The combination of preoperative celiac axis stenting and neoadjuvant chemotherapy in an elderly patient with pancreatic cancer: a case report.

BACKGROUND: Celiac axis stenosis (CAS) is frequently observed in patients undergoing pancreaticoduodenectomy (PD). This poses challenges because of the potential disruption of the hepatic arterial blood flow. CASE PRESENTATION: We present the case of an 81-year-old woman diagnosed with pancreatic head cancer and severe CAS caused by calcification. The patient received neoadjuvant chemotherapy (NAC) and underwent preoperative endovascular stenting of the celiac axis to restore blood flow. After two cycles of NAC, subtotal stomach-preserving PD was performed. An intraoperative assessment of the hepatic arterial blood flow determined that it was well maintained. PD was performed using the standard technique; specialized techniques were not necessary. Importantly, no ischemic complications were encountered. CONCLUSION: This case report describes the successful combination of preoperative celiac axis stenting, NAC, and surgical intervention for the management of CAS in an elderly patient with pancreatic cancer. This approach offers a potential solution for maintaining the hepatic arterial blood flow in the presence of CAS without vascular reconstruction, particularly in elderly individuals.

Rare case of retroperitoneal mitotically active leiomyoma in a postmenopausal woman.

Leiomyomas are benign smooth muscle tumors, and retroperitoneal leiomyomas without coexisting uterine leiomyomas are extremely rare. Mitotically active leiomyomas, which are leiomyomas with increased mitotic activity, are rarely observed in postmenopausal women, except under the influence of exogenous hormones. This report presents a rare case of a retroperitoneal mitotically active leiomyoma in a postmenopausal woman. The patient presented with an abdominal mass and underwent surgical resection of the retroperitoneal tumor. Pathological examination revealed a mitotically active retroperitoneal leiomyoma with 31 mitotic figures per 10 high-power fields. The patient did not experience recurrence during the 2-year follow-up period. This case highlights the need to consider retroperitoneal mitotically active leiomyomas in postmenopausal women and suggests that myomectomy can prevent their recurrence.

[Two Cases of Closed LECS for Early Gastric Cancer].

In recent years, laparoscopy and endoscopy cooperative surgery(LECS)is reported as the treatment of gastric cancer. We report closed LECS performed for an elderly patient with remnant gastric cancer and gastric cancer in a patient with lung cancer. Case 1 is an 85-year-old male. Early gastric cancer was pointed out in the remnant stomach after distal gastrectomy. ESD was not indicated because of the size of tumor. Because of his age and many comorbidities, closed LECS was performed. Postoperative pathological diagnosis was pT1a(M), pPM0, pDM0, Ly0, v0. Case 2 is a 56-year-old male. He was undergoing chemotherapy for lung cancer with pleural dissemination. Upper gastrointestinal endoscopy revealed early gastric cancer. ESD was not indicated for this lesion because of the depth of tumor. Pleural dissemination of lung cancer is his prognostic factor, and gastrectomy with lymph node dissection was considered excessively invasive. Therefore, closed LECS was performed. Postoperative pathological diagnosis was pT1b2(SM2), pPM0, pDM0, Ly1c, v1a. Closed LECS could be useful therapeutic option for early gastric cancer.

A case of immunoglobulin G4-Related disease with pleural effusion, requiring exclusion of tuberculous pleurisy.

Immunoglobulin G4 (IgG4)-related pleurisy is a rare type of IgG4-related disease. We present the case of a 69-year-old woman with left pleural effusion and elevated adenosine deaminase levels. Initially, tuberculous pleuritis was suspected; however, the bacterial cultures and polymerase chain reaction test results for tuberculosis were negative. Thoracoscopic pleural biopsy revealed dense lymphocytic infiltrates with large numbers of IgG4-positive plasma cells. The ratio of IgG4-positive to IgG-positive plasma cells exceeded 40%. The patient was diagnosed with IgG4-related disease.

[A Case of Inverted LECS for GIST Near the Pylorus Ring].

Laparoscopy and endoscopy cooperative surgery(LECS)is a surgical procedure to avoid excessive resection of the gastrointestinal wall and preserve its function. For gastrointestinal stromal tumors(GIST)near the cardia and pylorus ring, the function of the cardia and pylorus can be preserved by minimum excision and hand-sewn suture closures. Here, we report a case successfully treated with inverted LECS for GIST near the pylorus ring. The patient was a 58-year-old male. Upper gastrointestinal endoscopy had revealed a 45 mm sized SMT near the pylorus ring. Biopsy by EUS-FNA indicated gastric GIST. The tumor was separated from the pylorus ring and inverted LECS was performed. The defect was closed with hand-sewn sutures, forming an L-shape. The postoperative course was good and he was discharged from hospital 10 days after surgery. It is considered that devising the direction of closure by means of the LECS procedure can preserve the pyloric function without passage obstruction or stasis, even for gastric GIST near the pylorus ring.

[Unresectable Advanced HER2-Positive Gastric Cancer Leading to a Perforation during Chemotherapy with Trastuzumab plus Paclitaxel].

The patient was a 70s female with gastric cancer. CT and PET scans revealed metastases of para-aortic lymph nodes, hepatoduodenal ligament lymph nodes, and left supraclavicular lymph nodes. She was diagnosed with T4a, N2, M1(LYM), and cStage ⅣB and was given chemotherapy with paclitaxel due to chronic kidney disease and trastuzumab treatment. We planned to perform radical gastrectomy with lymph node dissection due to the disappearance of FDG uptake except for primary gastric cancer on PET scans 5 months after chemotherapy. However, the patient developed pan-peritonitis due to gastric cancer perforation; therefore, emergency distal gastrectomy with Billroth Ⅱ reconstruction was performed. She received chemotherapy(only trastuzumab)after getting discharged. Reports about gastric cancer perforation during chemotherapy using trastuzumab are rare. We should consider the possibility of perforated gastric cancer during chemotherapy and optimal surgical procedures, including the extent of lymph node dissection in the case of Stage Ⅳ gastric cancer.