 months after the operation. A local recurrence of the anastomosis was detected in March, 2006, and she underwent a resection for it. This was followed by 6 courses of adjuvant chemotherapy with modified FOLFOX6. Because multiple liver metastases and lymph node metastases were detected in March, 2007, she received RFA and 6 courses of adjuvant chemotherapy with modified FOLFOX6 again. Liver metastases disappeared but lymph node metastases still remained. Therefore, she received 4 courses of bevacizumab plus modified FOLFOX6. The metastatic lesions disappeared and were judged to be CR. Therefore, she was followed-up with the oral administration of UFT. Metastases of liver and lymph nodes of the mediastinum were detected in May, 2008, for which she received 4 courses of bevacizumab plus FOLFIRI2. Because the effects of the chemotherapy were judged to be CR, she continued with 4 courses of the same regimen. The regimen was discontinued due to diarrhea, and she therefore began to receive 4 courses of bevacizumab plus LV/5-FU regimens. CR has been maintained at present, over 7 years after the initial surgery.

[A case of advanced esophageal cancer revealed a pathological complete response and survived more than 8 years, treated by radiation therapy combined with nedaplatin and 5-FU chemotherapy].

We report here the long-term survival case of advanced esophageal cancer treated with definitive chemoradiotherapy (CRT). A 61-year-old woman visited our hospital because of a disturbance in her swallowing in September, 2003. She was diagnosed with a middle esophageal type 3 tumor, which was 9 cm in length by endoscopy. Squamous cell carcinoma was diagnosed by pre-operative endoscopic biopsy. CT revealed the tumor with direct invasion to the aorta, and multiple metastases of the lymph nodes(T4, N1, M0: Stage IVa). CRT(combination of 5-FU and nedaplatin with 40 Gy of radiation)was administered. After the completion of CRT, the tumor size was remarkably reduced, but stenosis of the lumen of the esophagus remained partially. Therefore, we performed sub-total esophagectomy in February, 2004. A pathological complete response was diagnosed with no carcinoma cells evident in the resected specimen. Pathological therapeutic evaluation of the esophageal cancer was grade 3. The patient had received no adjuvant chemotherapy, but she is alive and healthy now with no relapse of carcinoma for more than 8 years after operation.

[A case of pathologically by complete response in advanced sigmoid colon cancer with multiple metastases of lung and Liver, left hydronephrosis after chemotherapy including bevacizumab/FOLFOX6].

A 61-year-old complaining of anorexia and general fatigue was admitted to our hospital for further examination. She was diagnosed as advanced sigmoid colon cancer with multiple metastases of lung, liver, and left hydronephrosis. Since curative surgery was not deemed possible, we started chemotherapy with bevacizumab/FOLFOX6 (bi-weekly drip infusion). After the 6th course, colonoscopy revealed a significant tumor reduction and changes to the scar tissues. CT did not reveal a complete disappearance, but found some reductions in metastases of lung and liver. Sigmoidectomy and lymph node resection (D1) were performed. We did not disappeared any dissemination and the histological diagnosis revealed a complete disappearance of cancer cells in the main tumor. She was discharged 13 days after surgery, following chemotherapy which included bevacizumab and XELOX. The chemotherapy using bevacizumab/FOLFOX6 is a candidate for the standard treatment strategy for inoperable advanced colon cancer. Herein we report this rare case with a review of the literature.

[A case of advanced gastric cancer successfully treated with docetaxel and S-1 combined therapy].

A 46-year-old woman with lower abdominal distension was diagnosed as gastric cancer in our hospital. She had multiple metastases of lungs, lymph nodes, bilateral ovaries, and uterus. After she underwent sub-total gastrectomy, bilateral oophorectomy, and total hysterectomy, she received adjuvant chemotherapy followed by docetaxel and S-1. After 6 courses of chemotherapy, PET/CT revealed no recurrences (complete response), and she was therefore administered S-1 for only 6 months. She has remained without recurrence 15 months after the operation.

[A case of anthracycline- and taxane-resistant recurrent advanced breast cancer successfully treated with S-1 monotherapy].

We experienced a case of anthracycline- and taxane-resistant recurrent breast cancer with multiple liver metastases and multiple bone metastases showing marked improvement by S-1. A 52-year-old woman visited our hospital because of her liver dysfunction in May 2008. She underwent a partial mastectomy preserving chest muscles in another hospital in 2000, but further details were unknown. Radiographic imaging tests revealed multiple metastases to the liver and bones in May 2008, and she was referred to our hospital for management of metastatic lesions. Tumor of the liver was diagnosed as metastases from the breast carcinoma, ER+, PgR+, HER2 (0), and histopathologically by core needle biopsy under ultrasonography. She received 4 courses of EC after 4 courses of biweekly docetaxel treatment. She showed a partial response (PR), so she was treated by the same course of treatment again. But she was diagnosed with an enlargement of liver metastases and recurrence of bone metastases by PET examination. Then the oral treatment with S-1 was started, and at the end of the second course, a significant reduction of abnormal accumulation in PET was noted. She has been quite well without any adverse effects from S-1. S-1 monotherapy was thus considered to be an effective treatment for advanced or recurrent breast cancer resistant to anthracyclines and taxanes.

[Two cases of advanced gastric cancer with peritoneal dissemination, and Virchow's metastases successfully treated by combination therapy of S-1 and docetaxel].

We report two cases of advanced gastric cancer successfully treated with combination S-1 and docetaxel (DOC) therapy. Case 1: A 43-year-old woman underwent radical total gastrectomy for advanced type 4 gastric cancer one and a half years ago. She was diagnosed as peritonitis carcinomatosa with much ascites, so the following combination chemotherapy was started. Case 2: A 53-year-old man underwent palliative gastrectomy for advanced type 3 gastric cancer with multiple lymph node metastases involving Virchow's metastases. After surgery, he received the following combination chemotherapy: DOC at the starting dose of 40 mg/m2 by iv infusion over 1 hour on day 1 and S-1 at the full dose of 80 mg/m2 daily for two weeks every three weeks. After administration of this combination therapy, the Case 1 gastric cancer with much ascites and the Case 2 gastric cancer with multiple lymph nodes metastases had entirely disappeared. Thereafter the 2 cases received therapy with S-1 alone. No recurrence in Case 1 has been seen with S-1 chemotherapy. Case 2 revealed a few lymph node swellings in the abdominal cavity, so he is undergoing combination therapy of DOC and S-1. The combination DOC and S-1 show a high degree of safety and can be a new tool for the management of advanced gastric cancer with peritoneal dissemination and Virchow's metastases.

[Induced radioactivity in irradiated foods by X ray or gamma ray].

In the course of the archival studies on safety of irradiated foods by the US Army, experimental records conducted by Glass & Smith, and Kruger & Wilson were investigated, based on our experimental experience. Food irradiation by Co-60 or 4 approximately 24MeV X ray can induce small amount of radioactivity in the foods. The principal mechanisms of the nuclear reactions are (gamma, n). The resulting nuclear products found in irradiated target solutions were Ba-135m, Pb-204m, Hg-199m, Ag-107m,Ag-109m, Cd-111m,Cd-113m, Sn-117m, Sn-119m, Sr-87m, Nb-93m, In113m, In-115m, Te-123m, Te-125m, Lu-178m Hf-160m by the (gamma, n) reaction. The total radio-activities in beef, bacon, shrimp, chicken, and green beans were counted at 60 days after irradiation by Cs-137, Co-60, and fuel element. The activities more than background were found in irradiated bacon and beef by Co-60. and activities were found in most foods when foods were irradiated by high energy X ray and the fuel element. The results were understood as the neutron activation by (gamma, n) or (n, gamma) reaction. Therefore, high energy X ray and spent fuel element were not used for food irradiation. As the results of this study Co-60 has been used with small amount of induced radioactivity in food.

Effects of gamma ray and electron-beam irradiations on survival of anaerobic and facultatively anaerobic bacteria.

An extension of the approval for food irradiation is desired due to the increase in the incidence of food poisoning in the world. One anaerobic (Clostridium perfringens) and four facultatively anaerobic (Bacillus cereus, Escherichia coli O157:H7, Listeria monocytogenes, and Salmonella Enteritidis) bacteria irradiated with gamma ray or electron beam (E-beam) were tested in terms of survival on agar under packaging atmosphere. Using pouch pack, effects of two irradiations on survival of anaerobic and facultatively anaerobic bacteria were evaluated comparatively. E-beam irradiation was more effective than gamma ray irradiation in decreasing the D10 value of B. cereus at 4 degrees C, slightly more effective in that of E. coli O157, and similarly effective in that of the other three bacteria at 4 degrees C. The gamma irradiation of the bacteria without incubation at 4 degrees C before irradiation was more effective than that of the bacteria with incubation overnight at 4 degrees C before irradiation in decreasing the D10 values of these bacteria (B. cereus, E. coli O157, and L. monocytogenes). Furthermore, ground beef patties inoculated with bacteria were irradiated with 1 kGy by E-beam (5 MeV) at 4 degrees C. The inoculated bacteria in the 1-9 mm beef patties were killed by 1 kGy E-beam irradiation and some bacteria in more than 9 mm beef patties were not killed by the irradiation.