[A Case of Gastrointestinal Stromal Tumor(GIST)Originating in the Anal Canal].

We report a case of a gastrointestinal stromal tumor(GIST)that originated in the anal canal. A 70's woman with a subcutaneous tumor reaching from the anal canal was referred to our hospital. After a thorough examination, the tumor was resected percutaneously in the jackknife position. Histopathological examination showed proliferation of spindle-shaped tumor cells arranged in irregular bundles. Immunohistochemical staining showed that the tumor was positive for c-kit and CD34, and negative for a-SMA and S-100, so the tumor was diagnosed as GIST. As a-SMA-positive smooth muscle cells were seen around the tumor, we suspected that this tumor originated from the internal sphincter muscle.

[A Study of Patients with Regional Lymph Node Recurrence after Breast Surgery].

Regional lymph node recurrence without distant metastasis after the initial treatment of breast cancer is a relatively rare event. The optimal management for regional lymph node recurrence is poorly understood. We retrospectively evaluated 21 patients who developed regional lymph node recurrence between January 1, 2003 and December 31, 2014. The median interval between regional lymph node recurrence and distant metastasis was 1.0 years(range, 0.4 to 2.5 years). On followup, 15 cases(71.4%)were found to eventually develop distant metastases. Median follow-up time after lymph node recurrence was 1.8 years(range, 0.4 to 20.3 years). The 2-year survival rate after regional lymph node recurrence was 65.5%. The mean distant-disease-free interval was 2.2 years in patients with estrogen receptor(ER)-positive tumor(n=10)and 0.7 years in patients with ER-negative tumor(n=11). The distant-disease-free interval after regional lymph node recurrence was significantly shorter in patients with ER-negative tumor than in patients with ER-positive tumor(p=0.008). The 2-year survival rate after regional lymph node recurrence was significantly lower in patients with ER-negative tumor(33.3%)than in patients with ER-positive tumor(100%, p=0.016). This study revealed that regional lymph node recurrence after initial treatment is associated with an increased risk of distant metastasis and death and ER-negative tumors are indicative of a poor prognosis.

[A case of skeletal muscle metastasis on the left thigh after esophagectomy for esophageal adenocarcinoma in Barrett' s esophagus].

We report the case of a 45-year-old man with advanced esophageal adenocarcinoma in Barrett's esophagus. After neoadjuvant chemotherapy using S-1, docetaxel, and cisplatin, the patient underwent thoracoscopic esophagectomy with a two-field lymph node dissection and reconstruction with a gastric tube through the posterior mediastinal route. The pathological stage was CT-pT4 (diaphragm), ly2, v1, CT-pN1, CT-pStage IVa. Fourteen months after the operation, the patient complained of pain in his left thigh with a palpable indurated mass that was increasing in size. Needle biopsy specimens revealed skeletal muscle metastasis of the adenocarcinoma. The metastastic lesion was resected and local control was achieved successfully for 13 months, after which the patient died because of intrabronchial bleeding.