Introduction: Personalized treatment of breast cancer is selected based on a combination of genetic diagnosis with subtype classification by immunohistochemistry. We report a case in which the results of HER2 fluorescence in situ hybridization (FISH) and NCC Oncopanel were divergent. Case: A 57-year-old woman was diagnosed as having breast cancer and underwent right mastectomy with axillary dissection at the age of 37 years. Enlargement of the right supraclavicular lymph node was detected at the age of 47. The disease had recurred post-treatment, and multiple metastases were detected in the lungs, chest wall, lymph nodes, and bones. Axillary lymph node resection was performed, and the histopathological diagnosis was ER+, PgR+ and HER2 (2+). Although HER2 FISH was positive, the NCC oncopanel test revealed no change in the amplification of HER2. Conclusion: This case serves to underscore the fact that the NCC oncopanel test and HER2 FISH could yield discrepant results. Therefore, it is important to obtain a thorough and precise understanding of the obtained results and formulate an accurate diagnosis to ensure selection of the optimal personalized treatment strategy for patients with breast cancer.

We report a case of diaphragmatic metastasis from endometrial carcinoma that was resected laparoscopically and thoracoscopically. A 55-year-old woman underwent multiple surgeries for endometrial carcinoma recurrence 33 months after the initial treatment. Follow-up CT revealed a low-density area in the liver, suggesting liver metastasis from the endometrial carcinoma. On referral to our department, diaphragmatic metastasis with hepatic or pulmonary invasion or liver metastasis was suspected. We planned to perform staging laparoscopy first, followed by laparoscopic partial diaphragmatic resection, partial hepatic resection, and staging thoracoscopy, depending on the intraoperative findings, and then partial lung resection if there was pulmonary invasion. Although no evidence of pulmonary invasion was detected during the surgery, liver invasion was suspected; hence, combined thoracoscopic and laparoscopic partial diaphragmatic resection and partial hepatectomy were performed. She had an uneventful postoperative course and was discharged after 4 days. Multiple lung metastases were detected 24 months postoperatively and the patient received chemotherapy. Currently, 36 months after the last surgery, the patient remains alive. We suggest that combined thoracoscopic and laparoscopic surgery for diaphragmatic tumors is a less invasive and relatively safe approach.

A 70-year-old man who had undergone total gastrectomy and Roux-en-Y reconstruction for gastric cancer (M, Less, Type3, 92×78 mm, tub2>tub1, pT3N2 (6/78) M0 Stage ⅢA) 1 year 6 months prior was admitted to our hospital with abdominal pain, vomiting and diarrhea. Abdominal CT revealed intussusception at the site of the anastomosis. Emergency surgery was performed, and based on the intraoperative findings, the diagnosis of retrograde intussusception of the Roux-en-Y anastomosis towards the ligament of Treitz was made. After replacement by Hutchinson’s maneuver, and confirmation of improvement in the ischemic changes and absence of necrotic changes, the operation was completed without intestinal resection. Retrograde intussusception at the Roux-en-Y anastomosis is rare, but should be considered in the differential diagnosis of abdominal pain in patients with a history of gastrectomy.

We report the case of a patient with a gastrointestinal stromal tumor (GIST) arising from the small intestine that was preoperatively diagnosed as an ovarian tumor. The patient was a 67-year-old woman who presented with anemia and was referred to the department of obstetrics and gynecology to rule out a gynecological cause for the anemia. Computed tomography and magnetic resonance imaging showed a tumor to the right of the uterus, and the tumor was diagnosed as an ovarian tumor. However, intraoperatively, the tumor was identified as arising from the small intestine. We performed partial resection of the segment of the small intestine containing the tumor. Histopathological examination revealed that the tumor originated from the proper muscle layer of the small intestine and immunohistochemical analysis showed positive staining of the tumor cells for c-kit. Based on the findings, the tumor was diagnosed as a GIST arising from the small intestine. Herein, we report this case with a review of the literature.

A 60-year-old man visited a nearby hospital for a medical check up, and the laboratory data revealed anemia. Upper and lower gastrointestinal endoscopy revealed no abnormalities, but during follow- up, the patient reported black stools, and was referred to our hospital. Abdominal CT revealed a tumor, 10 cm diameter, in the pelvic cavity, and the patient was admitted to our hospital for further examination and treatment. Blood transfusions led to improvement of the general condition of the patient, however, as the melena persisted, surgery was performed. Intraoperatively, the primary tumor was found in the jejunum and the adjacent mesenteric lymph nodes were significantly swollen. Moreover, tumors, measuring 3 cm in diameter at the maximum, were also observed in the adjacent omentum. The tumor in the jejunum was resected, with dissection of the mesenteric lymph nodes and resection of the omental tumors. Histopathological examination of the resected specimen revealed the primary tumor in the jejunum as an undifferentiated carcinoma of the small intestine. The omental tumors were metastases from undifferentiated carcinoma of the small intestine. Since disseminated lesions were observed in the omentum, a PET-CT was performed, which confirmed the presence of multiple disseminated lesions in the abdominal cavity. Chemotherapy was initiated, however, the patient’s condition worsened, and he died at 5 months after the surgery.

The patient was a 38-year-old woman who had been diagnosed as having ileocolic Crohn’s disease in 1994 and undergone resection of the ileocecal region and a part of the small intestine for ileal stenosis in 2004; the length of her residual small intestine was 230 cm. As symptoms of intestinal stenosis occurred despite postoperative medical therapy, in 2014, the patient was treated conservatively for 3 month, being prescribed exclusive intake of enteral formulas, followed by partial resection of the small intestine, including the anastomotic site of the previous operation. Prophylactic antibiotics were used only on the day of the surgery. While the preoperative blood tests showed no abnormalities of the coagulation profile, the PT and APTT were mildly prolonged one day after the surgery and markedly prolonged 6 days after the surgery (PT 72.8 seconds, APTT 98.3 seconds). Vitamin K deficiency was suspected, although there were no clinical symptoms. Her coagulation ability improved rapidly after intravenous infusion of a vitamin K preparation. Patients with Crohn’s disease have multiple risk factors for vitamin deficiencies; however, virtually no previous reports have documented vitamin K deficiency-induced coagulopathy that appeared perioperatively. We report a case of vitamin K deficiency-induced coagulopathy that occurred in the early postoperative period.

A 66-year-old man who had undergone endoscopic decompression three times for sigmoid volvulus was brought to our hospital by ambulance with the chief complaint of abdominal pain. Abdominal computed tomography showed no evidence of sigmoid volvulus. The cecum was dilated and located in the upper left abdomen. The ascending colon was collapsed and ran from left to right along the inferior part of the duodenum. The contrast effect in the ascending colon was weak. Based on these findings, cecal volvulus was diagnosed. Because the abdominal pain resolved after the examination, we judged that the volvulus had corrected spontaneously and decided to perform elective surgery at a later date. Subsequently, the sigmoid colon was resected through a small incision in the left lower abdomen to prevent recurrence of sigmoid volvulus, and laparoscopic cecopexy was performed. The risk and invasiveness were reduced by opting for elective surgery.

A 69-year-old woman with a positive fecal occult blood test was diagnosed as having ascending colon cancer by colonoscopy. Surgery was scheduled, but postponed because of a positive RT-PCR test for SARS-CoV-2 RNA in respiratory samples collected for screening purposes on the day prior to admission. No chest CT findings or symptoms of pneumonia were present at that time. Eight days after the positive RT-PCR test, the patient was admitted to another hospital under the direction of the local health authority, was diagnosed as having moderate COVID-19 pneumonia, and received remdesivir and anticoagulant therapy for seven days. The RT-PCR test was repeated thrice over the next two weeks, and the last one returned a negative test result. On the same day, a repeat chest CT showed improvement of the pneumonia. Therefore, two days after the negative RT-PCR test result, laparoscopic right hemicolectomy was performed. The postoperative course of the patient was uneventful, and he was discharged 8 days after the operation without any pulmonary complications. None of the staff involved in the inpatient treatment contracted COVID-19. We present a report of this case with some review of the literature.

Anal sphincter injury during vaginal delivery can cause intractable fecal incontinence. Although a variety of surgical procedures have been attempted, none has been demonstrated until now to definitively yield satisfactory outcomes. We present the case report of a patient who underwent successful surgical treatment for obstetric trauma-induced fecal incontinence.

A 29-year-old Japanese woman with a history of perineal tear during her first delivery presented to our hospital with severe fecal incontinence. Digital examination revealed complete disruption of the perineal body caused by vaginal birth-induced trauma, as well as of the external anal sphincter in front of the anterior rectal wall. We considered that additional repair of the lacerated perineal body would be more effective than anal sphincter repair alone to resolve the fecal continence. Therefore, surgical reconstruction of the lacerated perineal body was performed under spinal anesthesia with the patient placed in the jackknife position. Postoperatively, the patient was successfully relieved of the fecal continence, without any complications. Our new technique of perineal body-plasty can be an effective treatment option for obstetric trauma-induced fecal incontinence.

We report a case of intra-abdominal desmoid tumor that was diagnosed preoperatively as a pancreatic tumor. The patient was a 71-year-old woman who was followed as pancreatic cyst. Abdominal enhanced CT revealed an enhancing tumor recently. The tumor was located anterior to the pancreatic body. We performed resection of the pancreatic body and tail, along with splenectomy. The postoperative histopathological diagnosis was desmoid tumor. Desmoid tumor is rare and histopathologically benign, but clinically borderline, because it can recur locally, and therefore, requires careful follow-up.

We present the report of a 23-year-old male patient who presented to us with a diffuse extensive skin rash with erosions and crusting. He had received treatment with steroids for the skin rash, but without relief, for more than 3 years. His blood glucagon levels were found to be elevated, and abdominal contrast-enhanced computed tomography (CT) and somatostatin receptor scintigraphy revealed a hypervascular tumor measuring 39 mm in diameter in the pancreatic tail, with high somatostatin expression. Laparoscopic distal pancreatectomy was performed. The blood glucagon levels returned to normal range immediately after the operation and the skin symptoms disappeared completely by day 8 after the surgery. However, immunohistochemical analysis of the resected tumor tissue showed only focal positive staining for glucagon. Until now, 2 years since the surgery, the patient remains asymptomatic and free of recurrence.

We encountered a case of glucagonoma in which immunohistochemistry failed to provide sufficient evidence of glucagon production by the tumor, despite the patient showing typical clinical symptoms of glucagonoma. We report the significance of the findings of immunohistochemical staining in the diagnosis of glucagonoma, with a review of the literature.

The patient was a 54-year-old man who had been diagnosed as a case of chronic alcoholic pancreatitis. He developed exacerbations of pancreatitis and abdominal distention due to duodenal stenosis associated with pancreatitis several times a year and received conservative treatment. In November 2020, he was hospitalized due to exacerbation of abdominal distention. Upper gastrointestinal endoscopy showed dilatation of the stomach and a stenotic bowel segment extending from the duodenal bulb to the descending limb of the duodenum. Biopsy returned a benign result, although the serum level of the tumor marker CA19-9 was elevated. Therefore, it was difficult to rule out the possibility of pancreatic cancer and a pancreatoduodenectomy was performed with a diagnosis of chronic pancreatitis with duodenal stenosis. Postoperative histopathological examination revealed narrowing of the duodenum due to fibrosis, with no evidence of malignancy, including in the head of the pancreas.

A 64-year-old man who presented to his primary care physician with a 4-day history of abdominal pain and elevated inflammatory marker levels in the blood was referred to our hospital for further detailed investigation. Physical examination revealed localized tenderness and signs of peritoneal irritation in the right abdomen. Abdominal contrast-enhanced computed tomography showed locally increased fat density in the greater omentum immediately beneath the right abdominal wall and spiral twisting of the omental blood vessels. Based on these findings, we diagnosed the patient as having torsion of the greater omentum and performed emergency laparoscopic surgery. The greater omentum was found to be adherent to the right abdominal wall and to have become necrotic. The periphery of the greater omentum was adherent to an appendix epiploica of the transverse colon and had become necrotic after rotating two and a half turns at a site 10 cm away from the site of adhesion towards the center of the greater omentum. We resected the necrotic portions and completed the surgery. Torsion of the greater omentum is rare, and preoperative diagnosis is sometimes difficult because the location of the pain varies depending on the location of the necrotic tissue. Laparoscopic surgery is useful for treating this disease because it is minimally invasive and facilitates a definitive diagnosis.

A 44-year-old man with no significant past medical history presented to the emergency department with a left-sided abdominal bulge that developed after he hit his abdomen against the blunt end of a bicycle motocross handlebar. Abdominal computed tomography showed a left abdominal wall hernia containing a loop of small intestine. The herniated intestine was easily reducible. We made the diagnosis of traumatic abdominal wall hernia (“handlebar” hernia) caused by direct blunt trauma, and performed laparoscopic-assisted herniorrhaphy. Laparoscopy revealed tears in the abdominal wall muscles (transverse abdominal, and internal and external oblique muscles) and bowel injury (Type Ⅰa). The hernia defect was closed in 2 layers of muscle, along with mesh repair. The patient was discharged on postoperative day 5.

Traumatic abdominal wall hernia (TAWH) caused by a handlebar is very rare, and we report our case herein, along with a review of the literature.

Port-site hernia is a rarely encountered abdominal wall scar hernia that occurs at the port insertion site after laparoscopic surgery. We encountered a case of a 5-mm port-site hernia that developed near a transabdominal ureterostomy. The patient was a 75-year-old woman who had undergone laparoscopic right nephroureterectomy and left transabdominal ureterostomy. We successfully repaired the hernia by inserting a slit mesh into the retromuscular position without causing stenosis of the ureterostomy. The retromuscular method could be useful for managing hernias occurring near a transabdominal ureterostomy.