[A case of a patient with gastric cancer and peritoneal dissemination who survived for more than 10 years after successful treatment with S-1].

A 50-year-old female patient underwent distal gastrectomy and intraperitoneal CDDP administration for advanced gastric cancer accompanied by severe peritoneal dissemination. She valued her quality of life and chose an oral anticancer drug, S-1, as a postoperative chemotherapy agent. S-1 was administered at a dose of 100mg/body/day for 4 weeks, followed by a 2- week rest. There were no adverse events due to S-1 and no exacerbation of peritoneal dissemination in the 5 years following surgery. The S-1 administration schedule was then changed to alternate-day administration. Eight years after the surgery, the patient discontinued S-1 treatment and has since survived for 11 years with no obvious cancer recurrence.

[A case of osteonecrosis of the jaw during treatment by bevacizumab for sigmoid colon cancer].

A 67-year-old man was diagnosed to have sigmoid colon cancer with peritonitis carcinomatosa. The cancer was surgically resected, and he thereafter underwent chemotherapy with mFOLFOX6+bevacizumab. He complained of gingival swelling throughout treatment and osteonecrosis of the jaw was noted. The bevacizumab therapy was therefore discontinued and the necrotic tissue removed. No recurrent necrosis has occurred. The addition of bevacizumab to the FOLFOX or FOLFIRI chemotherapy regimens has been shown to improve the survival rate and response rate in colorectal cancer. Osteonecrosis of the jaw is a rare toxicity of bevacizumab. Bevacizumab might compromise the microvessel integrity in the jaw, which thus may lead to bone necrosis. Osteonecrosis of the jaw in this case recovered after the discontinuation of bevacizumab and the removal of the necrotic tissue. The pathogenesis and treatment of osteonecrosis have not been elucidated.

Hemothorax caused by spontaneous rupture of hepatocellular carcinoma: a case report and review of the literature.

We report a rare case in which hemothorax occurred in addition to hemoperitoneum due to spontaneous rupture of hepatocellular carcinoma (HCC) originating from the caudate lobe of the liver. The case pertains to a 56-year-old female who was transported to our hospital for impaired consciousness due to hemorrhagic shock. Computed tomography (CT) demonstrated ruptured HCC originating from the caudate lobe and accompanying hemoperitoneum and right hemothorax. Hemostasis was carried out by transcatheter arterial embolization (TAE), and surgery was conducted approximately one month after TAE. In the present case, no lesions as possible sources of bleeding were observed inside the pleural cavity, and, moreover, the diaphragm had no abnormalities in the intraoperative findings, suggesting that blood from the ruptured tumor may have traversed the intact diaphragm to enter the right pleural cavity soon after the HCC rupture. However, to the best of our knowledge, no similar cases of HCC have been reported to date, and this case is thus believed to be very rare. This unusual phenomenon may therefore be strongly associated with the location of the ruptured tumor and the formation of a hematoma inside the omental bursa. We discuss the mechanism causing hemothorax in the present case and also review the previously reported cases of ruptured HCC complicated by hemothorax.