We report a case of Barrett adenocarcinoma with coexisting giant hiatal hernia presenting an upside-down stomach (UDS). Hiatal hernia repair and Ivor-Lewis esophagectomy were simultaneously performed by laparoscopic and thoracoscopic approaches. A 68-year-old man was given a diagnosis of type IV hiatal hernia with UDS. Upper gastrointestinal endoscopy revealed an early-stage adenocarcinoma in the long-segment Barrett esophagus. The operation was initiated with laparoscopy. It took time to reposition the herniated stomach because of severe intrasaccular adhesion and the massive greater omentum occupying the sac. The stomach was mobilized and repositioned after adhesiolysis and partial resection of the omentum. The cardia was transected and the gastric conduit was prepared extracorporeally. Crural repair was performed by interrupted sutures and reinforced with a prosthetic mesh. Then, the thoracoscopic part was performed in the prone position. The thoracic esophagus was mobilized and the specimen was retrieved after transecting the esophagus at the level of the azygos arch. Esophago-gastrostomy was created with an endoscopic linear stapler and hand-sewn closure of the entry hole. From the viewpoint of pulmonary function and securing the visual field in the sac, minimally invasive surgery was useful.

A 71-year-old man who suffered esophageal damage due to an accident approximately 30 years previously complained of dysphagia. Endoscopic examination revealed a whitish papillary tumor in the esophagus. Biopsy results seemed to suggest an extremely well-differentiated squamous cell carcinoma or inflammation, but a definitive diagnosis could not be reached despite multiple inspections. Chest CT showed irregular thickening of the wall of the esophagus and pneumonia by penetration, and PET showed high trace accumulation in the affected area. We decided to operate on the patient due to the possibility of cancer, potential obstruction to the passage of food, and secondary pneumonia. Intraoperatively, the tumor was found to be soft and edematous, and since intraoperative diagnosis of pleural lavage fluid and the LN around the recurrent laryngeal nerve were negative, we performed thoracic esophagectomy without typical lymph node dissection, and reconstruction using a gastric tube. Gross examination of the tumor revealed a warty appearance. HE staining showed that the squamous laminar structure of the esophagus was maintained, although a slight variant form was present. Immunostaining revealed the tumor to be verrucous carcinoma (VC) with a positive reaction of basal layer to p53, p63 and Ki67 as biomarkers. VC is a subtype of squamous cell carcinoma that most commonly occurs in the mouth. We report a rare case of esophageal VC with a review of the literature of similar cases.

A 70-year-old man who was seen for anorexia underwent upper gastric endoscopy which revealed an ulcerated tumor at the gastric body. Enhanced CT showed a 20-mm space occupying lesion in the S2 area of the liver. Biopsy yielded a pathological diagnosis of adenocaricinoma, tub1 with HER2 IHC score3+. He was given a diagnosis of cT4aN0M1HEP Stage IV gastric cancer. Based on the possibility of conversion surgery, we started capecitabine+cisplatin+trastuzumab chemotherapy (capecitabine: 2,000 mg/m² (day 2–16), cisplatin: 80 mg/m² (day 2), trastuzumab: 6 mg/kg (day 2)). Two cycles later, the liver tumor shrunk to 5 mm. After staging laparoscopy, we conducted laparoscopic simultaneous distal gastrectomy and partial S2 hepatectomy. He was discharged on postoperative day 9 and started adjuvant chemotherapy from one month after the operation. He has remained recurrence-free in the 4 months since the operation. This case shows the possibility that laparoscopic simultaneous resection can be feasible in treating gastric cancer with liver metastasis.

We report a case of a rare solitary fibrous tumor (hereinafter abbreviated as SFT) originating from the omentum with abdominal pain due to torsion in a 45-year-old woman. She was admitted to our hospital with a chief complaint of lower abdominal pain. The CT showed an elliptical tumor showing a heterogeneous contrast effect, 6.6×5.1 cm in size, at the ventral side of the uterine body. Laparotomy yielded a preoperative diagnosis of omental tumor torsion. Feeding blood vessels of the tumor in the pelvic cavity reached more than 20 cm and twisted around about 5 times. The feeding vessels were cut on the central side and the tumor was removed in one piece. Pathological examination showed that tumor cells were positive for CD34, STAT6, CD99, bcl-2, and negative for c-kit, S-100, desmin. Consequently, it was diagnosed as an SFT.

An 80-year-old man presented with lumbago and fever. Pyogenic spondylitis was suspected on CT and the patient was admitted. Inflammatory changes were observed in the upper and lower vertebral bodies, with anterior ossification of the 12th thoracic vertebra and the 1st lumbar vertebra on MRI, and Streptococcus bovis (S. bovis) was detected on blood culture, based on which pyogenic spondylitis was diagnosed. Ceftriaxone was administered for 28 days and the drug was switched to oral minocycline hydrochloride. When colonoscopy was performed to investigate a tumorous lesion in the colon, early cancers were found in the descending colon and sigmoid colon, for which laparoscopy-assisted left colectomy was performed. Both cancers were pT1a(SM)N0M0 Stage I. Complications such as pancreatitis, bowel obstruction and urinary obstruction developed after surgery, but the patient was discharged on the 33rd hospital day. We report on the literature review of 17 cases of S. bovis bacteremia-associated colorectal tumor in Japan, including the present case.