Intraductal papillary-mucinous neoplasms (IPMN) of the pancreas have recently been defined and classified by the World Health Organization. In addition, many cases of IPMN continue to be recognized frequently. We report a case of a 65-year-old female who underwent surgical resection of the pancreas twice within a period of 6 months for primary and recurrent IPMN. We first performed distal pancreatectomy with splenectomy for IPMN in the pacreatic body. A histopathological study revealed invasive adenocarcinoma and the negative margin of the pancreatic duct. A cystic mass in the uncinate process of the gland was identified by CT scan 6 months after the initial surgery. Complete pancreaticoduodenectomy was performed. Recurrent IPMN consisted of adenosquamous cell carcinoma. She currently is alive without evidence of disease at 3 years from the second resection. Recurrent disease in the residual pancreas suggests that a long-term surveillance is critical.

A 47-year-old man was admitted to our hospital for anal pain and diagnosed with submucosal tumor by digital examination. Transsacral resection was performed because the patient refused a stoma. Leiomyoma with highly malignant potential was histologically diagnosed. Surveillance was performed by computed tomography, magnetic resonance imaging and digital examination, but a correct diagnosis was difficult. Due to local tumor increases in the resected region, trans-anal resection was performed 2 years later at the time of local recurrence diagnosis. Over the last 10 years, a total of 8 local resections have been performed since the first surgery. No distant metastases have been confirmed to the patient without a stoma. It appears that a local resection of leimyosarcoma of the rectum with a close surveillance was effective.

We report a case of disease-free survival of liver and lung metastases of rectal cancer resected for a total of five times. A 54-year-old female with metastatic liver and lung tumors of rectal cancer was admitted to our hospital. After a radical resection of the original tumor was performed at a previous hospital, liver and lung metastases had been confirmed in 1 year and 9 months and in 2 years and 2 months, respectively, and that both metastases had been resected as well. On admission to our hospital, computed tomography (CT) showed a liver metastasis of 3-cm in diameter in segment 3 and a lung metastasis of 2-cm in diameter in lingular segment. Two surgeries were performed to resect both of them. Because of a recurrent liver metastasis observed in segment 4, we performed a right hepatic lobectomy and partial duodenectomy 2 years later from the surgeries. After the fifth surgery for metastatic lesions, no sign of recurrence has been observed in 2 years and 11 months.

We evaluated the effect of hepatic arterial infusion (HAI) chemotherapy after curative resection of liver metastases of colorectal cancer. A total of 161 patients underwent curative resection of liver metastases. Among them, 50 patients underwent HAI of 5-FU, and 111 patients had no HAI therapy. The 50% disease-free survival time (50% DFS) was 758 days and 342 days in the HAI group and the non-HAI group (logrank test, p<0.01), and the 50% overall survival time (50% OS) was 978 days versus 730 days (p<0.05), respectively. Among the 71 patients with multiple resectable metastases (H2 or H3), the HAI group had a significantly superior 50% DFS. HAI therapy seems to be an effective form of adjuvant chemotherapy after hepatic resection of metastatic colorectal cancer.

We evaluated the effectiveness of arterial infusion chemotherapy for liver metastasis from gastric cancer. Nineteen patients (9 synchronous cases, 10 metachronous cases) were treated with hepatic arterial infusion chemotherapy (HAIC). The response rate was 26%(CR 3, PR 2, PD 14), and the median survival time was 357 days after the diagnosis of liver metastasis. The treatment was discontinued in 8 patients because of treatment associated complications and disease progression. Absence of extrahepatic lesion, response of HAIC, and hepatectomy did not improve the prognosis. The combination of systemic chemotherapy with HAIC tended to improve the prognosis. It may be necessary to reevaluate HAIC as a treatment modality for liver metastasis from gastric cancer.

BACKGROUND/AIMS We reviewed the medical records of patients with obstructive jaundice caused by the local recurrence of gastric cancer to clarify the role of percutaneous transhepatic biliary drainage (PTBD). METHODOLOGY Eleven patients with a mean age of 60.1 years (range: 51-71 years) underwent PTBD because of obstructive jaundice caused by the extrahepatic recurrence of gastric cancer. RESULTS Jaundice was relieved in all the patients, and the serum total bilirubin (T-bil) level decreased from 12.2 to 2.1 mg/dL. No major complications associated with the execution of PTBD occurred. Although various symptoms caused by jaundice, such as anorexia, itching, nausea, abdominal pain, and fever, were relieved in all the patients within one week after PTBD, general fatigue persisted in 3 patients and abdominal fullness persisted in one. Seven of the 11 patients were discharged from the hospital after the execution of PTBD and remained at home for a median of 93 days. The median survival time (MST) of the remaining 4 patients who could not be discharged was 48 days. Chemotherapy was added in 5 patients after the execution of PTBD; these patients exhibited a significantly longer MST of 247 days, compared to 62 days among the patients who did not receive chemotherapy (P=0.0176). CONCLUSIONS PTBD was safely conducted and improved the quality-of-life of patients with obstructive jaundice caused by the local recurrence of gastric cancer. Furthermore, the use of chemotherapy after PTBD might prolong patient survival although RCT (randomized controlled trial) study should be performed to assess the precise effect of chemotherapy after PTBD.

A 70-year-old man was admitted to our hospital with obstructive jaundice. Computed tomography revealed a tumor in the left intrahepatic bile duct extending to the common bile duct without any significant lesions in the liver. Cholangiography showed a filling defect due to an intraductal tumor. Cytology of the bile juice was negative and tumor markers were carcinoembryonic antigen 5.7 ng/ml, carbohydrate antigen 19-9 49 U/ml, alpha-fetoprotein 9 ng/dl, and PIVKA-II 19 200 AU/ml. With a preoperative diagnosis of hilar bile duct carcinoma, a laparotomy was performed. The common bile duct was filled with a tumor and it extended into the bilateral intrahepatic bile ducts. The intraductal tumor was removed together with the extrahepatic bile ducts. An intraoperative histological examination of the tumor showed a well-differentiated hepatocellular carcinoma. No lesions were detected in the liver by ultrasonography, palpation during the operation, or a computed tomography scan after the operation. At 1 year postoperatively, no recurrence has been seen in this patient.

We report a case of a 54-year-old man with unknown primary squamous cell carcinoma in the bilateral neck. The patient was treated with chemotherapy and radiation therapy, because his right common carotid artery was invaded by the right neck tumor, and a complete curative operation was not considered possible. We chose instead combination chemotherapy with nedaplatin, adriamycin and 5-fluorouracil (NAF), because it was reported that NAF was available for advanced squamous cell carcinoma of the esophagus. After 3 cycles of NAF chemotherapy, the patient showed a partial response of approximately an 86% decrease in the right neck tumor for over three months. In addition to NAF, radiation therapy was performed. In the CT findings after chemotherapy and radiation therapy, the patient showed a complete response in the bilateral neck tumors. Unknown primary squamous cell carcinoma in the neck has been treated by combination therapy consisting of chemotherapy, radiation therapy and surgery. The regime of 5-fluorouracil and cisplatin is said to be an effective treatment for unknown primary squamous cell carcinoma in the neck. Based on our experience, NAF would be available as chemotherapy for unknown primary squamous cell carcinomas in the neck.

A 76-year-old man was admitted to our hospital complaining a weight loss and dysphagia. Gastro-intestinal fiberscopy (GIF) examination showed an early gastric cancer located at cardia. Because of his severe co-morbidities, such as unruptured intracranial aneurysm and idiopathic ventricular fibrillation, he was considered to be inoperable and only followed periodically by the GIF examination every half year. After 3 years since his first examination, the gastric cancer progressed to be T2 advanced gastric cancer. Chemo-radiation therapy (CRT) was administered for consecutive 5 weeks in the following fashion: weekly docetaxel (DOC) div 20 mg/m2 x 5 weeks, and RT 1.8 Gy/day x 5 days/week x 5 weeks. Although the CRT was completed on schedule, diarrhea of grade 3, serum creatinine elevation of grade 2, and esophageal candidiasis appeared during the therapy. A month later after the completion of CRT, the tumor disappeared thoroughly, leaving the tiny redness on the mucosa of cardia. Two months later after CRT, GIF examination reconfirmed the disappearance of the tumor. The patient has shown a clinical complete response (CR), suggesting the efficacy of CRT for inoperable gastric cancer.

BACKGROUND/AIMS Primary signet-ring cell colorectal carcinoma is rare and has been reported to have an extremely poor prognosis. The purpose of the present study was to define the characteristics of this cancer. METHODOLOGY Clinicopathological features were analyzed in 154 Japanese patients. RESULTS The mean age at diagnosis was 54.3 years. The most common tumor site was the rectum (32.9%). Frequent type of the tumor was scirrhous in 45.8%, ulcerated in 34.5%. Lymph node metastasis was found in 77.4% and synchronous peritoneal dissemination was seen in 38.7%, while synchronous liver metastasis was only detected in 2.9%. Most patients (78.2%) were in stages III or IV. The overall median survival time was 12.7 months and the 5-year survival rate was 9.4%. For stage II patients, the median survival time and 5-year survival rate were 17.4 months and 14.3%, respectively, while the median survival time was 15.4 months in stage III and 7.9 months in stage IV. The 5-year survival rate of patients with T2 disease was 75.0%, while patients with T3 or T4 had survival rates of 5.1% and 0%, respectively. CONCLUSIONS Since the prognosis of primary signet-ring cell colorectal carcinoma is extremely poor, early diagnosis and aggressive treatment strategy are necessary.

PURPOSE: The purpose was to evaluate the contralateral nodal control (CLNC) in postoperative patients with oral and oropharyngeal cancer treated with ipsilateral irradiation of the neck and primary site. Late radiation-induced morbidity was also evaluated. METHODS AND MATERIALS: The study included 123 patients with well-lateralized squamous cell carcinomas treated with surgery and unilateral postoperative irradiation. Most patients had tumors of the gingiva (41%) or buccal mucosa (21%). The majority of patients underwent surgery of the ipsilateral neck (n = 102 [83%]). The N classification was N0 in 73 cases (59%), N1 or N2a in 23 (19%), and N2b in 27 cases (22%). RESULTS: Contralateral metastases developed in 7 patients (6%). The 5-year actuarial CLNC was 92%. The number of lymph node metastases was the only significant prognostic factor with regard to CLNC. The 5-year CLNC was 99% in N0 cases, 88% in N1 or N2a cases, and 73% in N2b cases (p = 0.008). Borderline significance (p = 0.06) was found for extranodal spread. Successful salvage could be performed in 71% of patients with contralateral metastases. The prevalence of Grade 2 or higher xerostomia was 2.6% at 5 years. CONCLUSIONS: Selected patients with oral or oropharyngeal carcinoma treated with primary surgery and postoperative ipsilateral radiotherapy have a very high CLNC with a high probability of successful salvage in case of contralateral metastases. However, bilateral irradiation should be applied in case of multiple lymph node metastases in the ipsilateral neck, particularly in the presence of extranodal spread. The incidence of radiation-induced morbidity is considerably lower as observed after bilateral irradiation.

Lymph node metastases (LNM) are common in hypophariyngeal carcinomas; the neck dissection is an important therapeutic approach. AIM: to analyze the incidence and distribution of LNM and failures in treating the contralateral neck. METHODS: a retrospective study of 174 patients with hypopharyngeal cancer treated from 1978 to 2003. The distribution of LNM and regional recurrences were evaluated. RESULTS: 44% of the cases were false negatives and 4.9% were false positives. Among the 48 patients who underwent bilateral ND, 29 had bilateral metastases and one had contralateral metastasis. Contralateral neck recurrences occurred in 12 cases that underwent unilateral ND. Among the nine patients with contralateral neck recurrence alone, eight were surgically salvaged. The risk of contralateral metastases was related to clinical staging (p=0.003) and involvement of the medial wall of the pyriform sinus (p=0.03), but not to radiotherapy (p=0.28). CONCLUSION: Contralateral metastases were more frequent when the medial wall of the pyriform sinus was affected, in the presence of ipsilateral palpable metastases and clinical stage IV.

Case. 61-year-old woman. She noticed a left neck tumor and had a checkup by a nearby doctor. Biopsy showed a squamous cell carcinoma. She was searched from head to foot, but the primary carcinoma could not be identified. It was referred to our hospital as a primary unidentified carcinoma. In examination, the anal region had phyma in a rectal examination, and biopsy revealed it to be a squamous cell carcinoma. For anal canal cancer cStage IV, we performed chemotherapies of S-1+CDDP and local radiotherapy. There was a contraction of a lymph gland, and CT four months later lower endoscopy did not show the apparent phyma. We have continued chemotherapies in an outpatient department sequentially, but the image shows no increase of lymph gland nor increase of the primary tumor for 20 months with no decrease in QOL of the patient. Chemoradiotherapy including S-1 was effective for this case of anal canal cancer distant metastasis for which no apparent cause has been established thus far.

We report a case of squamous cell carcinoma of the anal canal which showed complete response following chemoradiotherapy. A 54-year-old woman was diagnosed as having squamous cell carcinoma of the anal canal (T2N0M0 stage II). Chemoradiotherapy comprising peroral tegafur/uracil and external radiotherapy (60 Gy) to the pelvic space resulted in complete response 4 months after the initiation of the treatment. PET-CT showed recurrence in paraortic lymph node, right sacral and left pubic bone 11 months after the initiation of treatment, although the primary lesion did not relapse. The patient is now given 5-fluorouracil/cisplatin in addition to external radiotherapy (57.5 Gy) to the metastatic lymph node. This case suggests that we should take measures to prevent distant metastases in the treatment of squamous cell carcinoma of the anal canal.

The patient was a 58-year-old man with a mediastinal lymph node recurrence 26 months after surgical resection of squamous cell carcinoma of esophagus. We started a treatment with systemic chemotherapy (FAP chemotherapy) on the supposition of systemic recurrence. Next, chemoradiotherapy with docetaxel (DOC) was chosen for the expectation of powerful local control. Then bi-weekly DOC chemotherapy was chosen for the third-line therapy at an outpatient clinic. A complete response (CR) was observed after the sixth course and the treatment was finished at the twelfth course. CT showed CR after the treatment for six months. The prognosis of the cases with post-operative recurrences was poor, and its formation of recurrence varied. The strategy of the treatment should be considered a case-by-case.

PURPOSE: The aim of this study is to evaluate risk factors of neck recurrence in patients with pN1-N2 neck stage, submitted to a modified radical neck dissection with preservation of the internal jugular vein. MATERIALS AND METHODS: We reviewed the medical records of 72 patients with squamous cell carcinoma of the oral cavity (43 cases) and oropharynx (29 cases). The clinical stage of the neck was N1 in 23 cases and N2a-c in 49. RESULTS: Neck recurrences occurred in 6 cases at the side in which the internal jugular vein was preserved. Neck recurrence did not have significant correlation with tumor site (P =.391), T stage (P =.999), N stage (P =.203), adjuvant radiotherapy (P =.999), number of positive lymph nodes (P =.180), lymph nodes size (P =.429), and extracapsular spread (P =.400). CONCLUSIONS: Modified radical neck dissection with internal jugular vein preservation can be performed in selected patients with lymph node metastases, with no significant increase on the risk of neck recurrence.

We report three patients who underwent radical resections for advanced squamous cell carcinoma of the gallbladder, two of whom are still alive without recurrence 10 and 9 years after surgery. The other patient, who had lymph node involvement, suffered recurrence of the disease and died 9 months after surgery. Our experience indicates that radical surgery can sometimes provide a chance for long-term survival in patients with this neoplasm. Lymph node metastasis, albeit a rare event, might be a poor prognostic factor in patients with this type of gallbladder carcinoma.

Distant metastases in small cell carcinomas of the uterine cervix are rare, and a disseminated manifestation of the disease is uncommon. This is a case report of a 40-year-old woman treated with platin-based radio-chemotherapy for a moderately differentiated squamous cell cervical cancer FIGO Stage IB 1 (with positive paraaortic lymph nodes). One year later she presented with remarkably unusual cutaneous metastases of the left thumb and scalp as the first signs of spread of disease, including kidney, lung and brain metastases. An advanced retrospective immunohistochemical staining of the cervical biopsy discovered a small neuroendocrine component of the carcinoma as the presumably causative factor for the rare metastastic pattern and poor prognosis.

We report a successful case with pulmonary metastases from lower gingival cancer by a surgical procedure and four cycles of adjuvant chemotherapy including paclitaxel (PTX), cisplatin (CDDP) and 5-fluorouracil (5-FU). A 47-year-old woman underwent chemotherapy with CDDP and 5-FU after an operation for lower gingival squamous cell carcinoma and its neck lymph node metastases. At 4 months from the initial treatment, pulmonary metastatic lesion was resected by video-assisted thoracoscopic surgery (VATS). Fourteen months later, pulmonary metastatic lesion was found and dissected again using VATS. Furthermore, the patient was treated by adjuvant chemotherapy with PTX 135 mg/m(2) over 3 hours on day 1, CDDP 75 mg/m(2)on day 2 and 5-FU 350 mg/m(2)/day by continuous intravenous infusion on day 2 through 5. After that, there is no evidence of pulmonary recurrence for more than six years.

A 70-year-old woman was admitted with cervicomediastinal lymph node metastases from squamous cell carcinoma of unknown primary site (Sq-CUPS). The patient was treated with 4 cycles of chemotherapy combining carboplatin and paclitaxel with subsequent radiation therapy. After serial treatment, a partial response was obtained, and the disease has not recurred for over 2 years. Chemotherapy with carboplatin and paclitaxel followed by sequential radiation therapy was suggested to be potentially useful for Sq-CUPS with involvement of cervicomediastinal lymph nodes, although this group of patients is generally regarded to have a poor prognosis.