[A Case of Solitary Inguinal Lymph Node Metastasis 15 Years after Colorectal Cancer Surgery].

The patient is a 69-year-old man. 17 years ago, a colectomy was performed for colorectal cancer, and a disseminated nodule was found during the operation, so the disseminated nodule was also resected. After the surgery, 12 courses of FOLFOX4 were administered, and there was no recurrence thereafter. He was diagnosed with hepatocellular carcinoma 12 years after the colectomy and underwent liver resection. Fifteen years after the colectomy, a mass shadow appeared in the right inguinal region, and inguinal lymph node metastasis of hepatocellular carcinoma or colorectal cancer was suspected. In the same year, he underwent the tumor resection and histopathological diagnosis revealed colon cancer inguinal lymph node metastasis. After the lymph node resection, he has been followed up for 2 years with no recurrence of colorectal cancer. It is extremely rare to have a solitary inguinal lymph node recurrence 15 years after colon surgery.

[Three Cases in Which Long-Term Survival Was Obtained by Irradiation for Postoperative Lymph Node Metastasis].

Case 1: Left total mastectomy was performed for a 58-year-old woman for diagnosis of left breast cancer. Seven years after surgery, left internal mammary node metastasis revealed. Irradiation was performed on the left chest wall and left supraclavicular area. Six months later, the lymph node swelling disappeared. Thereafter 8 years have passed without recurrence. Case 2: A 65-year-old man had a semi-emergency total gastrectomy for bleeding from gastric cancer. Three years after surgery, anterior pancreatic lymph node metastasis was detected. Radiation therapy was selected because his general condition was not so good. Three months later, lymph node swelling disappeared. Thereafter 4 and a half years have passed without recurrence. Case 3: A 67-year-old man underwent surgery for middle thoracic esophageal cancer after neoadjuvant chemotherapy. Seven months after surgery, left tracheobronchial lymph node metastasis was found. Irradiation was performed to bilateral supraclavicular area and mediastinum in combination with chemotherapy. Three months later, the lymph node normalized, and 6 and a half years have passed without recurrence. All 3 cases in this study were recurrences of regional lymph node. Radiation therapy may be effective for regional lymph node recurrence outside the dissected area or in areas that have been inadequately dissected.

[A Case of Intra-Abdominal Desmoid Tumor with Acute Abdominal Pain].

A 70-year-old man was admitted to our hospital with acute abdominal pain. Abdominal CT showed a 6-cm-sized tumor near the third portion of the duodenum, and a duodenal GIST was suspected. Although the abdominal pain was intense and the tumor was suspected to be ruptured, the vital signs were stable; therefore, we initially planned to perform an elective surgery. However, because the pain could not be controlled, the surgery was performed on the 6th day of hospitalization. The tumor appeared to be a duodenal GIST because it was pulling the third portion of the duodenum inwards. It had a strong tendency to infiltrate the surrounding organs; therefore, forced resection of the right colon, which is the surrounding organ, was performed. Pathological findings showed that the resected specimen was a desmoid tumor and the surgical margins were negative. The postoperative course 1 year after surgery was favorable, and no tumor recurrence occurred. We report a case of desmoid tumor, which caused acute abdominal pain.

[Pancreatic Head Cancer Invading the Ascending Part of the Duodenum with Difficulty in Diagnosis-A Case Report].

A 61-year-old man visited our hospital because of nausea and vomiting. Abdominal CT revealed a severe stenosis of the ascending part of the duodenum but no evidence of tumors in the duodenum or pancreas. Upper gastrointestinal endoscopy showed severe stenosis of the ascending part of the duodenum with an ulcerative lesion. A biopsy of the site showed no evidence of malignancy. Nevertheless, duodenal and/or pancreatic cancer(s)could have caused the stenosis; therefore, we decided to perform an operation for the diagnosis and treatment of the obstruction. The surgery revealed severe stenosis of the ascending part of the duodenum with scar tissue. We performed subtotal stomach-preserving pancreaticoduodenectomy. Pathological findings showed pancreatic head cancer invading the ascending part of the duodenum. In this case, the diagnosis was difficult to make preoperatively because of the lack of an obvious neoplastic lesion. We believe duodenal invasion by pancreatic cancer without recognizing any tumor mass on CT is rare.

[Strategies of Treatment for Obstructive Colorectal Cancer and Compared with Non-Obstructive Cancer].

The aim of this study was assessment of the laparoscopic surgery after using ileus tube(trans-anal or trans-nasal)for obstructive colorectal cancer compared with non-obstructive cancer. METHOD: Between April 2010 and March 2019, 129 patients underwent laparoscopic colorectal surgery. 97 patients were non-obstructive colorectal cancer(group N)and 32 patients were obstructive colorectal cancer(group O). Differences between the groups were analyzed using the Mann- Whitney's U-test, as appropriate. RESULT: In group O, the length of hospital stay was significantly long. There were no significant differences between-group differences in the operation time, estimated blood loss, the rate of conversion to open surgery and postoperative complications. CONCLUSION: The laparoscopic colorectal surgery is feasible in patients treated with using ileus tube for obstructive colorectal cancer.

Invasive micropapillary carcinoma of the breast with minimal regional lymph node metastasis regardless of the huge size: report of a case.

We present a 38-year-old premenopausal Japanese woman with invasive micropapillary carcinoma (IMC) of the left breast with minimal lymph node metastasis despite a huge size. The patient noticed a left breast mass and a bloody nipple discharge 2 years before admission. On admission, physical examination revealed a huge, elastic hard mass with skin ulcer 12x12 cm in diameter occupying the entire left breast. The patient underwent modified radical mastectomy with level III lymph node dissection, and the defect was reconstructed with a vertical rectus abdominis myocutaneous flap. Histopathologically, IMC comprised about 60% of the tumor, admixed with papillotubular and mucinous carcinoma. Only one of twenty-five lymph nodes had tumor metastasis. The patient remains well 8 months postoperatively without any signs of recurrence.

Feasibility of induction chemotherapy using bronchial arterial infusion for locally advanced non-small cell lung cancer: a pilot study.

PURPOSE: We examined the feasibility and effectiveness of bronchial arterial infusion (BAI) as induction chemotherapy before surgery for locally advanced non-small cell lung cancer (NSCLC). METHODS: Eighteen patients with locally advanced NSCLC were given BAI consisting of cis-diamminedichloroplatinum (CDDP) (50-100 mg/m(2)) as induction chemotherapy before surgery (induction BAI). Six patients with clinical stage IIIA cancer had bulky N2 metastatic lymph nodes, and 12 patients with clinical stage IIIB cancer had T4 disease. RESULTS: Of the 18 patients, 12 (67%) showed a partial response to the BAI therapy. Standard pulmonary resection was performed in 5 patients, pulmonary resection with the combined resection of adjacent organs was performed in 10 patients, and pulmonary resection with carinal resection and reconstruction was performed in 3 patients. Complete resection was possible in 14 patients (78%). There were no serious BAI therapy-related complications or postoperative deaths. The 5-year survival rate of the 18 patients was 35.7% and the median survival time (MST) was 19.4 months. Survival was better when complete resection was achieved after the induction BAI, especially in patients with stage IIIB (T4) disease. CONCLUSION: Based on our preliminary findings, BAI with CDDP as induction chemotherapy is feasible and may be an effective therapeutic modality for locally advanced NSCLC.