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After endoscopic treatment for esophageal cancer, a 65-year-old male underwent surveillance esophagogastroduodenoscopy. A 12-mm discolored flat lesion was noted on the greater curvature of the middle gastric body. Magnifying endoscopy with blue laser imaging demonstrated an irregular papillary surface. Biopsy revealed atypical cells with mucus and irregularly distributed nuclei. The lesion was diagnosed as a gastric-type neoplasm with low atypia. Thereafter, endoscopic submucosal dissection (ESD) was conducted and specimen was sent for biopsy. The ESD specimen suggested a signet-ring cell carcinoma with MUC5AC-positive phenotype and adenocarcinoma of the fundic gland type, with MUC6 positivity and pepsinogen I positivity in the shallow and deeper layers, respectively. Moreover, the cervical region of fundic glands demonstrated a transformation zone of the signet-ring cell carcinoma into an adenocarcinoma of the fundic gland type. Herein, we report this rare case along with a literature review.

We report the case of a 36‒year‒old man who was treated with S‒1 plus oxaliplatin(SOX)therapy for gastric cancer with disseminated intravascular coagulation(DIC). The patient visited our hospital for the treatment of an unresectable type 4 advanced gastric cancer. He had respiratory distress at the first visit. A chest CT scan revealed ground‒glass shadows as well as interstitial and septal thickening diffusely located in both the lungs, which suggested cancerous lymphangiopathy. Moreover, based on blood test results, DIC was diagnosed. After the administration of SOX in combination with recombinant human soluble thrombomodulin, the patient recovered from DIC, and the values of the tumor markers(CEA and CA19‒9) were normalized. After more than 14 months post treatment, the patient has survived without relapse. There are several reports that chemotherapy for gastric cancer is effective for DIC; however, there are no reports on regimens using oxaliplatin. Regimens using this drug may improve the prognosis of gastric cancer complicated by disseminated myelocarcinomatosis and DIC.

The patient was a 69-year-old woman.Upper gastrointestinal endoscopy showed a protruding tumor in the mid-thoracic esophagus, and biopsy revealed small cell carcinoma in November 2012. Four courses of neoadjuvant chemotherapy comprising CDDP and CPT-11 were administered, and radical resection was performed in March 2013.I n March 2014, chest computed tomography revealed the recurrence of mediastinal lymph nodes; thus, we administered chemoradiotherapy comprising 5- FU and CDDP, and the size of the recurrent tumors decreased.However, in February 2015, positron emission tomographycomputed tomography revealed liver metastases.Therefore, we switched to a new chemotherapy regimen containing CDDP and VP-16.Although the treatment was very effective and the liver metastases significantly decreased in size, it was discontinued after 9 courses owing to neurotoxicity.Next, 7 courses of chemotherapy comprising amrubicin, which is administered for treating small cell lung carcinoma, were administered, which suppressed tumor growth for approximately 8 months.However, the tumor then re-grew.Chemotherapy comprising S-1 was administered; however, the tumor gradually progressed.The patient died 51 months after the initial treatment.

It has been reported that docetaxel, cisplatin, and 5-FU combination chemotherapy(DCF)is effective for advanced esophageal cancer. However, we often encounter severe hematotoxicity during DCF therapy. Here, we retrospectively analyzed the data of patients with advanced esophageal cancer treated with DCF at our department, and assessed the efficacy of pegfilgrastim and the issues associated with its use. According to the results, pegfilgrastim may reduce the severe hematotoxicity associated with DCF therapy and may contribute to the maintenance of the intensity of DCF. However, neutropenia had already occurred before pegfilgrastim administration on day 7 in most patients. Therefore, the appropriate timing of pegfilgrastim administration in DCF must be determined in a future prospective study.

The patient was a 67-year-old man. A Type 0-Ⅱa+Ⅱc tumor, 20mm in size was observed in the 1st portion of the duodenum under magnifying endoscopy. Mucosal cancer was suspected and endoscopic resection was performed, with pathological findings as follows: Type 0-Ⅱa+Ⅱc, 19×12 mm, tub1, pT1b(SM2: 700 mm), pUL0, Ly0, V0, pHM0, pVM0. He refused subtotal stomach-preserving pancreaticoduodenectomy(SSPPD)because of the high morbidity and mortality rates. Instead, he underwent only laparoscopic sampling of No. 5, 6, 12b, and 13a lymph nodes, and metastasis in a No. 6 node was pathologically confirmed. He eventually underwent SSPPD with D2, but no metastases were found in other lymph nodes. Pancreaticoduodenectomy is currently considered the best treatment option for complete removal of regional lymph nodes in duodenal cancer despite high morbidity and mortality rates. Further studies are needed to determine the pattern and incidence of lymph node metastasis by location and depth of the primary tumor, to establish optimal treatment guidelines for duodenal cancer.

Nanoparticle albumin-bound paclitaxel(nab-PTX)was approved for the treatment of gastric cancer without a large-scale clinical trial in Japan. Its safety and efficacy should be validated in clinical practice. We retrospectively investigated prognostic factors related to time to treatment failure(TTF)in 11 patients with unresectable or recurrent gastric cancer treated with nab- PTX in our hospital. In univariate analysis, Onodera's prognostic nutritional index(PNI)and the time from the start of first-line chemotherapy to the start of nab-PTX were related to TTF. In multivariate analysis, Onodera's PNI was identified as an independent predictive factor for TTF (hazard ratio 0.056, p=0.022). PNI could contribute to adequate patient selection and the improvement of nab-PTX therapy efficacy ingastric cancer.

A 56-year-old man underwent distal pancreatectomy in July 1997, and chemotherapy was administered as adjuvant therapy. The histopathological diagnosis was a neuroendocrine tumor of the pancreas, NET G2 (Ki-67 labeling index: 3%), T2N0M0 stage IB, according to the TNM classification. In July 2011, follow-up endoscopic examination showed a submucosal tumor covered with almost normal gastric mucosa in the posterior wall of the upper stomach. Endoscopic ultrasound showed a heterogeneous-echoic submucosal tumor present at both the submucosal layer and the proper muscle layer. Abdominal enhanced CT revealed a 3-cm-diameter enhanced mass in the posterior wall of the upper stomach. We performed local resection of the gastric posterior wall. The histopathological diagnosis was a metastatic gastric tumor secondary to a pancreatic endocrine tumor, NET G2 (Ki-67 labeling index: 10%). In this paper, we report a rare case of metastatic gastric cancer secondary to a pancreatic neuroendocrine tumor 15 years after the first operation, together with a review of the literature.

The gastrointestinal (GI) toxicity of non-steroidal anti-inflammatory drugs (NSAIDs) is well recognized. Risk factors for NSAIDs-related GI toxicity includes advanced age, generalized disease, past history of peptic ulcer, concomitant use of steroid, duplicated use of various NSAIDs. The guidelines recommended using a proton pump inhibitor or a prostaglandin for the treatment and prevention of NSAIDs-related GI toxicity. The updated guideline added cyclooxygenase-2 (COX-2) selective inhibitors, which have demonstrated equivalent efficacy to nonspecific NSAIDs in the management of arthritis and pain, to the prevention strategy. Several large, randomized, clinical trials compared the rates of serious GI events in patients taking COX-2 selective inhibitors and nonspecific NSAIDs but came to different conclusions. More recently, the overall safety profile of COX-2 selective inhibitors and traditional NSAIDs has come under intense debate especially due to the recently shown cardiovascular risk of COX-2 selective inhibitors. Therefore, it is essential to determine the actual risk of GI toxicity with COX-2 selective and traditional NSAIDs alone or combined with other compounds from independent Japan studies.

The case was a 36-year-old male whose chief complaints were anorexia and weight loss. Upper gastrointestinal endoscopy revealed circumferential stenosis in the fourth portion of the duodenum, while CT revealed a tumor with a diameter of 60 mm continuing as a single mass from the pancreatic body and tail to the fourth portion of the duodenum, and this was accompanied by findings that raised suspicions of circumferential invasion of the superior mesentric artery (SMA). Based on these results and biopsy, the patient was diagnosed with pancreatic and SMA invasion of duodenal cancer that was considered to be unresectable. After performing gastrojejunostomy, we administered DOC (40 mg/m2, day 1), CDDP (60 mg/m2, day 1), and S-1( 80 mg/m2, day 1-14) for 3 courses. The tumor response was PR and the images indicated the SMA invasion was disappeared. We judged that the tumor could be gone by a resection while preserving the SMA. In the surgical findings, the tumor continued as a single mass from the pancreatic body and tail to the third portion of the duodenum, and the surrounding area exhibited marked fibrosis. We performed a pancreatic tail resection along with combined resection of third and fourth portions of the duodenum, transverse colon and splenic flexure, and left adrenal gland. The case was diagnosed to be well-differentiated invasive ductal pancreatic cancer with duodenal invasion. Cancer invasion was not observed in any of the stripped surfaces surrounding the pancreas. The T3, N1, M0, fStage III antitumor effects were mildly effective. In this case, the treatment was initially started by considering the case as one of duodenal cancer, but the final results of a pathological diagnosis revealed that it was pancreatic cancer. However, either way, even though the case was unresectable before the chemotherapy performed for duodenal cancer was significantly effective for the pancreatic cancer. Therefore, a resection became possible, and an R0 resection was also effective.