[Successful Endoscopic Submucosal Dissection of Early Gastric Cancer in a Patient after Azacitidine Therapy for the Treatment of Myelodysplastic Syndrome].

A 76‒year‒old man was introduced to our hospital after being suspected of having early gastric cancer with an upper gastrointestinal endoscope that was performed to find the cause of anemia. Two cancers were revealed: type 0‒Ⅱa+Ⅰ lesion in the lesser curvature of the upper body and type 0‒Ⅱa+Ⅱc lesion in the greater curvature of the middle body. The blood test showed abnormalities(hemoglobin, 6.8 g/dL; platelets, 26,000/µg). Thus, myelodysplastic syndrome(MDS) was suspected, and since this was prioritized over gastric cancer, the patient was transferred to the hematology department. As high risk MDS was diagnosed, azacitidine therapy was initiated. After 2 cycles of treatment, the blood abnormalities improved(hemoglobin, 11.3 g/dL; platelets, 254,000/µg). ESD was performed in our department for the 2 lesions. Histopathological examination showed that both lesions represented well‒differentiated adenocarcinoma, and so radical resection was performed. Since MDS occurs due to aging and is common among patients, we believe that timely treatment is necessary.

[A Case of Advanced Gastric Cancer Confirmed as Pathological Complete Response Following S-1 plus Oxaliplatin Chemotherapy and Gastric Resection].

A 69-year-old woman presented with persistent nauseous, underwent upper gastrointestinal endoscopy, and was diagnosed with type 2 advanced gastric cancer at the antrum. Abdominal contrast CT image data revealed that there was a large, swollen, pancreatic superior lymph node invading the common hepatic artery. We determined that the tumor was unresectable and systemic chemotherapy was performed using S-1 plus oxaliplatin(SOX)therapy. After 5 courses of chemotherapy, the abdominal contrast CT image data indicated reduction of both the primary lesion and lymph node metastasis. A laparotomy was performed. As the No. 8a lymph node was forming hard scar tissue, we could not dissected clearly it from the common hepatic artery wall. We strongly suspected that cancer tissue remained at the artery wall. A distal gastrectomy and Roux-en-Y reconstruction were performed. Histologically, the resected specimen was determined to be Grade 3, with a pathological complete response(pCR). The patient was administered S-1 for 6 months after the operation and has enjoyed 2.5 years of recurrence-free survival. SOX therapy for unresectable gastric cancer and surgical intervention as conversion surgery were effective. This case demonstrated the possibility of life prolongation using these therapies.

Chronic gastric anisakiasis presenting as pneumoperitoneum.

Typically, the diagnosis of gastric anisakiasis is made at endoscopy with the identification of anisakis larvae. We report a case of gastric anisakiasis presenting as pneumoperitoneum. A 70-year-old Japanese woman was admitted to our hospital with abdominal fullness and pain. Plain chest X-ray in the upright position showed the presence of free gas below the diaphragm. A tentative diagnosis of perforation peritonitis was made and an emergency laparotomy was performed. At laparotomy, a 4 cm, circumscribed red mass was noted on the anterior wall of the upper body of the stomach near the lesser curvature and a partial gastrectomy was carried out. The histological diagnosis showed a foreign body, assumed to be a part of anisakis larvae, seen in the centre of the granuloma. On the serosal aspect, there was histological evidence of peritonitis with fibrin and neutrophils. In addition, an antianisakis larvae immunoglobulin G antibody test was positive. Chronic gastric anisakiasis was suspected because of the presence of eosinophilic granuloma in the resected area and denatured anisakis larvae. Thus, we interpret this case as gastric perforation acutely based on chronic gastric anisakiasis.

Successful surgical treatment for metachronous advanced cancers of the gallbladder and the common bile duct--case report.

A 73-year-old woman with a tentative diagnosis of gallbladder cancer had undergone cholecystectomy with liver resection and dissection of regional lymph nodes. Pathological examination of the resected specimen revealed well-differentiated papillary adenocarcinoma of the gallbladder with subserosal invasion. No evidence of metastasis was noted in the dissected lymph nodes. After surgery, she had been disease free in the follow-up study. Ten years after surgery, however, carcinoma arising from the common bile duct was newly found, and pancreaticoduodenectomy with regional lymph nodes dissection was performed. Histological examination confirmed well-differentiated adenocarcinoma of the common bile duct. Lymph nodes had no evidence of malignancy. The patient has been doing well with no evidence of recurrence 20 and 10 years after each operation, respectively. Apparently, these two cancers occurred independently and each surgical treatment for this patient was successful.