Surgical Case Reports最新文献

{"title":"Laparoscopic Abdominoperineal Resection of Undifferentiated Spindle Cell Sarcomas of the Rectum with Lymph Node Metastases: A Rare Case Report.","authors":"Ryo Shibayama, Yutaka Hanaoka, Yutaka Takazawa","doi":"10.70352/scrj.cr.24-0049","DOIUrl":"10.70352/scrj.cr.24-0049","url":null,"abstract":"<p><strong>Introduction: </strong>Undifferentiated sarcomas of the gastrointestinal tract are rare and have poor prognoses, especially those with lymph node metastases. There is no consensus on the treatment plan. While there are reports on undifferentiated pleomorphic sarcomas of the rectum, no reports on undifferentiated rectal spindle sarcomas with lymph node metastases have been presented previously.</p><p><strong>Case presentation: </strong>We report a case of a 97-year-old woman referred to our hospital with anal pain. Imaging findings indicated multiple tumors in the rectum below the peritoneal reflection protruding from the anus and two enlarged pararectal lymph nodes. Laparoscopic abdominoperineal resection of the rectal sarcomas with lymph node metastasis was performed to alleviate the pain with uneventful postoperative courses. The immunostaining did not reveal a trend of tumor cell differentiation. The tumor was diagnosed as undifferentiated spindle cell sarcoma based on histopathological findings. Because of advanced age, the patient is followed up on an outpatient basis without additional postoperative treatment.</p><p><strong>Conclusion: </strong>The prognosis of undifferentiated sarcomas is poor. While radical resection is the primary treatment, the efficacy of preoperative radiation therapy, cytotoxic chemotherapy, and immune checkpoint inhibitors has been investigated recently. Accumulating cases of this disease is important to determine treatment plans, and this report is valuable in this regard.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Biliary Intraepithelial Neoplasm in a Young Man Diagnosed by Laparoscopic Hepatectomy to Treat Recurrent Intrahepatic Lithiasis and Cholangitis.","authors":"Yuto Yamahata, Jungo Yasuda, Hironori Shiozaki, Yasuro Futagawa, Tomoyoshi Okamoto, Toru Ikegami","doi":"10.70352/scrj.cr.24-0048","DOIUrl":"10.70352/scrj.cr.24-0048","url":null,"abstract":"<p><strong>Introduction: </strong>Biliary intraepithelial neoplasia (BilIN) is defined as a bile duct epithelial tumor with intraductal papillary neoplasia of the bile duct. BiIlN is a precancerous lesion of intrabiliary neoplasia. We performed laparoscopic hepatic resection for recurrent cholangitis due to intrahepatic lithiasis and diagnosed BilIN. This case suggests that it is necessary to consider the possibility of malignancy in cases of repeat cholangitis due to intrahepatic lithiasis.</p><p><strong>Case presentation: </strong>A 34-year-old man developed cholecystitis due to gallstones at the age of 25 years and underwent laparoscopic cholecystectomy at the age of 26 years. One year later, cholangitis developed, and 2 years later, acute pancreatitis developed due to bile duct stones. Three years later, at the age of 31 years, he underwent endoscopic lithotripsy for bile duct stones and cholangitis. At that time, intrahepatic lithiasis was also detected in segment 6, but there was no stricture in the bile duct, and he was kept under observation. Three years later, at the age of 34 years, cholangitis in the bile duct of segment 6 was observed, and endoscopic nasobiliary drainage was performed. At that time, no strictures or common bile duct stones were found in bile duct of segment 6; however, we decided to perform laparoscopic hepatic resection of the ventral region of segment 6 because of the recurrent cholangitis. Pathological examination revealed bile duct inflammation and BilIN-1 in the bile duct epithelium; the bile duct stump was negative.</p><p><strong>Conclusions: </strong>We experienced a case of a young patient with recurrent cholangitis due to intrahepatic lithiasis and diagnosed BilIN after laparoscopic hepatectomy. In such a case, it is also necessary to select a strategy that considers the coexistence of precancerous lesions, such as BilIN.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11861583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Graves' Disease in a Patient with Kartagener's Syndrome (Complete Visceral Inversion, Chronic Sinusitis, and Bronchiectasis).","authors":"Naoyoshi Onoda, Masashi Yamamoto, Hiroo Masuoka, Minoru Kihara, Takuya Higashiyama, Akihiro Miya, Kahoru Nishina, Akira Miyauchi","doi":"10.70352/scrj.cr.24-00437","DOIUrl":"10.70352/scrj.cr.24-00437","url":null,"abstract":"<p><strong>Introduction: </strong>Kartagener's syndrome (KS) is a rare disease characterized by a triad of situs inversus totalis, chronic sinusitis, and bronchiectasis. The disorder is caused by a hereditary genetic abnormality that impairs ciliary movement. Although aberrant pass course of the inferior laryngeal nerves due to visceral inversion should be considered during thyroid surgery in patients with KS, no report of surgical treatment for Graves' disease (GD) in patients with KS has been found to date.</p><p><strong>Case presentation: </strong>A Japanese male in his 40s was referred to our hospital for surgical treatment for drug-refractory GD. He was diagnosed to have KS by genetic alteration of the <i>DNAH5</i> gene as well as clinical triad. No abnormal branching in the mediastinal great vessels was identified in the present case, and left-sided non-recurrent inferior laryngeal nerve (NRLN) was not observed during surgery. Previous literature has demonstrated that the presence of a right-sided aortic arch and an anomalous branch of the left subclavian artery, as well as the absence of a left ductus arteriosus demonstrable on preoperative imaging studies, are prerequisites for the development of the extremely rare left-sided NRLN.</p><p><strong>Conclusion: </strong>We reported the first case of surgical treatment for GD in a patient with KS and discussed the preoperative diagnosis of NRLN.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Lobectomy for Chronic Pulmonary Vein Occlusion after Catheter Ablation for Atrial Fibrillation: A Case Report and Literature Review.","authors":"Satoshi Suzuki, Nobuhiro Izumi, Kazuya Kishimoto, Hirotaka Kinoshita, Takuya Tanimura, Kantaro Hara, Hidetoshi Inoue, Takuma Tsukioka, Junichi Soh","doi":"10.70352/scrj.cr.24-0034","DOIUrl":"10.70352/scrj.cr.24-0034","url":null,"abstract":"<p><strong>Introduction: </strong>Pulmonary vein stenosis (PVS) is known as one of the chronic complications after catheter ablation for atrial fibrillation (AF). The endovascular approach is a less invasive treatment option for PVS, while pulmonary lobectomy is also chosen, especially for patients with pulmonary vein occlusion. Here, we present a case of pulmonary vein occlusion accompanied by pulmonary necrosis that was successfully treated by pulmonary lobectomy.</p><p><strong>Case presentation: </strong>A 65-year-old man underwent catheter ablation for AF along with administration of anticoagulants at his previous hospital. After treatment for 6 months, hemoptysis appeared, and chest computed tomography (CT) showed an infiltration shadow in the lower lobe of the left lung. The patient was admitted to the hospital, and antibiotic therapy was initiated. Despite 10 days of antibiotic therapy, there was no improvement, and the lung infiltration worsened. Therefore, on the 10th day of hospitalization, the patient was transferred to our institute. A bloody lavage fluid was obtained under a bronchoalveolar lavage, suggesting alveolar hemorrhage. Then, a contrast-enhanced chest CT scan confirmed a complete occlusion of the left inferior pulmonary vein with suspicion of pulmonary necrosis. We performed a left lower lobectomy under a video-assisted thoracic approach. The lower lobe of the left lung was dark red with a bad smell, and there was 500-ml bloody pleural fluid. Intraoperative transesophageal echocardiography showed no thrombus in the inferior pulmonary vein. The surrounding tissue of the occlusion area of pulmonary vein was sclerotic and inflammatory with firm adhesions to the vagus nerve. The inferior pulmonary vein was separated on the non-hardening peripheral side of the occlusion point using a stapler. Pathological examination confirmed multiple hemorrhagic infarctions in the parenchyma. The patient was discharged on the 8th postoperative day, and there was no recurrence of hemoptysis at 6 months postoperatively.</p><p><strong>Conclusions: </strong>We successfully treated patients with pulmonary vein occlusion following catheter ablation through pulmonary lobectomy. While endovascular treatment is less invasive and remains the first choice for PVS, lobectomy should be considered in patients with complete occlusion, especially when accompanied by pulmonary necrosis, or in recurrent patients after endovascular treatment.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidental T1a Gallbladder Cancer with Signet Ring Cell Carcinoma Following Laparoscopic Cholecystectomy: A Case Report.","authors":"Yoshihito Kitamura, Masakazu Hashimoto, Ryo Nagao, Makoto Shinohara, Keigo Nakashima, Yui Hattori, Michinori Hamaoka, Masashi Miguchi, Toshihiro Misumi, Nobuaki Fujikuni, Satoshi Ikeda, Yasuhiro Matsugu, Takashi Nishisaka, Hideki Nakahara","doi":"10.70352/scrj.cr.24-0078","DOIUrl":"10.70352/scrj.cr.24-0078","url":null,"abstract":"<p><strong>Introduction: </strong>Signet ring cell carcinoma (SRC) of the gallbladder is a rare type of gallbladder cancer. We report a case of SRC of the gallbladder that was characterized by the diffuse presence of SRC on the gallbladder mucosa and diagnosed after cholecystectomy.</p><p><strong>Case presentation: </strong>A 40-year-old man was referred to our department with upper abdominal pain and vomiting. Based on the findings of blood tests, computed tomography, and magnetic resonance imaging, acute cholecystitis was suspected, and emergency laparoscopic cholecystectomy was performed. Intraoperative findings showed mild inflammation. Although the tumor remained within the mucosa, tumor cell infiltration was suspected at the edge of cystic duct pathologically. Although additional endoscopic ultrasound and endoscopic retrograde cholangiography showed that horizontal extension into the residual cholecystic duct was suspected, there was no evidence of invasion into the common bile duct, lymph node metastasis, or distant metastasis. One and a half months after cholecystectomy, the patient underwent extrahepatic bile duct resection, lymph node dissection, and bile duct jejunal anastomosis. The postoperative course was uneventful, and the patient was discharged on the 10th postoperative day. Postoperative pathological analysis showed no obvious residual tumor tissue in the common bile duct or choledochal duct margins, and no metastasis in the submitted lymph nodes. Based on the above, a diagnosis of pT1aN0M0, pStage IA SRC was made. As no lymph node metastasis was observed, it was decided to follow up the patient without initiating postoperative chemotherapy, and the patient has been recurrence-free for 12 months after surgery.</p><p><strong>Conclusions: </strong>We describe an incidentally discovered case of intramucosal SRC diffusely spreading throughout the gallbladder after cholecystectomy for acute cholecystitis.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Management for Acute Ischemic Colitis Associated with Decompression Sickness.","authors":"Daisaku Kamiimabeppu, Kenji Baba, Masumi Wada, Naoki Kuroshima, Yota Kawasaki, Ken Sasaki, Takaaki Arigami, Ikumi Kitazono, Takao Ohtsuka","doi":"10.70352/scrj.cr.24-0185","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0185","url":null,"abstract":"<p><strong>Introduction: </strong>Ischemic colitis secondary to decompression sickness (DCS) is rare. Here, we present a case of ischemic colitis resulting in bowel necrosis following DCS.</p><p><strong>Case presentation: </strong>A 63-year-old male, with a history of hyperbaric oxygen (HBO) therapy for DCS 6 years ago, presented with limb and lower abdominal pain after a 55-m dive. The patient was diagnosed with DCS, and HBO therapy was initiated. However, due to worsening lower abdominal pain, contrast-enhanced computed tomography was performed on the second day. Imaging revealed a poorly enhanced segment extending from the rectum to sigmoid colon suggestive of bowel necrosis. Emergency surgery was performed, and the necrotic bowel segments were resected, followed by a descending colostomy. Pathological examination revealed ischemic colitis.</p><p><strong>Conclusions: </strong>Ischemic colitis should be considered a differential diagnosis in patients with DCS presenting with abdominal symptoms. Surgical intervention may be required in patients with recurrent DCS, depending on the patient's condition.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promising Treatment Strategy for Primary Malignant Melanoma of the Esophagus by Radical Esophagectomy and Nivolumab as Adjuvant Therapy: A Case Report.","authors":"Yusuke Yamamoto, Junya Kitadani, Keiji Hayata, Taro Goda, Shinta Tominaga, Tomoki Nakai, Shotaro Nagano, Ryuta Iwamoto, Manabu Kawai","doi":"10.70352/scrj.cr.25-0027","DOIUrl":"https://doi.org/10.70352/scrj.cr.25-0027","url":null,"abstract":"<p><strong>Introduction: </strong>Primary malignant melanoma of the esophagus (PMME) is a rare malignant tumor of the esophagus with very poor prognosis due to high rates of recurrence and metastasis even after radical resection. Recently, however, immune checkpoint inhibitors such as anti-programmed cell death-1 antibodies have been suggested to improve the prognosis of malignant melanoma. This report describes the use of postoperative nivolumab as adjuvant therapy after surgical resection of PMME, with recurrence-free follow-up for more than 1 year.</p><p><strong>Case presentation: </strong>A 69-year-old man had chest discomfort and tightness in his throat. Upper gastrointestinal endoscopy revealed multiple melanosis and an elevated lesion in the middle esophagus. After histological examination, he was diagnosed as having PMME, so he underwent thoracoscopic subtotal esophagectomy, three-field lymphadenectomy, pedunculated jejunum reconstruction with super-charge and super-drainage, and feeding jejunostomy due to the past history of gastrectomy. The adjuvant therapy using nivolumab (every 2 weeks, 240 mg) for 1 year was completed with no serious side effects, and there was no recurrence for more than 1 year postoperatively.</p><p><strong>Conclusions: </strong>Although cases of PMME treated with adjuvant nivolumab have rarely been reported, the present case suggests that this approach may represent a promising treatment option, similar to cutaneous melanoma.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12068939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Pulmonary Myxoid Sarcoma Located in the Left Lung Parenchyma: Case Report with a Review of Literature.","authors":"Keisuke Hanawa, Toshihiko Soma, Tsuyoshi Shoji, Hiromichi Katakura","doi":"10.70352/scrj.cr.24-0052","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0052","url":null,"abstract":"<p><strong>Introduction: </strong>Primary pulmonary myxoid sarcoma (PPMS) is a very rare low-grade sarcoma. It is known to have a characteristic chromosomal translocation at t(2;22)(q33;q12) and a distinctive genetic alteration, Ewing sarcoma breakpoint region 1 (EWSR1):cAMP response element binding protein 1 fusion. Most cases of PPMS reported so far have been found in the bronchi or bronchioles, and there are only a few cases of them arising from the peripheral lung parenchyma.</p><p><strong>Case presentation: </strong>A 58-year-old man was referred to our department for diagnosis and treatment because a computed tomography (CT) scan showed a 15mm nodule in the left lung. For diagnosis and treatment, he underwent a video-assisted wedge resection. The tumor protruded from the lung parenchyma and had a very striking appearance. Histological features and immunostaining results were not enough to make the diagnosis. Fluorescence in situ hybridization (FISH) analysis was subsequently performed, which suggested EWSR1 gene rearrangement, leading to the final diagnosis of PPMS. The patient is alive 18 months postoperatively with no evidence of recurrence.</p><p><strong>Conclusions: </strong>We encountered a rare case of PPMS arising from the peripheral lung parenchyma. In addition, our case was diagnosed as an overlap lesion of PPMS and angiomatoid fibrous histiocytoma. We can expect a good prognosis with surgical resection alone for the treatment of PPMS, but more accumulation of cases is desired for the establishment of an accurate diagnosis and prediction of the disease course.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathological Complete Response after Pembrolizumab Treatment for Unresectable Perihilar Cholangiocarcinoma with High Microsatellite Instability: A Case Report.","authors":"Yoshikuni Inokawa, Hironori Mizuno, Mihoko Yamada, Shoji Kawakatsu, Nobuyuki Watanabe, Shunsuke Onoe, Takashi Mizuno, Kohei Okayama, Fumihiro Okumura, Masaki Kajikawa, Tomoki Ebata","doi":"10.70352/scrj.cr.25-0025","DOIUrl":"https://doi.org/10.70352/scrj.cr.25-0025","url":null,"abstract":"<p><strong>Introduction: </strong>Pembrolizumab has been introduced to solid cancers with microsatellite instability (MSI)-high cases; however, its clinical experience for cholangiocarcinoma remains very limited. Here, we present a case who successfully underwent conversion surgery following pembrolizumab treatment for MSI-high perihilar cholangiocarcinoma, which pathologically exhibited complete response.</p><p><strong>Case presentation: </strong>A 69-year-old male with Bismuth IV perihilar cholangiocarcinoma with bulky lymphadenopathy was referred, who initially required left hepatic trisectionectomy, caudate lobectomy, bile duct resection, and portal vein resection and reconstruction (H123458-B-PV). During the waiting period after preoperative portal vein embolization, the right hepatic artery was involved by rapid tumor progression, needing a modification of the initially scheduled surgical procedure to additional hepatic artery resection and reconstruction (H123458-B-PV-HA). We revised the surgical decision of resectable to locally unresectable disease. He received systemic chemotherapy with gemcitabine and cisplatin as first-line, showing the best effect of stable disease followed by slight tumor progression and re-elevation of tumor marker after 5 courses of treatment. Cancer multi-gene panel analysis using percutaneous biopsy specimen showed the nature of MSI-high. Therefore, he received pembrolizumab treatment as second-line therapy, leading to a drastic downsize >30% in tumor diameter and normalization of the tumor marker as well after only 2 cycles of administration. After confirmation of keeping tumor shrinkage during 22 courses of pembrolizumab treatment without any severe adverse events, we decided to perform conversion surgery and performed left trisectionectomy, caudate lobectomy, and bile duct resection with portal vein resection (H123458-B-PV). Although the right hepatic artery was extensively fibrotic, there was no evidence of malignancy by frozen section histologic diagnosis. The pathological findings showed pathological complete response with no residual tumor cells. The patient is under periodical checkup without adjuvant chemotherapy, and no tumor recurrence was observed at 4 months postoperatively.</p><p><strong>Conclusions: </strong>We experienced clinical partial response but pathological complete response after second-line pembrolizumab treatment for unresectable locally advanced perihilar cholangiocarcinoma with a biologic nature of MSI-high. Conversion surgery may be considered as a promising option for such effective case, whereas there is a possibility to avoid resection in the MSI-high setting.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mycophenolate Mofetil for Steroid-Refractory Immune-Related Hepatitis and Sclerosing Cholangitis Following Neoadjuvant Chemoimmunotherapy in Non-Small Cell Lung Cancer: A Case Report.","authors":"Hideto Iguchi, Takahiro Kaki, Yuhei Harutani, Daiki Kitahara, Yoshimitsu Hirai, Kuninobu Kanai, Issei Hirai","doi":"10.70352/scrj.cr.25-0192","DOIUrl":"10.70352/scrj.cr.25-0192","url":null,"abstract":"<p><strong>Introduction: </strong>Neoadjuvant chemoimmunotherapy is increasingly regarded as the standard treatment for resectable non-small cell lung cancer. Although it improves survival outcomes, immune-related adverse events can delay or prevent curative surgery. Optimal strategies for managing these adverse events in the preoperative setting remain unclear. This case is notable for being, to the best of our knowledge, the first to report curative surgery following treatment of neoadjuvant chemoimmunotherapy-induced, steroid-refractory immune-related hepatitis using mycophenolate mofetil.</p><p><strong>Case presentation: </strong>A 74-year-old man with stage IIIA (cT2bN2M0) squamous cell carcinoma of the right lower lobe received neoadjuvant chemoimmunotherapy consisting of carboplatin, paclitaxel, and nivolumab. Following 2 treatment cycles, he developed fever, jaundice, and grade 3 liver dysfunction. Laboratory and imaging studies revealed features consistent with hepatitis and sclerosing cholangitis, suspected to be immune-related. High-dose corticosteroids were administered, resulting in only transient improvement. Owing to steroid-refractory disease, mycophenolate mofetil was initiated, leading to normalization of liver function and resolution of symptoms. However, the primary tumor exhibited regrowth following immunosuppression. Surgical resection was performed, consisting of right middle and lower lobectomy with lymph node dissection. Histopathology confirmed ypT1cN0M0 stage IA3 with 50% residual viable tumor. The postoperative course was complicated by persistent air leakage, empyema, and a bronchial fistula, ultimately requiring open-window thoracostomy. The patient was discharged and remains free of disease recurrence at follow-up.</p><p><strong>Conclusions: </strong>This case highlights the potential role of mycophenolate mofetil in managing steroid-refractory immune-related liver injury induced by neoadjuvant chemoimmunotherapy in non-small cell lung cancer. Although immunosuppressive therapy may enable definitive surgery, it may also contribute to tumor regrowth and serious postoperative complications. As the use of neoadjuvant chemoimmunotherapy expands, further clinical experience is needed to guide the management of immune-related adverse events and ensure safe and effective surgical outcomes.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12099075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}