Purpose: Catheter-related bloodstream infection (CRBSI) is one of the serious complications of totally implantable central venous catheter port (CV port) placement. Malnutrition is a potential risk factor for CRBSI, as it is associated with impaired immunity. However, the nutritional status of patients who develop CRBSIs is poorly documented. This study was conducted to investigate the risk factors, nutritional changes, and treatment options in patients with CRBSI.

Methods: The nutritional status of patients who underwent CV port placement at our institution between January 2012 and October 2019 was retrospectively assessed using the Prognostic Nutritional Index, Controlling Nutritional Status score, and serum albumin level.

Results: Fourteen of a total of 412 patients developed CRBSI. There were no significant differences in the patient characteristics or nutritional status between the patients with and without CRBSIs (CRBSI and non-CRSBI groups, respectively). In the CRBSI group, the nutritional status was maintained until the onset of CRBSI; however, it deteriorated on port removal and took four weeks to normalize. Effective treatment was hampered by diagnostic challenges.

Conclusion: The risk of CRBSI depends more on the method of handling of the CV port than on the patient characteristics or nutritional status. Long-term assessment of nutritional indicators may provide additional information on the effects of CRBSI. Patients should be treated in accordance with a standardized CRBSI protocol while balancing the risks and benefits of each therapeutic procedure used.

Fibroadenomas, which occur predominantly in young women, sometimes grow rapidly to become huge. Such giant juvenile fibroadenomas are relatively rare. We report two cases of juvenile fibroadenoma in two young women aged 12 and 13 years old. Both patients presented with left breast swelling. Ultrasonography revealed a well-defined tumor measuring 12 cm in diameter in the first case and 9 cm in diameter in the second case. In both cases, core needle biopsy led to the diagnosis of fibroadenoma. Tumor resection was performed because of the possibility of phyllodes tumor and asymmetry in shape between the left and right breasts. Histopathology of the resected specimens in both cases confirmed the diagnosis of fibroadenoma, and there were no malignant findings. A review of the literature published over the last 33 years revealed 34 cases of fibroadenoma and 10 cases of phyllodes tumor in children under 15 years of age. Previous reports demonstrated associations among tumor growth, plasma estrogen levels, and the Ki-67 index; however, no clear association was found in this case.

In both the cases reported herein, the postoperative course was good, the cosmeticity was maintained, and there was no recurrence. Considering the low frequency of malignant and phyllodes tumors, it is important to make as much effort as possible to preserve the breast tissue.

A 49-year-old woman underwent endoscopic examination of the upper gastrointestinal tract for anemia, which revealed a giant elevated lesion measuring 8.5 cm in length. Biopsy revealed a hyperplastic polyp, which were thought to be the cause of the anemia, but the possibility of cancer or coexisting cancer could not be ruled out. Because the tumor was large in diameter and difficult to resect endoscopically, laparoscopic distal gastrectomy (LDG) was performed. The histopathological diagnosis of the resected specimen was glandular epithelial hyperplastic polyp, and there were no malignant findings. Malignant transformation of large gastric hyperplastic polyps is not rare, and surgery is recommended for patients in whom the tumor cannot be resected en bloc by endoscopy. Laparoscopic surgery is a minimally invasive and effective technique, with good cosmetic results.

The patient was a 41-year-old woman who was under follow-up for neurofibromatosis type 1 (NF1) at our orthopedic surgery department. During one of her regular medical checkups, she went into shock, and a blood test revealed a Hb level of 5.8 g/dl. Suspecting gastrointestinal bleeding, we performed esophagogastroduodenoscopy (EGD), which revealed a 20-mm-sized submucosal tumor in the anterior wall of gastric pylorus with a bleeding ulcer over the tumor. Gastrointestinal stromal tumor (GIST) was suspected. After the patient’s general condition stabilized with blood transfusions, we performed laparoscopic surgery. To avoid postoperative gastric outlet obstruction due to cicatricial stricture at the suture site after partial resection, we performed distal gastrectomy. Immunohistochemistry revealed CD34-positive spindle-shaped cells and the tumor was diagnosed as a GIST.

A 60-year-old man was admitted to our hospital for treatment of a type 2 tumor detected on the lesser curvature at the gastric cardia, and biopsy revealed the diagnosis of poorly differentiated tubular adenocarcinoma. Abdominal CT revealed swelling of multiple lymph nodes in the No.1, 3a, and 7 stations, with a maximum diameter of the enlarged lymph nodes of 30 mm. Based on the findings of laparoscopy, the patient was diagnosed as having gastric cancer, T3N2M0, cStageⅢ, and was started on chemotherapy. After 3 courses of chemotherapy containing docetaxel+oxaliplatin+S-1 (DOS), both the primary tumor and the lymph nodes showed marked decrease in size; thereafter, total gastrectomy with lymph node dissection (D2+ No.16a2int+ No.16b1lat) was performed. Postoperative histopathology did not reveal any residual cancer cells in either the primary lesion or the lymph nodes; thus, the treatment effect of chemotherapy was classified as Grade 3. Thus, some gastric cancer patients may undergo curative resection even in the presence of extensive lymph node metastases when effective chemotherapy has been administered. Further discussions are needed about the optimal chemotherapeutic regimens in such cases. Herein，we report a case of advanced gastric cancer with pathological complete response after neoadjuvant chemotherapy with the DOS regimen.

We encountered two cases of unresectable advanced gastric cancer with peritoneal dissemination that responded to fluorouracil + folinate + oxaliplatin (FOLFOX) therapy. Case 1 was a 66-year-old man with anorexia and abdominal pain who was diagnosed as having type 4 gastric cancer and referred to our hospital. He had esophageal infiltration and peritoneal dissemination. Although it was considered difficult to improve the oral intake by sigh surgery, he was started on FOLFOX therapy as his general condition was well maintained. Partial response, based on the RECIST criteria, was achieved, the ascites disappeared, and the patient resumed oral intake. Case 2 was a 73-year-old woman with a history of poor oral intake who was diagnosed as having type 4 gastric cancer and referred to our hospital. Laparoscopic exploration revealed multiple nodules of peritoneal disseminations, and FOLFOX therapy was started. Partial response was achieved, the ascites disappeared, and the patient resumed oral intake. From the viewpoint of improving the QOL and prognosis, FOLFOX therapy is considered as being a useful and effective therapeutic option for patients with unresectable advanced gastric cancer and peritoneal dissemination with difficulty in oral intake.

We present a case of surgically resected lymphangioma of the ileocecal valve in an adult in whom tumor regrowth was observed during the follow-up period, with a review of the literature. The patient, a 74-year-old man, was detected as having a submucosal tumor (SMT) measuring 30 mm in diameter on the ileocecal valve in a colonoscopy (CS) performed 7 years previously. Histopathological examination of the tumor suggested the diagnosis of lymphangioma, and a wait-and-watch policy was adopted. Three years later, he underwent another CS after conservative therapy for colonic diverticulitis, and the SMT had increased in diameter to 50 mm. Therefore, surgery was planned, and an open ileocecal resection was performed because of the two prior surgeries. The final histopathological diagnosis was cystic lymphangioma. Lymphangioma arising from the gastrointestinal tract in adults is a relatively rare entity. It has been reported that tumors measuring greater than 30 mm in diameter are associated with an elevated risk of intussusception, although lymphangioma does not show malignant transformation potential. Therefore, both careful observation and appropriate treatment planning, taking into consideration possible tumor growth over time, are essential for patients with this type of tumor.

Appendiceal endometriosis is an entity of extragonadal endometriosis. Endometriosis causing appendiceal intussusception is rare and difficult to diagnose by radiology. Herein, we report a case of appendiceal intussusception caused by endometriosis in a 47-year-old asymptomatic woman; a screening colonoscopy revealed a mass with externalization from the appendicular orifice, covered by normal mucosa. On CT, the mass was identified as an enhancing tumor of the appendix. Based on the above findings, appendiceal tumor or endometriosis was suspected, and laparoscopic partial cecal resection was performed. The postoperative pathological findings were consistent with appendiceal endometriosis. We review the literature of appendiceal intussusception and discuss the associated conditions, diagnosis, and surgical management of this unusual entity.

A 13-year-old boy presented to our hospital with the complaint of right lower quadrant pain and was treated conservatively under the diagnosis of appendicitis with abscess formation. Two months later, we performed laparoscopic appendectomy. The histopathological diagnosis was positive for synaptophysin and chromogranin A, and the Ki-67 index was less than 1.0%. Based on the findings, we made the diagnosis of neuroendocrine neoplasm of the appendix (NET G1). Since there was no vascular invasion, the patient was followed up without additional treatment. At present, 2 years 6 months since the surgery, he remains alive with no evidence of recurrence. This disease is extremely rare in children, and it is difficult to diagnose preoperatively due to a lack of knowledge about the characteristic imaging findings. Therefore, even in pediatric patients, histopathological examination of the appendix is need for a confirmatory diagnosis.

A 70-year-old man was diagnosed as having colorectal cancer invading the inguinal canal. He had undergone bilateral inguinal hernia repair using a Mesh-plug at the age of 61 years.

After a positive fecal occult blood test, we performed screening colonoscopy, which revealed cecal cancer (tub2). Abdominal computed tomography showed locally advanced cecal cancer invading the anterior abdominal wall. We suspected that the tumor had invaded the inguinal canal.

We performed ileocecal resection with lymph node dissection (D3). Intraoperatively, a firm inguinal mass was found, which was resected with clear margins. The inguinal canal was repaired by direct suture.

No regional lymph node metastases were found. Immunohistochemistry showed positive immunostaining of the cancer cells developing on the mesh-plug. Although the mechanism of invasion of the inguinal region in this case remains unknown, the tumor could have developed on the implanted polypropylene mesh prosthesis.

There were no postoperative complications. The patient was treated with mFOLFOX6 + bevacizumab as adjuvant chemotherapy for the cecal cancer.

He remains alive without recurrence 13 months after the surgery.

A 73-year-old man with right hypochondralgia was referred to our hospital. Abdominal CT revealed thickening of the gallbladder wall, gallbladder stones, and a cutaneous abscess. Percutaneous gallbladder biopsy showed no evidence of malignancy. Thus, the preoperative diagnosis was chronic cholecystitis with a cutaneous fistula. We performed open cholecystectomy and fistulectomy. Histopathologically, the diagnosis was confirmed as xanthogranulomatous cholecystitis (XGC). XGC is a subtype of chronic cholecystitis in which the gall bladder wall structure is destroyed by inflammatory cell infiltration. Herein, we report a case of XGC complicated by a cholecystocutaneous fistula, which was successfully treated by surgery.

Acute pancreatitis during pregnancy is considered as being extremely rare, ranging in incidence from 0.001% to 0.03% of pregnant women. The mortality rate is said to be less than 1% for mothers and less than 18% for newborns, although these figures have improved as compared with before, due to improved test accuracy and the spread of the NICU management environment.

When this disease is encountered, both mother and child often show a serious clinical course, and prompt and appropriate treatment is necessary. We report the case of a woman who was diagnosed as having severe acute pancreatitis during pregnancy, whose life was saved by conservative treatment after emergency caesarean section.

The patient was a 36-year-old woman, gravida 3, para 1. On the 6th day of the 26th week of pregnancy, she developed acute epigastric pain and vomiting, and requested to be transported to the emergency room. Careful examination of the patient in the emergency room led to the diagnosis of acute pancreatitis, and the patient was urgently admitted to our hospital’s obstetrics and gynecology department and started on conservative treatment; however, the maternal oxygenation worsened, and emergency caesarean section was performed on the 2nd day after completion of the 27^th week of pregnancy. Thereafter, the patient’s condition improved and she was discharged from the hospital with continued conservative treatment for pancreatitis. Computed tomography was performed 35 days after the onset, and no complication, such as pancreatic pseudocyst formation or encapsulated necrosis was found.

We report a case of total pancreatectomy for recurrence of Acinar Cell Carcinoma (ACC) in the remnant pancreas after pancreatoduodenectomy.

The patient was a 56-year-old man who had undergone pancreaticoduodenectomy for ACC at a previous institution. He presented three years after the operation, with cancer recurrence in the remnant pancreas. The tumor had expanded into the elevated jejunum and the patient suffered from severe upper abdominal pain due to obstruction of the jejunum. He was referred to our institution for palliative therapy. However, it seemed that the tumor showed relatively few invasive features, without any distant metastasis. Considering his relatively young age and severity of pain, we planned total remnant pancreatectomy. Intraoperative exploration revealed no tumor invasion of the hepatic artery, so that we elected to perform resection and re-anastomosis of the bile duct. The postoperative course was uneventful and the patient was discharged on the 28^th postoperative day with good control of his diabetic state. Four months after the operation, however, abdominal CT revealed multiple liver metastases and chemotherapy (GEM+nab-PTX) was started, but the patient died 9 months after surgery.

Herein, we present a case of vaginal cancer found after hysterectomy in a patient with a high-grade squamous intraepithelial lesion (HSIL). A 62-year-old postmenopausal woman was referred to us with a HSIL. High-risk human papillomavirus type 18 was identified. Eight years passed without abnormal cytology. HSIL was noted again at the age of 70 years, and conization was performed. Histopathological examination of the cervix showed a HSIL, with no lesion on the margin. However, the HSIL persisted on cytology. Therefore, six months later, we performed hysterectomy. Histopathology revealed no evidence of cervical intraepithelial neoplasia 3 in the cervix. One year after the hysterectomy, vaginal cytology showed atypical squamous cells, which led to the pathological diagnosis of vaginal cancer. Radiation therapy was started. This case highlights the importance of paying attention to the possible presence of vaginal cancer in the presence of cytological abnormalities.

A 35-year-old woman was diagnosed as having a neurogenic tumor upon further examination after a pelvic mass was noted accidentally during a medical examination, and it was resected by laparoscopic surgery. When the dorsal periphery of the tumor was dissected, it was found that the tumor originated in a nerve emerging from the 3^rd sacral foramen. The tumor was easily dissected from the sacral foramen and could be completely removed laparoscopically, with preservation of the surrounding organs. Postoperative histopathology revealed the diagnosis of schwannoma. Surgical resection is the treatment of first choice for retroperitoneal schwannomas, and in recent years, laparoscopic surgery has been reported to be useful, although treatment based on sufficient evidence has not yet been established. In this report, we discuss the strategy from diagnosis to treatment based on previous reports.