[A case report of complete response to low-dose S-1 monotherapy for pancreatic cancer in elderly patient].

A 87-year-old woman was diagnosed with pancreatic body cancer(Stage II ). Because of her age and history of open distal partial gastrectomy, it seemed that having her undergo an invasive surgery would be difficult. Therefore, S-1 was administered orally at a dose of 50mg/day for 28 consecutive days followed by a 14-day rest course(low-dose S-1 monotherapy). After 2 courses, the tumor marker(CA19-9)dramatically decreased to within the normal range. After 5 courses, the tumor could not be identified on the abdominal CT image, and it was judged to be a complete response. Low-dose S-1 monotherapy may be useful for improving the prognosis of pancreatic cancer without causing intolerable toxicity, especially for elderly patients.

A case of post-operative stenosis caused by colonic ischemia after low anterior resection for rectal cancer, followed by delayed colo-anal anastomosis.

Cases of delayed colo-anal anastomosis (DCAA) are currently reported instead of the colo-anal anastomosis with a protective loop ileostomy for rectal cancer. Post-operative colonic ischemia is considered as one of the serious complications of colorectal resection. Although indication of DCAA should be carefully selected, we experienced a case of post-operative stenosis caused by colonic ischemia after low anterior resection for rectal cancer, followed by this procedure.

Correction to: Clinical Impact of Inferior Mesenteric Lymph Node Metastasis in Patients with Cancer of the Sigmoid Colon or Rectum.

[This corrects the article DOI: 10.1007/s13193-021-01389-3.].

Robot-assisted excision of rectal duplication cysts: A case report.

Rectal duplication cysts are extremely rare and account for only 4% of all gastrointestinal duplication cysts. They may become challenging for removal in the case of a large tumor in a narrow pelvis. Herein, we report a case of rectal duplication cysts excision via robotic-assisted laparoscopic surgery and its utility.

Metachronous triple cancers of the stomach, duodenum and rectum in a patient with familial adenomatous polyposis.

Familial adenomatous polyposis (FAP) is an autosomal dominant disorder characterized by the presence of at least 100 adenomatous polyps in the colon and rectum. The risk of upper gastrointestinal tumors is relatively high in patients with FAP, but a case of triple cancers has not been reported in the literature. We herein report a case of metachronous triple cancers of the stomach, duodenum and rectum in a patient with FAP.

A case report of anaplastic carcinoma with osteoclast-like giant cells arising in the pancreatic body.

The patient is a 58-year-old woman. She was referred to our hospital following a computed tomography scan that revealed a 2-cm tumor-like lesion in the pancreatic body. Endoscopic ultrasound fine-needle aspiration examination revealed a suspected undifferentiated carcinoma with pleomorphic type. The patient was diagnosed with anaplastic carcinoma of the pancreas (ACP) and underwent distal pancreatectomy with lymph nodes dissection. The resected body and tail of the pancreas had a nodular tumor measuring 30 mm in diameter. Histologically, the main lesion of the tumor showed well-differentiated adenocarcinoma, and diffuse proliferation of atypical short spindle cells and round cells accompanied by multinucleated giant cells aggregation was observed around the tubular structure; hence, it was diagnosed with ACP. The postoperative course was uneventful, and the patient was discharged 14 days after the operation. It has already been about 5 years since the surgery, and although the tumor has recurred, the patient is still alive and undergoing chemotherapy.

[A case of huge omental-origin liposarcoma controlled by a combination of ifosfamide and adriamycin].

A 51-year-old woman came to our hospital after a medical check -up. She suffered from abdominal distension. Abdominal CT revealed the abdominal cavity filled with omental cake. The preoperative diagnosis was unassertive. Laparotomy through midline incision was performed. The bulk of the omental tumor occupied the abdominal cavity, but infiltrated the bowel or abdominal wall less. Fractional resection of the tumor, right hemicolectomy, sigmoidectomy, wedge resection of small intestine and left ovariectomy were performed in parallel. Resected specimens weighed 6. 6 kg in total. The operation was considered palliative because of the peritoneal dissemination. Postoperative intraabdominal administration of cisplatin(50mg) made the ascites disappear. She was discharged 3 weeks after the operation. The final diagnosis was liposarcoma(myxoid type), and 5 courses of adjuvant chemotherapy with adriamycin and ifosfamide were performed. No relapse was found 11 months after the operation, but tumor regrowth occurred in the thoracic and abdominal cavity and the patient died 14 months after the operation.

A case of emergency pancreatoduodenectomy for bleeding from the duodenal mucosa due to arteriovenous malformation of the pancreatic head.

A rare case of bleeding from the duodenal mucosa due to arteriovenous malformation of the pancreatic head is reported. Caution needs to be observed, then excision may be necessary since noninvasive treatment such as coil embolization is not enough for complete hemostasis when patient suddenly decompensates.

Clinical Impact of Inferior Mesenteric Lymph Node Metastasis in Patients with Cancer of the Sigmoid Colon or Rectum.

The aim of this study was to clarify the clinical impact of inferior mesenteric lymph node (IMLN) metastasis from cancer of the sigmoid colon or rectum. A total of 952 patients underwent curative surgery with IMLN dissection for either sigmoid colon cancer or rectal cancer from January 2000 to August 2018. Of these, 26 (2.7%) were pathologically diagnosed with IMLN metastasis. Excluding 1 patient, 25 patients were retrospectively investigated for clinicopathological characteristics and long-term outcomes. Specifically, the clinical course of patients with recurrence was meticulously scrutinised. Of the 25 patients, 14 (56%) had recurrence during the follow-up period. The 5-year recurrence-free survival was 31.2%, and 5-year overall survival was 59.7%. No serious morbidity, such as anastomotic leakage, was observed. Of the 14 patients with recurrence, 6 underwent secondary surgery with curative intent and 5 of the 6 patients remained cancer-free. In contrast, 8 patients were treated with chemotherapy, radiotherapy or best supportive care. Although IMLN metastasis was strongly associated with recurrence, long-term survival could be expected in most cases. Furthermore, there could be a chance for complete cure in patients with recurrence if secondary surgery is successfully carried out.

[A case of diffuse peritoneal malignant mesothelioma--intraabdominal administration of cisplatin is useful for diminishing ascites].

A 59-year-old man with a history of exposure to asbestos suffered from abdominal distension and visited our hospital. Abdominal CT revealed vast ascites but there was no obvious primary lesion. Serum tumor markers and hyaluronate were within the normal range. Abdominal puncture was carried out, and cytology of ascites was negative. We suspected diffuse malignant peritoneal mesothelioma because hyaluronate in ascites rose to 10×104 ng/mL. Ga-scintigraphy and FDG-PET were negative. We performed laparoscopic observation for definite diagnosis and found fine white particles at the peritoneum. The result of biopsy was malignant mesothelioma. The patient underwent intraperitoneal administration of cisplatin and his ascites was diminished. He lived for a year with no recurrence but died 23 months after diagnosis because of progression of pleural mesothelioma and liver metastases. Relapse of ascites was not found in the entire clinical course. Cisplatin administration in the peritoneal cavity is thus very effective in preventing progression of ascites.

Congestive ischemic colitis occurring after resection of left colon cancer: 4 case series.

BACKGROUND: Ischemic colitis can occur after colectomy and is sometimes difficult to treat. We report 4 cases of refractory, delayed onset, regional congestive colitis occurring on the anal side of the anastomosis after laparoscopic left hemicolectomy. CASE PRESENTATION: A total of 191 patients underwent surgery for left colon cancer (transverse, descending, and sigmoid colon cancer) at our hospital from January 2012 to December 2017. During the procedures, the left colic artery (LCA) or sigmoid colic artery (SA) was dissected, the superior rectal artery (SRA) was preserved, and the inferior mesenteric vein (IMV) was dissected at the inferior margin of the pancreas. Congestive ischemic colitis due to venous return dysfunction occurred in 4 cases (2.1%), 5 to 34 months postoperatively. The patients had diarrhea and blood in the stool. On computed tomography (CT), the patients exhibited continuous intestinal edema and high-density adipose tissue from the anastomosis site to the rectum. Contrast enhancement showed dilation of the vasa recti and arteries from the inferior mesenteric artery (IMA) to the SRA. Three patients improved with long-term intestinal rest; in 1 case, the stenosis did not improve and required colorectal resection. CONCLUSION: Diagnoses were easy in these cases, but treatment was prolonged and surgery was necessary in 1 case. While this condition is rare, caution is warranted as it is difficult to treat.

[Case of indwelling catheter dislocation into the duodenum during hepatic arterial infusion chemotherapy].

A 44-year-old man underwent hepatic arterial infusion chemotherapy and systematic chemotherapy using fluorouracil (5-FU) for recurrent liver metastasis of colon cancer. He reported upper back pain 38 weeks later. Arteriography using a port system revealed a dislocated catheter tip in the second part of the duodenum. Conservative therapy using antibiotics was employed without removing the catheter tip. Various complications related to intrahepatic arterial infusion chemotherapy have been reported. Catheter chip dislocation is rare, but can sometimes become a severe complication, thereby warranting careful follow-up after hepatic arterial infusion chemotherapy.

Tissue oxygenation in a murine SCC VII tumor after X-ray irradiation as determined by EPR spectroscopy.

PURPOSE: The goal of this study was to clarify the dynamics of oxygenation (partial pressure of oxygen, pO(2)) in SCC VII murine tumors in mice after X-ray irradiation. MATERIALS AND METHODS: Changes in pO(2) in tumors were measured by 1.2-GHz electron paramagnetic resonance (EPR) spectroscopy after they were exposed to various doses of irradiation. The pO(2) in tumors was followed for up to six days after irradiation at doses of 0, 5, 10, 15, and 20 Gy. Paramagnetic crystals were used as an oximetry probe and implanted into normal or tumor tissues in mice for prolonged periods. RESULTS: The pattern of tumor oxygen after a single dose of radiation with the 5-Gy dose was different from those with other doses (10, 15, and 20 Gy). After 5 Gy, pO(2) increased rapidly (P<0.01, Student's t test) and then returned to the level observed before irradiation by 12h (P<0.01). In contrast, after 10, 15, or 20 Gy, pO(2) increased rapidly by 6h after irradiation, continued to increase until at least 24h (P<0.01), and then gradually decreased. CONCLUSIONS: In tumors that received 5 Gy, post-irradiation increases in pO(2) at 4h after irradiation were detected by EPR oximetry (P<0.01) noninvasively.

Impaired cell adhesion, apoptosis, and signaling in WASP gene-disrupted Nalm-6 pre-B cells and recovery of cell adhesion using a transducible form of WASp.

Wiskott-Aldrich syndrome (WAS) is an X-linked immunodeficiency disease affecting cell morphology and signal transduction in hematopoietic cells. The function of Wiskott-Aldrich syndrome protein (WASp) and its partners in protein interaction have been studied intensively in mice; however, detailed biochemical characterization of its signal transduction and assessment of its functional consequence in human WASp-deficient lymphocytes remain difficult. In this study, we generated Nalm-6 cells in which the WAS protein gene (WASP) was disrupted by homologous recombination-based gene targeting and a cell-permeable form of recombinant WASp for functional study. The WASP⁻/⁻ cells showed impaired adhesive capacity and polarization to plate-bound anti-CD47 mAb, anti-CD9 mAb, or to fibronectin. The defective morphological changes were accompanied by impaired intracellular signaling. In addition, the WASp-deficient cells displayed augmented apoptosis induced by CD24 cross-linking. A recombinant fusion protein composed of Hph-1 cell-permeable peptide and WASp prepared in Escherichia coli. Hph-1-WASp was efficiently transduced and expressed in WASP⁻/⁻ Nalm-6 cells in a dose-dependent manner. The wild-type WASp, but not the mutant restored adhesion capacity, spreading morphology, and cytoskeletal reorganization. Additionally, the recombinant protein was successfully transduced into normal lymphocytes. These findings suggest that gene-disrupted model cell lines and cell-permeable recombinant proteins may serve as important tools for the detailed analysis of intracellular molecules involved in PID.