A 72-year-old man was diagnosed with stage II esophageal cancer and treated with chemoradiotherapy (CRT) for esophageal preservation. At 69 days after the end of CRT, an aortoesophageal fistula was diagnosed and emergency thoracic endovascular aortic stent graft repair (TEVAR) was scheduled. After TEVAR, conservative control of mediastinitis proved to be difficult. As a result, at 30 days after TEVAR, right transthoracic subtotal esophagectomy and cervical esophagostomy were performed. Thereafter, at 22 days after esophagectomy, the patient underwent left transthoracic removal of an infected aortic stent graft and replacement of the descending aorta. At 35 days after aortic replacement, mediastinitis had healed and the patient was discharged. Many metastases developed over the whole body three months after discharge. Esophageal reconstructive surgery was discontinued and outpatient chemotherapy was initiated.

The patient was a 70-year-old woman who had received definitive chemoradiotherapy for cervical esophageal cancer 8 years ago, and had undergone pharyngolaryngectomy, bilateral neck dissection, free jejunal reconstruction, and permanent tracheostomy for local recurrence 1 year later. The patient visited an internal medicine department with the chief complaint of chest pain. Upper gastrointestinal endoscopy revealed a type 2 lesion with a speckled pattern in the lower thoracic esophagus. A biopsy indicated squamous cell carcinoma and the patient was referred to our department for further examination and treatment. She was diagnosed with cT3rN1M0, cStage IIIA, and underwent two courses of 5-FU+cisplatin as neoadjuvant chemotherapy. McKeown esophagectomy, two-field dissection, gastric tube reconstruction with an anterior sternal route, and cervical free jejunum-gastric tube anastomosis were then performed. There were no postoperative complications such as anastomotic leakage or tracheal necrosis, and the patient was discharged on the 36th day after surgery. We report this case as a rare example of McKeown esophagectomy for esophageal carcinoma in a patient with a history of pharyngolaryngectomy, reconstruction of a free jejunum, and radiotherapy for the upper thoracic esophagus.

A 38-year-old woman was diagnosed with gastric cancer by esophagogastroduodenoscopy performed to investigate the cause of black stools and anemia. Additionally, preoperative imaging suggested the presence of infrapyloric lymph node metastasis. Laparoscopic distal gastrectomy, D2 lymph node dissection, and Roux-en-Y reconstruction were performed for gastric cancer (M, Type 0-IIc+III, tub2>por2, cT2N2M0, cStage IIA). As the infrapyloric lymph nodes were firmly attached to the pancreatic head and duodenum and involved the right gastroepiploic artery, they were carefully dissected and completely resected. A pathological examination showed no malignant findings in the enlarged and hardened lymph nodes; however, there were foamy histiocytes and multinucleated giant cells scattered in the fatty tissue surrounding the lymph nodes, and there was evidence of xanthogranulomatous inflammation. We report this case as an example of xanthogranulomatous inflammation that was difficult to differentiate from lymph node metastasis in preoperative imaging of gastric cancer.

Serous cystic neoplasms (SCNs) usually do not require treatment because most are considered to be benign tumors. However, cases that are symptomatic or show enlargement may require surgery. The patient in the present case was a 76-year-old woman who was diagnosed with SCN of the pancreatic body 16 years ago without follow-up. She visited our hospital with a chief complaint of upper abdominal pain and weight loss. Imaging revealed that the SCN had enlarged markedly, and surgical resection was required. Because it was considered to be difficult to preserve the pancreas head due to suspected tumor invasion of the gastroduodenal artery, we performed total pancreatectomy. Pathological examination of the resected specimen revealed no malignancy. Most SCNs do not need surgical treatment, but those with increasing size with compression or infiltration of surrounding organs require highly invasive surgery. Therefore, regular follow-up and determination of the optimal timing for surgery is important in such cases.

There are few reports on granulocyte colony stimulating factor (G-CSF)-producing retroperitoneal dedifferentiated liposarcoma. A 73-year-old woman was referred to our hospital because she became aware of a mass in the right side of the abdomen. Contrast-enhanced CT revealed a 25-cm large mass with the same density as that of fat in the retroperitoneum around the right kidney. A high density area was present inside the tumor and liposarcoma was suspected. Blood tests revealed a predominantly neutrophilic leukocyte count of 25,300/μl, a negative blood culture, and a normal procalcitonin level, leading to diagnosis of a G-CSF-producing tumor. Resection of the retroperitoneal tumor, right hemicolectomy, right nephrectomy, and right adrenalectomy was performed as curative treatment. The white blood cell count decreased postoperatively and normalized on day 6, and the patient was discharged on day 18. She has since been under outpatient observation for 3 years without recurrence. We report this case as a rare example of G-CSF-producing retroperitoneal dedifferentiated liposarcoma.

A 48-year-old female visited a local hospital 3 years ago due to an abnormal finding on a chest X-ray at her annual medical check-up. CT revealed a cystic tumor in the upper left abdomen. Follow-up CT one year ago showed that the tumor had gradually increased in size and she was referred to our hospital. A physical examination revealed a palpable mass in the left upper abdomen. Contrast CT showed that the retroperitoneal cystic tumor was 10 cm in diameter and had a mural nodule. This tumor was adjacent to the tail of the pancreas, the upper region of the stomach, and the diaphragm. High accumulation of FDG in the mural nodule was detected on FDG-PET. Serum CEA and CA19-9 were elevated. Since increasing tumor size, elevation of serum levels of tumor markers, and abnormal uptake at the mural nodule on FDG-PET suggested malignancy, resection was performed. After a midline incision of the upper abdomen, findings suggested that the tumor had spread to the tail of the pancreas, hilum of the spleen, and part of the diaphragm; therefore, the retroperitoneal cystic tumor was completely removed by distal pancreatectomy and splenectomy with partial resection of the diaphragm without intraoperative tumor rupture. Pathologically, the tumor was diagnosed as primary retroperitoneal mucinous cystadenocarcinoma with a mural nodule of a sarcomatoid component. The patient has received S-1 as adjuvant chemotherapy and there has been no evidence of recurrence for 6 months after the operation.

Adenosquamous carcinoma, in which adenocarcinoma and squamous cell carcinoma are simultaneously present in the same lesion, is rare among gallbladder cancers and is considered to have a poor prognosis. In this study, we retrospectively reviewed the cases of 10 patients who underwent surgical resection for adenosquamous carcinoma located in the gallbladder from 2008 to 2022. The most common surgical procedure was gallbladder bed resection (8 cases), and concomitant resection of other organs was performed in 4 cases. Eight cases were T3/4, 6 had positive lymph nodes metastasis, and 8 achieved R0 resection. Three cases had postoperative complications of Clavien-Dindo grade 3 or higher. The median overall survival after resection was 6.7 months, and 3 of the 4 patients who were able to receive adjuvant therapy survived for more than two years. The prognosis tended to be poor in cases with postoperative complications or lymph node metastasis. Adenosquamous carcinoma of the gallbladder is a tumor with a poor prognosis even if radical resection can be performed because the disease is often advanced when detected. Introduction of multidisciplinary treatment is likely to improve the oncologic outcome.