A 64-year-old man had dysphagia and underwent gastroendoscopy. A submucosal tumor with bridging folds was found from the middle to the lower esophagus. Although fine needle aspiration biopsy revealed esophageal leiomyoma, FDG-PET/CT showed high-level FDG accumulation with a maximum standardized uptake value of 11.3 in the tumor and the tumor was suspected to be malignant such as leiomyosarcoma. Enucleation was performed but ‍no malignant intraoperative findings were found. The tumor was 6.5 cm in diameter, consisted of spindle-shaped ‍cells, positive for α-SMA, weakly positive for desmin but negative for CD34, c-kit and S-100 on immunohistochemistry. The Ki-67 index was 3%, and a diagnosis of leiomyoma was made. Immunohistochemical staining showed glucose transporter-1 expression in cell membranes. We should consider the differential diagnosis for chest neoplasms remembering that benign esophageal leiomyomas are potential causes of false-positive FDG-PET.

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An 80-year-old man presented with a chief complaint of abdominal pain, accompanied by peritoneal irritation over the entire abdomen. Abdominal CT scan showed a high density area in the ventral side of the right kidney and pelvic cavity. Acute intraabdominal hemorrhage was suspected. Laparotomy revealed aneurysms in the right gastroepiploic artery with rupture, which were partially resected. Histopathological examination clearly revealed partial disruption of the tunica media in the right gastroepiploic artery, justifying the diagnosis of segmental arterial mediolysis.

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The patient was a 79-year-old man with epigastralgia and vomiting. Endoscopic examination revealed a pedunculated tumor in his fornix. An endoscopically obtained tumor biopsy revealed an α-fetoprotein (AFP)-producing gastric carcinosarcoma. Computerized abdominal tomography detected the tumor and swollen lymph nodes, but no distant metastases. Serum AFP was 263.0 ng/ml. The patient was diagnosed as an AFP-producing gastric carcinoma, U, post, type I, cT3N1M0, cStage IIB, and underwent total gastrectomy with Roux-en-Y esophagojejunostomy and lymphadenectomy. The tumor specimen was 135 mm × 65 mm × 145 mm. Histopathologically, the tumor consisted of an epithelial component with a ductal conformation and a mesenchymal component with spindle-like cells. The epithelial component was positive on immunohistochemistry for keratin AE 1/3, CAM 5.3, and AFP. The mesenchymal component was positive for mesenchymal markers (desmin, CD56, and myogenin). There was muscular differentiation and the tumor appeared to be a true carcinosarcoma, U, Post, type 1, pT3(SS), ly2, v1, pN3a, pStage IIIB. The patient was discharged on the fourteenth postoperative day. Three months after operation, liver metastases were noted and he died three months later. Carcinosarcomas are categorized as true carcinosarcomas or so-called carcinosarcomas. There is no effective treatment for gastric carcinosarcoma except resection and its prognosis is very poor, with an average postoperative survival of 11 months. In Japan, 16 cases of true gastric carcinosarcoma have been reported, including this case. AFP-producing carcinosarcoma has been reported only once apart from our case. As gastric carcinosarcomas are rare and have a very poor prognosis, appropriate treatment must be identified.

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We report a case of a 16-year-old woman with a 10-cm nodular lesion in the right lobe and multiple intrahepatic metastases in both lobes of the liver. The tumor was diagnosed as fibrolamellar hepatocellular carcinoma (FLC). In consideration of the advanced behavior with multiple metastases of both lobes and possible lymph node metastasis, transcatheter arterial chemoembolization (TACE) was performed twice. Two months later, we employed hepatic resection because of a residual viable lesion and tumor marker (PIVKA-II) elevation. After transileocolic portal vein embolization, right 3 segmentectomy and radiofrequency ablation of the tumors in lateral segment was performed. Since local recurrence in S3 of the liver occurred 3 years after surgery, partial hepatectomy was performed. One year later, right lung metastasis appeared, and pulmonary lobectomy was done. She now has a good postoperative course without recurrence. Here, we focus on the treatment of FLC.

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We report a rare case of hepatocellular carcinoma with sarcomatous changes, along with a literature review. A 78-year-old man visited an outpatient clinic with a chief complaint of epigastric discomfort. He was referred to our hospital for further evaluation of a liver tumor detected by abdominal ultrasonography. Hepatitis B and C virus markers were negative. Serum PIVKA-II level was elevated at 854 mAU/ml. Abdominal computed tomography showed a tumor 6.7 cm in diameter in segments 4 and 5 of the liver. The tumor in segment 5 was well enhanced, but the part in segment 4 was accompanied by marginal enhancement. Cancer invasion to the intrahepatic bile duct was ‍suspected on magnetic resonance cholangiopancreatography. Mixed type hepatocellular carcinoma and cholangiocellular carcinoma was the most strongly suspected from these findings. We performed an extended right hepatectomy with lymphadenectomy and removal of extrahepatic bile duct followed by biliary tract reconstruction. The postoperative course was uneventful. The liver tumor of this patient was pathologically diagnosed as hepatocellular carcinoma with sarcomatous change. The patient is still alive 37 months after surgery without disease recurrence.

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We report a case of signet-ring cell carcinoma of the extrahepatic bile duct. A 76-year-old woman with abdominal pain was referred to a clinic because of acute cholangitis. She underwent percutaneous transhepatic gallbladder drainage with administration of antibiotics. MRCP demonstrated a bile duct stricture from the upper to middle bile duct. Abdominal CT revealed an irregular mass with enhanced effect in the same region as shown by MRCP. Histological examination of the biopsy specimens from a stenotic portion revealed possible tubular adenocarcinoma. She underwent bile duct resection for curative operation under a diagnosis of carcinoma of the middle bile duct. The histological diagnosis was signet-ring cell carcinoma of the bile duct. The patient is alive without any evidence of recurrence 24 months after surgery.

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We report a case of pancreatic acinar cell carcinoma, treated by neoadjuvant chemotherapy and subsequent curative resection. A 55-year-old woman, presenting with back pain and weight loss, was given a diagnosis of stage IVa pancreatic cancer. Because the tumor size was large measuring 6.8 cm in diameter, the patient underwent neoadjuvant chemotherapy using a combination of gemcitabine and S-1 (GS), attempting to reduce the tumor volume as well as to observe possible progression of micrometastasis of the liver or peritoneum. After 2 months of chemotherapy, the tumor volume decreased to 4.8 cm in diameter, with no findings of distant metastasis. Thereafter, the patient underwent curative distal pancreatectomy with D2 lymphadenectomy. The pathological findings of the resected specimen demonstrated stage III moderately differentiated acinar cell carcinoma. Subsequently, she had completed adjuvant GS therapy using the same regimen 6 months prior to surgery without any adverse events. However, she had a local recurrence 3 months later, and required re-administration of GS therapy.

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A 34-year-old man had an 8-year history of systemic lupus erythematosus (SLE) controlled by oral prednisolone. He had abdominal pain and underwent colonoscopy 3 years after the initial diagnosis. Colonoscopy revealed an ulcerative lesion and stenosis in the rectosigmoid colon. He was treated by prednisolone enema, because colonic inflammation associated with SLE was diagnosed. He obtained symptomatic relief for a period, but he developed abdominal distension again after 1 year. The lesions were eventually diagnosed as ulcerative colitis as a complication of SLE. Despite the introduction of oral mesalazine, the stenosis did not show significant improvement and he was referred to our hospital for surgical treatment. Laparoscopic low anterior resection was performed without perioperative complications, after 5 years from the first abdominal pain. Pathological results revealed that the stenosis was a result of thrombosis caused by anti-phospholipid antibody and lupus vasuculitis. Stenosis of the large intestine due to SLE is a very rare entity and only 4 cases have been reported in the literature. To the best of our knowledge, this is the first case report of laparoscopic colectomy for stenosis of the large intestine due to SLE.

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A 50-year-old man was admitted to our hospital with lower abdominal pain and vomitus. He complained of oppressive pain in the lower abdomen. Blood examination showed an elevated inflammation reaction. Abdominal CT showed that the superior mesenteric artery was running along the right dorsal side of the superior mesenteric vein and that most of the small intestine was located at the right side of the vertebra. Accordingly, it was suspected that he was suffering from intestinal malrotation. Furthermore, he was suspected to have colon volvulus, because the ascending colon was dilated with indications of a bird’s beak sign and whirl like appearance in the center of the abdomen. We therefore performed an emergency laparotomy, suspecting strangulated intestinal obstruction. Intraoperative findings were in accordance with the preoperative CT findings. We diagnosed the case as a malrotation of the non-rotation type. In addition, a ligament was detected between the cecum and retroperitoneum. We then diagnosed the case as volvulus because a 180-degree counterclockwise torsion could be found in the ileocecal region along the ligament’s axis. Ileocecal resection was carried out. The postoperative course was satisfactory without any complications. Although the occurrence of a cecal volvulus along with malrotation of the intestine is rare, an emergency operation may be required in cases where necrosis of the intestine is suspected. Consequently, when intestinal malrotation is found at the time of a medical examination of an acute abdominal malfunction, prompt medical or surgical treatment is essential.

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A 44-year-old woman presented with right upper quadrant pain and fever. A preoperative diagnosis of gastrointestinal stromal tumor of the duodenum was made by CT. Removal of the tumor, cholecystectomy, and partial resection of the stomach and duodenum was performed. Retroperitoneal extraskeletal osteosarcoma accompanied by malignant fibrous histiocytoma and liposarcoma, was diagnosed upon histopathological examination. After postoperative adjuvant chemotherapy for osteosarcoma, the tumor recurred 3 times to the stomach, superior border of the pancreas and the liver, respectively, but they were resected surgically each time. The patient is free from the tumor 7 years after the first operation.

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