Ectopic gastric pancreatic cancer: report of a case.

It is very rare for ectopic pancreas to become cancerous. We herein report on a case of ectopic pancreatic cancer developed in the stomach. A neoplastic lesion was detected in the pyloric part in an upper GIS of a 76-year-old female, requiring biopsy, but because it was classified as Group I, it was observed temporarily. Following blood collection after approximately 2 years, the CA19-9 increased from 177.5 to 279.5, so a GIS was again performed. Although the pyloric part of the stomach became more stenosed than before, it was still considered Group I disease based on biopsy findings. When EUS was performed, the tumor appeared as a submucosal tumor, and was thus suspected as GIST. In an abdominal CT, a neoplastic lesion with a clear boundary was observed in the pylorus, as was an enlarged lymph node in the hepatoduodenal ligament. Therefore malignancy could not be ruled out, and a gastrectomy on the pylorus side, lymph node dissection (D2), and cholecystectomy were performed. The tumor was a submucosal tumor covered by a coherent mucosa. According to histopathological findings, it was diagnosed as ectopic pancreatic cancer developed in the ectopic pancreas (Heinrich type II), consisting of acinar tissue and capillary tubes. Thus ectopic pancreas should be considered in the differential diagnosis of gastric submucosal tumors. Regarding surgery for ectopic pancreas, it is considered necessary to establish a treatment policy by making an immediate pathological diagnosis with sufficient consideration of the possibility of malignancy.

[A case of advanced gastric cancer responding to S-1/paclitaxel/lentinan as neoadjuvant chemoimmunotherapy].

A 71-year-old man suffering from epigastric discomfort and dizziness was admitted to our hospital and diagnosed with advanced gastric cancer with bulky lymph node metastases and liver metastasis. We thought a complete resection would be difficult, so he was treated with neo-adjuvant immunochemotherapy in combination with S-1 80 mg/m2 (2 weeks administration and 2-week rest), paclitaxel (PTX) 50 mg/m2 (day 1, 8, 15) and Lentinan (LNT) 2 mg/body (day 1, 8, 15). After 5 courses of this treatment, swollen lymph nodes decreased in size and the metastatic liver tumor disappeared. Total gastrectomy with lymph node dissection was performed. The histological diagnosis was pT2 pN0, Stage I B. Histological effects of primary tumor and lymphnodes were judged to be grade 2 and grade 3, respectively. We considered that the combination of S-1, PTX and LNT can be effective and safe for advanced gastric cancer.

[Preoperative chemoradiotherapy for advanced lower rectal carcinoma].

Preoperative chemoradiotherapy in combination with radiation of 30 Gy and chemotherapy with oral uracil-tegafur for 14 patients with advanced lower rectal carcinoma was performed. Tumors were located at RaRb in 5 cases, RbRa in 2, Rb in 3, and RbP in 4 with a mean diameter of 3.8 cm. Preoperative lymphnodes were diagnosed as cN0 in 8 cases, cN1(metastases of perirectal nodes)in 4, cN1(perirectal and along superior rectal artery nodes)in 1, and cN3(perirectal and lateral nodes)in 1. Efficacy for primary carcinomas was evaluated as Partial Response in 9 cases, Stable Disease in 5 and perirectal nodes were down-sized in 4 without down-sizing of either along superior rectal artery nodes or lateral nodes. Margins of primary carcinomas to anal verge were prolonged in 7 cases with a mean prolongation of 0.81 cm. Autonomic nerve-preserving resections with lymphadenectomy of perirectal and along superior rectal artery nodes were performed. Histopathologically efficacy for primary tumors was diagnosed to as not effective in 9 cases, partially effective in 5, and all lymphnodes were combined with necroses and fibrosis. Preoperative chemoradiotherapy is safe for preserving autonomic nerves and serves to preserve the sphincter. A forthcoming study with more appropriate radiation, chemotherapy and lymphadenectomy is being considered.