Capecitabine (X) and cyclophosphamide (C) can be administered orally and have synergistic effects with non-overlapping toxicities in patients with metastatic breast cancer (MBC). We administered XC therapy to heavily pretreated patients with MBC with excellent efficacy and minimal toxicity. A retrospective review was conducted of 67 patients with human epidermal growth factor receptor (HER) 2-negative MBC treated with XC therapy. The overall response rate was 41.8%. The median progression-free survival (PFS) was 9.2 months, and median overall survival (OS) was 31.5 months. The median PFS was 22.2 months in patients who suffered from hand-foot syndrome (HFS), but was 8.3 months in patients without HFS (p = 0.0003). HFS could be used as a prognostic factor. After disease progression (PD) was observed with administration of X (n = 7), additional administration of XC was effective (Response rate RR = 28.6%). After PD was observed with paclitaxel + bevacizumab (n = 12), XC was effective (RR = 33.3%). Grade 3 or 4 leukopenia was observed in 17.9%, and neutropenia was observed in 14.9% of patients. HFS was observed in 7.5% of patients, although no cases of grade 4 HFS occurred. Only two patients with grade 2 and 3 hemorrhagic cystitis interrupted therapy. XC therapy may be a promising oral chemotherapy that maintains good quality of life and is preferable for patients with MBC.

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The 2013 Clinical Practice Guidelines for Hepatocellular Carcinoma mention that drain placement is not always necessary after elective liver resection. However, No-drain policy has not been widely used. In principle, a prophylactic drain is not placed after hepatectomy, in our institution. This study was designed to assess the feasibility of non-drain policy after hepatectomy by investigating postoperative complications in patients without abdominal drainage. The study included 270 patients who had undergone liver resection without placement of drains in our institution between January 2009 and December 2015. Among the 270 cases, 24 cases (8.9%) exhibited postoperative complications ≥ grade II by the Clavien-Dindo classification. The complications included pleural effusion and/or ascites (n = 6), intra-abdominal abscess (n = 3), ileus (n = 3), cardiopulmonary event (n = 3), wound infection (n = 3), bile leakage (n = 2), liver failure (n = 1), and others (n = 3). Among these, 7 cases (2.6%) required postoperative abdominal drainage. The above mentioned incidence of postoperative complications in our series without drain after liver resection was better than that reported in previous studies, suggesting the feasibility of omitting a prophylactic drain after hepatectomy.

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BACKGROUND : Laparoscopic cholecystectomy (LC) is a standard treatment modality for gallbladder disease. This study aimed to evaluate the relationship between body mass index (BMI) and outcomes of LC.
METHODS : Data pertaining to 189 patients who underwent LC at Nakagami Hospital for symptomatic cholecystolithiasis, acute cholecystitis, or chronic cholecystitis between December 2014 and November 2015 were analyzed. Patients were divided into four groups based on BMI. Operation time, intraoperative blood loss, complication rates, and postoperative length of stay (LOS) were compared.
RESULTS : No significant differences were observed among the BMI groups with respect to operation time, intraoperative blood loss, complication rates, or LOS.
CONCLUSIONS : In this study, no significant difference between normal weight and obese patients was found for any of the outcomes of LC.

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[Purpose] Standard treatment protocols or surgical methods for treating perforations near the duodenal papilla are not established. We aimed to determine an appropriate treatment protocol after reviewing operative outcomes of cases of perforation near the duodenal papilla.
[Objectives and Methods] We reviewed the findings of eight cases where patients had been operated on for perforation near the duodenal papilla, in our hospital, from January 2008 to December 2015. We evaluated the relationships between time from the onset to operation, intraoperative inflammation, degree of peritonitis, and short-term outcomes. The treatment protocol in our hospital involves operating as soon as possible after diagnosis, and we performing simple closure if intraoperative inflammation and peritonitis are mild to moderate.
[Result] The mean time to operation from symptom onset was 16.1 h. Inflammation and peritonitis became more severe as time to operation increased. Complications were detected in three cases ; none was greater than Clavien-Dindo IIIb, and no patient died during hospitalization.
[Conclusion] Good results may be achieved by performing simple closure in cases with slight inflammation and peritonitis. Surgery should be performed as soon as possible because the degree of inflammation and peritonitis is related to the time to operation.

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A 37-year-old women suffered a contusion to the left side of her chest while playing with her toddler 2 weeks prior to presentation. She then noticed swelling, redness, and induration of her entire left breast. She also had painful red nodules on both legs and palms and was evaluated at our clinic. CT and MRI showed early and persistent contrast enhancement of the entire left breast, but without evidence of a tumor.
The patient was diagnosed with acute mastitis and erythema nodosum, antibiotics and prednisolone were started, and the fever resolved rapidly with improvement in the erythematous nodules. However, fever again developed 2 days after completing treatment, and prednisolone was resumed. Drainage was performed for a well-demarcated abscess in the left breast. Aspiration biopsy showed an epithelioid cell granuloma with marked lymphocytic infiltration and multinucleated giant cells. The diagnosis was granulomatous mastitis.
Incision and drainage were required even after prednisolone was tapered and discontinued. Fever has not recurred during 7 months of follow-up. Granulomatous mastitis with erythema nodosum in a patient with a chest contusion has not previously been reported in Japan. This case is reported along with a discussion of the relevant literature.

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The patient was a woman in her seventies who was detected to have a right breast mass on CT scan performed at another hospital. Mammography (MMG) revealed a tumor shadow of a category 3 in the right C, and ultrasonography (US) showed a 9.8 × 10.7 mm tumor of a category 3 in the right C area. On magnetic resonance imaging (MRI), it was a clearly demarcated oval-shaped tumor, which showed low signal intensity on T1-weighted images and heterogeneously high signal intensity on T2-weighted images. Dynamic CT scan revealed dotted enhancement in the inner part in an early phase which spread over the whole with time. Aspiration biopsy cytology (ABC) resulted in Class III. Following a core needle biopsy (CNB), invasive ductal carcinoma was diagnosed. Preoperative examinations revealed no distant metastases. At surgery, we performed right partial mastectomy and sentinel lymph nodes biopsy. The histopathological diagnosis was atypical epithelioid fibrous histiocytoma.
As we have experienced a case of benign fibrous histiocytoma arisen in the breast which is rare, we here present the case.

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Treatment of breast cancer developing at the site of pacemaker implantation poses various problems. We report the treatment strategies we employed in 3 cases of breast cancer on the left side developing at the site of pacemaker implantation to treat complete atrioventricular block. Case #1. Left breast cancer : Breast-conserving surgery of the left-sided breast cancer was performed after reimplantation of the pacemaker in the right chest. Case #2. Left breast cancer : Mastectomy and sentinel lymph node (SLN) biopsy were performed, as the cancer was not directly at the site of the pacemaker implantation. The SLN biopsy revealed macrometastasis ; however, to avoid malfunction of the pacemaker, axillary lymph node and post-mastectomy radiotherapy was not administered. Case #3. Left breast cancer in a woman with repeated pacemaker infections ; the border between the cancer and the infectious scar was indistinct. In this case, the lead of the pacemaker needed to be cut so that the mastectomy could be performed. We need to pay greater attention to these problems in patients with pacemakers, because their numbers are expected to increase with the aging of the population.

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Acute superior mesenteric artery (SMA) occlusion is generally considered to have a poor prognosis. In particular, such an occlusion associated with SMA gas embolism is very rare, and recovery from it has not been reported. A case of a 65-year-old woman with SMA gas embolism, who resumed her daily life following multimodal rescue therapy, is reported. She was initially referred to our hospital for acute epigastralgia. Multi-detector row computed tomography (MDCT) demonstrated a contrast defect in the SMA. On angiography, SMA occlusion was seen just after branching of the first jejunal artery, which was treated by thrombectomy and thrombolytic interventional therapy. Consequently, peripheral arteries from the SMA including the ileocolic artery restored the imaging effect through the marginal artery of the first to fourth jejunal artery, but simultaneous MDCT showed a small amount of portal venous gas. Close observation was maintained because of peripheral mesenteric artery enhancement. Two hours later, MDCT demonstrated gas embolism in the SMA, after which an emergency operation was performed. The jejunum to 20 cm in the ascending colon, corresponding to the range of SMA gas distribution, was resected. The patient is now alive, 1 year and 4 months after surgery. SMA gas embolism is a rare and severe condition, but appropriate surgery may lead to a good prognosis.

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A 72-year-old man noticed discomfort in the popliteal fossa when bending his knees. CT angiography of the leg showed a giant popliteal aneurysm from the left distal superficial femoral artery (SFA) to the popliteal artery (PA). Surgery was performed under general anesthesia using a combined medial and posterior approach for aneurysm resection and graft replacement.
First, a medial approach was made from above and below the knee, and the distal SFA proximal to the popliteal aneurysm and distal PA were taped. Then, graft replacement was performed using an 8-mm vascular graft with distal end-to-side anastomosis and proximal end-to-end anastomosis. Next, through a posterior approach, the aneurysm was dissected as much as possible, and the PA distal to the aneurysm was ligated and dissected. With the patient in a supine position, again through a medial approach, the aneurysm was dissected proximally, and the inflow branches were dissected to complete the aneurysm resection.
The patient had a good postoperative course without leg ischemia. In patients with a giant popliteal artery aneurysm extending in the long-axis direction, a combined medial and posterior approach is very useful to ensure an adequate operative field and enable complete exposure of the aneurysm.

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The case involved a 58-year-old woman who had been on hemodialysis due to diabetic nephropathy. A plain chest X ray examination pointed out a mass image in the left lung. The size of the mass increased with time, and she was referred to our department. We performed partial resection of the lung by using thoracoscope, without gaining definitive diagnosis. A synovial sarcoma was suspected by postoperative pathological examination, and split signal was detected in more than 50% of the neoplastic cells by the close inspection by the FISH method using the SS18 probe. Combined with other findings, a single phase type synovial sarcoma was diagnosed. We judged it to be primary in the lung, because otherwise normal even in the orthopedic examinations after the definitive diagnosis. She is now alive without having recurrence in the whole body after four years from the surgery. Primary pulmonary synovial sarcoma is very rare, and few clinical experiences have not clarified the features of the disease. It is reported that about half of the patients die of this disease and the prognosis is poor. We need enough follow-up studies and the accumulation of cases, because no effective chemotherapies have been established as yet.

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The case involved a 59-year-old man who underwent right trans-thoraco-abdominal subtotal esophagectomy and gastric tube reconstruction via retro-sternal route about 4 years and 2 months earlier. There were previous histories of chronic renal failure and oral intake of aspirin for sequela of cerebral infarction. He had been on oral intake of proton pump inhibitor(PPI) and recurrence free. He had received yearly esophagogastroduodenoscopy (EGD), and no ulcer was found at the previous EGD conducted 6 months previously. He had noticed tarry stool since 10 days earlier, and was brought into our hospital by ambulance because of severe pain from the anterior thoracic region to the back. Close exploration offered the diagnosis of perforation of an ulcer in the gastric tube into the pericardium. On the same day, we performed pericardial drainage that resulted in symptomatic remission. EGD performed on the 16^th hospital day confirmed absence of perforation findings and oral PPI regimen was resumed. He was discharged from the hospital to home on the 22^nd hospital day. The patient had undergone periodic EGD during the PPI regimen and showed Helicobacter pylori antigen negative. This case suggests that there is a possibility of causing ulcer at the gastric tube even possible prophylactic strategies are employed. Not the least cases followed a fatal course have been reported so that prompt pericardial drainage may be mandatary if it occurs.

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The patient was a 50-year-old man who underwent laparoscopic distal gastrectomy for gastrointestinal stromal tumor (GIST) of the stomach with lymph node metastasis at the age of 48. He was classified as a patient at high risk of developing recurrence by the Fletcher's classification and imatinib mesylate was administered after the surgery. A CT scan revealed a 2-cm solid mass in the perigastric mesentery 18 months after the GIST surgery. Recurrence of GIST was clinically suspected and he underwent the resection of the tumor with a part of the gastric wall to where the tumor continued. The resected tumor was elastic-hard and the section was white and solid. Histopathology revealed the growth of spindle-shaped tumor cells surrounding collagen fiber progression ; no mitosis was found. Since c-kit, CD34, and DOG-1 were negative and nuclear β-catenin was positive on immunohistochemical staining, he was diagnosed with intra-abdominal fibromatosis (IAF). It may be impossible to distinguish between GIST and IAF clinically. So far no cases of gastric GIST associated with IAF have been reported in Japan. We here report a rare case of IAF that developed during imatinib administration and mimicked recurrence of GIST of the stomach.

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A 62-year-old man complaining of epigastric discomfort was found to have a type 3 tumor at the posterior wall of the upper body of the stomach by esophagogastroduodenoscopy. Following a biopsy, moderately differentiated tubular adenocarcinoma (tub2) was diagnosed. Laparoscopic-assisted total gastrectomy was performed. Histopathology revealed that the tumor was mainly composed of invasive micropapillary carcinoma (IMPC) where adenocarcinoma cells showed a micropapillary growth pattern with lacuna formation between the surrounding stroma, accompanying by the coexistence of tub2. The final diagnosis of the tumor was 35 × 30 mm in diameter, T3 (SS), ly2, v2, N2 (3/60), and Stage IIIA. Adjuvant chemotherapy with TS-1 was conducted. No recurrence has occurred as of 5 years after the operation.
IMPC effects the breast, lung, salivary gland, urinary bladder, and large intestine. It is a highly malignant tumor associating with lymphatic invasion and lymph node metastasis in high frequencies, and hence carries a poor prognosis. As clinical reports on IMPC of the stomach are extremely few, we present our case with a review of the literature.

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The patient was a man in his seventies who underwent total gastrectomy for gastric cancer (pStage Ib) associated with partial situs inversus with multiple visceral malformations about one year and seven months earlier. Following a one-year oral administration of TS-1, recurrence occurred in the jejunal loop. As non-curative factors other than the local recurrence were absent, the jejunal loop was resected that contributed to an improvement of his quality of life (QOL). We present this case with a review of the literature.

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A 41-year-old woman without previous medical histories was admitted to our hospital due to abdominal pain. Abdominal CT scan showed wall thickening and an obstruction at the terminal ileum. Small bowel series, ileum-endoscopy and biopsy failed to reveal apparent cause of the obstruction. A possibility of a tumor or enteritis was ruled out. She recovered through conservative therapy, and was discharged. Two months later, she was brought into our emergency department again, complaining of acute abdominal pain. Abdominal CT scan revealed small vowel obstruction, ascites and intra-abdominal free air. On the same day, an emergency operation was performed with a diagnosis of perforative peritonitis. We employed laparoscopic-assisted ileocecal resection. The histopathological diagnosis was intestinal endometriosis. The patient has been treated with endocrine therapy at the gynecological department and shows no recurrence as of 8 months after the operation. We report a rare case of intestinal endometriosis with perforation due to intestinal obstruction.

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The patient was a 40-year-old man who had visited his previous doctor with the complaints of black stools and dizziness. Blood tests showed severe anemia, and upper gastrointestinal bleeding was suspected. He had undergone contrast CT and had been diagnosed with small bowel bleeding ; he was then referred to our hospital. When admitted to our hospital, CT was performed again and revealed no extravasation, but an enhanced mass of 7.5 mm, which was considered the source of bleeding, was seen. Urgent enteroscopy was performed, and a semi-pedunculated tumor of 10 mm was observed in the ileum. Neither bleeding from the tumor nor progression of anemia was observed, so elective single-incision laparoscopic surgery with partial resection of the small intestine was performed after confirming that there was no other bleeding source. On pathological examination, the diagnosis was pyogenic granuloma. Pyogenic granuloma occurs rarely in the digestive tract, and there are only 12 reported cases that originated from the ileum in Japan. However, because severe anemia often occurs, this disease should be noted as a cause of gastrointestinal bleeding, and an algorithm from its diagnosis by dynamic CT and enteroscopy to treatment such as laparoscopic surgery is useful.

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We report a case of an ovarian abscess that was associated with appendicitis. A 34-year-old woman visited our hospital with the chief complaints of acute abdominal pain and high grade fever. She had no history of sexual exposure. On the basis of the CT and MRI findings, the patient was diagnosed as having appendicitis and a right ovarian abscess. Appendectomy and unilateral salpingo-oophorectomy were performed. Based on histopathological examination of the resected specimens, the patient was diagnosed as having an ovarian abscess secondary to chronic appendicitis. There was no evidence of malignancy either in the appendix or in the ovary. Ovarian abscess secondary to appendicitis is rare, therefore, we report this case, with some review of the literature.

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A 48-year-old man was told during a periodic health examination in 2015 that his stool was positive for occult blood, and colonoscopy was performed. Colonoscopy showed multiple polyp aggregates from the cecum to the middle of the transverse colon. Follow-up colonoscopy was scheduled, but in June 2016, the patient was evaluated as an emergency outpatient with a chief complaint of fever and persistent right abdominal pain. Colonoscopy at that time showed marked enlargement of multiple tumor-like polyps in the colonic lumen that made passage of the colonoscope through the ascending colon difficult.
Contrast abdominal CT showed large masses from the ileocecal (Bauhin's) valve to the hepatic flexure. An area of obstruction was seen, and since a malignancy with inflammation could not be ruled out, the patient was urgently admitted to the hospital. On hospital day 9, an extended right hemicolectomy was performed. Histopathology showed filiform polyposis. This case of filiform polyposis requiring resection in a patient without a history of chronic inflammatory bowel disease such as Crohn's disease or ulcerative colitis is reported, along with a review of the relevant literature.

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A 64-year-old man with a chief complaint of abdominal pain was evaluated by his physician in April 2016. A CT scan showed a 12-cm lesion with low density in the abdomen. Colon perforation with abscess formation was diagnosed, and the patient was transported to our hospital. Contrast CT showed a well-demarcated lobular lesion without contrast enhancement, and some type of tumor was suspected. Abdominal ultrasound and MRI suggested a cystic lesion, but no definitive diagnosis could be reached. The patient remained symptomatic, and surgery was performed because a malignancy could not be ruled out.
Laparotomy showed an elastic soft lesion in the right upper abdomen, a right hemicolectomy was performed, and the lesion was completely resected. Macroscopic examination showed a 12-cm cystic lesion filled with a yellow serous fluid. Histopathology showed a cyst wall comprised of fibrous connective tissue with inflammatory cells, but without epithelial cells. A mesenteric pseudocyst was diagnosed. Mesenteric pseudocysts are rare in adults. This case is reported, and the relevant literature is reviewed.

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We report the cases of two patients with electrolyte depletion syndrome caused by tubulovillous adenoma of the rectum that had transformed to T3 cancer. The patients were a 62-year-old man and a 79-year-old man, both of whom presented with severe diarrhea and consciousness disturbance. Blood examinations showed severe hypokalemia and evidence of acute kidney injury. Colonoscopy performed to investigate the cause of the diarrhea showed a tubulovillous tumor of the lower rectum with malignant transformation in both patients. In both patients, radical resection, namely, abdominoperineal resection with lymph node dissection was performed, and the persistent diarrhea and electrolyte imbalance improved promptly after the surgery. Histopathological examination showed villous adenoma of the rectum that had transformed to T3 cancer in both cases.

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A 60 year-old man, who underwent right lateral hepatic sectionectomy, transcatheter arterial chemoembolization (TACE), and radiofrequency ablation (RFA) for chronic hepatitis C virus-related hepatocellular carcinoma (HCC), was found to have a 35 mm solitary mass in the spleen during abdominal ultrasound and computed tomography (CT) in December 2015. Contrast-enhanced CT and magnetic resonance imaging revealed no viable lesion of HCC in the liver despite increased AFP and PIVKA II, suggesting the splenic tumor was a metastasis of HCC. Splenectomy was performed in January 2016 in order to avoid the risk of rupture and to increase long-term survival. Operative findings revealed no dissemination. Macroscopically, the splenic tumor showed a yellowish expanding growth with a capsule measuring 38×31 mm in diameter that was limited to the splenic parenchyma. Histological and immunochemical examination confirmed splenic metastasis of HCC, negative for lymphatic metastasis of the splenic hilum. We report a rare case of solitary splenic metastasis of HCC.

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The case involved a 73-year-old man who had been on anticoagulation therapy after coronary artery bypass surgery and aortic valve replacement for ischemic cardiomyopathy. He presented to our emergency clinic because of persisting epigastralgia. When he was seen, the blood pressure was as low as 97/62 mmHg, and the palpebral conjunctiva looked pale. Blood analysis showed the low Hb level of 8.5 g/dl. Increases in the biliary enzyme levels and the bilirubin level were noted, and stool examination was positive for occult blood. Biliary hemorrhage was likely. An abdominal CT scan showed findings suggestive of hemorrhage within the gallbladder. MRI revealed findings suggestive of the acute phase of hemorrhage. Accordingly gallbladder hemorrhage was diagnosed and laparoscopic-assisted cholecystectomy was performed. After the operation, increased biliary enzymes and jaundice were normalized with time and no hemorrhagic complications were associated. The patient improved and was discharged from the hospital on the 8^th postoperative day.
Gallbladder hemorrhage is a comparatively rare entity and anticoagulation therapy has a risk of causing the disease. Since hemostasis can be easily achieved by surgery and the prognosis is favorable so that early diagnosis is important. When we encounter acute abdomen during anticoagulation therapy, gallbladder hemorrhage must be considered as a differential diagnosis.

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A 78-year-old man who visited a neighboring hospital because of jaundice was referred to our hospital. Preoperative imaging diagnosis was distal bile duct cancer associated with preduodenal portal vein, intestinal malrotation, left side gallbladder, and preduodenal common bile duct.
Pancreaticoduodenectomy was performed. It was clarified that the portal vein, the right hepatic artery, and the common bile duct had pursued on the anterior aspect of the duodenum, concomitant pancreatitis was associated, and the tumor was easily bleeding. We dissected surroundings of the portal vein and right hepatic artery, pulled out the pancreas to the left side, transected the pancreas, and removed the surgical specimen. The postoperative course was uneventful, and he was discharged from the hospital on the 11^th postoperative day.
The patients with bile duct cancer who have unnatural run of the portal vein can also have other developmental anomalies like in our case. Preoperative diagnosis is important and careful operative procedures are crucial for them.

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An 83-year-old woman with abdominal pain and liver dysfunction was referred to our hospital. Examinations revealed a bile duct carcinoma, and pancreaticoduodenectomy was performed. When the pancreatic head was dissected from the portal vein, we discovered that the uncinate process of the pancreas extended to the left behind the portal vein and that it fused continuously with the pancreatic body on the left side of the portal vein. We re-evaluated the preoperative computed tomography scan and found that this anomaly had been detectable. Therefore, we diagnosed this case as portal annular pancreas. A single pancreatic duct was observed and it ran through the pancreas on the ventral side of the portal vein. We dissected the pancreas and transected its body to the left side of the fusion part. This procedure made it possible to perform the usual anastomosis between the pancreas and jejunum. Postoperatively, pancreatic fistula developed but improved in response to conservative management. When pancreaticoduodenectomy is performed for patients with portal annular pancreas, we need to consider surgical procedures including transection and reconstruction of the pancreas. However, as similar reports are extremely rare, the standard operating procedure is not established. Here, we report our case with a review of the relevant literature.

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Anaplastic carcinoma of the pancreas is a subtype of invasive ductal carcinoma that has a poorer prognosis than common pancreatic ductal carcinoma. We report two cases of anaplastic carcinoma originating from intraductal papillary mucinous neoplasm with long-term survival. The first case was 66-year-old woman who presented with obstructive jaundice and a multilocular cystic tumor 35 mm in diameter with contrast enhancement was found in the pancreatic head. The patient was diagnosed with branch main duct intraductal papillary mucinous carcinoma and she underwent subtotal stomach-preserving pancreaticoduodenectomy. The pathological diagnosis was anaplastic carcinoma originating from intraductal papillary mucinous neoplasm, osteoclast-like giant cell type. The patient remains disease-free 6.5 years postoperatively. The second case was a 70-year-old woman who presented with abdominal distention and she was found to have main pancreatic duct dilation. The patient was diagnosed with main duct intraductal papillary mucinous carcinoma and she underwent subtotal stomach-preserving pancreaticoduodenectomy. The pathological diagnosis was anaplastic carcinoma originating from intraductal papillary mucinous neoplasm, spindle-cell type. The patient remains disease-free 5.5 years postoperatively. In anaplastic carcinoma, there is a different clinical course depending on histological type and origin, and cases with long-term survival after R0 resection have been reported, similar to our experiences.

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A 72-year-old woman who had been admitted to hospital with a nontuberculous mycobacterial infection was incidentally found to have an 18-mm splenic artery aneurysm at the hilus of the spleen with no evidence of rupture on abdominal computed tomography. The following year, the splenic artery aneurysm had grown to 19 mm in diameter, and it was concluded that observation could be continued. However, two years after observation began, she was admitted to hospital with purulent spondylitis, and the aneurysm had grown to 47 mm in diameter. Thus, the spleen was resected. The resected specimen showed a splenic artery aneurysm at the hilus of the spleen with severe atherosclerosis. A case of a giant splenic artery aneurysm that expanded rapidly during observation is described.

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Benign metastasizing leiomyoma (BML), which refers to metastasis of a histologically benign leiomyoma to distant organs, is a very rare condition. Most patients with BML have a history of undergoing surgery for uterine leiomyoma. Herein, we report a case of BML in the abdominal cavity of a 47-year-old premenopausal woman who had undergone hysterectomy for uterine leiomyoma 7 years earlier. PET examination revealed an abdominal tumor on the right side of the abdominal cavity. Laparoscopic resection of the tumor was performed, and histopathological examination of the resected specimen revealed the diagnosis of BML. The histological findings of the tumor were identical to those of the previously resected uterine leiomyoma. There was no evidence of malignancy, such as atypia or mitoses, in the tumor. Immunohistochemistry revealed positive staining for both estrogen receptor and progesterone receptor. Until now, 42 months since the laparoscopic resection, the patient remains free of recurrence.

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We report the case of a patient with recurrent malignant solitary fibrous tumor (SFT) in the abdominal cavity who underwent for the recurrent tumor three times over a period of 11 years after the first resection. An 87-year-old woman who was admitted to our hospital for depression complained of abdominal fullness. She had undergone resection for extrapleural SFT at 77, 80 and 83 years of age. Abdominal CT showed a large mass in the abdominal cavity extending from the pelvis to the upper abdomen. CT angiography demonstrated the feeding arteries for the tumor arising from the internal iliac arteries and inferior gastric arteries of both sides. We performed resection of the tumor under the diagnosis of recurrent extrapleural SFT. The resected specimen was 29 × 27 × 9 cm in size and weighed 1900 g. The cut-surface showed an en-capsulated solid mass with hemorrhagic and necrotic areas. Histopathological examination revealed fibroblast-like cells in a patternless arrangement, with mitotic figures in 4/10 high-power fields. Immunuhistochemistry revealed positive staining of the neoplastic cells for CD34, Bcl-2, MIB-1 and STAT6. The histopathological findings closely resembled the findings of the previously resected recurrent SFTs. The patient survived for more than 11 years despite developing SFT recurrence three times.
Malignant extrapleural SFT shows a high potential for recurrence, and patients with this tumor should be carefully followed up for long periods of time.

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