We report the case of a 58-year-old man who underwent open distal gastrectomy for gastric cancer in July 2012. Pathological finding revealed a tumor with: L, less, tub2>por1, pT1b(SM2)N0M0, pStage IA. The patient was followed up postoperatively and CT 12 months after surgery revealed a mass lesion in the pancreatic head, which was diagnosed as a local recurrence. In August 2013, because there were no elevated tumor markers and no other recurrence findings on imaging, the patient underwent open pancreaticoduodenectomy, partial hepatectomy, and partial transverse colon resection. After reoperation, S-1 was administered orally for one year as adjuvant chemotherapy, followed by observation. Nine years after resection, the patient remains alive without recurrence. The disease was localized, and this case indicates that surgery is a treatment option for local recurrence of gastric cancer if radical resection is feasible.

The prognosis of hepatocellular carcinoma (HCC) with inferior vena cava tumor thrombus (IVCTT) is very poor due to a high incidence of postoperative recurrence. We report the case of a patient with HCC with IVCTT who has survived for 14 years with radical surgical resection and postoperative antiviral therapy with nucleoside analogues (NUCs). A 47-year-old man with hepatitis B virus infection was referred to our hospital for fever of unknown origin. Using serial imaging studies, he was diagnosed with HCC of 12 cm in the right liver with a tumor thrombus extending via the right hepatic vein into the IVC. The stage was T3N0M0 (General Rules for the Clinical and Pathological Study of Primary Liver Cancer, 6th edition). Right hepatectomy and removal of the IVCTT combined with the IVC wall was performed. NUC therapy has been administered from 3 months after surgery. At present, 14 years after the surgery, the patient remains HBV-DNA negative and there has been no sign of recurrence.

Hepatopancreatoduodenectomy was introduced for curative resection of cholangiocarcinoma with extensive intraductal extension and has been reported to have a good outcome in patients with R0 resection and negative lymph node metastasis. However, surgical mortality and postoperative complication rates remain high, and guidelines clearly state that patient selection and surgical indication must be determined with due consideration of safety. In this report, we describe a case of cholangiocarcinoma with extensive intraductal extension in an elderly patient who underwent right hemihepatectomy with combined resection of the caudate lobe and extrahepatic bile duct and postoperative radiotherapy to avoid hepatopancreatoduodenectomy, with a good outcome.

A 72-year-old male presented to our hospital with fever and right abdominal pain. Physical examination revealed a painful and palpable mass on the right hypochondrium. Laboratory findings showed elevated inflammatory markers. Abdominal CT showed a swollen and irregularly thickened wall of the gallbladder and fluid collection around the gallbladder, suggestive of an abscess. Acute cholecystitis with abscess was diagnosed, and the patient was treated with percutaneous transhepatic gallbladder drainage and antibiotic therapy. Cytology of bile showed no malignant findings. One month later, complete cholecystectomy was performed. The resected specimen showed a raised cauliflower-like lesion throughout the gallbladder mucosa. Histopathological examination gave a final diagnosis of intracholecystic papillary neoplasm (ICPN) with associated invasive carcinoma with xanthogranulomatous cholecystitis (XGC). In recent years, the concept of ICPN as a precancerous/early cancerous lesion of the gallbladder has been recognized, but its coexistence with XGC is extremely rare. Therefore, we present this case as an example of this condition with a literature review.

A female patient underwent enucleation of a solid-pseudopapillary neoplasm (SPN) of the pancreatic head at 12 years of age, followed by a total of four surgeries for local recurrence, duodenal metastasis, and liver metastasis. At 45 years of age, a hilar mass and two hepatic masses were found, and a fifth resection was performed with diagnosis of local recurrence and liver metastasis. She has been free of recurrence for 3 years since the last surgery. Pancreatic SPN is generally considered to be a low-grade tumor with low metastatic potential and low recurrence rates, and cases of patients who undergo four surgeries for recurrence and survive for more than 30 years are rare. Several factors have been investigated to identify highly malignant SPN, but no conclusive evidence has been established. Long-term postoperative follow-up appears to be required throughout life.