{"title":"Successful conversion surgery for patients with pancreatic cancer, positive peritoneal cytology, and liver metastasis who were treated with chemotherapy involving nanoliposomal irinotecan with fluorouracil and folinic acid.","authors":"Ayaka Itoh, Kazuto Shibuya, Nana Kimura, Mina Fukasawa, Shunsuke Kawai, Takamichi Igarashi, Toru Watanabe, Katsuhisa Hirano, Isaku Yoshioka, Tsutomu Fujii","doi":"10.1007/s12328-025-02175-2","DOIUrl":"https://doi.org/10.1007/s12328-025-02175-2","url":null,"abstract":"<p><p>A 67-year-old woman was diagnosed with pancreatic head cancer. Staging laparoscopy (SL) was performed, peritoneal cytology (CY) was positive (CY1), and a peritoneal access port was created. The patient was started on nab-paclitaxel plus gemcitabine therapy (GnP). After 6 courses of GnP therapy, computed tomography revealed a single metastatic tumour in the liver. The disease was considered advanced, and nal-IRI + 5-FU/LV therapy was initiated as second-line treatment. After 13 courses of treatment, both the liver nodule and the primary tumour decreased in size, and CY became negative (CY0). A second-look SL and partial resection of the metastatic liver were performed. Thereafter, after 7 additional courses of nal-IRI + 5-FU/LV therapy. A third-look SL revealed no distant metastasis, and CY0. Then, pancreatoduodenectomy was performed as the conversion surgery. Histological examination revealed Grade 1a disease. She resumed adjuvant chemotherapy and is alive 7 months postoperatively without any signs of recurrence. In our rare case, a patient with CY1 pancreatic cancer and liver metastasis was successfully treated with nal-IRI + 5-FU/LV and was able to undergo radical resection. To our knowledge, this is the first report on conversion surgery with this regimen, which is not considered to have a high response rate.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Risa Nomura, Juri Ikemoto, Yasutaka Ishii, Yumiko Tatsukawa, Shinya Nakamura, Sayaka Miyamoto, Kenichiro Uemura, Shinya Takahashi, Koji Arihiro, Shiro Oka
{"title":"A case of extensive intraepithelial lesions throughout the pancreas with focal high-grade pancreatic intraepithelial neoplasm: implications for diagnosis and surgical strategy.","authors":"Risa Nomura, Juri Ikemoto, Yasutaka Ishii, Yumiko Tatsukawa, Shinya Nakamura, Sayaka Miyamoto, Kenichiro Uemura, Shinya Takahashi, Koji Arihiro, Shiro Oka","doi":"10.1007/s12328-025-02169-0","DOIUrl":"https://doi.org/10.1007/s12328-025-02169-0","url":null,"abstract":"<p><p>In the preoperative pathological diagnosis of high-grade pancreatic intraepithelial neoplasia (PanIN), pancreatic juice cytology is commonly used. However, when multiple stenoses are present in the main pancreatic duct (MPD), localizing the tumor can be challenging. Here, we report a case of high-grade PanIN with beaded MPD stenoses and extensive intraepithelial lesions. A 72-year-old man was found to have elevated pancreatic enzymes and cystic MPD dilation on abdominal ultrasonography. Contrast-enhanced computed tomography showed diffuse MPD dilation and localized pancreatic atrophy in the pancreatic head. Magnetic resonance cholangiopancreatography revealed cystic dilation of the MPD in the pancreatic body. Endoscopic ultrasonography showed mild MPD stenosis in the pancreatic head, surrounded by hypoechoic area. Endoscopic retrograde cholangiopancreatography revealed multiple bead-like MPD stenoses in the body of the MPD, and a short stenosis in the pancreatic head. Brush cytology of the MPD stenosis in the pancreatic head revealed malignancy, while lavage cytology from the tail side was suspicious for malignancy. Based on these findings, high-grade PanIN extending from the head to the tail was diagnosed, leading to total pancreatectomy. Histological examination demonstrated extensive intraepithelial neoplastic lesions, with high-grade PanIN corresponding to the MPD stenosis in the pancreatic head.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A case of distal bile duct cancer in a patient with polysplenia syndrome and ventral pancreatic malrotation.","authors":"Kento Maeda, Keitaro Hirai, Yohei Miyamae, Keisuke Ieta, Ichiro Sakamoto, Takashi Hoshino, Hidetoshi Yasuoka, Satoru Kakizaki, Tetsushi Ogawa","doi":"10.1007/s12328-025-02171-6","DOIUrl":"https://doi.org/10.1007/s12328-025-02171-6","url":null,"abstract":"<p><p>Polysplenia syndrome is a rare congenital anomaly characterized by visceral malposition associated with multiple spleens. In relation to the pancreas, reported abnormalities include the annular pancreas, as well as defects in the body, tail, or uncinate part of the pancreas. Here, we present a case of polysplenia syndrome with ventral pancreatic malrotation and distal bile duct cancer. The patient was a 64-year-old man who presented to our hospital with obstructive jaundice. After endoscopic drainage and an anatomical evaluation of the vasculature, a subtotal stomach-preserving pancreaticoduodenectomy was performed for distal bile duct cancer. Polysplenia syndrome is associated with malposition of various organs and blood vessels, which varies from case to case. Therefore, understanding the anatomical variations in each patient is crucial before surgery. The accumulation of case reports will provide valuable information for the treatment of future cases. We report this valuable case along with a literature review.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Gastric adenocarcinoma with submucosal invasion occurs in a sporadic fundic gland polyp of a Helicobacter pylori-uninfected patient on proton pump inhibitor.","authors":"Haruki Kanai, Kengo Kasuga, Sakuya Katakai, Shingo Ishihara, Yoshiyasu Takayama, Xing Hua Ma, Hiroshi Kosugi, Takashige Masuo, Yoji Takeuchi, Toshio Uraoka","doi":"10.1007/s12328-025-02167-2","DOIUrl":"https://doi.org/10.1007/s12328-025-02167-2","url":null,"abstract":"<p><p>Gastric fundic gland polyps (FGPs) are common benign lesions, typically found in Helicobacter pylori (HP)-uninfected stomachs. While syndromic FGPs resulting from genetic diseases may exhibit dysplasia, sporadic FGPs rarely develop into adenocarcinomas. Here, we present the first case of invasive gastric adenocarcinoma that occurred in a sporadic FGP in an HP-uninfected patient. A 77-year-old man on proton pump inhibitor (PPI) therapy for 6 years developed an enlarged reddish FGP. The absence of atrophic changes in the entire gastric mucosa was confirmed endoscopically and multiple HP tests were negative. After PPI discontinuation, the lesion initially reduced in size from 25 to 15 mm in 1 month; however, malignancy was suspected because of rapid enlargement and persistent discoloration. En bloc resection was performed by endoscopic mucosal resection. Histological examination confirmed FGP and submucosal adenocarcinoma with a depth of approximately 700 μm, negative for lymphovascular invasion, and negative resection margins. A subsequent distal gastrectomy confirmed the absence of residual disease or lymph node metastases. The unusual endoscopic findings of rapid enlargement and reddish tone pushed us to perform endoscopic treatment, which resulted in a correct diagnosis and appropriate treatment.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rare rapid progression of intra-ampullary papillary-tubular neoplasm with low-grade dysplasia.","authors":"Karen Kimura, Kazuya Koizumi, Sakue Masuda, Makomo Makazu, Jun Kubota, Toshiyasu Kawahara, Hiroki Yamaue, Shinichi Teshima","doi":"10.1007/s12328-025-02159-2","DOIUrl":"https://doi.org/10.1007/s12328-025-02159-2","url":null,"abstract":"<p><p>A 78-year-old woman presented with epigastric pain and underwent contrast-enhanced abdominal computed tomography (CT), which revealed a mass in the ampullary region. Endoscopic ultrasonography (EUS) and retrograde cholangiopancreatography (ERCP) confirmed a papillary lesion with a contrast defect in the bile duct. An initial biopsy suggested an adenoma. Owing to the extent of the lesion, surgery was recommended; however, the patient opted for follow-up. After five months, CT and EUS revealed significant tumor growth, raising the suspicion of malignancy. Consequently, subtotal stomach-preserving pancreatoduodenectomy was performed, and postoperative pathology confirmed an intra-ampullary papillary tubular neoplasm (IAPN) with low-grade dysplasia. IAPN is noninvasive and consists of the growth of the ductal epithelium, which is equivalent to adenoma or low-grade adenocarcinoma. Although it is generally characterized by slow growth owing to its noninvasive nature, this case was unique in that it showed rapid progression. Despite being a low-grade IAPN, this case represents a rare instance of rapid enlargement within five months. This case underscores the importance of vigilant monitoring of low-grade IAPN, given its potential for accelerated growth.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anaplastic carcinoma of the pancreas derived from an intraductal papillary mucinous neoplasm: a case report.","authors":"Yoko Kawano, Teijiro Hirashita, Hiroki Ichihara, Shota Amano, Hiroomi Takayama, Takashi Masuda, Yuichi Endo, Tsutomu Daa, Masafumi Inomata","doi":"10.1007/s12328-025-02166-3","DOIUrl":"https://doi.org/10.1007/s12328-025-02166-3","url":null,"abstract":"<p><p>We report the case of a patient with anaplastic carcinoma of the pancreas derived from an intraductal papillary mucinous neoplasm. A 51-year-old man was reported to have an enlarged cystic lesion in the pancreatic head. Contrast-enhanced computed tomography revealed a multifocal cystic lesion with an internal contrasted nodule. The patient was diagnosed with IPMN with high-risk stigmata and underwent pylorus-preserving pancreaticoduodenectomy. The pathological diagnosis was anaplastic carcinoma of the pancreas, classified as pleomorphic type, derived from intraductal papillary mucinous neoplasm. Based on the morphological features and immunohistochemical reactivity for MUC1, MUC2, MUC5AC, and MUC6, the intraductal papillary mucinous carcinoma was classified as pancreatobiliary type. Immunostaining for tumor-suppressor genes CDKN2A(p16), TP53, SMAD4, and STK11 was performed; aberrant expression of p53, Smad4, and STK11 was observed in intraductal papillary mucinous carcinoma and anaplastic carcinoma. The patient's postoperative course was uneventful; however, para-aortic lymph node metastasis was observed 10 months postoperatively. Immunohistochemical analysis of intraductal papillary mucinous neoplasm subtypes and tumor-suppressor genes may contribute to predicting prognoses in such cases.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"EUS-guided ethanol ablation in patients with solid pseudopapillary neoplasm: a four-case series.","authors":"Yousik Myung, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Hiroki Koda, Indria Melianti, Adwoa Agyei-Nkansah","doi":"10.1007/s12328-025-02163-6","DOIUrl":"https://doi.org/10.1007/s12328-025-02163-6","url":null,"abstract":"<p><strong>Background/aims: </strong>Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor with low malignant potential, though 10-15% may show invasive or metastatic behavior. This study aimed to evaluate the safety and efficacy of endoscopic ultrasound-guided ethanol ablation (EUS-EI) in patients with SPN who were not surgical candidates.</p><p><strong>Methods: </strong>Four patients with SPN who declined or were ineligible for surgery underwent EUS-EI at Aichi Cancer Center. Technical and clinical outcomes, as well as adverse events, were assessed.</p><p><strong>Results: </strong>Technical success was achieved in all patients (100%). Clinical success was observed in three patients (75%), including two with complete ablation and one with significant tumor reduction. No major adverse events or tumor recurrence occurred during follow-up.</p><p><strong>Conclusions: </strong>EUS-EI may be a safe and effective alternative for managing SPN in non-surgical candidates.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Recurrence as a tumor deposit after endoscopic submucosal dissection of early rectal cancer.","authors":"Takaaki Yoshikawa, Momoko Iketani, Atsushi Yamauchi, Sonoka Katsuyama, Sota Nakagami, Kenshiro Hirohashi, Shujiro Yazumi","doi":"10.1007/s12328-025-02160-9","DOIUrl":"https://doi.org/10.1007/s12328-025-02160-9","url":null,"abstract":"<p><p>We found a 15 mm, 0-IIa + IIc polyp in the rectosigmoid with colonoscopy (CS), and performed endoscopic submucosal dissection (ESD) for it. The histopathologic specimen revealed that it was well-differentiated adenocarcinoma, T1b (SM2, 2000 μm), Ly0, v0, BD1, pHM0, and pVM0. Despite the non-curative resection with SM-deep invasion, the patient chose careful follow-up with contrast-enhanced computed tomography and CS. A nodule was first detected on the left side just out of the lower rectum 3 and a half years after ESD. Since it enlarged gradually, we judged that it was local recurrence in form of lymph-node metastasis and performed additional surgery 5 years after ESD. Pathological findings disclosed that the nodule was local recurrence as a tumor deposit (TD). One year after TD resection, lung metastasis was additionally founded and was resected surgically. If ESD accomplishes complete resection for T1b colorectal cancer and deep submucosal invasion is the only factor of non-curative resection, follow-up may be chosen instead of additional surgical resection. However, careful follow-up should be considered, because recurrence including TD may happen several years after ESD.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Three cases in which plasmapheresis was effective for persistent obstructive jaundice due to malignant biliary obstruction after biliary drainage.","authors":"Yuhei Iwasa, Keisuke Iwata, Ryuichi Tezuka, Takuji Iwashita, Shinya Uemura, Shota Iwata, Yosuke Ohashi, Yuki Murayama, Masahito Shimizu","doi":"10.1007/s12328-025-02168-1","DOIUrl":"10.1007/s12328-025-02168-1","url":null,"abstract":"<p><p>We describe three cases in which plasmapheresis was effective for persistent obstructive jaundice, even after biliary drainage. All three cases involved resectable or borderline resectable malignant tumors that caused obstructive jaundice. Jaundice is refractory to biliary drainage and medication and results in prolonged hyperbilirubinemia. Plasmapheresis led to improvements in all cases. Plasmapheresis may be a treatment option for persistent obstructive jaundice resistant to standard therapies.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tomotaka Takaki, Shinichiro Kobayashi, Shinji Okano, Takahiro Enjyoji, Shunsuke Murakami, Jun Onumata, Mika Matsukuma, Yasuhiro Maruya, Kengo Kanetaka, Susumu Eguchi
{"title":"Beyond the common recurrence sites after esophagectomy: colonic metastasis in esophageal cancer.","authors":"Tomotaka Takaki, Shinichiro Kobayashi, Shinji Okano, Takahiro Enjyoji, Shunsuke Murakami, Jun Onumata, Mika Matsukuma, Yasuhiro Maruya, Kengo Kanetaka, Susumu Eguchi","doi":"10.1007/s12328-025-02164-5","DOIUrl":"https://doi.org/10.1007/s12328-025-02164-5","url":null,"abstract":"<p><p>The postoperative recurrence rate of esophageal cancer ranges from 28 to 47%, with recurrences often affecting distant organs such as the lungs, liver, bones, and brain. However, colonic metastasis is rare. This report presents a case of transverse colon metastasis after radical resection of esophageal cancer in a 70-year-old man. The patient underwent neoadjuvant chemotherapy followed by esophagectomy for advanced esophageal cancer 15 months ago. He reported loss of appetite during a routine outpatient visit, and computed tomography revealed bowel obstruction and intussusception with a tumorous lesion in the transverse colon. Positron emission tomography did not reveal any abnormal accumulation in other areas. Based on these findings, a transverse colectomy was performed. Pathological examination of the resected specimen revealed squamous cell carcinoma components in the normal colonic mucosa, which were diagnosed as colonic metastases from the esophageal cancer. Postoperatively, the patient recovered uneventfully and commenced adjuvant therapy with capecitabine monotherapy, which was later discontinued at the patient's request. Four months post-surgery, liver metastasis developed, and the patient underwent immunochemotherapy. Colorectal metastasis from esophageal cancer is relatively rare, making preoperative diagnosis challenging. Nonetheless, a multidisciplinary approach combining surgery and perioperative systemic therapy has the potential to improve patient outcomes.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}