We report a case of accessory breast cancer in the right axillary region. A 67-year-old woman visited our department complaining of a lump in the right underarm. We suspected cancer of an accessory breast from the findings of mammography and ultrasonography; a histological diagnosis of breast cancer was obtained by needle biopsy. With a preoperative diagnosis of accessorybreast cancer accompanied by ipsilateral axillary nodal involvement, the patient underwent wide local resection of the right axillary region with lymph-node dissection (level II). Histopathological findings of the resected specimen revealed that the tumor was composed of solid tubular carcinoma with intraductal component, with normal breast tissue in the region adjacent to the tumor. A diagnosis of right axillary accessory breast cancer (pT2, N1, pStage IIb) was confirmed. Postoperative chemotherapy and radiotherapy were administered. At present, 18 months after surgery, no sign of recurrence has been observed.

　　We report the first case in the Japanese literature of toxic shock syndrome following incisional hernia repair. We performed incisional hernia repair in a 54-year-old man with a BMI of 32.6 kg/m2 who underwent sigmoidectomy for cancer of the sigmoid colon one and half years earlier. Postoperative course was complicated by subcutaneous hemorrhage, which resolved with conservative management, and he was discharged on the 9th postoperative day. However, 3 days after discharge, he was readmitted with shock, high fever, diarrhea, vomiting, somnolence, and acute renal failure. He was diagnosed with toxic shock syndrome (TSS) due to TSS toxin-1 produced by MRSA infection of the subcutaneous hematoma. Drainage was performed and vancomycin, clindamycin, and gamma-globulin therapy were administered, with intensive supportive care. Treatment was successful and he was discharged 24 days after admission.

The patient was an 80-year-old man who was diagnosed with cStage IIIB non-small cell lung cancer (NSCLC) and early gastric cancer. The advanced lung cancer was treated with chemotherapy while the gastric cancer was monitored. Immune checkpoint inhibitors were effective against the lung cancer for a long period, but new gastric cancer appeared and progressed to an advanced stage, necessitating total gastrectomy 5 years after the diagnosis of NSCLC. The patient is currently being treated with a molecular targeted agent for progression of the lung cancer after gastrectomy. In the future, the number of cases with multiple primary cancers will increase alongside aging of the population and advances in cancer treatment, and a system for tumor-agnostic treatment selection and medical treatment will be necessary.

A 57-year-old man was admitted to our hospital with adhesive bowel obstruction following pancreaticoduodenectomy performed for cholangiocarcinoma 4 months earlier. After admission, the patient remained nil per os and was closely observed. On the third day of admission, he developed worsening abdominal pain, and computed tomography revealed strangulation of the small intestinal mesentery dorsal to the superior mesenteric artery, with prolapse of the small intestine into the right upper quadrant to form a closed loop. Strangulated bowel obstruction secondary to internal hernia was diagnosed, and he underwent emergency surgery. Intraoperatively, we detected a hernia orifice formed by the mesentery and peritoneum at the site of the defect following resection of the ligament of Treitz, and we observed that approximately 2 m of the small intestine had prolapsed into the right upper quadrant. The herniated intestine was returned to the abdominal cavity, and the hernia orifice was sutured following hernia reduction. Few reports have described an internal hernia after pancreaticoduodenectomy; however, it has been reported that this operation can result in various types of internal hernia because of the complicated reconstructive procedure. Here we report our findings in this unique case together with a literature review.

We report a case of a 72-year-old woman with a tumor arising from a colostomy site that had been created 25 years earlier when rectal amputation was performed for perforated sigmoid cancer. She was referred to our hospital due to complaints of pain from the colostomy. The diagnosis was carcinoma arising at the colostomy site with lymph node metastasis. Laparoscopic surgery was performed by attaching an Applied Alexis® wound retractor to the incision site of the colostomy. Lymph node dissection was performed and the left hemicolon was resected. Carcinoma arising from a colostomy site is rare. Laparoscopic surgery was considered to be a useful procedure because it allows for lymph node dissection and intestinal mobilization with minimal invasiveness.

A 63-year-old man was admitted to our hospital in March 2017 with dysphagia and right homonymous hemianopsia. We diagnosed him with esophagogastric junction cancer (adenocarcinoma) with metastases to the cerebral occipital lobe, bone, and lymph nodes. After one cycle of 5FU + cisplatin (FP), the brain metastasis was resected because of the hemiplegic symptoms he developed. Histology of the resected tissue showed no viable tumor cells. After three cycles of FP, the primary lesion and metastases were resolved. Upper gastrointestinal endoscopy revealed a scar at the primary site. This was considered a complete response (CR). In April 2018, CT revealed a mass at the cardia, which was considered as lymph node metastases with gastric wall invasion. Although two additional cycles of FP were administered for recurrent tumors, the efficacy was progressive. In August 2018, proximal gastrectomy and D1 + lymph node dissection were performed. The pathological diagnosis was gastric intramural metastases and lymph node metastases (ypN1 [2/22]). Weekly paclitaxel therapy was administered for three months after surgery. Two years have passed since the last surgery without recurrence. We report a rare case of esophagogastric junction cancer with brain, bone, and gastric intramural metastases that responded to combined modality therapy.

A chest X-ray taken during a medical checkup for a 75-year-old man revealed a nodular shadow in the right middle lung field. Chest computed tomography (CT) for further examination showed an intra-abdominal tumor as an additional finding, and the patient was referred to our department. Contrast-enhanced CT revealed a tumor (16×10×5 cm) in the left upper to middle abdomen. The tumor had a clear border and uniform fat density inside. It compressed the stomach to the ventral side, but the patient had no subjective symptoms. Magnetic resonance imaging also showed the tumor contained a uniform fatty component inside, as well as no obvious non-fatty components. An intra-abdominal lipoma was suspected, but the possibility of a welldifferentiated liposarcoma could not be ruled out due to its size. During curative surgery, intraoperative findings revealed a soft tumor, weighing 612 g, with a well-defined border in the mesentery of the transverse colon. Pathological findings showed proliferation of mature adipocytes without malignancy. We report here this case of mesenteric lipoma, a rare intraabdominal tumor, and review the relevant literature.