[A Case of Locally Advanced Adenosquamous Carcinoma of the Pancreas Accompanied by Hepatic Metastasis Treated by Resection of the Primary Lesion as Palliative Care].

A 61-year-old man presented to our hospital with appetite loss. Gastroscopy revealed a tumor on the upper body of the stomach. Persistent bleeding was observed from the tumor; therefore, the patient was immediately hospitalized. An abdominal CT scan revealed that the tumor arose from the pancreas and invaded the spleen, stomach, and transverse colon. Furthermore, a hepatic tumor was observed at the posterior segment and blood tests showed increased CA19-9 level. Therefore, the tumor was diagnosed as pancreatic cancer with invasion of the adjacent organs and hepatic metastasis. Although the tumor was classified as unresectable for the distant metastasis, resection of the primary lesion was performed to control the bleeding and obstruction at the invasion sites. The pathological diagnosis of the tumor was adenosquamous carcinoma. The patient subsequently underwent chemotherapy and was discharged from the hospital on postoperative day 34. The patient was able to spend time at home and was treated at an outpatient clinic until postoperative day 110, when his generalcondition deteriorated. In this case, resection of the primary lesion was ineffectual for a life prognosis but was beneficial for palliative care.

[A Case of Solitary Lymph Node Recurrence Accompanied by Metachronous Multiple Lesion after Definitive Chemoradiotherapy for Esophageal Cancer].

A 53-year-old man was diagnosed with squamous cell carcinoma of the upper thoracic esophagus in cT3N1M0, cStage III (UICC 6th edition). The patient underwent definitive chemoradiotherapy(dCRT)and achieved a complete response in May 2008. Five and a half years after dCRT, swelling of the cardiac lymph node was detected on CT. Frequent check-up was performed in the subsequent 1 year and 10 months, during which the recurrent lesion was revealed as solitarybyPET -CT. No signs of recurrence were detected at the site of the primarylesion byendoscopic examination; however, another superficial cancer was found at a different site. Endoscopic submucosal dissection was performed for the esophageal lesion, and laparoscopic lymphadenectomy was applied to the cardiac lymph node. We herein report a case of a male patient who underwent minimal invasive locoregional treatments for both metachronous multiple lesions and solitaryly mph node recurrence after dCRT.

[A case of Complete Response(CR)to combination therapy of S-1 and Gemcitabine(GEM)for unresectable pancreatic cancer].

Pancreatic cancer is among the most lethal of all digestive cancers, and it is very difficult to obtain long-term survival of unresectable cases. This case report reveals that combination chemotherapy with S-1/gemcitabine(GEM)was very effective for a patient with unresectable pancreatic body cancer. The patient was a 72-year-old female(Stage IVb). They were administered S-1 80mg/day for 2 weeks and GEM 1, 000mg/m2 on day 8 and 15 followed by a 2-week recovery period. After finishing the 2 courses, there was a notable reduction in tumor size. After finishing 9 courses, the tumor could not be observed and it was judged it to be CR. Currently, at 1 year and 4 months from the initial diagnosis, there is no recurrence of tumor, and the general condition of the patient is very good. Combination chemotherapy with S-1/GEM may be useful to improve the prognosis for unresectable pancreatic cancer.