Background. In the present study, we report two cases of gastric metastasis arising from lung cancer treated with gastrectomy. Cases. Case 1 involved a woman in her 60's diagnosed with lung cancer and who subsequently underwent left upper lobectomy. A three-month follow-up period with computed tomography revealed a gastric tumor, and gastroendoscopic images showed a submucosal tumor. We diagnosed the patient with primary gastric cancer and performed total gastrectomy; however, the pathological findings showed metastatic adenocarcinoma arising from lung cancer. Furthermore, after three months, multiple liver metastases appeared, which were treated with chemotherapy. Nevertheless, the liver tumors proliferated, and the patient died three months postoperatively. Case 2 involved a man in his 70's who had been diagnosed with lung cancer and underwent left lower lobectomy and lingulectomy. Two years after the surgery, he was admitted for gastrointestinal hemorrhage resulting from gastric cancer. We then performed completion gastrectomy to cure the hemorrhage, and the patient was diagnosed as having metastatic growth from lung cancer. However, he died six months after gastrectomy. Conclusions. In lung cancer patients who complain of digestive symptoms, physicians should perform endoscopy and search for any possible metastasis of lung cancer according to the characteristic findings.

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Background. Combined large cell neuroendocrine carcinoma (LCNEC) is a rare histological type of primary lung cancer. Case. We experienced the case of a 60-year-old man who had a solid round lung nodule measuring 16×11 mm located in the right S⁶. The patient underwent radical surgery, and histopathology revealed LCNEC combined with adenocarcinoma (Ad) and squamous cell carcinoma (Sq), defined as pathological T1aN1M0 stage IIA disease. He received adjuvant chemotherapy with cisplatin (60 mg/m², day 1) and irinotecan (60 mg/m², day 1, 8, 15) for a total of four cycles and has since been followed without evidence of recurrence for one year after the surgery. Conclusions. We herein present an extremely rare case of cancer consisting of combined LCNEC with both Ad and Sq.

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Background. Primary lung cancer associated with an elevated CA19-9 level is extremely rare. Case 1. A 67-year-old woman complaining of a cough and back pain was referred to our hospital. Chest CT revealed a mass in the lower lobe of the right lung. The CEA and CA19-9 levels were 29.51 ng/ml and 6340 U/ml, respectively, and bronchoscopic cytology showed adenocarcinoma. We therefore diagnosed the patient with lung cancer and performed right middle and lower lobectomy with lymph node dissection after chemotherapy. The postoperative diagnosis was mucinous bronchioloalveolar carcinoma with mediastinal lymph node metastasis (T3N2M0 stage IIIA). Adjuvant chemotherapy was administered after the operation, and the CA19-9 level decreased to 129 ng/ml. However, the patient developed recurrence four months after surgery, and the CA19-9 level again became elevated. Case 2. A 78-year-old woman was referred to our hospital due to an abnormal shadow on an X-ray film. The CEA and CA19-9 levels were 75.58 ng/ml and 1622 U/ml, respectively, and chest CT revealed a nodule in S⁵ of the left lung. We thus diagnosed the patient with lung cancer and subsequently performed surgery. A diagnosis of adenocarcinoma was made based on the findings of an intraoperative pathological study, and left upper lobectomy with lymph node dissection was performed. The postoperative diagnosis was mixed adenocarcinoma with mediastinal lymph node metastasis (T3N2M0 stage IIIA). The CA19-9 level decreased to 889 U/ml after the operation. Conclusions. Elevation of the CA19-9 level reflects the condition of patients with lung cancer and has the potential to be a useful marker of recurrence and the response to treatment.

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Background. Many cases of thyroid carcinoma with detected metastatic sites have been reported; however, solitary metastasis of thyroid carcinoma to the mediastinum is rare. Case. A 51-year-old man underwent a checkup during cancer screening with CT, which showed a solitary nodule in the superior mediastinum. Four years after the first screening, positron emission tomography with ¹⁸F-fluorodeoxyglucose (FDG)-PET revealed increased FDG uptake in the tumor in the late phase. The patient was referred to our hospital. We suspected metastasis of cancer or ectopic thymoma, etc. and subsequently performed tumorectomy via a skin incision near the superior margin of the sternum. The nodule demonstrated an oval shape and had a smooth margin with no invasive characteristics; therefore, it was not difficult to exfoliate. A histological examination revealed thyroid papillary carcinoma, although no nodules in the thyroid were detected using CT, magnetic resonance imaging (MRI) or ultrasonography before the operation. We were not able to identify continuity from the thyroid to the nodule. Hence, we diagnosed the lesions as solitary metastasis of occult thyroid carcinoma. Conclusions. In this case, we highly suspected solitary metastasis of occult thyroid carcinoma; however, it was difficult to distinguish the lesion from ectopic thyroid carcinoma. Therefore, careful follow-up is required.

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Background. The standard therapy for a patient with metastatic or recurrent soft tissue sarcoma is systemic chemotherapy. However, a sarcoma is less sensitive to cytotoxic chemotherapeutic agents. In Japan, pazopanib is the first approved oral multitargeted tyrosine kinase inhibitor for soft tissue sarcoma. We herein report a patient who experienced a long-term therapeutic effect with pazopanib treatment. Case. A 77-year-old man with recurrent fibrosarcoma of the right chest wall underwent systemic chemotherapy with doxorubicin. However, after the treatment was discontinued, the tumor size increased and he developed grade 4 neutropenia. Thereafter, second-line treatment with pazopanib was initiated. The tumor size decreased and the patient continued the pazopanib treatment for seven months without experiencing severe adverse effects or a dose reduction. We were able to continue the pazopanib therapy without a dose reduction for seven months until the enlargement of the tumor. Conclusion. When it is difficult to apply cytotoxic systemic chemotherapy, pazopanib may be one of the useful therapeutic options for the treatment of fibrosarcoma.

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Background. Most cases of osteosarcoma primarily occur in the bone of the trunk and the limbs. However, it is seldom found primarily in the lung. We herein experienced a case of primary pulmonary osteosarcoma. Case. A 59-year-old woman was admitted to our hospital due to a pneumothorax. She had been in a generally normal state until 3 days before the admission when dyspnea gradually developed. A chest X-ray showed a right pneumothorax and the patient had a cavernous lesion with a slightly thick wall in the right S¹, which was connected with the pleural space and had a maximum size of 27 mm. We consulted with our respiratory surgery team, because air-leakage from the drainage tube had continued. A thoracoscopic excision of the cavity was subsequently performed. The histology and immunohistochemical findings of the lesion demonstrated an osteosarcoma. According to a PET/CT examination and a bone scintigram, since no accumulation was found in the other organs, the lesion was diagnosed as a primary pulmonary osteosarcoma. Conclusion. We experienced a patient with primary pulmonary osteosarcoma accompanied by a pneumothorax. A primary pulmonary osteosarcoma is a rare disease, and the case of a pneumothorax caused by an osteosarcoma is also extremely rarely.

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Background. Small intestinal metastasis of lung cancer is a severely debilitating disorder, thereby patients hardly receive chemotherapy due to poor performance states. Case. A 66-year-old man with upper abdominal pain, melena and anemia was referred to our hospital for further investigation. CT scanning revealed a mass measuring 6.0 cm in diameter in the lower lobe of the left lung and multiple small intestinal tumors which caused intussusceptions and an ileus. Double-balloon enteroscopy (DBE) was performed and the endoscopic findings showed multiple tumors measuring 5-30 mm in diameter in the small intestine. Histologically, biopsy specimens of the small intestinal tumors and a lung tumor obtained at bronchoscopy showed the same features, thus a diagnosis of large cell neuroendocrine carcinoma (LCNEC) with multiple intestinal metastasis was made. After 2 cycles of carboplatin and etoposide combination chemotherapy, the lung tumor and multiple small intestinal metastases both markedly decreased in size. Thereafter, the patient was able to eat and spent several days at home. After the third cycle, left main bronchus and esophagus stenosis occurred via the direct invasion of the lung tumor, while the small intestinal tumors did not progress. Alternative chemotherapy, carboplatin and paclitaxel, was not effective. The patient ultimately died of lung and small intestinal tumor progression on the 178th hospital day. Conclusion. In general, cytotoxic chemotherapy is not recommended for a patient with small intestinal metastases and a poor performance status. However in the present case, chemotherapy was able to temporarily improve the patient's quality of life (QOL).

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