This report presents a case of a 48-year-old woman who experienced chronic cough without having been diagnosed with tuberculosis or atypical mycobacteria infections. The patient presented with a one-year history of masses exposed to reddish skin of the right breast. She has a prominent family history of breast cancer. One of her sisters suffered from breast cancer with a germline mutation in BRCA2, therefore the masses were suspected to be advanced breast cancers. A thoracoabdominal computed tomography image revealed linear opacities of the lung parenchymal lesion and the continuity of the breast abscess to abdominal wall via the thoracic cavity. Therefore, we considered that the lesion could be the tuberculosis abscess of the breast penetrating to the thoracic cavity and progressing to the abdominal wall. Mycobacterium tuberculosis was isolated from a culture of sputum. The final diagnosis of tuberculous abscess of the breast was made.

In Japan tuberculosis is on the trend of decrease and breast tuberculosis is a relatively rare manifestation, however, it is still necessary to keep in mind that there is a possibility of extrapulmonary tuberculosis for breast nodules or abscesses.

We herein report this case and provide a review of the pertinent literature.

Mammary-type myofibroblastoma (MTMF) is a relatively rare benign mesenchymal neoplasma that has been reported in diverse body regions. In this study, we report three cases of MTMF in the breast. Although image findings in each case depicted a variety of images, all showed a benign pattern. Histopathologically, the tumors consisted of spindle cells stained with CD34 and desmin. The pathological subtype defined in the WHO classification is palisading/Schwannian-like pattern in two cases and fibrous/collagenized pattern in the other. The ratio between the amount of spindle and stromal cells may lead to different image findings, suggesting that the diagnosis of MTMF is difficult based on images alone, since there are no characteristic findings. We believe that accurate histopathological examination, including immunohistochemistry, is important for diagnosis.

The patient was a 70-year-old woman who had been taking methotrexate (MTX) for rheumatoid arthritis (RA) for six months. A few days before the consultation, she noticed a mass in the right breast and visited our department. The mass was fist-sized, painless, and had good mobility. Axillary lymph nodes were palpable. MMG revealed a high-density mass in the right mammary gland, and ultrasonography showed an irregular low-echo mass with a hallo of 39 × 41 × 33 mm in the right CD region. We diagnosed invasive ductal carcinoma by needle biopsy. CT showed no metastasis, and we diagnosed right breast cancer (cT2N1M0 Stage IIB). Right mastectomy and axillary dissection (Level I + II) were performed. The patient did not experience any problems after surgery and was discharged on the 7^th postoperative day. We diagnosed diffuse large B-cell lymphoma with diffuse infiltration of atypical lymphocytes revealed through histopathological examination, and CD20-positive and GATA3-negative evidenced through immunohistochemistry. Since EBER was negative, Epstein-Barr virus infection was negative. The patient continued the treatment at another hospital.

The patient was a 68-year-old man with an erythematous nodule measuring 11 mm in his lower abdomen. He consulted a nearby dermatologist, and the excisional biopsy suggested a neuroendocrine carcinoma. A computed tomography scan showed hilar lymph node swelling. A video-assisted thoracic surgery biopsy was performed, and the histological findings were similar to those taken from the skin nodule. He was referred to our hospital for the evaluation and treatment of cancer with an unknown primary site. On immunohistochemistry, the tissue specimen was CD56(+), ChromograninA(+), Synaptophysin(+), ER(+), PgR(+), and HER2(-). The MIB-1 was 10-20%. These findings suggested primary breast cancer. The patient was then introduced to our department. The physical examination, mammography, and ultrasonography of the mammary gland and axillary lymph nodes had unremarkable findings. Positron emission tomography scan revealed the mediastinal and right inguinal lymph nodes. The patient was diagnosed with a male occult breast cancer with skin and distant lymph node metastases. Tamoxifen treatment was promptly initiated. He has been taking tamoxifen for four years and has not experienced a relapse. The prevalence of male breast cancer is approximately 0.5% that of female patients. Male occult breast cancer is a rare condition with few reported cases. We report a case of male occult breast cancer and present a review of the literature.

The authors report two cases of a bronchial anomaly in which surgery was performed using differential lung ventilation. Both patients had a tracheal bronchus (TB), with the right upper lobe bronchus arising from the trachea. Case 1 involved a 57-year-old man who had a thymic cyst in the anterior mediastinum, and the right upper lobe apical bronchus branching independently from the trachea (TB). We planned resection of the cyst by video-assisted thoracic surgery (VATS) via the right thoracic cavity, however, decided against it, because the existence of the TB would preclude stable differential lung ventilation. We had not acknowledged that he had a TB before surgery. Ultimately, we could not avoid resection of the cyst via a midline sternotomy. Case 2 involved an 81-year-old woman who had cancer of the right upper lobe bronchus, which branched independently from the trachea (TB). We could perform right upper lobectomy by VATS nearly in the usual manner, although it was necessary to keep in mind that the TB branched out from a more proximal aspect of the trachea than usual. Preoperative grasp of the existence of TB and careful assumption for possible events such as ventilatory insufficiency are important.

A 75-year-old man who was pointed out an abnormality on a chest X-ray was referred to our hospital because of a suspected diagnosis of lung cancer.

Contrast-enhanced chest CT and PET/CT showed a 20 mm-sized non-uniformly enhanced mass protruding from the chest wall in the upper lobe of the right lung with a strong accumulation of FDG (SUVmax 22.5). We suspected primary lung cancer with chest wall invasion and right upper lobectomy + combined chest wall resection + hilar mediastinal lymph node dissection was performed after the definite diagnosis of squamous cell carcinoma was gained by an intraoperative needle biopsy. Pathological examination of the resected specimen showed that the tumor was macroscopically confined to the chest wall and showed an exclusionary growth toward the lung parenchyma, with no obvious cancer lesions in the lung parenchyma. Pathologically, the tumor was diagnosed with primary or metastatic squamous cell carcinoma in the chest wall. After the surgery, no lesions suspected to be the primary lesion were found in other organs, and it was considered to be primary squamous cell carcinoma in the chest wall. Squamous cell carcinoma in the chest wall is an extremely rare disease, and we report it with a review of the literature.

A 51-year-old man with a smoking history presented with right pneumothorax. A chest computed tomography incidentally showed a nodule shadow 2.5 cm in diameter in the left pulmonary upper lobe. The patient underwent thoracoscopic left upper lobectomy with the diagnosis of lung adenocarcinoma. Postoperative course had been good until cerebral stroke occurred on the 9^th postoperative day. A brain magnetic resonance angiography showed the occlusion of the right middle cerebral artery. The patient was transferred to an Acute Ischemic Stroke Center within 2 hours after the onset of the stroke, because we have no facilities for neuroendovascular treatment. He could receive successful recanalization through endovascular thrombectomy at the Center. Ten months later, the patient became ambulatory, and was discharged home. He has no recurrence. Recently, several reports suggest that thrombosis in the stump of the pulmonary vein after lobectomy, especially after left upper lobectomy, causes embolic cerebral infarction on rare occasions. Endovascular thrombectomy is a useful technique for treating acute embolic cerebral infarction after surgical intervention. If it is difficult to provide endovascular thrombectomy for patients with cerebral stroke at our own hospital, it is important to enhance medical collaboration between hospitals on a usual basis for rapid treatment against embolic cerebral infarction.

The patient was a man in his 63-year-old who had undergone right lower lobectomy + lymph node dissection for cancer of the right lower lobe of the lung (pT2N0M0, squamous cell carcinoma) in our hospital 16 years previously. He had been free from recurrence for postoperative 5 years and his periodic follow-up studies were terminated. A chest X-ray film taken at a medical checkup revealed an abnormal shadow. A chest CT scan for close exploration showed a ground-glass opacity appearance 28 mm in maximum diameter including a solid portion in the center of S1b in the right upper lobe. Bronchoscopic lung biopsy revealed the diagnosis of pulmonary adenocarcinoma, cT1bN0M0 cStage I A2. We thus performed right middle lobe preserving right upper lobectomy. As we confirmed funicular adhesion of the middle lobe to the inferior mediastinum during surgery, no preserving strategy to prevent tosion of the middle lobe was necessary. His postoperative course was uneventful and the residual middle lobe did no have a problems in expansion. He was discharged from our hospital. The histological stage was pT1c(4)N0M0 pStage I A3, and other three lesions which could not be predicted before surgery were found. After the surgery expansion of the residual middle lobe is satisfactory.

When the middle lobe is preserved after right upper or lower lobectomy, lobectomy of the residual lobe may pose a problem of causing torsion of the muddle lobe. However, we did not need any strategies to prevent the middle lobe torsion due to the postoperative restiform adhesion.

Percutaneous endoscopic gastrostomy (PEG) has great benefits in terms of nutritional control and ingestion, and it tends to be accepted by nursing homes. Contrary to an increasing tendency of PEG cases, other enteral nutritional methods are often selected if hiatal hernia is associated. We have recently experienced two cases of a hiatal hernia in which we performed laparoscopic hernia repair followed by PEG. This paper reports on the benefits of the PEG based on our experience.

Case 1 involved a 79-year-old woman who had been received enteral nutrition via a NG-tube for difficulty in swallowing due to dementia and cerebral infarction. Since the patient needed long-term nutritional support, we performed laparoscopic repair of the hiatal hernia (Type II), followed by PEG. Case 2 involved an 87-year-old woman who had difficulty in swallowing due to dementia and aging. As she had frequent bouts of aspiration pneumonia, we performed laparoscopic repair of the hiatal hernia (Type IV), followed by PEG. Two patients were discharged from our hospital without having aspiration pneumonia and/or worsening of the nutritional status.

We can select laparoscopic repair of hiatal hernia followed by PEG, even for patients who have a hiatal hernia.

An 81-year-old man who had been aware of right lower quadrant pain for one month was brought into our hospital by ambulance because the pain became worse from one week before. Following close exploration, emergency operation was decided with a diagnosis of mesenteric abscess. We performed partial resection of the small intestine, with adjuvant chemotherapy. A culture did not isolate Actinomyces, but histopathological findings disclosed actinomyces druse within the mesenteric abscess. We diagnosed the case as small bowel mesenteric actinomycosis. Actinomycosis is relatively rare, and especially it is very rare when the disease affects the mesentery of the small intestine like in our case presented here.

A 68-year-old man presented with upper abdominal pain. Spontaneous pain and localized tenderness were observed in the left upper quadrant of abdomen, but there were no signs of peritoneal irritation. Abdominal computed tomography showed multiple diverticula on the mesenteric side of the proximal jejunum and extraintestinal gas in the nearby mesentery. The diagnosis of mesenteric penetration in the jejunal diverticulum was made. Since the abdominal symptoms were slight and the imaging findings were localized, conservative treatment with fasting and administration of antibacterial drugs was selected. A re-examination of the abdomen on the 3rd hospital day revealed exacerbation of mesenteric inflammation and extraintestinal gas, therefore emergency operation was performed on the 4th hospital day. Multiple diverticula were found in the jejunum ranging 60 cm from the vicinity of the Treitz ligament, and, in the jejunal mesentery from 30 cm to 50 cm, inflammatory findings were observed. A partial jejunal resection including the penetration was performed. The patient was discharged 9 days after the operation. Penetration or perforation of the jejunal diverticulum is a rare disease. It has few physical symptoms and may become severe while we are struggling to make the diagnosis. This disease should be kept in mind as a differential diagnosis of acute abdomen by grasping its characteristic imaging findings.

An 80-year-old woman presented with the acute onset of abdominal distension and abdominal pain. She had a history of receiving definitive radiotherapy for cervical cancer four years previously. Since then, she had been hospitalized four times for bowel obstruction, when she was treated conservatively. She was diagnosed with bowel obstruction caused by radiation ileitis with a contrast-enhanced computed tomography and a contrast radiography through an ileus tube. We planned elective surgery for recurrent obstruction. In intraoperative findings, intraabdominal adhesion was mild and her terminal ileum was segmentally constricting. Wall thickening and punctate whitening on the serosal surface of the proximal ileum were also observed. We performed laparoscopic ileocecal resection and massive small bowel resection of about 150 cm segment. After the operation, she suffered from short bowel syndrome, but she was relieved by taking antidiarrheal agents and oral dietary supplements. Radiation enteritis can cause intestinal obstruction and fistula formation and is often difficult to treat. We discuss here the treatment options for radiation ileitis and changes in postoperative nutritional status with a review of the literature.

An 18-year-old man initially presented to a clinic with chief complaints of right lower abdominal pain and diarrhea. He was then referred to our hospital for suspected appendicitis. On admission, abdominal computed tomography showed ileocecal intussusception, and a laparoscopic ileocecal resection was performed. Intraoperative findings showed an invasion of the terminal ileum and cecum into the ascending colon. Macroscopically, several small nodules were found on the lumen of the ileocecal valve. In addition, the wall of the cecum was thickened and the surrounding lymph nodes were swollen. On histopathological assessment, there was proliferation of lymphoid follicles in the ileocecal mucosa. Thus, the diagnosis of intussusception due to lymphoid hyperplasia (LH) was made.

A 40-year-old woman presented complaining of hematochezia. On lower gastrointestinal endoscopy, a submucosal tumorous elevation was identified in the cecum. Contrast-enhanced computed tomography showed thickening of the cecal wall, and diffusion-weighted magnetic resonance imaging showed a hyperintensity at the same site. Appendiceal cancer was suspected, and laparoscopic ileocecal resection was performed. On gross inspection of the resected sample, the appendix had become inverted into the cecal lumen, a sign of appendiceal intussusception. On histopathological examination, there were patches of glands resembling endometrial tissue from the muscularis propria to the subserosal layer, and appendiceal intussusception caused by heterotopic endometriosis was diagnosed. Endometriosis-induced appendiceal intussusception is a rare condition, and its preoperative diagnosis is considered difficult. A case of appendiceal intussusception caused by heterotopic endometriosis that was difficult to differentiate from appendiceal tumor is presented along with a discussion of the literature.

A 70-year-old woman with atypical genital bleeding was admitted to our hospital. Abdominal computed tomography showed a 60 × 30 mm mass of the left ovary and well-enhanced wall thickening of the cecum. She underwent ovariectomy and ileocecal resection. Pathological examination showed goblet cell carcinoid pT4aN2M1 pStage IV. Three months after the operation, peritoneal dissemination was detected. She chose 5-fluorouracil monotherapy instead of doublet therapy including FOLFOX/FOLFIRI combined with molecular targeting agents because of her poor performance status. After the chemotherapy, tumor marker levels decreased markedly, and recurrent tumors shrank.

A case of uni-centric Castleman's disease (CD) that formed in the mesentery of the transverse colon is presented. The patient was a 75-year-old man who was found to have hypoalbuminemia on health screening. Enhanced computed tomography showed a 3-cm mass in the abdominal cavity. Laparoscopic resection was performed for diagnosis. Histological findings showed a Castleman-like lymph node. Since there were no other lesions, uni-centric CD was diagnosed. After 4 years of observation, he had no symptoms of systemic inflammatory responses or recurrences. CD is a benign lymphoproliferative disorder of unknown etiology. Only histological examination can provide a definitive diagnosis. CD has been considered rare, especially in the abdominal cavity, but increasing numbers of abdominal cases are being reported recently. CD has been classified as uni-centric or multi-centric. In uni-centric CD, the clinical symptoms are usually mild and disappear after surgical resection, and recurrences are seldom experienced. However, patients show multifocal lymphadenopathy and chronic systemic inflammatory symptoms in multi-centric CD. Appropriate intervention can provide multi-centric CD patients with a prolonged prognosis. Even after resection, follow-up should continue, focusing on local recurrence, multiple other lesions, and systemic inflammatory symptoms.

A 70-year-old man complaining of perineal pain was brought to hospital by ambulance. Swelling and heat were evident in the left buttock. Computed tomography showed rectal cancer causing stenosis, surrounded by air and fluid retention that had spread into the left buttock. Fournier's gangrene due to rectal cancer was diagnosed, and he was treated with debridement and a colostomy. After postoperative infection control had been achieved, preoperative chemoradiotherapy for the locally advanced rectal cancer was started on postoperative Day 29. The response evaluation was partial response (PR), and total pelvic exenteration and reconstruction with a left gracilis myocutaneous flap were performed on postoperative Day 117. Histopathological examination confirmed R0 resection. Although the patient developed a postoperative pelvic dead space infection, this improved, and at 4 years postoperatively, he remains recurrence-free while undergoing regular outpatient observation.

This case of the long-term survival of a patient with locally advanced rectal cancer and Fournier's gangrene who underwent curative resection after preoperative chemoradiotherapy is reported.

A 51-year-old man with a chief complaint of bloody stool was referred to our hospital. On colonoscopy, multiple mass lesions were found in the ascending colon, transverse colon, sigmoid colon, and rectum. With a diagnosis of six colon cancers, subtotal colectomy was planned. 3D CT-colonography and CT-arterio-venography (CTC-AV) showed that the descending colon could be preserved without impairing curability of the cancers, preserving the left colic artery and inferior mesenteric artery and vein. Laparoscopic extended right hemicolectomy with D3 lymph node dissection (D3LND), laparoscopic low anterior resection with D3LND, and diverting ileostomy were performed uneventfully. The patient's postoperative course was uneventful, and he was discharged from the hospital on the 13^th postoperative day. To preserve the descending colon, his bowel habits were maintained with antidiarrheal drugs, and he could return to his normal social life.

A 29-year-old man with xeroderma pigmentosum was admitted to our hospital for laparoscopic cholecystectomy. Ultraviolet-blocking films were used to reduce the amount of ultraviolet radiation reaching him in the operating room. The patient's postoperative course was uneventful, and he was discharged six days after surgery. Xeroderma pigmentosum is a rare disease, and it is more common in Japan than in Western countries. Because xeroderma pigmentosum is characterized by photosensitivity, effective protection from ultraviolet radiation in the operating room is essential. This case suggests that laparoscopic surgery can be performed safely for patients with xeroderma pigmentosum by taking appropriate perioperative measures to protect patients from ultraviolet radiation.

A 71-year-old man diagnosed with duodenal carcinoma underwent preoperative imaging evaluation, which revealed that the splenic artery (SpA) that supplied the pancreatic body originated as an independent branch of the aorta, with severe arteriosclerosis, suggestive of stenosis at its root. Additionally, collateral flow from the pancreatic head entered the pancreatic body further into the spleen, and the common hepatic artery was completely replaced by the superior mesenteric artery. Pancreatoduodenectomy (PD) was performed ; however, postoperative pancreatic juice leakage persisted with consequent residual pancreatic necrosis, which necessitated residual pancreatectomy and splenectomy, 12 days after PD. Pancreatic head resection may have led to blockage of collateral flow and impaired blood supply to the residual pancreas, which may have been exacerbated by postoperative pancreatitis and pancreatic juice leakage. Blood flow to the residual pancreas is usually maintained by the short gastric, left gastroepiploic, and posterior gastric arteries, and pancreatic necrosis is rare. Therefore, the anatomical peculiarity of the SpA, which independently originated from the aorta, may be implicated as an etiopathogenetic contributor in this patient. We report a unique case of pancreatic necrosis after pancreatoduodenectomy, together with a literature review.

Case 1 was a 52-year-old woman who presented with a chief complaint of upper abdominal pain. Abdominal ultrasound showed a cystic lesion in the tail of the pancreas. Computed tomography (CT) showed that it was a 3-cm multilocular cystic lesion, and on magnetic resonance imaging (MRI), it was hypointense on T1-weighted and hyperintense on T2-weighted imaging. The possibility of malignancy could not be excluded, and spleen-preserving laparoscopic distal pancreatectomy was performed. Case 2 was a 66-year-old woman. A 3-cm unilocular cystic lesion in the tail of the pancreas had been identified on CT 3 years previously, and it had now grown to 5 cm. CA19-9 was also elevated, at 42 U/mL. On MRI, the interior of the cyst was hyperintense on diffusion-weighted imaging and did not communicate with the main pancreatic duct. A mucinous cystic neoplasm was regarded as most likely, and laparoscopic distal pancreatectomy and splenectomy were performed. Histopathological investigations showed that, in both cases, the cyst was surrounded by splenic tissue and that the cyst wall was covered with squamous epithelium or mucosal epithelium, leading to a diagnosis of epidermoid cyst growing in an intrapancreatic accessory spleen. Although accessory spleens are comparatively common, it is rare for a cyst to grow inside an intrapancreatic accessory spleen. Laparoscopic surgery may be an appropriate surgical procedure that combines low invasiveness and the capacity for diagnostic treatment of cystic lesions of the tail of the pancreas that are difficult to diagnose preoperatively.

A 60-year-old woman underwent right nipple-sparing mastectomy with sentinel lymph node biopsy for right breast cancer, followed by breast reconstruction using an extended latissimus dorsi flap. She presented to our hospital with a soft elastic mass and dull pain in her right lumbar area, 5 years postoperatively. Computed tomography revealed a muscle defect with prolapsed retroperitoneal fat in the right lumbar area. Therefore, we diagnosed the patient with a right upper lumbar hernia and performed hernia repair via an anterior approach with the patient placed in the left lateral decubitus position. The hernia orifice (4×3 cm) was identified in the superior lumbar triangle and was repaired using the BARD^® ONFLEX^® modified type L size mesh. The patient was discharged on postoperative day 6, without any complications. Physical examination performed during postoperative follow-up was unremarkable, and the patient denied dull pain or recurrence.

A 70-year-old man was admitted to our hospital for a lump in the left groin. Physical examination showed an egg-sized lump in the left inguinal region. The lump was easily reducible in the supine position, and the patient was diagnosed with a left inguinal hernia. Palpation showed absence of the left testis in the scrotum. Computed tomography revealed prolapse of the sigmoid colon into the hernia sac and a soft tissue shadow at the neck of the sac. Following consultation with the urology department and based on the patient's history of a scrotal injury secondary to a vehicular accident, this shadow was attributed to traumatic testicular dislocation. Dislocated testes may undergo malignant transformation. Therefore, we performed laparoscopic left inguinal hernia repair concomitant with left orchiectomy. Intraoperatively, the soft tissue mass could not be accurately identified as the testis owing to atrophy. Histopathological evaluation of the resected specimen revealed no evidence of testicular malignancy. This is the first Japanese case report that describes an inguinal hernia complicated by traumatic testicular dislocation. We emphasize that careful scrotal palpation is important to confirm the presence of the bilateral testes in the scrotal sac in patients who undergo physical examination for evaluation of inguinal hernia, to avoid missing the diagnosis of testicular dislocation.