[A Case of Peritoneal Mesothelioma Diagnosed by Ileus].

The present case involved a man aged about 70 years. He visited our hospital with the main complaint of abdominal pain. We diagnosed him with intestinal obstruction, and we decided to perform surgery. White knot sections were spread inside the abdominal cavity, and the small intestine appeared as a single block. This block was resected and examined for peritoneal mesothelioma. Peritoneal mesothelioma is thought to have incubation period of 20-25 years after exposure to asbestos, and the number of affected patients will increase in the future. In some cases, peritoneal mesothelioma occurs only in the peritoneum; therefore, diagnosis often becomes difficult. Once intestinal obstruction occurs, administering chemotherapy is difficult. Therefore, early diagnosis is thought to be very important.

[Experience of Ramucirumab plus FOLFIRI as Second-Line Treatment for Metastatic Colorectal Cancer in Our Hospital].

We experienced 2 cases in which ramucirumab plus FOLFIRI as second-line treatment was beneficial. Case 1 was a 67-yearold man, underwent panitumumab plus mFOLFOX6 as first-line treatment for unresectable rectal cancer with ureteral invasion and multiple liver metastases, but the disease became worse at 9.3 months. We changed to ramucirumab plus FOLFIRI as second-line treatment. After 2 courses, a grade 3 febrile neutropenia was observed, but treatment was beneficial and continued administration for 9 months or more. Case 2 was a 73-year-old man who underwent panitumumab plus mFOLFOX6 as first-line treatment after cytoreductive surgery of the primary lesion for sigmoid colon cancer with intestinal obstruction and liver metastasis, but the disease became worse at 4.7 months. Upon entering ramucirumab plus FOLFIRI therapy, the metastatic lesions shrinked remarkably. Adverse events of grade 3 or higher were not observed and finally continued administration for 7.9 months. It was suggested that ramucirumab plus FOLFIRI combination therapy for metastatic colorectal cancer could be an effective as second-line treatment.

[Experience with Gemcitabine plus Nab-Paclitaxel Therapy for Advanced Metastatic Pancreatic Cancer in Our Hospital].

A 71-year-old-man was referred to our hospital because of jaundice of the skin. On biochemical examination of blood, we identified an elevation in the levels of AST and ALT, the serum level of biliary enzymes, and the serum levels of tumor markers. We found pancreatic head cancer with invasion to the main blood vessels and duodenum, with liver metastases, on abdominal CT. We made a diagnosis of unresectable advanced pancreatic head cancer with distant metastasis, and we initiated gemcitabine plus nab-paclitaxel therapy as first-line chemotherapy. The serum CA19-9 level decreased gradually after initiating therapy; both the primary tumor and liver metastases slightly reduced in size after 3 courses of first-line therapy, as assessed on abdominal CT. Hair loss, peripheral neuropathy, and neutropenia were observed as adverse events, but treatment continued as it was tolerable. Finally, because his disease condition worsened after 7 courses of the therapy, we switched to TS-1 as second-line therapy. Eleven months have elapsed since treatment was initiated, and the patient is continuing secondline therapy while maintaining PS.

Biliary deposition of Liesegang rings presenting as a polypoid mass in the liver: previously unrecognized lesion.

Liesegang rings (LR) are acellular, laminated structures that may be deposited within and around cysts and inflamed or necrotic tissue. Previous reports have shown that the kidney and breast are commonly affected organs of LR. Herein is reported a rare case of biliary deposition of LR presenting as a tumor-like polypoid mass in the liver. A 70-year-old man was found to have a cystic lesion, measuring 3.0 cm in diameter, in the lateral segment of the liver. The lesion was accompanied by a solid mass, 1.8 cm in diameter, within the cystic cavity. Lateral segmentectomy of the liver was performed because clinical examinations could not exclude the possibility of hepatobiliary cystadenoma or cystadenocarcinoma. Pathology of the resected specimen indicated a soft polypoid mass, connecting to the cystically dilated bile duct with elongated stalk-like structures. Histologically the surface of the mass was covered by non-neoplastic biliary-type epithelium. Beneath the epithelium, extensive deposition of numerous ring-like laminated structures, which exhibited an identical appearance to LR, was observed. This is a unique and previously unrecognized lesion involving the occurrence of LR deposition in the hepatobiliary tracts, which further formed a grossly visible mass resembling a hepatic tumor.