Vinsonpereira2087

Pathological CR could not be predicted from clinical findings after neoadjuvant chemotherapy. It was suggested that neoadjuvant chemotherapy for locally advanced rectal cancer with invasion to other organs or lateral lymph node metastasis is useful for improving the prognosis, surgical resection is indispensable as a multidisciplinary treatment, and that the pathological therapeutic effect leads to prognosis prediction.We herein report 2 cases of gastric cancer treated by S-1 and oxaliplatin combination therapy before later undergoing gastrectomy. The pathological results of both cases demonstrated complete response. Case 1 had a giant tumor which was suspected to have invaded the pancreas. Case 2 was associated with extensive lymph node metastasis. Based on the findings of these 2 cases, preoperative chemotherapy with S-1 and oxaliplatin for advanced gastric cancer shows sufficient efficacy.The patient was a 73-year-old woman who had undergone breast-conserving surgery followed by irradiation (50 Gy/25 Fr)to the residual breast for left breast cancer 4 years before. Computed tomography for routine examination revealed a soft tissue mass on her left chest wall. Ultrasonography showed a hypoechoic mass with heterogeneous internal echo, 3.5×3.0×1.5 cm in size. Core-needle biopsy was performed, and histological examination revealed proliferation of spindle-shaped or pleomorphic and highly atypical cells. On immunohistochemistry, the tumor was negative for AE1/AE3, CD34, SMA, desmin, and S-100 and focally positive for CD68. Based on these findings, undifferentiated sarcoma was suspected. The patient underwent wide local excision of the chest wall with a surgical margin of 3-4 cm from the tumor edge. The histological diagnosis was undifferentiated pleomorphic sarcoma. Judging from the clinical course, this tumor was radiation-induced sarcoma. The patient remains disease-free 54 months after the operation.A 78-year-old woman visited our hospital for a tumor in her left breast with discharge. The 10 cm tumor had ulceration and foul smell. Scirrhous breast carcinoma was diagnosed based on core-needle biopsy findings. Chest and abdominal computed tomography( CT) revealed the tumor invading the pectoralis major muscle and a large number of swollen lymph nodes from the left axilla to the subclavian region, but no distant metastases. After 6 months of locally advanced breast cancer treatment with abemaciclib and fulvestrant, ulceration improved. CT revealed that the tumor and lymph nodes tended to shrink. Left mastectomy with axillary lymph node dissection and combined resection of pectoralis major muscle was performed. Postoperative pathological histology revealed ypT2, ypN0, ypM0, ypStage ⅡA. Subsequently, abemaciclib plus fulvestrant therapy was continued as an adjuvant therapy. The patient has survived without recurrence 6 months after the operation. We report a case of locally advanced breast cancer in which abemaciclib and fulvestrant were effective.We report a case of successful laparoscopic distal gastrectomy for gastric cancer with an Adachi type Ⅵ group 24 vascular anomaly. A male in his 60s exhibited a type 0-Ⅱa plus Ⅱc lesion at the lesser curvature of the gastric angle by esophagogastroduodenoscopy and was diagnosed with tub2. He was referred to us for surgical treatment. The clinical diagnosis was cT1bN0M0, and cStage Ⅰ. Preoperative multidetector-row computed tomography(MDCT)showed an Adachi type Ⅵ group 24 vascular anomaly. At laparoscopic surgery, we dissected No. 8a lymph nodes with exposure of the surface of the portal vein because the common hepatic artery was absent. The left gastric artery and splenic artery formed a common trunk. As there are various kinds of vascular anomalies of the celiac artery branch, we must understand the arterial running pattern prior to gastric surgery. This technique is more useful in laparoscopic surgeries where tactile sensation is limited. To prevent perioperative and postoperative complications, we must recognize the anomaly pattern prior to surgery using MDCT.The patient was a 76-year-old woman who was referred to our department for jaundice. From further evaluation, resectable cancer of the pancreas head was diagnosed. The patient did not want to undergo surgery, although it had been planned. Thus, we performed biliary stenting and subsequently applied chemoradiotherapy. Then, the patient underwent the best supportive care(BSC). Eleven months after the diagnosis of the pancreatic cancer, she presented with hematemesis while in the hospital for a lumbar compression fracture, and her vital signs showed that she was in shock. Emergency endoscopic examination of the upper gastrointestinal tract revealed bleeding from the duodenal bulb. Endoscopic hemostasis was difficult; therefore, emergency interventional radiology(IVR)was conducted. Owing to the ruptured gastrointestinal pseudoaneurysm in the duodenum, embolization was performed. The 2nd-look endoscopic examination of the upper gastrointestinal tract showed that the biliary stent was exposed to the duodenal bulb, which led to the formation of a choledochoduodenal fistula. As the subsequent course, the patient received conservative treatment and had no onset of retrograde choledochitis; however, the patient died due to the original cancer 15 months after the diagnosis and 4 months after the bleeding.A 67-year-old man visited his doctor because of anorexia and was diagnosed with gastric cancer based on endoscopic findings. Endoscopy revealed a 0-Ⅰ type tumor, 6 cm in size, at the gastric angle. Preoperative CT showed no apparent lymph node or distant metastases. Distal gastrectomy was performed for gastric cancer with Billroth Ⅰ reconstruction. He had no complications and was discharged on postoperative day 11. The pathological Stage was pT2N0M0, pStage ⅠB, and he underwent no adjuvant chemotherapy. Four months postoperatively, serum CA19-9, AFP, and PIVKA-Ⅱ were elevated, and CT revealed multiple liver tumors. A liver biopsy was performed for the definitive diagnosis. Semaxanib The patient was diagnosed with liver metastases from gastric cancer. It is considered that AFP and PIVKA-Ⅱ were produced by the liver metastasis from gastric cancer. He received chemotherapy for liver metastasis and died 1 year after the recurrence.