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A 78-year-old man was aware of lightheadedness and darkness at a routine outpatient visit, and his blood pressure was declined at 87/51 mmHg. Contrast-enhanced CT scan showed an extravascular leakage image at jejunum. We diagnosed as small intestinal hemorrhage. Because he was in hemorrhagic shock, emergency surgery was performed. A tumor was found coincident with the bleeding site, and partial resection of the small intestine including enlarged lymph nodes was performed. Based on the pathological findings of T-cell origin and positive for serum anti-HTLV-1 antibody, he was suspected as adult T-cell leukemia/lymphoma(ATLL). Endoscopic examination of the upper and lower gastrointestinal tracts, bone marrow examination, and PET-CT scan were performed, but no other lesions were found. We report a case of the T-cell lymphoma with suspected solitary ATLL of the jejunum.

A 77-year-old man visited a clinic because of nausea and chest discomfort. On blood test, hepatobiliary enzymes were elevated, and he referred to our hospital. Contrast-enhanced CT revealed stenosis of the extrahepatic bile duct and brush cytology of the bile duct showed adenocarcinoma. We therefore performed pancreatoduodenectomy for extrahepatic bile duct cancer. Pathological diagnosis was small cell neuroendocrine carcinoma, pT3N2M0, Stage ⅢA. The patient did not receive adjuvant chemotherapy and 3 months later contrast-enhanced CT and MRI showed multiple liver metastases. The patient was treated with cisplatin plus irinotecan in the first-line, cisplatin plus etoposide in the second-line, and amrubicin in the third-line and accordingly he died 1 year and 3 months after the surgery. Chemotherapy for neuroendocrine carcinoma of the bile duct is recommended as in small cell lung cancer, but the prognosis is extremely poor. We report this case with a review of some of the literature.

According to the risk classification of recurrence, the standard treatment for gastrointestinal stromal tumor(GIST)is complete surgical resection and postoperative adjuvant therapy with imatinib; however, the usefulness of neoadjuvant therapy is unclear. We report a case of giant GIST in the pelvis suspectedly having bladder infiltration that was radically resected and underwent preoperative imatinib therapy. A 52-year-old man visited a clinic because of abdominal pain, fever, and frequent urination. An abdominal mass was determined, and the patient was referred to our hospital for detailed examination and treatment. Contrast-enhanced CT revealed a 17 cm diameter irregular mass from the lower navel to the pelvis, and the bladder boundary was partially unclear. Transrectal biopsy was performed using endoscopic ultrasonography, and according to the Fletcher classification, a high-risk GIST was diagnosed. After preoperative imatinib therapy of 400 mg/day was administered for 3 months, surgery was performed. The tumor was strongly adhered to the bladder, but no invasion was observed, and partial small intestine resection was performed. The surgical margin was negative without capsule damage. On day 34 postoperatively, imatinib therapy was resumed, and as of 1 year postoperatively, the course is well without recurrence.

An 81-year-old man with esophageal cancer had undergone subtotal thoracic esophagectomy and retrosternal reconstruction using a gastric tube. He developed anemia. Gastrointestinal endoscopy was performed, which revealed a tumor in the posterior wall of the lower part of the gastric tube. Biopsy revealed well-differentiated adenocarcinoma. There was no lymph node metastasis and no distal metastasis on CT. We performed partial resection of the stomach tube because of his age and physical condition. We identified the position of the tumor by upper gastrointestinal series CT and gastrointestinal endoscopy. The tumor was located on the posterior wall of the lower part of the gastric tube and the back of the sternum lower border. Marking was performed by gastrointestinal endoscopy before operation. We simulated the operation and decided to perform laparostomy without sternotomy incision. We cut the anterior wall of the gastric tube in front of the tumor using the endoscope. We could then confirm the diagnosis of cancer, and clipped and removed the tumor from the posterior wall. The resected site was sutured with 4-0 absorbable thread. The pathological diagnosis was T1a(M)N0M0, ly0, v0, PM0, DM0, pStage ⅠA.

We report a case of mediastinal lymph node recurrence of esophageal cancer after endoscopic submucosal dissection (ESD). We first administered chemotherapy and then performed esophagectomy. A 78-year-old man underwent ESD for early esophageal cancer at a different hospital in January 2015. H e was diagnosed pathologically with scc, pSM1, pHM1, pVM0, ly0, v0. Additional treatment was not administered because of his age. In June 2017, chest enhanced CT showed swollen mediastinal lymph nodes. This was diagnosed as a recurrence of esophageal cancer, and he presented at our hospital. We first performed chemotherapy for that lesion, because the swollen lymph node was large and may have invaded the surrounding organs. We then performed esophagectomy.

We report a rare case of liver recurrence of gastric cancer 14 years and 3 months after curative gastrectomy. An 81-yearold man underwent total gastrectomy, D2 lymphadenectomy, Roux-en-Y reconstruction, and cholecystectomy for advanced gastric cancer in November 2002. H e was diagnosed pathologically with M, Type 5, 53×42 mm, tub2>tub1, pT4a, ly2, v2, pN1, pPM0, pDM0, M0, pStage ⅢA(JGCA 15th). Postoperative adjuvant therapy was not administered. He was followed up for 5 years after surgery without adjuvant therapy, and he did not exhibit recurrence. In February 2017, he experienced difficulties in swallowing and visited our hospital. Abdominal contrast-enhanced CT showed an 8×5 cm liver tumor in the lateral segment. Part of the tumor protruded to outside of the liver, and the tumor invaded and pushed the jejunum in the Roux limb. We performed liver biopsy and diagnosed him with liver metastasis of recurrent gastric cancer. Late relapse after gastrectomy, especially after 10 years or more, is very rare.

In elderly patients, surgical procesure is decided considering the general condition and surgical invasion. The aim of this study was to clarify the appropriate rage of lymph node dissection for elderly colorectal cancer patients. One hundred forty one colorectal cancer patients aged 75 years or more, who underwent R0 colorectal resection with D2 or D3 lymph node dissection in clinical T3/T4 or clinical N+, were enrolled in this study. The patients whose tumor located in the rectum below the peritoneal reflection(Rb)were excluded. Five-year overall survival(OS)rate and disease specific survival(DSS)rate were 79.1% and 89.4%, respectively. More than 2 preoperative co-morbidities and macroscopic type 3-5 were independent prognostic factors in OS, whereas the rage of lymph node dissection was not risk factor. When comparing the outcomes of D2 and D3 dissections by age, D3 dissection was better tendency in DSS in patients aged under 80, however, D2 dissection was better tendency in patients aged 80 or more. In elderly colorectal cancer patients, there was no difference in prognosis between D2 and D3 dissection, and especially in patients aged 80 years or more, D2 might be sufficient if R0 resection was possible.

Background: The aim of this study was to evaluate the safety of laparoscopic-assisted colorectomy(LAC)for elderly patients more than 70 years old., Methods: The outcomes of 131 patients more than 70 years old who underwent LAC between April 2013 and March 2014 were retrospectively analyzed.Morbidity and mortality were evaluated using the Clavien-Dindo classification., Results: Postoperative complications exceeding Grade II in the Clavien-Dindo classification were found in 20 patients(15.3%).No mortalities were observed in this study., Conclusions: LAC can be performed safely for elderly patients older than 70 years.

Baxter infusor was evaluated for the degree of its safeness, and effectiveness, to use in a chemotherapy. The study covered a total of 36 cases, each receiving an average 11 days of care under this therapy. In seventeen of those cases, the patient had received outpatient care, or had spent day and night at their homes. In nine of the total 36 cases, the infusor had been set for use by the patients or by their family. Results were evaluated with a focus on three factors: the patients' quality of life, the infusor's ease of use and its comparability to conventional systems. As to quality of life, those patients generally appreciated the infusor as an improvement to conventional systems with 10 of them citing "an ability to live with their family", 16 citing "freedom to move around", and 35 citing "satisfying functional performance", as reasons for their favorable acceptance. 97% of the patients had found the infusor easy to use, and all had found it simpler and easier to use than the conventional system. Their overall rating for the infusor was "good" to "excellent" in 97% of the cases. And 33 out of the 36 patients thought the infusor safe and effective if used at the homes.

A 49-year-old male patient was admitted to our hospital complaining of right scrotal mass. Serum tumor markers, HCG, beta-HCG and AFP, were all elevated. After right high inguinal orchiectomy, a pathological report revealed a mixed-type germ cell tumor, which was composed of choriocarcinoma, embryonal carcinoma and seminoma. Because of persistent elevation of these tumor markers, RPLND was performed. There were viable tumor cells in the dissected lymph node specimens. As pulmonary metastases developed after RPLND, the patient was treated with 3 courses of VAB-6 combination chemotherapy (vinblastine, actinomycin-D, cyclophosphamide, bleomycin and cis-platinum). Pulmonary metastases disappeared and tumor markers returned to normal range except for moderate elevation of serum HCG. Two months later, pulmonary metastases developed again with re-elevation of tumor markers. Four courses of EP salvage chemotherapy (etoposide and cisplatinum) were given. After EP chemotherapy, the patient was given etoposide orally for about 7 months. During this period, no abnormality was found except for slight elevation of serum HCG. Five months after discontinuing chemotherapy, serum HCG returned to normal and complete remission was obtained.

Renal cell carcinoma (RCC) is one of the most insensitive urologic tumors to either radiotherapy or anticancer chemotherapy. Recently, effectiveness of interferon (IFN) against RCC has been reported. However, because this effect is somewhat limited, a new modality of treatment is needed. We herein report our experience with IFN and OK-432, a streptococcal preparation for patients with advanced RCC. Twenty patients aged from 26 years to 75 years, with an average age of 52.3 years, were entered into this study. Intramuscular injection of human lymphoblastoid interferon (HLBI) at a dose of 3 X 10(6) units was given daily for between 4 and 76 weeks. Treatment with OK-432 then followed HLBI, unless the patient achieved CR or the status of the patient seriously deteriorated during the initial treatment with HLBI. OK-432 was given to 12 patients at a dose of 5KE (Klinische Einheit) 2 days a week for between 10 and 64 weeks. Effectiveness of HLBI therapy was 20% (CR 1 case, MR 3 cases, NC 11 cases, PD 5 cases). With adjuvant OK-432 therapy for patients whose disease proved to be resistant to HLBI, effectiveness was 25% (CR 1 case, MR 2 cases, NC 6 cases, PD 3 cases). The results obtained indicated that OK-432 following IFN is a potentially active antitumor regimen in patients with advanced RCC.

Between 1980 and 1985, 17 patients with advanced urothelial carcinoma and 13 with metastatic prostatic carcinoma refractory to hormonal therapy were treated with a combination chemotherapy of cyclophosphamide (CPM), adriamycin (ADM) and cis-diammine-dichloroplatinum (CDDP) to evaluate its antitumor effect and toxicity. ADM (1 mg/kg) on day 1, CPM (2 mg/kg) on days 2 through 5 and CDDP (1.5 mg/kg) on days 6 and 7 were administered every 3 weeks. Of the 17 patients with urothelial carcinoma, 13 were eligible for evaluation. One patient achieved CR with a disease-free interval lasting for 29 months, one showed PR (duration of response 2 months), 4 NC and 7 PD, with an overall response rate of 15% (2/13). Of the 13 patients with prostatic carcinoma, 11 could be evaluated. No patients achieved CR, one had PR (duration of response 5 months), 2 NC and 8 PD, with an overall response rate of 9% (1/11). No statistically significant difference in survival was noted between responders (CR + PR) and non-responders (NC + PD) to the combination chemotherapy, irrespective of whether they had metastatic urothelial or prostatic carcinoma. Myelosuppression was frequently noted, with sepsis occurring in one patient. No mortality attributable directly to this regimen was noted.