Nivolumab is strongly recommended as second-line therapy for unresectable advanced or recurrent esophageal cancer. This recommendation was based on the ATTRACTION-3 trial, which did not include patients aged 75 years or older; thus, the efficacy and safety of nivolumab in elderly patients with esophageal cancer remains unclear. We retrospectively evaluated the efficacy and safety of nivolumab in 23 patients older than 75 years who had received the drug at the study center. The median age was 78 years (range: 75-84). Twenty-two patients had squamous cell carcinoma, and one patient had basaloid squamous cell carcinoma. The reason for treatment was postoperative recurrence in nine patients (eight recurrences after radical resection and one recurrence after ESD) and non-excision in 14 patients. Fourteen patients received radiation therapy before or after receiving nivolumab. The target lesions treated (multiple choice) included 26 lymph node metastases (six cervical, nine mediastinal, ten abdominal, and one axillary), 13 primary lesions, and nine lung metastases. Adverse events of all grades occurred in 16 patients (69%), and grade 3 or higher events occurred in eight patients (34%). The response rate was 14%, and the disease control rate was 47% in three patients with PR, eight patients with SD, and 12 patients with PD. The median overall survival was 12.7 months. Nivolumab therapy for elderly patients with esophageal cancer was associated with a high incidence of adverse events, suggesting the need for adequate adverse event screening.

Although laryngeal cysts are rare among the diseases causing congenital laryngeal stridor, they require prompt treatment because large cyst lesions can cause severe respiratory distress due to obstruction of the upper airway. Our case was a 1-day-old boy. He was born by scheduled cesarean section due to pelvic position at 38 weeks and 2 days of gestation, and was brought to our hospital with inspiratory stridor and decrease in arterial blood oxygen saturation (SpO₂) from about 2 hours after birth. Laryngoscopy revealed a white transparent, smooth cystic lesion extending from the oropharynx to the larynx. A plain CT scan of the cervical region showed a cystic lesion 14×10 mm in size in the epiglottis vallecula. Suspecting upper airway obstruction due to the cyst, we decided to perform a transoral endoscopic epiglottic cystectomy. A pediatric laryngoscope was used to lift the base of the tongue to secure a clear view, and a flexible endoscope was used to perform a laryngotracheal cystectomy. The postoperative course was good, and the patient was discharged from the hospital without any problems in breathing or feeding. Neonatal epiglottic cysts are considered to be a rare disease. The treatment options are puncture aspiration of the cyst, (open window) resection, or excision of the cyst, but it is generally believed that (open window) resection is sufficient rather than a total excision, which requires increased operating time and tissue invasion, and thus increases the burden of surgery on the newborn. However, there have been past reports of recurrent cases and cases of asphyxia from cyst contents. Neonatal epiglottic cysts should be treated in collaboration with obstetrics, pediatrics, and anesthesiology, taking into consideration the method of securing the airway, surgical invasion, and the risk of recurrence in each case.

Pharyngoesophageal diverticulum is an infrequent type of diverticulum among all gastrointestinal diverticula, and among them, Killian-Jamieson diverticulum, which occurs between the inferior margin of the cricopharyngeal muscle and the longitudinal esophageal muscle, has been rarely reported. We report a case of Killian-Jamieson diverticulum treated by cervical incision. Preoperative cervical contrast-enhanced CT scan showed that the base of the diverticulum was located on the left side of the esophagus, caudal to the cricopharyngeal cartilage, which led us to suspect a Killian-Jamieson diverticulum. Many reports indicate that it is difficult to differentiate Zenker's diverticulum from Killian-Jamieson diverticulum in preoperative imaging studies. However, the location of the base of the diverticulum with reference to the cricopharyngeal cartilage to which the cricopharyngeal muscle attaches may provide a means of differentiation. The space where the Killian-Jamieson diverticulum originates is also the entrance to the recurrent nerve and is anatomically quite close. Therefore, it may be useful to safely exfoliate the thyroid gland by capsular dissection, and to ensure confirmation and preservation of the recurrent nerve by Nerve Integrity Monitor.

Reports on coronary vein aneurysms are rare; however, an association with the atrioventricular accessory pathway has become clear in recent years, and it could be a potential cause of arrhythmia. The patient was a 55-year-old male. He visited our department due to a suspected paracardiac mass which was identified on a plain CT as part of a detailed examination during a medical check-up. Owing to the difficulty of making a diagnosis by contrast-enhanced CT, MRI, etc., thoracoscopic surgery was performed. The surgery was completed by means of exploratory thoracoscopy after identifying a thoracoscopic coronary vein aneurysm; subsequently, a diagnosis was made in conjunction with the findings from a post-operative electrocardiogram-gated cardiac CT. Based on the fact that the aneurysm was not associated with arrhythmia, that it occurred relatively distant from the coronary sinus, and that the thrombosis inside was extremely small, we determined that resection was not necessary. The patient was thereafter closely observed in order to prevent any rupture due to enlargement of the mass.

CASTLE is a relatively rare malignant tumor that originates in the thyroid gland or the ectopic thymic tissue adjacent to the thyroid gland. Its histology is similar to that of malignant diseases such as squamous cell carcinoma of the thyroid, and it is often difficult to obtain an accurate diagnosis using fine-needle aspiration cytology. Therefore, pathological diagnosis is often confirmed after surgical resection. We encountered a case in which CASTLE diagnosis was made using core needle biopsy and tissue immunostaining before surgery. In addition to radical surgical resection, postoperative radiation can be useful for preventing local recurrence. As the disease has a relatively good prognosis, thyroid lobectomy, bicentral lymph node dissection, and healthy lateral segmental lymph node dissection were performed to preserve the organs. The patient is currently cancer-free at one year after treatment and is undergoing follow-up.