[A Case of Left Upper Abdominal Evisceration for Transverse Colon Cancer with Multiple Organ Invasion].

The case is a 73-year-old woman. She visited primary care doctor for abdominal pain, vomiting, diarrhea, and melena that persisted for 2 weeks. She was referred to our department because she had an elevated inflammatory response and CT showed a mass in her left upper quadrant. Contrast-enhanced CT showed a tumorous lesion mainly in the splenic flexure of the transverse colon, involving the greater curvature of the stomach, the tail of the pancreas, and the hilus of the spleen, accompanied by abscess formation. We suspected highly advanced colon cancer with multiple organ involvement, but we opted for multiple visceral resection because it was associated with high-grade inflammatory findings due to abscess formation. After she was treated with antibiotics, she underwent laparotomy on the 6th day of illness. Intraoperative findings showed no clear nodular lesions suggesting dissemination in the abdominal cavity and intraoperative washing cytology was negative. Since the mobility of the mass that invaded the posterior wall of the greater curvature of the stomach, the tail of the pancreas, and the splenic hilum centered on the splenic flexure was confirmed, the entire left upper abdominal evisceration was resected by resecting the splenic flexure of the colon, the stomach, the tail of the pancreas, and the spleen. The postoperative course was uneventful, and she was discharged on postoperative day 9. Histopathological examination confirmed invasion of colon cancer into the pancreas, spleen, and retroperitoneum. In this report, we present a case of colon cancer with multi-organ invasion that underwent left upper abdominal evisceration.

[A Case of Radical Resection of Mucinous Cystadenocarcinoma of the Appendix by Laparoscopic Partial Cecal Resection].

A 70-year-old man was admitted to our hospital with a chief complaint of right lower abdominal pain during defecation. The contrast-enhanced CT scan showed a highly expanded appendix, so we suspected an appendiceal mucinous neoplasm, but the diagnosis did not clearly suggest cancer. So, we decided to perform laparoscopic surgery. Based on the intraoperative findings, it was considered that radical resection may be possible by partial cecal resection, and the patient underwent the procedure. Mucinous adenocarcinoma(MACA)was revealed by the postoperative pathological diagnosis. However, because the histological type was G1(well-differentiated)and no metastasis to regional lymph nodes(No. 201)was observed, we decided not to perform an additional ileocecal resection with LN dissection. The patient had a good postoperative course and was discharged from the hospital on postoperative day 4. The patient is still alive, 9 months postoperatively, with no recurrence.

Small bowel fistula with colorectal cancer and mesenteric lymph node metastasis: a report of two cases.

A 65-year-old man presented to our hospital with complaints of diarrhea. Computed tomography showed a fistula with the small intestine, and a single incision laparoscopic low anterior resection for rectum with D3 dissection and partial resection of the small intestine were performed. Lymph node dissection, including a part of the inflow vessel area, was also performed because lymph node swelling was observed in the mesentery of the small intestine around the fistula. Histopathological analysis revealed that the lymph nodes in the small intestine were positive for metastasis. The patient was a 61-year-old woman who presented to our hospital with a chief complaint of diarrhea. A partial resection of the small intestine, including resection of the left hemicolectomy and lymph node dissection around the fistula, was performed at laparotomy. Histopathological examination revealed numerous lymph node metastases in the small intestinal mesentery.

[Endobronchial Lipomatous Hamartoma Extended beyond a Bronchial Wall:Report of a Case].

Pulmonary hamartomas are common benign lung tumors. Most cases are parenchymal chondromatous hamartomas, whereas endobronchial lipomatous hamartomas are rarely encountered. A 78-year-old man was referred for left superior subsegmental atelectasis due to obstruction by an endobronchial tumor that was found incidentally on chest computed tomography for the postoperative follow-up of colon cancer. Bronchoscopy showed a polypoid tumor in the orifice of the left upper segmental bronchus. Lipoma was diagnosed by a bronchoscopic biopsy. We performed a segmentectomy of the upper division of the left lung because the tumor was presumed to be located peripherally to the left B3 segmental bronchus. A histopathological examination revealed that the tumor was an endobronchial lipomatous hamartoma that extended to the pulmonary parenchyma beyond the bronchial wall.

[Excision of a Rapidly Enlarged Bronchogenic Cyst Infected after Endoscopic Ultrasound-guided Fine Needle Aspiration].

We report the case of a 75-year-old woman who developed acute mediastinitis from an infected bronchogenic cyst due to endoscopic ultrasound-guided transesophageal fine-needle aspiration (EUS-FNA) for making diagnosis. The patient developed fever, chest pain, and discomfort after EUS-FNA. A repeat chest computed tomography( CT) demonstrated a rapidly increased size of the mediastinal mass. Thoracoscopic surgery was performed five days after EUS-FNA and the mediastinal mass was excised successfully. Postoperative histological examination confirmed the diagnosis of a bronchogenic cyst.

[Preoperative Chemoradiotherapy for Advanced Rectal Cancer Resulting in Pathological Complete Response].

A 73-year-old woman was referred to our institution due to the presence of narrow and bloody stools. On rectal examination, a rectal mass was observed. Colonoscopy revealed a type 2 tumor in the rectum(RbP)that extended to the dentate line. On biopsy, the tumor was diagnosed as tub1/tub2. No enlarged lymph nodes or metastases were noted on CT. On MRI, the tumor did not invade outside the rectum, and was noted to be proximal to the levator ani muscle. The patient was diagnosed with rectal cancer(cT4a, cN0, cM0, cStage Ⅱb). Preoperative chemoradiotherapy(CRT)was performed to preserve the patient's anus. A total dose of 50.4 Gy of radiation was administered in daily fractions of 1.8 Gy, and chemotherapy was administered with S-1(80 mg/day)orally. Colonoscopy revealed that the tumor significantly reduced in size post-CRT. Further, the boundary between the tumor and levator ani muscle was observed to be more distinct. The patient underwent a laparoscopic intersphincteric resection(D3)+ileostomy. Pathological examination revealed no viable tumor cell in the removed specimen. No tumor recurrence was observed 2 years postoperatively. We report a case in which preoperative CRT for advanced rectal cancer resulted in a pathological complete response.

[A Case of Colitic Cancer with a Total Proctocolectomy in the Second Term].

The patient was 70-years-old women, 27 years ago, she was diagnosed with total colitis-type ulcerative colitis. Eighteen years after the diagnosis, she self-suspended his hospital visit because her condition was stable. After 4 years, ulcerative colitis rekindled, she resumed taking a 5-ASA. And 2 years later, colonoscopy revealed type 3 tumor in the descending colon. Tumor biopsy indicated an adenocarcinoma(tub1, tub2)derived from ulcerative colitis. Originally total proctocolectomy is necessary, but patient strongly hoped to leave the colon. We performed laparoscopic left hemicolonectomy(D2, SST). The pathological diagnosis was pT3, pN2, pM0, pStage Ⅲc. After the operation, chemotherapy(mFOLFOX6)was carried out for 6 months. We regularly checked tumor markers and followed up with a colonoscopy once every 6 months. But 3 years and 9 months after surgery, ulcerative colitis rekindled and adenocarcinoma in the transverse colon found by colonoscopy. We performed total proctocolectomy with ileal J-pouch anal-canal anastomosis. Four months after the second operation, advanced defecation disorder has not been observed.

[A Case Involved Successful Treatment of Cecum Colon Cancer with Idiopathic Thrombocytopenic Purpura(ITP)by Laparoscopic Resection].

A 91-year-old woman visited a local hospital with the chief complaint of bloody stool. The patient was noted that her platelet count is 1,000/µL, so she was referred to our hospital. Also after admission, she had bloody stool continuously. Then lower gastrointestinal endoscopy was done and it indicated that the reason for these symptoms is cecum colon cancer (cT3N0M0). We decided to perform an operation. Before the operation, in order to improve her platelet count to 100,000/µL high dose intravenous immunoglobulin, steroid therapy and platelet transfusion had done. The operation is laparoscopic ileocecal resection and the amount of bleeding is 10 g. The postoperative course was uneventful, and her platelet count became within normal range by platelet transfusion for 4 days. Until latest follow-up she has neither recurrence of the cancer nor thrombocytopenia. This case suggests that appropriate treatments make it impossible laparoscopic surgery for cecum colon cancer with ITP perform safety and resection for cancers may contribute to improve ITP.

[Hemothorax Due to Rupture of an Aneurysm of a Branch of the Right Subclavian Artery with von Recklinghausen's Disease].

A 52-year-old man with a history of von Recklinghausen's disease presented to our hospital with abrupt onset of right chest and back pain. A contrast-enhanced chest computed tomography (CT) revealed massive right hemothorax, extravasation of the contrast medium at a branch of the right subclavian artery, and a tumor surrounding the second right dorsal rib. Based on findings from emergent angiography, hemothorax secondary to the rupture of an aneurysm of a branch of the right subclavian artery was diagnosed, and transcatheter arterial embolization(TAE) was performed. After hemostasis, intrathoracic hematoma was removed by surgery, and a recurrence of hemothorax did not occur until at least 8 months after the initial TAE procedure.

[Congenital Defect of the Left Pericardium with Spontaneous Pneumothorax;Report of a Case].

Congenital cardiac membrane deficiency is a relatively rare condition. Here, we report a case of congenital cardiac membrane deficiency that manifested as left spontaneous pneumothorax. A 72-year-old man was hospitalized for recurrence of the spontaneous pneumothorax. Computed tomography findings led us to suspect pericardial deficits, and the perioperative findings during thoracoscopic surgery for the pneumothorax confirmed complete absence of the left pericardium. We resected a lung cyst but did not treat the pericardial deficit. The patient's postoperative course was uneventful.

[Emergency Surgery for a Lung Hernia after Resection of a Metastatic Rib Tumor;Report of a Case].

The patient was a 60-year-old woman who underwent chest wall resection for a metastatic tumor in the anterior portion of the right 3rd rib, from thyroid cancer. The anterior portion of the right 3rd rib and the 2nd and 3rd intercostal muscles were resected, and chest wall reconstruction was not performed. On the 5th postoperative day, the patient developed a pulmonary hernia. Radiologically, more than half of the right upper lobe and middle lobe were prolapsed from the resected chest wall. The patient complained of cough and dyspnea, and an emergency surgery was performed. Elevated intrathoracic pressure due to obesity was considered to be a serious risk factor of the lung hernia after chest wall resection without reconstruction.

[Postoperatively Diagnosed Pulmonary Actinomycosis;Report of Three Cases].

Three cases of pulmonary actinomycosis have been postoperatively diagnosed in our hospital in the past 3 years. All the cases were preoperatively difficult to differentiate from lung cancer, and all were diagnosed in men. One of the patients was diagnosed on the basis of clinical symptoms, while the other 2 patients were diagnosed during the treatment and follow-up of other diseases. On radiological examination, 2 patients showed mass-like shadows, and the 3rd showed a cavitary lesion; fluorodeoxyglucose (FDG) -positron emission tomography showed high FDG accumulation in all the patients. One of the patients was pathologically suspected with lung cancer on transbronchial lung biopsy. Right upper lobectomy was performed in 2 patients, and right lower lobectomy in 1. One of the patients who underwent right upper lobectomy, also received chest wall resection because of the perioperative finding of chest wall invasion of lung cancer. Clinically, all the cases were preoperatively diagnosed as lung cancer.