Solitary fibrous tumor (SFT) is a relatively rare tumor that develops mostly as an intrathoracic lesion related to the pleura. Hepatic malignant SFTs are rare. Here, we present a case of a 56-year-old man with a bulky tumor in the right hepatic lobe. The tumor was found incidentally by abdominal CT as part of an examination for hepatic dysfunction. The definitive diagnosis of SFT was established after liver biopsy, and the patient was referred to our hospital for surgical treatment. At the first visit, imaging studies revealed the primary focus of the malignancy as well as metastatic lesions in the hepatic S2 segment and pancreatic body. The treatment regimen was as follows: after antecedent TAE, primary hepatic and intrahepatic metastatic foci were first resected by extended resection of the two central areas. Nine months later, the pancreatic head tumor was enucleated and distal pancreatectomy was performed to remove metastatic foci including the new lesion on the pancreatic head. Postoperative adjunctive therapy was not administered, and the patient is currently alive without recurrence 22 months postoperatively. To the best of our knowledge, there have only been a few reports on primary hepatic malignant SFTs and this is the only SFT case involving pancreatic metastases reported thus far. This case indicates that total tumor resection allows patients with distant metastasis to achieve recurrence-free survival. Should recurrence occur, we would proactively consider the use of molecular-targeted drugs (approved in 2012), with re-resection in mind.

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A 65-year-old woman complaining of melena was found to have severe anemia by a blood test at a nearby hospital. Upper GI endoscopy and colonoscopy showed no bleeding lesion but enhanced CT revealed a strongly-enhanced tumor in the small intestine. We used capsule endoscopy and double balloon endoscopy to examine the small intestine and detected a 20-mm submucosal-tumor like mass with erosion and depression in the lower jejunum. Under a diagnosis of gastrointestinal stromal tumor in the jejunum associated with GI bleeding, laparoscopy-assisted partial resection of the small intestine was performed. Histopathological and immunohistological examinations revealed a glomus tumor in the small intestine with an intermediate malignancy. Glomus tumors arising from the GI tract are rate and most of them are originated from the stomach. There was no report of glomus tumor in the small intestine from Japan and were only two such case reports in the English literature, thus highlighting the extreme rarity of this clinical entity.

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A 69-year-old man, who had been given a diagnosis of ascending colon cancer with 4 liver metastases in the bilateral lobe, received chemotherapy (bevacizumab+FOLFOX, 12 cycles) in a previous hospital. After the chemotherapy, colonoscopy showed that the lesion of the ascending colon disappeared. CT scans revealed that all of the liver metastases decreased in size. He was then referred to our hospital for surgery. We resected only the liver tumors and left the primary colonic lesion as it was. The post-operative course was good and he was discharged on the 9th postoperative day. Pathological examination revealed all tumor cells had become necrotic and no viable cells were found in the liver tumors (pathological complete response). He has survived without recurrence for 39 months after the last chemotherapy, 36 months after the operation, respectively, despite no adjuvant chemotherapy.

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We report a rare case of solitary metastasis to the retroperitoneum from the colon cancer and retrospective comparison of multiple CT examinations, resected curatively five years after the primary operation. A 66-year-old woman underwent right colectomy (partial resection) with D3 lymph node dissection for ascending colon cancer in November 2006. Final findings was moderately differentiated adenocarcinoma, pSS, pN2, cH0, cP0, cM0, fStage IIIb. Five years after the operation, a solitary tumor was pointed out in the right pararenal lesion of the retroperitoneal space on enhanced abdominal CT examination. However, this lesion was already present as a 4-mm nodule in the CT taken before the initial operation. The serum level of CEA had increased in accordance with the tumor growth. FDG positron emission tomography CT showed lesion accumulation of ¹⁸F-FDG. On a diagnosis of a solitary metastatic tumor from the colon cancer we performed curative resection of this tumor in November 2011 and the postoperative course was uneventful. The histopathological diagnosis was adenocarcinoma, compatible with metastasis of the colon cancer.

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Rectovesical fistula is a rare complication following low anterior resection (LAR) for rectal cancer. We report two cases of rectovesical fistulas that developed after laparoscopic low anterior resection (Lap-LAR). The first patient was a 67-year-old man who underwent Lap-LAR with D3 lymph node dissection for RaRb rectal cancer. The Denonvilliers’ fascia was simultaneously resected. The patient’s immediate postoperative course was uneventful; however, he developed a fever, pneumaturia and dysuria without symptoms of peritonitis on postoperative day (POD) 9. Abdominal CT demonstrated air bubbles in the right seminal vesicle and urinary bladder, and rectovesical fistula was diagnosed. The second patient was an 82-year-old man who underwent Lap-LAR for Ra rectal cancer. The operation was performed in a similar fashion to that described in the first case. The patient developed a mild fever, pneumaturia and testicular pain without symptoms of peritonitis on POD 12 and rectovesical fistula was diagnosed. Both patients were conservatively treated with antibiotics and immediately recovered, although some reports have described difficulties in conservatively treating this entity. As a complication after LAR, rectovesical fistulas are associated with anastomotic leakage. The development of rectovesical fistulas is likely promoted by localized abscess formation and vulnerability of the exposed seminal vesicle due to resection of the Denonvilliers’ fascia. To the best of our knowledge, this is the first report in Japan on rectovesical fistulas occurring after Lap-LAR.

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A 68-year-old woman was admitted to our hospital because of sudden onset of abdominal pain. Abdominal computed tomography showed an aneurysm in the middle colic artery and hemorrhagic ascites. Rupture of the middle colic artery aneurysm was diagnosed, and emergency colorectomy with resection of the diseased artery was performed. On postoperative day 4, the patient resumed oral intake, but fever continued. On postoperative day 7, CT showed an impending rupture of the right posterior segment of the hepatic artery and multiple small aneurysms in the abdominal arteries. Embolization of the hepatic artery was performed. Histological examination of the resected diseased artery showed a typical segmental arterial mediolysis in the arterial wall proximal to the aneurysm.

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