An 86-year-old woman presented with abdominal pain. Her blood tests revealed elevated inflammatory markers. An abdominal CT examination demonstrated an enlarged appendix with inflamed surrounding adipose tissue. An appendectomy was laparoscopically performed. Upon resection, the enlarged appendix was found to be 65 × 24 mm in size, with tumor cells of high N:C ratio. In immunohistochemical staining, the resected tissue was positive for neuroendocrine markers, including chromogranin A, synaptophysin, and CD56, and a definitive diagnosis of neuroendocrine carcinoma (NEC) was obtained. Postoperative evaluation revealed multiple liver metastases; however, a policy of no chemotherapy was adopted, and the patient died approximately 3 months later. Our literature search identified only 11 reported cases of NEC of the appendix, including the present case. There are no established treatment guidelines, thereby warranting the need to compile such cases for improved diagnosis and treatment of this condition. Here, we report a case of NEC of the appendix that was preoperatively diagnosed as acute appendicitis and was pathologically diagnosed following surgical resection. Furthermore, we review the literature for this condition.
We report a case of intrapelvic locally recurrent rectal cancer after surgery in which clinical complete response was achieved after chemoradiotherapy with capecitabine and oxaliplatin (CAPOX), and discuss the relevant literature. The patient was a 67-year-old woman who had undergone lower anterior resection for Ra rectal cancer. Nine months after the surgery, contrast-enhanced CT scans of the abdomen and pelvis, which were taken because of perineal pain, revealed a 48-mm mass in the pelvic floor, and the patient was thus diagnosed as having local recurrence. Since the lesion was suspected to have invaded surrounding organs, radical resection was considered impractical, and chemoradiotherapy was chosen. Radiation (50 Gy) + eight courses of CAPOX were administered. A contrast-enhanced CT examination of the abdomen 5 months after starting chemoradiotherapy revealed a marked size reduction of the recurrent lesion, which was identified as a 23-mm soft tissue shadow, with no signs of distant metastasis. As of 9 years and 6 months after the diagnosis of intrapelvic local recurrence and 8 years after the completion of chemoradiotherapy, metastatic recurrence has not been reported.
A 63-year-old man, who had been aware of a tumor around the anus three years earlier, complained of increasing tumor to a local clinic. The tumor protruded through the anal skin. As a result of biopsy, it was diagnosed as anal canal mucinous adenocarcinoma. The image findings revealed a multilocular cystic mass of 10 × 10 cm in diameter with calcification on the right side of the anus. The tumor invaded part of the prostate. No swelling of lateral lymph nodes or inguinal lymph nodes was observed. Laparoscopic abdominoperineal rectal resection with bilateral lateral lymph node dissection was performed and the tumor was completely resected. The histopathological findings showed anal gland-derived mucinous adenocarcinoma, and the stage diagnosis was pT4b (prostate) pN0 pM0, Stage IIIB. The tumor marker CA19-9, which was as high as 586 U/ml preoperatively, decreased to 3 U/ml one month after surgery. Currently, 2 years have passed since the operation without recurrence.
Emergency loop ileostomy and trans artificial anal decompression tube were useful for obstructive colon cancer with remarkable dilation of the right colon. An 83-year-old man was scheduled to undergo surgery for a splenic flexure colon cancer diagnosed with a positive fecal occult blood test. Preoperative examination revealed remarkable dilatation of the right colon. The patient was diagnosed with large bowel obstruction due to splenic flexure colon cancer. Emergency loop ileostomy and trans artificial anal decompression tube placement were performed for decompression of the dilated right colon. Emergency primary resection for obstructive colon cancer has been reported to have a high incidence of perioperative complications, and it is advisable to perform primary resection after decompression and wait for the primary resection. The trans artificial anal decompression tube was useful for urgent decompression of the colon between the ileocecal valve and the tumor.
The patient was a 77-year-old male with a history of laparoscopic Hartmann's procedure for rectal cancer. Colonoscopy for postoperative follow-up diagnosed a 25mm Borrmann type-2 adenocarcinoma occurring at the site of colostomy. On CT scan, neither direct invasion to the abdominal wall, lymph node metastasis nor distant metastasis was detected. A partial resection of the colon, including the stoma and surrounding skin, was performed laparoscopically. Carcinoma occurring at the site of colostomy is rare, and a case resected by laparoscopic surgery has not been previously reported.