An 11-year-old female adolescent visited a local breast clinic for evaluation of right breast mastitis. The patient did not improve despite abscess puncture and antibiotic therapy;therefore, she was referred to our department. Ultrasonography revealed an abscess in the AC area of the right breast and a mass (2cm in size) within the abscess. Emergency abscess drainage was performed under general anesthesia on the same day. We made a right perinipple incision (4cm) and observed a grayish-white mass accompanied by discharge of pus.

The patient had a congenital nevus on the central right breast. Examination of the nevus using a magnifying glass revealed clusters of many small dark brown nevi (100-120), each measuring approximately 2 mm in diameter, each of which formed a comedo. Based on the skin findings, the patient was diagnosed with nevus comedonicus. Histopathological evaluation of the mass removed from the abscess cavity revealed keratinized necrotic material;we suspected an epidermal cyst, which was consistent with the component derived from the comedo. We report a case of pediatric mammary abscess secondary to congenital nevus comedonicus.

Herein, we report the case of a 59-year-old woman with traumatic diaphragmatic hernia. She had been diagnosed 5 months earlier as having a left rib fracture after twisting her body. She visited us two months ago with felt hypochondrial pain, and abdominal computed tomography (CT) revealed fractures of the 7th to 10th ribs on the left side and a left traumatic diaphragmatic hernia. Based on the CT findings, she was diagnosed as having a diaphragmatic hernia with prolapse of the transverse colon into the thoracic cavity. She refused surgery and was followed up. However, thereafter, she presented to us with respiratory distress and abdominal pain, and a repeat CT revealed incarcerated hernia, necessitating emergency surgery. The transverse colon and omentum in the hernia sac were returned to the abdominal cavity, and the hernial orifice was closed with sutures and reinforced with a mesh. Thus, we report a case of laparoscopic hernia repair of an incarcerated traumatic diaphragmatic hernia. We found the laparoscopic approach to the surgery useful in this case.

A 78-year-old man with a history of having undergone laparoscopy-assisted subtotal esophagectomy for esophageal cancer 6 years ago visited us complaing of poor appetite and frequent vomiting. A gastrointestinal series and upper gastrointestinal endoscopy showed pyloric obstruction. We performed endoscopic balloon dilatation twice, but the obstruction failed to improve. We performed reoperation with dissection of the adhesions and Roux-en-Y reconstruction. The operation led to successful relief from the symptoms of obstruction. Delayed gastric conduit emptying (DGCE) is a rare late complication after esophagectomy. Gastrojejunostomy is regarded as a useful option to prevent digestive reflux.

A 74-year-old man was detected as having an abdominal tumor of approximately 5 cm in diameter on abdominal ultrasonography at the primary care doctor; he visited our hospital. Upper gastrointestinal endoscopy revealed type 2 lesion at the rear wall of the upper body of the stomach. This lesion was approximately 3 cm away from the cardia. Gastric neuroendocrine carcinoma was diagnosed using biopsy and immunostaining examination. Abdominal computed tomography revealed thickening of the stomach wall from the cardia to the rear wall of the body. Based on these results, the patient was diagnosed with gastric neuroendocrine carcinoma. Gastric neuroendocrine is classified into large cell and small cell types based on the Japanese Classification of Gastric Carcinoma, 14^th edition of 2010. Current data indicates that 76％ cases of gastric carcinoma have advanced cancer when detected; the 5-year survival rate is 24％ and the mean survival time is 7-9 months. In another report where 10 cases of gastric large cell endocrine carcinoma was studied, 3 cases had lymph node metastasis and one case had liver metastasis. The mean survival time of these patient was over 24 months. Based on this analysis, the prognosis of large cell type is considered to be good.

[Background] Postoperative lymphorrhea is often a serious condition because it causes massive body fluid loss. The condition can be controlled by fasting or fat restriction in most cases, however, some cases do not respond to conservative therapy. There are no established treatment methods for such cases, and surgery is often considered.

[Case] 65-year-old man. After 5 courses of SOX + trastuzumab therapy, he underwent laparoscopic total gastrectomy, R-Y reconstruction, D2 + para Ao lymph node dissection as conversion surgery. On the 2nd postoperative day, the amount of drainage was about 930 ml/day. As he started eating on the 6th postoperative day, the drainage increased to a maximum of 3,800 ml/day. Because there was no evidence of chyliferous leakage, we assumed hepatic lymph leakage. The drainage amount remained at about 800 ml/day even after abstention of oral intake by the patient. Therefore, we considered it as a case of refractory lymphorrhea, and treated the patient by continuous subcutaneous injection of 300 μg/day of octreotide. The drainage decreased in response to this treatment, and the octreotide administration was discontinued on the 7th day. The patient started eating on the 20th postoperative day. After confirming that there was no increase in drainage, the drain was removed on the 22nd postoperative day.

We encountered a case of refractory lymphorrhea after chemotherapy for gastric cancer, in which octreotide proved effective.

The patient was a 67-year-old man who visited our hospital with the chief complaint of tarry stool. Blood examination at the first visit showed severe anemia, with a Hb level of 4.7 g/dl.

Physical examination revealed a huge abdominal mass in the upper right abdomen, and the findings of abdominal CT suggested the diagnosis of primary duodenal GIST. We performed segmental resection of the duodenum, with reconstruction by duodenal diverticulization.

The postoperative course was uneventful and the patient was discharged 10 days after the operation. The tumor measured 11x8x6cm in size, and the histological diagnosis was primary duodenal GIST.

The patient was a 70-year-old woman who presented with pain in her right lower abdomen. She was diagnosed as having an appendiceal diverticulum with appendiceal mucinous neoplasm and underwent laparoscopic cecectomy. Based on the histopathological findings, we made the diagnosis of true diverticulum of the appendix complicated by low-grade appendiceal mucinous neoplasm (LAMN).

This is the first report of an appendiceal true diverticulum with LAMN. Herein, we report a rare case with a review of the literature.

A 33-year-old pregnant woman presented to our outpatient clinic at 11 weeks and 3 days of gestation with the chief complaint of abdominal pain, and was diagnosed as having appendicitis after a thorough clinical examination. On account of the patient being at the organogenic stage of the fetus, we selected conservative treatment. Although her symptoms improved initially, the abdominal pain recurred at 14 weeks and 4 days of gestation. Laboratory analysis showed elevated inflammatory response markers, with a white blood cell count of 11,700/mm³ and serum CRP of 1.14 mg/dL. Diffusion-weighted MR imaging showed a multicystic mass near the uterus visualized as a high signal intensity, together with normal ovaries, and we made the diagnosis of relapsing appendicitis. Emergency surgery was performed and the appendix was removed. The postoperative course was good, and the patient was discharged on the fifth postoperative day. Histopathological examination of the excised specimen revealed extensive endometriosis tissue in the appendicular region. The stromal cells in the endometriotic tissue showed decidual changes that may have occurred in association with pregnancy.

Hepatocellular carcinoma (HCC) commonly metastasizes to the lungs, bones, and lymph nodes, while cecal metastasis from HCC is rare. We report the case of an 83-year-old man who had undergone surgery for HCC 10 years earlier and presented to us with a cecal metastasis. He was transported to our emergency room with a history of melena. Colonoscopy was performed, which revealed the cecal tumor. A tumor biopsy revealed that the tumor was malignant, and we performed ileocecal resection with lymphadenectomy. Histopathology of the resected specimen revealed findings consistent with HCC. We considered this as being a hematogenous metastasis of the cecum from the liver, because intraoperatively, there was no evidence of peritoneal dissemination or tumor(s) on the serosal surface, and histopathology revealed no evidence of malignancy in the lymph nodes. At present, 8 months after the surgery, the patient remains alive.

We report a case that was initially diagnosed as gastric cancer which turned out to be a hepatic metastasis.

A 59-year-old male patient was referred to our hospital with a diagnosis of gastric cancer. He had a history of non-B non-C hepatocellular carcinoma (HCC) that had recurred several times, and he had undergone radiofrequency ablation thrice and transarterial chemoembolization thrice since February 2019. Imaging examinations confirmed disappearance of the liver lesion. In March 2021, the patient presented with anemia, and an upper gastrointestinal endoscopic examination revealed a type 1 lesion in the middle third of the gastric body and a superficial esophageal cancer with suspected submucosal invasion in the mid-thoracic esophagus. Biopsy of the stomach tumor revealed poorly differentiated adenocarcinoma, and that of the esophageal tumor revealed moderately differentiated squamous cell carcinoma.

In addition, the patient showed a sharp increase of the serum level of alpha-fetoprotein isoform L3 (AFP-L3), which suggested the possibility of recurrence of the HCC. Thus, we decided to resect only the gastric tumor, because of bleeding from the tumor that necessitated frequent blood transfusions, but not the esophageal cancer. Distal gastrectomy was performed in May 2021, and the final histopathology report revealed the diagnosis of gastric metastasis from HCC. After the operation, the serum AFP-L3 level decreased rapidly.

There are few case reports of mild acute cholecystitis progressing to acute emphysematous cholecystitis, with rapid changes in the clinical and imaging findings. We present a case of mild acute cholecystitis that progressed to acute emphysematous cholecystitis, with rapid exacerbation of the clinical and imaging findings.

An 82-year-old man was admitted to our hospital complaining of right hypochondrial pain of sudden onset. Physical examination revealed tenderness in the right hypochondrium. Based on the findings of abdominal CT and hematological examinations, we made the diagnosis of mild acute cholecystitis. From the CCI and ASA class, early laparoscopic cholecystectomy was judged as being associated with some risk, and the patient was started on antibiotic treatment. While the abdominal symptoms improved with this treatment, on the 3rd day of hospitalization, the patient developed high fever (38.0°C) and worsening of the right hypochondrial pain. Blood examination revealed increased levels of inflammatory response markers. DIC-CT showed acute emphysematous cholecystitis with localized peritonitis. Emergent PTGBD was performed because he had already taken aspirin on the day and had poorly controlled DM. After the abdominal and inflammatory findings improved, subtotal cholecystectomy was performed due to the presence of severe abdominal inflammatory findings on the 10th day after PTGBD. The patient was discharged 14 days after the operation after an uneventful postoperative course. It is important to keep in mind that even cases of mild cholecystitis can progress to severe acute emphysematous cholecystitis, with rapid changes in the clinical and imaging findings.

A 74-year-old man was referred to our hospital for adjuvant chemotherapy of pancreatic cancer. The patient had been treated 3 years earlier by distal pancreatectomy for pancreatic body cancer (pT2N0M0 pStage IB). However, an isolated lung metastasis was identified 28 months after the surgery, and the patient underwent thoracoscopic partial resection of the lung. Histopathological examination revealed that the lung metastasis originated from the pancreatic cancer, with positive immunohistochemistry for CK19 and CA19-9. Until now, one and a half years after the surgery, the patient has shown no evidence of recurrence. This case serves as an important reminder to consider surgery as a potentially useful treatment strategy for isolated lung metastasis from pancreatic cancer.

A 51-year-old woman who underwent enucleatic myomectomy in her 30s and panhysterectomy in 40s without the pregnancy history presented with abdominal pain. Contrast-enhanced abdominal computed tomography (CT) revealed a left-sided abdominal tumor (maximum diameter 10cm). CT performed a year prior to presentation revealed diverticulitis of the transverse colon and cholecystitis; however, this lesion was not detected on previous evaluation. The tumor showed rapid enlargement; we resected the mass, which was intraoperatively identified as single tumor mobile lesion continuous with the appendix of descending colon. A part of the tumor was adherent to the retroperitoneum; however, we were able to successfully extract the mass without any injury. Histopathological findings revealed fascicular proliferation of atypical spindle cells with clearly visible mitotic figures. Immunohistochemical analysis revealed atypical cells with immunopositivity for alpha-smooth muscle actin and desmin. A few tumor cells were immunopositivity for MDM2 protein. The tumor cells were immunonegativity for S-100, c-kit, as well as estrogen and progesterone receptors. We diagnosed the patient with leiomyosarcoma (as opposed to dedifferentiated liposarcoma). Leiomyomatosis peritonealis disseminata is a rare condition that occurred a recurrence in dissemination. We reported a rare case of leiomyomatosis peritonealis disseminata with malignant transformatoin.