Villous adenoma accounts for only 1% of adenomas arising from the large intestine. Malignant changes are more common for villous adenoma than for tubular and tubulovillous adenomas. However, preoperative diagnosis of villous adenoma is rare and treatment remains contentious.
A 77–year–old woman was referred to Kochi Medical School (KMS) Hospital for treatment of villous adenoma of the appendix. Preoperative abdominal computed tomography (CT) revealed that the tumor was 3 cm in diameter and accompanied by a cystic structure on the distal side. Strong accumulation of fluorodeoxyglucose (FDG) on FDG–positron emission tomography–CT and elevated serum carcinoembryonic antigen concentrations suggested malignant change. Consequently, laparoscopic ileocecal resection with regional lymph node dissection was performed. Pathologically, atypical cells with enlarged nucleus were arranged in the villous structure.
Until the minimum surgical intervention is proven safe, when malignant change is likely, surgical resection with lymph node dissection should be considered.

This meta-analysis will be performed to evaluate the safety and efficacy of biweekly CPT-11 plus CDDP versus CPT 11 alone in patients with advanced gastric cancer (AGC) who had received S-1–based first-line chemotherapy. Individual patient–level data from two prospective randomized trials employing the same regimens in the second-line setting for advanced or recurrent gastric cancer will be collected for the study. The primary endpoint is overall survival. Subset analysis will be performed to identify differences in 1) cases with metastatic progression or early relapse after adjuvant chemotherapy, 2) previous platinum therapy, and 3) histological intestinal or diffuse type. Cumulative data from 298 patients will help define a better regimen for S-1 failure cases and might give an important information in selecting a more suitable regimen for subsets of patients.

Background: Surgical resection is the mainstay of treatment for retroperitoneal liposarcoma; however, local recurrence is frequent and treatments for such cases remain controversial.
Results: A 63-year-old female presented at our hospital after two weeks of fever and showing a palpable mass in the left abdomen. A large, low-density mass on enhanced computed tomography was diagnostic for retroperitoneal liposarcoma, and the patients underwent tumor resection with left kidney. From that time, the patient underwent 13 surgical resections over 11 years, including the first surgery, with multiple visceral organ resections for retroperitoneal liposarcoma and its recurrence.
Conclusion: Repeated surgeries could prolong survival and postpone the emergence of tumor-related symptoms in patients with recurrent retroperitoneal liposarcoma.

Paragangliomas (PGLs) are rare neuroendocrine tumors. About 50% of PGLs develop in the head and neck region, of which approximately 50% originate from the carotid body, and classified as Carotid body tumors (CBTs). Proper management and therapeutic options for CBTs have not yet been clearly determined, to date. We hereby report a case of a huge transected CBT treated by ligation of internal carotid artery (ICA), resulting to an unexpected ipsilateral embolic stroke despite an anticoagulation therapy.

Background: Despite the recent improvement in chemotherapy for Stage IV gastric cancer (GC), cure of this condition remains challenging. In the present report, we would like to describe a case of Stage IV GC, in which the first-line treatment achieved complete response and R0 surgical resection was successfully performed.

Case Presentation: A 64-year-old female patient presented with a chief complaint of appetite loss. Gastrointestinal endoscopy revealed Type 2 tumor at the antrum of stomach. The biopsy specimen diagnosed the patients having HER2-positive moderately differentiated adenocarcinoma of stomach. Serum level of CA19-9 was elevated to more than 12000 u/ml (normal range < 37 U/ml). Enhanced abdominal computed tomography (CT) demonstrated enlarged para-aortic lymph nodes (LNs) as well as the regional LNs, and the patient was diagnosed as having Stage IV GC. The patient underwent four courses of first-line treatment with S-1+CDDP+Trastuzumab. Consequently, the LNs and the primary tumor became undetectable. The patient underwent distal gastrostomy with dissection of regional and para-aortic LNs. Pathologically, the tumor cells were identified sparsely in the fibrotic tissue of stomach, although the tumors in LNs were completely necrotic. So far, there is no sign of tumor recurrence for more than 6 months.

Conclusion: Conversion therapy for Stage IV GC is possible, and seems clinically beneficial in selected patients.

Background: Pancreatic neuroendocrine tumor (NET) is a well-known, but uncommon disease that manifests as a heterogeneous, intense, round mass on enhanced computed tomography (CT). Herein, we report a case of pancreatic NET with unusual CT manifestation. A 66-year-old female was referred to our hospital for treatment of intermittent back pain. CT revealed a diffusely swollen pancreas from the head to tail. Imaging enhancement was weak except for a small area at the pancreatic head, and the lumen of the main pancreatic duct seemed narrowed. The entire pancreas showed accumulation of fluoro-D-glucose (FDG) on positron emission tomography (PET), suggesting autoimmune pancreatitis; however, endoscopic ultrasound-fine needle aspiration revealed atypical cells with round nuclei in a rosette formation, resulting in a diagnosis of non-functioning NET. Pathological examination revealed tumor growth within the main pancreatic duct with large areas of necrosis, and an area of viable cells at the head of the pancreas. In conclusion, CT imaging depicted an NET within the main pancreatic duct as a diffusely enlarged pancreas mimicking autoimmune pancreatitis.

Gastric and colorectal cancers are leading causes of death worldwide. Although a relationship between inflammation and the innate immunity in cancer-bearing hosts is widely accepted, the precise cell mechanisms mediating this relationship have not been elucidated. The aim of this study was to investigate the status of systemic inflammation, immune suppression, malnutrition, and prognosis associated with interleukin (IL)-17 and vascular endothelial growth factor (VEGF) in patients with gastric and colorectal cancers.

The production of IL-17 and the serum levels of VEGF in patients with gastric and colorectal cancers were up-regulated in advanced stages of the diseases, which were positively correlated with the levels of myeloid-derived suppressor cells, the neutrophil-to-lymphocyte ratio, and C-reactive protein, while both were inversely correlated with IL-12 production, stimulation index, and nutritional markers including prealbumin and retinol binding protein. Overall survival of patients with stage III and IV gastric or colorectal cancer was significantly worse for patients with high IL-17 production or high VEGF levels than for those with low IL-17 production or low VEGF levels. The observations in the present study suggest that IL-17 and VEGF are closely associated with disease progression, and may serve as useful markers of the immune suppression, malnutrition, and prognosis in patients with gastric and colorectal cancers.

Combined hepatocellular carcinoma and cholangiocarcinoma (cHC) is a well-known, uncommon disease. Sarcomatoid changes in this combined tumor are even less common with the clinical features remaining largely unknown. Herein, we report a patient with sarcomatoid cHC and spontaneous intra-tumor hemorrhage that necessitated emergency palliative tumor resection.

We herein report the successful case resulted to be obtained pathological complete response by the preoperative chemotherapy. Eighty two year-old female patient visited to our clinic with abdominal pain, hematochezia and anorexia. CT scan revealed the primary tumor existed occupying the pelvic cavity and suspiciously invaded to the sacrum. Several enlarged nodes were notified however there was no distant metastasis. She was diagnosed as cStage IIIb rectal cancer. Although radical resection with sacrum below S4 could achieve R0 resection, her rectal cancer was considered to be difficult to resect. Chemotherapy after stoma creation was scheduled with written informed consent. After stoma creation standard dose of mFOLFOX6 was initiated. Chemotherapy continued with 20% dose reduction due to toxicity. After 11 courses, we judged that the response of mFOLFOX6 for her rectal cancer made R0 resection possible without extended resection. Then she underwent low anterior resection with D2 (prx D3) lymphadenectomy. Resected specimen showed that microscopically Ul-IV ulcer that the ulcer bed was replaced with fibrotic tissue and the surface layer covered with regenerated epithelium was found at the primary site. Any cancer cells were not seen in the resected bowel. As for the resected lymph nodes, there were necrotic tissues replaced with xanthoma cells. No cancer cells were found as well. Pathological response of chemotherapy was judged as complete response. Twenty months passed after surgery, there is not any symptom for relapse while undergoing scheduled follow-up observation without postoperative adjuvant chemotherapy because she did not desire adjuvant therapy.

The number of lymph nodes retrieved after colorectal resection for malignant disease is a quality indicator of pathological examination. However, the conventional method to search for lymph nodes within the resected mesentery is technically difficult and time-consuming. Therefore, a clinical study is planned to investigate the efficacy of new fat dissolution methods in lymph node retrieval after surgery for colorectal cancer. Herein, we introduce the concept of the planned study with summarized methods.

This meta-analysis will be performed to evaluate the efficacy of Hangeshashinto (TJ-14) in patients with chemotherapy-induced oral mucositis (COM) for gastroenterological cancer. Individual patient–level data from two prospective, double-blind, placebo-controlled randomized trials employing the same regimens using TJ-14 will be collected for this study. Cumulative data from 181 patients will help conclude whether TJ-14 is effective to COM for gastroenterological cancer or not. We will select the patients with severe (CTCAE grade ≥2) COM who did not reduce the dose of chemotherapy to evaluate the effect of TJ-14 precisely. The primary endpoint of this study is time to remission of severe (CTCAE grade ≥2) COM to grade ≤1 in the protocol treatment course, and the secondary end points are the incidence of grade ≥2 COM, and predictive factors of time to remission and of incidence of grade ≥2 COM.

Prediction of tumor responses before and during treatment for unresectable advanced and/or metastatic colorectal cancer is important to maximize treatment benefit to individual patients. In the present case series, we introduce the potential of using serum lactase dehydrogenase (LDH) concentrations to predict the tumor responses during treatment with anti-epidermal growth factor receptor antibody. Based on our observations, an early drop in serum LDH concentrations predicts tumor shrinkage, whereas maintenance of LDH concentrations presages a moderate response to treatment or tumor progression.

With the development of magnifying colonoscopy and an understanding of pit patterns of tumors, the diagnostic accuracy of tumors in the colon has improved. However, we encountered an aggressive, 2.5-cm diameter tumor in the colon, most of which grew under the component of tubular adenoma with high-grade atypia. This case represents an atypical example of colon cancer and we consider it worth reporting.