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A 64-year-old woman who had chronic type C viral hepatitis was referred with a liver tumor detected by magnetic resonance imaging(MRI). She had a history of rheumatoid arthritis which was treated by methotrexate. Ethoxybenzyl-MRI(EOBMRI) showed a low signal in the T1-weighted imaging, a high signal in the T2-weighted imaging and a low signal in the hepatobiliary phase. The tumor was 7 millimeters in diameter at S4, and exhibited enhancement in the arterial phase and wash out in the portal phase by contrast enhanced CT. Imaging findings suggested hepatocellular carcinoma, and we performed partial hepatectomy of S4. Histopathological examination confirmed reactive lymphoid hyperplasia(RLH)of liver. RLH of liver is a rare benign lesion and it is necessary to consider RLH as a differential diagnosis of the liver tumor.

We report a case of a 71-year-old woman.She visited our hospital with a complaint of high fever and abdominal distention. She has been pointed out intraductal papillary mucinous neoplasm(IPMN)4 years ago.Abdominal CT showed cystic legion, 80mm in diameter, on the pancreas.The lesion was unclear at the boundary between the main pancreatic duct and in contact with the stomach, transverse colon.Upper endoscopic and colonoscopic examination revealed the exhaustion image from the intestional tract but not pointed out the malignant findings.We performed total pancreatectomy, total gastrectomy and partial transverse colectomy.Pathological examination revealed the intraductal papillary mucinous carcinoma but the tumor did not invaded the stomach and colon.It is known that some cases of IPMN form fistulae to adjacent organs.We report a case of IPMN penetrating into the stomach and colon.

Solitary splenic metastasis from cancer is known as a rare disorder in cancer patients. In the present study, we report our experience regarding pathophysiology and treatment tactics of the splenic metastasis caused by ovarian cancer after perioperative chemotherapy. A 50s female presented to our clinic complaining of growing solitary splenic hilar node in CT. Hysterectomy, bilateral oophorectomy, omentectomy and adjuvant therapy was performed after neoadjuvant therapy with TC regimen. Five years and 3 months after surgery, she presented growing solitary splenic hilar nodule in CT. After staging laparoscopy, this lesion is judged to be able to be resected absolutely. Splenectomy and pancreas tail resection was performed. She has survived 39 months after 2nd surgery without recurrence. She recieved a diagnosis of solitary splenic metastasis from past ovarian cancer with whitch pattern of immunostaining was accord closely. Therapeutic tactics for solitary splenic metastasis is splenectomy because of the prognosis after complete resection is thought to be well.

Trousseau's syndrome is a coagulation disorder occurring in cancer patients. In the present study, we report our experience regarding the pathophysiology and treatment strategies of this syndrome that is caused by CA19-9-producing gastric cancer during long term chemotherapy. A 60s male presented to our clinic; he was found to have a high level of CA19-9. An advanced gastric cancer was identified by gastric scope. A totalgastrectomy was performed. Severalcourses of chemotherapy were administered, and the level of CA19-9 was measured over a long period. Three years and 2 months after the surgery, he presented to the emergency room complaining of acute onset of aphasia and paresis of the extremities. Brain MRI showed multiple cerebral infarctions. He was diagnosed with Trousseau's syndrome. Although decision making is difficult in the treatment of this syndrome, owing to the complex medicalhistory associated with it, it is essentialthat strategies be established for achieving successfultreatment results in the future.

Stromal sarcoma of the breast is a very rare disease accounting for 0.03%of primary breast malignant tumors. From 1995 to 2014, 384 patients with primary breast malignant tumors underwent resection at our institution, of which 2 cases(0.5%) were stromal sarcoma of the breast. Case 1: A woman aged in her 50's presented with a painful lump spanning the right breast identified 7-8 months previously by palpation. The patient first visited the outpatient department at our hospital when the lump gradually increased in size and bleeding from the breast was observed. The tumor measured 8 cm in its greatest dimension and it was elastic soft with a smooth surface, exhibited sphericity, and existed in combination with a partial skin ulcer. Biopsy indicated possibility of stromal sarcoma; therefore, simple mastectomy was performed and the patient was pathologically diagnosed with stromal sarcoma. Presently, the patient is alive and recurrence-free 3 years after the surgery. Case 2: A woman aged in her 80's presented with a left breast tumor identified 4-5 days previously via palpation. The patient visited a general practitioner who referred her to our hospital. The tumor measured 1.6 cm in its greatest dimension and it was elastic hard, irregular in shape, and exhibited dimpling. Biopsy indicated the possibility of malignancy; therefore, a partial resection was performed and the patient was pathologically diagnosed with stromal sarcoma. After 6 months, another lesion was detected and extirpation was performed. A recurrent lesion was detected after 7 months and extirpation was performed again. Presently, the patient is alive and recurrence-free 17 months after the third surgery. In stromal sarcoma of the breast, surgical resection with a negative margin is the only curative treatment. Tumor resection should be planned carefully and the possibility of sarcoma in breast tumors with atypical features as breast cancer should be considered.

Although esophageal reconstruction using the stomach is common in surgery for esophageal cancer, this procedure sometimes results in delayed gastric emptying and reflux. This is a case report of reoperation for intractable obstruction of the stomach after initial esophageal surgery in a 59-year-old man. The obstruction was resistant to conservative management. We resected the duodenum, preserving the vascular pedicle of the right gastroepiploic vessels, and performed reconstruction with a Roux-en-Y procedure in the second operation. There was marked improvement in gastric emptying.

This is a case report of gastric cancer with a tumor embolus in the portal vein of a 76-year-old male. Both computed tomography (CT) and upper gastrointestinal endoscopy were performed. The diagnosis was gastric cancer with an accompanying tumor embolus in the portal vein, specifically in the superior mesenteric vein. After neoadjuvant chemotherapy, a distal gastrectomy, and thrombectomy were performed. Upon pathological examination, the main tumor was diagnosed as adenocarcinoma, and the embolus was confirmed to extend from the main tumor into the superior mesenteric vein. Upon immunostaining examination, neither the embolus nor main tumor expressed alpha-fetoprotein (AFP), but both expressed carcinoembryonic antigen (CEA). Gastric cancer with a tumor embolus in the portal vein is considered an incurable disease. However, with no other non-curative factor than portal vein embolus, it is possible that gastrectomy with thrombectomy can result in a good prognosis. On the other hand, it is extremely difficult to improve the prognosis of gastric cancer with both tumor embolus in the portal vein and liver metastasis.

A 61-year-old woman presented with carcinoma of the left breast(T2N1M0, stage II B), which enforced left Bt+R1. In May 2008, the patient underwent preoperative chemotherapy consisting of 4 courses of FEC 75(fluororracil, epirubicin, and cyclophosphamide). Pathological examination revealed that the lesion was a papillotubular carcinoma,(ER-, PgR-, HER2 3+). In September, 2009, CT scans revealed metastases of the cervical lymph nodes and pancreas. Examination of biopsy specimens from the left cervical lymph nodes revealed that the metastases were from breast cancer(ER-, PgR-, HER2 3+). To treat the recurrences, combination therapy with trastuzumab+capecitabine was introduced in October, 2009. CT scans obtained in May 2010 revealed complete response of the metastases of the lymph nodes and pancreas. It is difficult to distinguish a metastases from a primary pancreatic cancer, but the present case was considered to be one of metastic pancreatic cancer because the findings were in agreement with the expression time of lymph node metastasis. Follow-up CT scans revealed that CR was maintained by the combination therapy of trastuzumab+capecitabine.

A 55-year-old man underwent a rectal amputation for rectal cancer in 1994. As the tumor marker was elevated in 2002, we performed an abdominal CT scan and detected local and multiple liver recurrences. We treated the patient with intra-arterial infusion of 5-FU/LV via the internal iliac artery and the hepatic artery. The chemotherapy was performed on a weekly basis; it consisted of 5-FU (500 mg/body), administered for 5 hours to bilateral reservoirs through an infusion pump and l-leucovorin (400 mg/body), administered intravenously for 2 hours. After 18 administrations of this regimen during a hospital stay and after a discharge from the hospital as an outpatient, the multiple liver metastases that were observed have disappeared. Further, the local recurrences showed a partial reduction in tumor size with a decrease in perineal pain. Subsequently, the patient did not require further doses of morphine. He exhibited no severe side effects except for grade 1 nausea, and his QOL was also good. Therefore, local intra-arterial infusion chemotherapy with 5-FU/LV appears to have been effective for rectal cancer recurrences.

A 68-year-old male with a history of gastric resection for gastric cancer underwent resection of the sigmoid colon for a sigmoid colon cancer in February, 2000. The cancer was classified as stage III b. After operation, l-LV + 5-FU therapy was administered, but metastases to the abdominal wall, right inguinal lymph node and spleen developed in succession, and resection was repeated. In October 2001, 1 year and 8 months after sigmoidectomy, however, multiple metastasis to the intraperitoneal lymph node had developed. As surgery was not indicated, TS-1/CDDP combined chemotherapy was started. TS-1 80 mg/day was administered for 4 weeks, the drug was withdrawn for 2 weeks and CDDP 80 mg was injected by intravenous drip at the 8th day of TS-1 administration, which was used as one course. From the second course after inception of the administration, CA19-9 decreased, and after the third course the upper intraperitoneal metastatic lesion disappeared on CT. CR has been continued for 4 months up to the present. Our results suggest a possibility that this therapy is effective not only for gastric cancer but also for colon cancer. This therapy can be administered at home. It is considered to be a useful therapy from the viewpoint of QOL as well. The high DPD activity of the tumor may have been one reason this treatment was effective. This case also seems significant from the viewpoint of attaining individualization of the drug selection in chemotherapy.

UFT is given to the patients with digestive cancer from the time before operation to prevent intra- and post-operative cancer dissemination and metastases. UFT (400 mg/day in terms of tegafur) was given preoperatively for 1-6 days in 6 patients with gastric cancer and 13 with colorectal cancer. The interval between the last administration and the beginning of the operation was 3.9 +/- 1.5 hours (mean +/- SD). The concentrations of tegafur, 5-FU, and uracil in the blood collected at the time of tumor resection were 9.68, 0.017, and 0.08 microgram/ml, respectively. In the patients with gastric cancer 5-FU concentration was 5.5 times higher in the normal mucosa, 3.3 times in lymph nodes, and 10.7 times in the tumor tissues than in the blood. In colorectal cancer patients, also, the 5-FU concentration was 5.6, 8.3 and 20.8 times higher in the normal mucosa, lymph nodes, and the tumor tissue, respectively, than in the blood. The 5-FU concentration in gastric cancer and colorectal cancer tissues decreased with time after administration of UFT but remained above the effective concentration 1.5-7 hours after administration of 200 mg. The tissue concentrations of FT-207, uracil, and 5-FU were correlated with each other.

Reduced operation for gastric cancer (R1 operation) is indicated for early gastric cancer without lymph node metastasis. We examined which cases can be regarded as early gastric cancer. Mucosal cancer of macroscopically I, IIa, and IIb type that is 2 cm or less in diameter and located at C and macroscopically IIa type submucosal cancer 1 cm or less in diameter appeared to be indicated for this operation. However, preoperative selection of these cases is difficult, and at present, reduction surgery cannot be performed with confidence. Therefore, we have proposed rational surgery for early gastric cancer consisting of removal of the tumor and dissection of group 1 lymph nodes, the lymph node along the left gastric artery, that along the common hepatic artery, and that around the celiac artery. This procedure seems to be appropriate in terms of antitumor immune response of regional lymph nodes and surgical results.

The effect of adjuvant chemotherapy with FT-207 on survival rates in gastric cancer patients was evaluated. Patients who underwent curative gastrectomy in our Department were classified into the four groups: (A) short-term chemotherapy; total doses of 5 g 5-fluorouracil, or 1/2 MF (F') C alone (futraful 400mg/day, or 5-fluorouracil 250 mg/day for 3 weeks, mitomycin C 2 mg and cytosine arabinoside 20 mg twice a week for 3 weeks; (B) intermediate term chemotherapy; 1/2 MF (F') C followed by the oral administration of futraful 0.6g/day for less than 6 months; (C) long-term chemotherapy; 1/2 MF (F') C followed by futraful 10.6g/day longer than 6 months (D) control; no chemotherapy No significant difference back ground factors among four groups was found. Patients who recurred during the administration of drugs were excluded from this study. The survival rate of Group (C) in stage III was significantly higher than that of Group (A), (B) and (D) (generalized Wilcoxon test, p less than 0.03). There was no difference between (B) and (D). The survival rate of Group (A) was lower than Group (D). The effectiveness of chemo- therapy was not observed in patients with stage I and II. Survival rates of patients receiving futraful longer than 3 months continuously were significantly higher compared to patients who had to discontinue the drugs due to side effects. These results suggested that the adjuvant chemotherapy with futraful lasting more than 6 months prolonged the survival time, but short-term chemotherapy decreased the survival rate when compared with no chemotherapy group.

48 previously untreated adult patients with B-lymphoma were treated with VEPA therapy. The complete remission rate was 79.2%. 48% of the patients were still alive after 4 years of the therapy. About 90% of the patients of stage II was expected to be cured by the therapy. VEPA therapy is greatly effective to B-lymphoma.