We report a rare case of spindle cell carcinoma of breast. A 52-year-old woman was admitted to hospital due to right large breast tumor. Core needle biopsy had demonstrated invasive carcinoma in previous hospital. After neoadjuvant chemotherapy, total mastectomy and axillary lymph node dissection were performed. Histopathologic analysis showed spindle cell carcinoma. Immunohistochemical staining showed that the cancer cells were slightly positive for estrogen receptor antibody, negative for progesterone receptor antibody and negative for HER2/neu protein. Postoperative adjuvant endocrine therapy was performed. 3 years later, CT revealed a solitary mass on the lower lobe of right lung. A partial lobectomy was performed utilizing VATS. Pathological diagnosis showed lung metastasis of spindle cell breast carcinoma. Postoperative endocrine therapy and chemotherapy was performed. The patient is doing well, without recurrence and metastasis 4 years after lung surgery.

The case was a 54-year-old male patient. He had a medical history of gastric ulcer. At the age of 42, he was performed partial resection of the jejunum due to perforation of multiple jejunal ulcers. After the initial surgery, he was again diagnosed with gastrointestinal perforations. Zollinger-Ellison Syndrome was strongly suspected and pancreaticoduodenectomy was performed. Histological examination of the resected specimen revealed multiple duodenal submucosal gastrinomas and non-functioning pancreatic neuroendocrine tumors. He visited a neighboring hospital because of a back pain in April 2011. Computed tomography（CT）and fluorine-18 deoxyglucose positron emission tomography（FDG-PET）revealed a tumor in the tail of the pancreas measuring 39×27mm in diameter, and suspected a malignant tumor. Distal pancreatectomy and splenectomy was performed in July 2011. The final pathological diagnosis was non-functional pancreatic neuroendocrine tumor. We performed genetic testing on him and mutation of the MEN1 gene was identified．The patient was therefore diagnosed as multiple endocrine neoplasia type 1. No recurrence was noted within the 6 years since undergoing the operation. We experienced a case of multiple endocrine neoplasia type 1 during long-term follow-up and report this case with some literature reviews.

We experienced the rare sural arteriovenous fistula attributable to intra-articular knee joint injection. A 72-year-old female was referred to our department from the orthopedics clinic with soreness and pulsatile mass around the left popliteal fossa. She received intra-articular injection into left knee joint through popliteal fossa for the gonarthrosis approximately 30 years ago. Arteriovenous fistula was diagnosed by duplex scan, and it was proved that the pulsatile mass was a venous aneurysm. Enhanced computed tomography and angiography showed an arteriovenous fistula arising from the left sural artery, but did not reveal the drainage vein. The surgical resection with posterior approach was chosen. An arteriovenous fistula between sural artery and vein, and a large venous aneurysm arising from sural vein at the level of the arteriovenous communication were proved during surgery. The sural venous aneurysm was resected and directly repaired. The sural artery including a fistula was dissected and its orifice was closed by patch angioplasty.

We present the case of a 33-year-old patient with Leigh syndrome who was successfully anesthetized for surgical gastrostomy. The patient was diagnosed with Leigh syndrome at the age of 2 years and 5 months, and he underwent tracheostomy at the age of 4 years. Until hospitalization, his respiration was managed via mechanical ventilation at home, and a nasogastric tube led to pneumothorax. After intrathoracic drainage at the emergency department of a general hospital, he was hospitalized in our intensive care unit（ICU）and his general condition was controlled. Pneumonia that occurred after the pneumothorax resolved, and percutaneous endoscopic gastrostomy（PEG）was attempted after the removal of the intrathoracic drain tube. However, esophageal constriction prevented PEG; therefore, surgical gastrostomy was scheduled under general anesthesia. General anesthesia was administered with only propofol and remifentanil, without inhaled anesthetics and muscle relaxants. Bicarbonate ringer solution was exclusively used for intraoperative fluid transfusion. Postoperatively, he was observed in the ICU under respiratory support with artificial ventilation, and he was moved to the general ward on the day after the operation without any complications. Thus, the selection of anesthetic and transfusion agents is important for a safe anesthetic management in patients diagnosed with Leigh syndrome.