Purpose: Three-course neoadjuvant chemotherapy with cisplatin and 5-fluorouracil plus docetaxel (DCF) has become a standard strategy for locally advanced esophageal squamous cell carcinoma. We have used two-course DCF therapy since 2019 because of intolerance to the three-course regimen. The aim of this study is to compare the outcomes of neoadjuvant chemotherapy with two-course DCF with cisplatin and fluorouracil (FP). Methods: A retrospective analysis was performed for patients treated with neoadjuvant chemotherapy and surgical resection for locally advanced esophageal squamous cell carcinoma between April 2016 and March 2022. Cases were divided into those receiving two-course FP therapy (n=15, FP group) and two-course DCF therapy (n=17, DCF group). The primary endpoint was the overall response rate (ORR) and the secondary endpoints were tolerability and recurrence rate. Results: There were no significant differences in background characteristics between the two groups. Grade 3 neutropenia/febrile neutropenia were found in 1/0 cases in the FP group and 6/3 cases in the DCF group. The completion rates of chemotherapy were 100% and 82.3% and the clinical PD/SD/PR/CR of chemotherapy were 2/6/7/0 and 2/1/14/0 in the FP and DCF groups, respectively. ORR (46.7% vs. 88.2%, P=0.021) and the downstaging rate for clinical stage (20.0% vs. 70.6%, P=0.006) were significantly higher in the DCF group, and DCF therapy was associated with a significantly lower recurrence rate within 1 year (30.8% vs. 0%, P<0.036). Conclusion: Two-course DCF therapy for locally advanced esophageal squamous cell carcinoma achieved a high response rate. Furthermore, the treatment strategy of neoadjuvant chemotherapy may contribute to survival benefits due to favorable tolerance.

A 71-year-old man was referred to our hospital due to duodenal and bile duct strictures. He had a history of distal gastrectomy for gastric cancer 22 years ago. Pancreatoduodenectomy was planned for diagnosis of duodenal cancer or cholangiocarcinoma. Severe adhesion was observed around the gastroduodenal anastomosis. Poorly differentiated adenocarcinoma was detected around the pancreatic parenchyma in intraoperative rapid pathological diagnosis of the resected pancreatic stump. Macroscopic findings of the specimen revealed tumor invasion from outside the bile duct wall. The adenocarcinoma was similar to gastric cancer resected 22 years ago. Due to addition of Alcian blue-PAS staining, peritoneal washing cytology, which had previously indicated cancer cells to be negative in rapid intraoperative examination, revealed positive cancer cells (CY1). Small mesenteric nodules of the small intestine sampled intraoperatively were also diagnosed as poorly differentiated adenocarcinoma (P1). The final diagnosis was local recurrence and peritoneal dissemination of gastric cancer. We report this case as an example of histological diagnosis of late recurrence of gastric cancer 22 years after initial treatment.

A 79-year-old woman underwent chest CT for follow-up of a nodular shadow in the lungs. The scan revealed a mass lesion in the gallbladder and she was referred to our department for further examination and treatment. The fundus of the gallbladder had a progressively contrasted tumor measuring more than 5 cm. Calcification was observed in the center of the stem. The tumor produced mucus with no peritumoral invasion. Thus, it was diagnosed as intracholecystic papillary neoplasm (ICPN), and extended cholecystectomy and sentinel lymphadenectomy were performed. Gross findings of the resected specimen showed a white papillary lesion with mucus accumulation and necrotic areas in the gallbladder cavity. Histopathological examination revealed ICPN with a mixture of low- and high-grade dysplasia and invasive carcinoma in a small area. Histologic subclassification led to diagnosis as a gastric type based on gross findings and MUC staining. Because of the micrometastasis in the #12c lymph node proved by pathological examinations, D2 lymph node dissection was added after the initial surgery.

A 23-year-old male was hit by the handle of a motorcycle during a competitive motorcycle race, resulting in abdominal trauma. The patient developed stomach ache and was transported to the emergency room. Physical examination revealed diffuse abdominal tenderness. CT indicated abdominal ascites and free air. Due to the CT findings, we diagnosed traumatic intestinal perforation and performed an emergency operation. The colon showed segmental clonal intestinal tract wall thickening, with rupture of the transverse colon in a region with less intestinal wall thickening. Partial colectomy and colostomy were performed. The resected specimen had a cobble stone appearance on the intestinal mucosal side and in the region with less intestinal wall thickening and intestinal rupture. Histopathological findings revealed scattered mucosal epithelioid cell granulomas and infiltration of inflammatory cells and lymphatic cyst formation in all cell layers. Based on these findings, the patient was diagnosed with traumatic intestinal rupture due to Crohn’s disease. This is the first report of colonic rupture due to trauma in a patient with Crohn’s disease, with most previous reports describing small clonal intestinal perforation. Thus, we report this case as a rare example of abdominal injury resulting in colonic rupture due to Crohn’s disease.

A 53-year-old woman was referred to our hospital with abdominal pain that occurred after an upper gastrointestinal X-ray examination with a barium contrast. Conservative therapy was started after diagnosis of intestinal obstruction, and her symptoms remitted. However, intestinal obstruction developed again and she was readmitted 10 days after discharge. Contrast-enhanced CT revealed an enhanced neoplastic lesion at the terminal ileum, and exploratory laparoscopy was scheduled. A white solid tumor was found at the terminal ileum and laparoscopic ileocecal resection was performed. The lesion was confirmed to be iliac adenomyoma histopathologically. The patient has remained recurrence-free for 1 year and 2 months postoperatively. Preoperative diagnosis of iliac adenomyoma is difficult on imaging, and the tumor is often asymptomatic and discovered incidentally. Here, we report a case of intestinal obstruction due to iliac adenomyoma that underwent laparoscopic resection.

A 77-year-old male patient presented to our hospital with a chief complaint of lower abdominal pain. Plain CT on admission demonstrated peri-appendiceal and intrapelvic fluid collections with multiple diverticula in the right colon, without an identified appendix, suggesting peri-appendiceal and intrapelvic abscesses caused by appendicitis or diverticulitis. Due to the general condition being impaired, conservative antimicrobial treatment was initiated. Portal vein thrombosis was subsequently diagnosed by contrast-enhanced CT on hospital day 4, and treated with heparin and antithrombin III. The patient resumed an oral diet on hospital day 14, and anticoagulation therapy was switched to edoxaban per-oral. He was discharged on hospital day 29. Post-discharge close examination revealed no abnormality in the appendix, leading to a diagnosis of portal vein thrombosis complicating an intra-abdominal abscess caused by diverticulitis. Laparoscopic right hemicolectomy was performed 3.5 months after initial discharge, after which the patient was discharged uneventfully. There has been no evidence of exacerbation of portal vein thrombosis or any symptoms attributed to the diverticulum for 1 year after surgery. We herein present a rare case of portal vein thrombosis associated with colonic diverticulitis, for which there are limited reports of conservative treatment followed by elective surgery.