A 73-year-old asymptomatic woman was referred to our department because of an abnormal shadow on a chest X-ray film. Computed tomography showed a giant solid tumor in the left side of the thoracic cavity and a solid tumor in the stomach. Endoscopic ultrasonography showed that both tumors were connected to the 4th layer of the mucosa. The esophageal tumor was diagnosed by fine-needle aspiration biopsy as esophageal gastrointestinal stromal tumor (GIST). Surgery was performed on a diagnosis of esophageal GIST with gastric gastrointestinal mesenchymal tumor. The esophageal tumor measured 130 mm, and the gastric tumor measured 42 mm. Both tumors were positive for c-KIT. Esophageal GIST and gastric GIST were therefore diagnosed. The esophageal GIST was apparently associated with high-grade malignancy, and gene analysis revealed a mutation in exon11. Postoperative treatment with imatinib was begun, but had to be discontinued because of adverse reactions. The patient visits our hospital every 4 months, and as of 2 years and 3 months after surgery there has been no evidence of recurrence.

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Neuroendocrine carcinomas generally have a poor prognosis, and large-cell types are rare. We report a case of large cell neuroendocrine carcinoma of the esophagus with long-term survival after surgical treatment. A 56-year-old man, previously hospitalized for dysphasia, was referred to our hospital with a diagnosis of neuroendocrine carcinoma of the esophagus. A localized polypoid tumor was detected in the middle thoracic esophagus, and on the basis of a diagnosis of T1bN0M0, Stage I neuroendocrine carcinoma, thoracoscopic esophagectomy was performed. Histopathological and immunohistochemical findings were cytokeratin AE1/AE3-positive, chromogranin A-positive, synaptophysin-positive, CD56-positive, p63-negative, Ki-67 (labeling index) 81.8%, and many mitotic figures. The final diagnosis was large cell neuroendocrine carcinoma, categorized as pT1b (SM1), ly1, v0, pN0, pStage I. The patient has been free from recurrence for 3 years and 5 months after surgery without any adjuvant therapy. We consider that this case of long-term survival after surgery alone was because the carcinoma was superficial without any lymph node metastasis.

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We report a rare case of esophageal cancer in a 63-year-old man with tracheobronchopathia osteochondroplastica. The patient was being followed endoscopically for suspected submucosal tumors in the esophagus. After six months the submucosal lesions became larger, and endoscopic ultrasonography-guided fine needle aspiration biopsy yielded a diagnosis of squamous cell carcinoma. CT confirmed the esophageal tumors as T3, and showed the trachea compressed by a swollen No. 105 lymph node. The tracheal wall and the right main bronchus were thickened. PET showed a high uptake in the esophageal lesions and in the No. 105 lymph node. Bronchoscopic findings then revealed multiple small nodular lesions in the anterior and lateral walls, from the trachea to the right main bronchus. The histopathological findings from further biopsy specimens indicated these small nodular lesions to be tracheobronchopathia osteochondroplastica. We then performed preoperative chemotherapy and esophagectomy for the T3 tumors. Tracheobronchopathic osteochondroplastica is a very rare benign disease of unknown etiology. However, digestive surgeons should be aware of this disease which might be confused with metastasis or invasion to the trachea.

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We successfully endoscopically removed an esophageal stent that had migrated into the stomach. A 63-year-old man was given a diagnosis of advanced esophageal cancer 7 cm long in the Ut-Ce region. A covered self-expanding type metallic stent was inserted. After that we continued chemotherapy on an outpatient basis, but 100 days later after placement of the stent, it migrated to the stomach. We replaced it with an uncovered self-expanding type metallic sent, then using a 2-channeled fiberscope, brought up the narrow drop stent from the stomach. Next we secured the migrated stent by two forceps into the replaced stent under fluorescence endoscopy. We successfully removed the migrated stent from the stomach, and did not remove the newly inserted stent. Removal of a stent that has migrated into the gastric lumen using a fiberscope and snares is rare.

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A 55-year-old woman was admitted because of an enlarged lymph node detected by abdominal computed tomography. There was a previous history at the age of 50 of a distal gastrectomy for early gastric cancer which was 1 cm in diameter and histopathologically well differentiated. Lymph node recurrence was diagnosed and resected, because there were no other metastasis. The smooth-surfaced tumor was located on the anterosuperior side of the common hepatic artery and was 3 cm in diameter. There was no invasion, therefore the tumor was easily removed. No other metastatic lymph nodes were found intraperitoneally. A histological examination showed that the tumor consisted of poorly differentiated adenocarcinoma cells. Metastatic lymph node from the gastric cancer was diagnosed. Generally, the recurrence rate of early gastric cancer like the present case is low, therefore this case is of interesting.

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A 40-year-old woman was referred because of middle upper quadrant pain. Abdominal computed tomography (CT) showed a huge 13.0×8.0 cm tumor at the gastric cardia, which was suspected to directly invade the liver. Biopsy yielded a pathological diagnosis of a high risk gastrointestinal stromal tumor (GIST) of the stomach. We started neoadjuvant chemotherapy with imatinib at 400 mg/day, to achieve reduced risks of operative procedures and functional preservation. After 28 weeks of treatment, CT revealed a dramatic reduction in tumor size to 8.0×3.5 cm, which we resected. Surgical findings revealed massive degeneration of the tumor and proximal gastrectomy was performed. The tumor did not invade other organs, and radical surgery was possible without rupture. Histological examination of the resected specimen revealed massive hyalinization and dramatic decrease in the number of viable tumor cells. Although a single peritoneal recurrence was detected by CT scan 28 weeks after surgery, partial response was obtained after 24 weeks of adjuvant chemotherapy with imatinib at 400 mg/day.

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We present two cases of gastric adenocarcinoma following complete remission of gastric diffuse large B cell lymphoma (DLBCL) after stomach-conserving treatment. The patients were a 61-year-old man and a 67-year-old woman. Each patient had been given a diagnosis of stage I gastric DLBCL. One patient had undergone chemotherapy, and the other had undergone chemoradiotherapy. After achieving complete remission of DLBCL, upper endoscopic studies during follow-up showed gastric adenocarcinoma in both cases. Both patients underwent total gastrectomy and lymph node dissection for the treatment of gastric adenocarcinoma, and histological examination of the resected specimen revealed stage IA gastric cancer with no residual gastric lymphoma. Patients who undergo stomach-conserving treatment for gastric DLBCL have favorable prognoses. However, recently, incidences of secondary malignancy following complete remission of lymphoma have been reported, suggesting that careful follow-up is important in such cases.

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We report a case of primary malignant solitary fibrous tumor (SFT) of the pancreas. A 50-year-old man was admitted to our hospital for further examination and treatment after tumor was detected in the pancreas tail on abdominal US as part of his medical check-up. Abdominal CT revealed well-demarcated tumors in the pancreas tail, 9 cm and 3 cm in diameter, and a similar tumor in the posterior pancreas head, 3 cm in diameter. A malignant endocrine tumor in the pancreas tail with lymph node metastasis on the posterior surface of the pancreatic head was suspected based on CT, MRI, and other tests. Distal pancreatectomy was performed. Immunohistochemically, the tumor was diagnosed as a Solitary fibrous tumor (SFT). Histopathologically, the tumor showed coagulative necrosis and multiple mitoses. These pathological findings suggested that the tumor was malignant SFT. Local relapse was recognized 21 months after surgery on abdominal CT. It is currently being followed after chemoradiation owing to refusal of surgery. SFT is an unusual tumor that most often arises in the pleura. Primary SFT of the pancreas is extremely rare. This is the first report that followed a malignant course, including local recurrence, in primary SFT of the pancreas.

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A 63-year-old man with epigastralgia and jaundice had a hypovascular tumor 25 mm in diameter at the pancreatic uncus and head. He underwent pancreatico-duodenectomy under the diagnosis of pancreatic cancer. Histopathologic examination revealed spindle cell type anaplastic ductal carcinoma (ADC) of the pancreas. No adjuvant chemotherapy was performed and 7 years after the operation, the patient is alive without recurrence. ADC, a relatively rare type of pancreatic carcinoma, is considered to have poor prognosis and is classified into 4 subtypes according to its microscopic morphology (giant cell, osteoclastoid, pleomorphic and spindle cell types, respectively). To the best of our knowledge, there have been no previous reports of long-term survivors with spindle cell type ADC.

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Both the thyroid and pancreas are uncommon sites for metastasis of rectal cancer, and no such cases have previously been reported in Japan. We report a case of long-term survival after resection of metachronous metastasis to the lung, the thyroid, the pancreas and the liver from the primary rectal cancer. A 71-year-old man underwent low anterior resection for rectal cancer in 1998, followed by lung resection for two lung metastases, then 6 years and 11 months after the first operation, right lobectomy and cervical lymph node dissection were performed for metastatic thyroid tumor. Distal pancreatectomy with splenectomy and regional lymph node dissection were performed for pancreatic metastasis 8 years and 2 months after the first operation. Partial hepatectomy was performed for liver metastasis 9 years and 3 months after the first operation. Histological examinations revealed that all resected specimens, showing moderately differentiated adenocarcinoma, had metastasized from the rectal cancer. Now, 12 years after resection of the primary cancer, he is doing well with no sign of recurrence. We consider that multiple metastatic tumors which are metachronous are worth trying to resect aggressively if curative resection seems possible.

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Internal hernia involving the transverse mesocolon hernia is rarely diagnosed preoperatively, and laparotomy is usually performed to reduce and repair the hernia. We report a case of internal transverse mesocolon hernia that was diagnosed preoperatively and repaired laparoscopically. A 25-year-old woman who complained of abdominal pain and vomiting. The abdomen was soft and not distended, but there was epigastric pain. Coronal section image by computed tomography revealed the dilated small intestine was pointed cranially beyond the transverse mesocolon dorsally. Internal hernia involving the transverse mesocolon was suspected, and emergency laparoscopic surgery was performed. The small intestine was incarcerated into the defect on the posterior leaf of the transverse mesocolon. No ischemic changes were detected in the incarcerated intestine. Internal transverse mesocolon hernia was diagnosed. The hernial defect was repaired laparoscopically and the postoperative course was uneventful.

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