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A 67-year-old man presented with obstructive jaundice in March 2022 and was diagnosed with borderline resectable pancreatic head cancer. Gemcitabine+nab-paclitaxel(GnP)was started as preoperative chemotherapy, and tumor shrinkage was observed. In August of the same year, he underwent a subtotal stomach-preserving pancreaticoduodenectomy, combined portal vein resection and reconstruction. The pathological evaluation of surgical specimen demonstrated that it was anaplastic pancreatic cancer and he was treated with adjuvant chemotherapy with GnP. In April 2023, a CT scan confirmed that there was no recurrence or metastasis, and the patient was given 20 doses of anticancer drugs over a 6 months period and then stopped taking them. In August of the same year, the chemotherapy was resumed due to the finding of elevated CA19-9. Immediately after the administration, a decrease in CA19-9 was observed, however it rose again in February 2024, and a CT scan indicated tumor recurrence in the residual pancreas. He is currently being followed up on an outpatient basis with S-1 medication. Anaplastic carcinoma has a poor prognosis, but we have experienced a case of long-term survival of approximately 2 years after surgery with multidisciplinary treatment.

An 84-year-old man was referred to our hospital because of watery diarrhea. Due to cerebral infarction, he had started treatment with a novel oral anticoagulants (NOAC) 1 month prior to admission. The patient underwent blood tests, enhanced computed tomography, and colonoscopy, which indicated infectious or medicinal colitis. The diarrhea persisted and he developed hypokalemia, so a second colonoscopy was performed, which showed edematous mucosa. Colonic mucosal biopsies showed a thick collagen band in the subepithelial region, and collagenous colitis was diagnosed. The watery diarrhea subsequently resolved 1 week after changing the NOAC to warfarin. Reports on collagenous colitis caused by NOAC are very rare, and we consider this case valuable.

A woman was admitted to our department for lung adenocarcinoma and she was treated with left upper lobectomy. The carcinoembryonic antigen level had increased. Enhanced computed tomography showed a hypovascular tumor in the pancreatic tail and in the extension of the distal main pancreatic duct. Endoscopic ultrasonography (EUS) clearly showed a low echoic lesion, and histological examination revealed adenocarcinoma. On immunostaining, the lesion was diagnosed as metastatic adenocarcinoma of the lungs. The patient was treated with chemotherapy for lung cancer and survived for 4 years after diagnosis. Differentiating a metastatic lesion to the pancreas from pancreatic ductal adenocarcinoma is very important. Accurate diagnosis enables administration of appropriate treatment. In this case, EUS was especially useful for assessing the tumor in the pancreas. When patients with a history of extra-pancreatic cancer present with a pancreatic lesion, pancreatic metastases should be considered, regardless of the time elapsed since occurrence of the primary cancer. EUS-fine needle aspiration (FNA) with histological examination is the best method for definitive diagnosis of pancreatic disease in this group of patients. This approach has very high sensitivity and accuracy for the diagnosis of pancreatic metastases.

A 40-year-old man was referred to our hospital because of a positive fecal occult blood test. Colonoscopy revealed many small whitish nodules in the mucosa of the sigmoid colon. Specimens endoscopically resected from the lesions revealed spindle cell proliferation in the lamina propria. Immunohistochemical study revealed strong and diffuse positivity for S-100 protein. Results of staining for neurofilament protein and epithelial membrane antigen were negative. The neurogenic tumors were diagnosed as mucosal Schwann cell hamartoma. No clinical features of multiple endocrine neoplasia type 2B or neurofibromatosis type 1 were found in the present case.

A 75-year-old woman was referred to our hospital for further examination of gastric antral abnormal endoscopic findings. Endoscopic study of the stomach revealed a depressed lesion in the gastric antrum. Atrophic findings were not recognized in the background gastric mucosa, and Helicobacter pylori infection was not detected by histology, an urea breath test, a rapid urease test and serological test. A diagnosis of adenoma was given histopathologically from the resected specimens. As a result of immunohistological study, the phenotype of the tumor was not classified as either gastric type or intestinal type. CDX2 was positive in part of the tumor.

The efficacy and safety of gemcitabine at a starting dose of 1,000 mg/m2 administrated once a week for 3 weeks with 1 week's rest was investigated in elderly 11 patients with unresectable pancreatic cancer. Objective response was not documented. However, pain intensity, analgesic consumption and Karnofsky Performance Status (KPS) were frequently improved. In total, a clinical benefit was observed in 8 out of 11 (73%) patients. Toxicity was mild and well tolerated. These results suggest that gemcitabine had a superior clinical benefit and a mild toxicity profile. Gemcitabine should be the standard treatment in elderly patients with unresectable pancreatic cancer.