We clinically reviewed 12 cases of thyroid cancer in children and young adults who underwent initial thyroidectomy in our department. The patients' age ranged from 8 to 19 years, four were male, eight were female, and the tumor length ranged from 0.6 to 10 cm (median 1.8 cm). All patients underwent hemithyroidectomy and lymph node dissection. The histologic types were well-differentiated papillary carcinoma (nine cases) and follicular carcinoma (three cases). Ten patients had lymph node metastases : nine papillary carcinomas and one follicular carcinoma. Four papillary carcinomas and one follicular carcinoma cases had recurrent lymph node metastasis after surgery and were reoperated. All four patients with papillary carcinoma were under observation for 27 to 96 months after reoperation without recurrence, while the patient with follicular carcinoma had another lymph node metastasis recurrence after reoperation, underwent reoperation, and is under strict observation. Thyroid cancer in children and young adults generally has a good prognosis despite the tendency for lymph node metastasis or distant metastasis from an early stage. We believe that it is important to perform hemithyroidectomy in children and young adults with low-risk thyroid cancer and to follow patients for a long period of time.

Purpose : The global COVID-19 pandemic not only changed our lives, but also impacted everyday clinical practice. The impact of the COVID-19 pandemic on the treatment of gastroenterological disorders in our hospital was investigated.

Methods : Cases of malignant disease (gastric cancer/colorectal cancer), benign disease (inguinal hernia, including femoral hernia), and cases of emergency surgery in our hospital over a period of six years in total, spanning the years before and after 2020 set as the basis when the COVID pandemic began, were investigated.

Results : The number of patients diagnosed with gastric cancer due to abnormalities detected in regular checkups decreased significantly after the start of the pandemic (p=0.04). The number of patients with inguinal hernia who presented directly to our hospital also decreased significantly after the start of the pandemic (p<0.01), as did the number of unilateral cases, whereas the number of bilateral cases increased (p=0.02). There were no other significant differences between the pre-pandemic and post-pandemic time periods.

Conclusions : For both malignant and benign disorders, the COVID-19 pandemic impacted opportunities for patients to be seen and the progression of the disease.

A 76-year-old woman whose right nipple areola gradually turned red around February 2022 presented to our hospital in February 2023 because the reddened area gradually increased. We confirmed reddened erosion localized in the right nipple areola. Enhanced CT scan showed swelling of the right nipple and areola, which was well enhanced. However, no tumor or distant metastasis was observed. A skin biopsy of the right areola revealed squamous cell carcinoma in situ. Since no Paget cells were observed, Bowen's disease was diagnosed. We considered her to be a candidate for surgery. A spindle-shaped lateral incision was made at a distance of 10 mm from the right areola and a right nipple areolar resection was performed. The histopathological diagnosis was non-invasive squamous cell carcinoma, 20×20 mm in size, occupying almost the entire right areola and epidermis, and p16 positive that suggested human papilloma virus infection. The postoperative course was uneventful. A case of Bowen's disease occurring in the right nipple areola is very rare, and we present this disease with a review of the literature.

An 83-year-old man was referred to the Dermatology Department of our hospital, complaining of exudate from the right axilla. An incisional biopsy was performed, which revealed apocrine carcinoma, and the patient was referred to us with suspected accessory breast cancer. A systemic examination revealed metastases in the right axillary lymph nodes, right fifth rib, and fourth thoracic vertebra. We performed a radical resection of the right axilla and axillary lymph node dissection for local control. Pathological examination revealed atypical cells with clear nucleoli and weakly eosinophilic granular cytoplasm growing in a cluster, alveolar, or fascicular pattern. Mammary gland tissue was also found within the tumor. The tumor was ER-negative, PgR-negative, HER2 2+, and GATA3-positive. Based on these findings, the patient was diagnosed with right accessory breast cancer. Given the patient's advanced age and multiple pre-existing conditions, postoperative systemic therapy was difficult ; therefore, radiation therapy was administered as local treatment. This is a rare case of male accessory breast cancer, which we report along with a review of the literature.

Adenoid cystic carcinoma of the breast accounts for approximately 0.1% of all breast cancers. Lymph node and distant metastases are rare. Although the prognosis is generally favorable, metastasis and recurrence have been reported in some cases. We report a case of adenoid cystic carcinoma of the breast, where lung nodules appeared 5 and 10 years post-surgery ; however, the patient survived long-term with surgery and follow-up. A 69-year-old woman was diagnosed with right breast cancer (adenoid cystic carcinoma), classified as cT2N0M0, cStageIIA, and triple-negative. We performed a total mastectomy with level I axillary lymph node dissection and postoperative adjuvant chemotherapy. Five years later, a nodule was detected in the upper lobe of the right lung. A lung segmentectomy was performed on the nodule, confirming it as a metastasis of the adenoid cystic carcinoma of the breast. During the treatment-free follow-up in our department, the nodule reappeared 5 years later. Despite the patient being under observation, the nodule has not increased in size or metastasized to other organs.

A 64-year-old woman underwent left mastectomy and axillary lymph node dissection for left breast cancer. This was postoperatively diagnosed as T3N1M0 pStage IIIA, hormone receptor-positive, and HER2-positive. She underwent postoperative chemotherapy and anti-HER2 therapy, but discontinued due to the appearance of respiratory symptoms during anti-HER2 therapy. At this time, multiple bone metastases were identified, and endocrine therapy was continued. In the third year postoperatively, upper abdominal discomfort appeared. Computed tomography (CT) showed multiple liver tumors, and upper gastrointestinal endoscopy showed gastric mucosal lesions. Further investigation, including gastric mucosal biopsy, resulted in a diagnosis of gastric and hepatic metastases of breast cancer, and chemotherapy was started. However, since the patient developed pseudocirrhosis, the regimen was changed, and medical therapy based on that for hepatic cirrhosis was started. Gastric metastasis of breast cancer and pseudocirrhosis are both comparatively rare. This case is presented along with a brief discussion of the literature.

Anomalous bifurcation of the right superior pulmonary vein is an important anomaly that should be recognized in respiratory surgery for the safe performance of surgery. We report a case in which thoracoscopic pulmonary lobectomy was safely performed using preoperative three-dimensional computed tomography (3D-CT) imaging. A 73-year-old man, during a follow-up of COPD, showed to have an abnormal lesion in the right lung at a chest X-ray. Chest computed tomography showed a 1.8-cm-diameter tumor in the right pulmonary upper lobe. Preoperative contrast-enhanced computed tomography (CT) and 3D-CT imaging showed a break in the right pulmonary vein passing dorsal to the right main bronchus and flowing into the right upper pulmonary vein (V2). The patient underwent uniportal video-assisted thoracoscopic right upper lobectomy for lung adenocarcinoma. First of all, we treated the dorsal V2, followed by the vessels and bronchus. The dorsal V2 could be confirmed under uniportal vision and safely treated. In this case, we could identify the dorsal V2 preoperatively that enabled us to make a plan to create an additional port, if the only uniportal method was insufficient. As a result, we could perform a safe surgery by only uniportal approach. There are a variety of anomalous runs of the pulmonary arteries and veins. Here, we report a case of lung cancer in a patient with an anomalous V2, supported by preoperative 3D-CT to identify the anatomical relationships between the vessel and bronchus.

An 81-year-old man underwent open gastrectomy (D1+ dissection, Billroth II reconstruction) for cStage I gastric cancer. On the 9th postoperative day, elevated inflammatory markers and computed tomography (CT) showed an intra-abdominal abscess near the anastomosis site. Fasting and antibiotic management were started when anastomosis leakage was diagnosed. On the 12th postoperative day, contrast-enhanced CT showed an enlarged abscess and a pseudoaneurysm in the short gastric artery (SGA). The patient was urgently referred for transcatheter arterial embolization (TAE). Before TAE, the patient developed decreased blood pressure, progressive anemia, and a new high-density area, which was thought to be coagulation, in the stomach on repeat contrast-enhanced CT. Angiography confirmed an aneurysm in the peripheral vessels of the SGA, with leaked contrast medium flowing into the remnant stomach via the anastomosis. TAE with coil embolization successfully achieved hemostasis. Following confirmation of stable blood flow in the gastric wall, CT-guided drainage was performed for the residual abscess. The patient was discharged on the 35th postoperative day. Rupture of a pseudoaneurysm after gastrectomy is a rare but serious complication. This case confirms the importance of investigating the source of the bleeding before emergency endoscopy.

A 79-year-old man underwent laparoscopic distal gastrectomy for antral gastric cancer in March 2021. The postoperative pathological results were T4a, INFc, Ly1c, V1b, N0, and pStage II b. Eleven months after initiating adjuvant chemotherapy with TS-1 (100 mg/day), the treatment was discontinued because of the onset of herpes zoster. Abdominal contrast CT performed 29 months after surgery revealed an appendiceal tumor ; therefore, laparoscopic appendectomy was performed. Because no disseminated lesions were observed, no additional procedures were required. Postoperative pathological examination indicated an adenocarcinoma with a histological structure similar to that of the previous gastric cancer. Based on the results of additional immunostaining, which exhibited similar staining patterns of CK (+), CK20 (-), CDX2 (+), MUC6 (+), and HER2 (-) in both tumors with comparable morphology, appendiceal metastasis from gastric cancer was diagnosed. The patient received postoperative treatment with G-SOX plus nivolumab and remained alive without recurrence 8 months after appendectomy. Appendiceal metastasis from gastric cancer is relatively rare, with only 16 cases reported in Japan. Herein, we report our case along with a review of the literature.

A 22-year-old woman presented to our hospital with right lower abdominal pain. She had no fever and mild tenderness in the right lower abdomen, but no guarding. Blood tests showed a mildly elevated inflammatory reaction. Abdominal computed tomography showed an enlarged appendix and the dirty fat sign. Conservative treatment for suspected acute appendicitis was planned, but surgery was performed because her abdominal symptoms worsened. On laparoscopy, an enlarged appendix was found, and an appendicectomy was performed. However, pus was found in the mesentery of the ileum about 50 cm from the ileum end, and a small laparotomy showed duplicated ileum. A partial resection of the small intestine was also performed. Pathologically, acute appendicitis and perforation of the duplicated ileum were diagnosed. There were no ectopic components and no tumors. The patient was discharged from the hospital on the seventh postoperative day. In this case, it was thought that the patient developed appendicitis first, and the perforation was caused by increased intestinal pressure in the duplicated intestinal tract. A case of intestinal duplication with acute appendicitis, which is rare, is reported.

A 70-year-old woman, who had been diagnosed as having intestinal malrotation of the non-rotation type and a lipoma in the transverse colon, visited a local clinic for abdominal pain. Computed tomography showed intussusception of the transverse colon with the lipoma at the lead point. Since neither obstruction nor ischemia was observed, elective laparoscopic surgery was performed. Because of the anatomical changes with intestinal malrotation and the dense adhesion between the bowels, the omental attachment to the transverse colon was dissected as the first step, followed by mobilization of the splenic flexure and the descending colon. The adhesion was then separated, and the colonic mesentery was dissected. Bowel resection and anastomosis were done extracorporeally. The patient's postoperative clinical course was uneventful, and she was discharged eight days after surgery. Waugh's syndrome, the association of intestinal malrotation and intussusception, is rarely observed in adults. Adult intussusception often requires surgical resection because of associated tumors. Though laparoscopic surgery can be one of the options, anatomical variations and dense adhesions should be taken into consideration when planning surgery. A case of Waugh's syndrome successfully treated by laparoscopic surgery is reported.

A 66-year-old man presented with a chief complaint of lower abdominal pain. Lower gastrointestinal endoscopy showed a circumferential Type 2 lesion in the sigmoid colon, and contrast-enhanced abdominal and pelvic computed tomography (CT) showed a long-S type persistent descending mesocolon (PDM) and horseshoe kidney. Sigmoid colon cancer cT3N1aM0 Stage III b was diagnosed, and laparoscopic-assisted sigmoid colectomy was scheduled. In addition to the anatomical abnormalities, small bowel invasion was also suspected, and the operation was converted to open surgery. The descending colon was deviated medially, and extensive adhesions due to the long-S type PDM had to be detached. Due to the horseshoe kidney, the root of the inferior mesenteric artery was covered by the renal isthmus, and because the dissection toward the proximal side of the inferior mesenteric artery was considered dangerous, D2 lymph node dissection was conducted. The operating time was 264 minutes.

The characteristics of PDM include extensive adhesions of the left mesocolon and angiectopia due to the shortening of the left mesocolon. In surgery for patients with concomitant horseshoe kidney, attention must also be paid to the courses of accessory renal arteries and veins, the ureters, and autonomous nerves. When embarking on surgery, a full understanding of these anatomical abnormalities is key. This is the first reported Japanese case of colon cancer in a patient with PDM and horseshoe kidney, and it is presented along with a discussion of the literature.

The patient was a man in his fifties, who inserted a spherical foreign body measuring 8 cm in diameter by himself through the anus five days prior to his hospital visit. On rectal examination, a foreign body was palpated about 5 cm apart from the anal verge. Emergency treatment under general anesthesia was performed on the same day. The foreign body could not be extracted by the transanal route in conjunction with hand assist through the mini-laparotomy because it was so huge. In addition, we failed to lead the foreign body to the abdominal cavity from the same reason. We discussed methods of extraction based on previously reported cases. Two days later, we used a vacuum extractor to pull the foreign body. Knee-chest position and 70 cmHg of the suction pressure under general anesthesia enabled us to extract the foreign body through the transanal route. Insertions of a wide variety of foreign bodies through the anus have been reported in the medical literature. Large foreign bodies are often difficult to be extracted, usually requiring operative management. Extraction using a vacuum extractor can be useful in selected cases of rectal foreign bodies, such as large spherical glass or crystal products.

A 72-year-old man presented to the Dermatology Unit in our hospital with perianal erosion. Skin biopsy of the lesion showed Paget's cells in the epidermis, of which immunohistochemical examinations showed positive staining for CK7, CK20 and CDX2. Colonoscopy revealed an elevated lesion encircling nearly half of the circumference of the lower rectum to the anal canal, and a biopsy provided a diagnosis of moderately-well differentiated adenocarcinoma. Abdominal computed tomography demonstrated swelling of the bilateral inguinal lymph nodes. He was diagnosed with anal canal cancer with pagetoid spread (PS) and bilateral lymph node metastases. After preoperative mapping biopsy by a dermatologist, we performed laparoscopic abdominal perineal resection, D3 lymph node and inguinal lymph node dissection on the metastatic side without skin valvuloplasty. The final diagnosis was rectal-type adenocarcinoma (pap>tub1), pT1b, pN1b and pStage III a. Postoperative adjuvant chemotherapy was administered, and the patient is alive without recurrence as of 1 year after surgery. Anal canal cancer with PS is relatively rare. Clinicopathological characteristics and treatment of reported domestic cases (n=83) were discussed.

With an incidence of lower than 0.1% of all malignant tumors arising in the liver, hepatic epithelioid hemangioendothelioma (HEHE) is an extremely rare entity. We have great difficulties in diagnosing the tumor preoperatively due to nonspecific imaging findings and a low correct diagnosing rate of biopsy of the tumor. In this paper we examined three cases of HEHE resected in our department from 2012 to 2021 in terms of preoperative diagnosis and therapies.

In Case 1, the preoperative diagnosis of intrahepatic cholangiocarcinoma was made by a biopsy of the tumor and right hepatic trisegmentectomy was performed. The histological diagnosis was HEHE. In Case 2, the patient was preoperatively diagnosed with HEHE from clinical course and imaging findings and underwent partial resection of the liver. The definite diagnosis of HEHE was made by postoperative histological findings. In Case 3, HEHE with simultaneous pulmonary metastasis was suspected from imaging findings. HEHE was finally diagnosed by a biopsy of the tumor and partial resection of the liver was performed.

It is hard to differentiate HEHE from other liver lesions preoperatively, but we emphasize that the importance of citing HEHE as a differential diagnosis from clinical course and imaging findings and cogitation effective therapeutic strategies.

A 54-year-old female patient underwent total mastectomy for left breast cancer, alongside sentinel lymph node biopsy and primary one-stage reconstruction using the latissimus dorsi flap. During a follow-up examination one year postoperatively, the patinent noticed swelling and discomfort in the left flank. Abdominal computed tomography revealed a left lumbar hernia, and laparoscopic surgery was chosen as the treatment approach. The procedure was performed using the totally extraperitoneal approach (TEP), identifying a hernial defect measuring 4×3cm. The iliohypogastric nerve was preserved, and the defect was repaired using a Kugel patch. At the six-month follow-up, no recurrence or neurological impairments were observed. Lumbar hernias following breast reconstruction using the latissimus dorsi flap are rare, and few cases of repair using the TEP technique have been reported.

A 78-year-old woman presented with right inguinal swelling. She had a history of right inguinal hemorrhage due to a right femoral injury during cardiovascular surgery, and the inguinal ligament was dissected for hemostasis. Three months after surgery, she became aware of right inguinal swelling and pain. She came to our department six months after the onset of symptoms. Laparoscopic surgery was performed for the right inguinal hernia. Intraoperatively, a 4-cm-diameter inguinal hernia defect was identified. Since the peritoneum around the hernia defect was difficult to separate due to postoperative scar, trans-abdominal pre-peritoneal (TAPP) repair was abandoned. In contrast, medial side dissection was easier, so the procedure was switched to modified intra peritoneal onlay mesh (IPOM) repair. The mesh was fixed to the rectus abdominis and Cooper's ligament on the medial side, as well as to the peritoneum on the lateral side, with a tacking device. The mesh on the dorsal side was fixed to the peritoneum with sutures. The space of Retzius was closed by suturing. Three years after surgery, no recurrences or complications were observed.

An 80-year-old man with a history of right inguinal hernia suddenly developed right inguinal pain in April 2019, and redness in the right inguinal area the following day. He visited a local physician, was diagnosed with a right incarcerated inguinal hernia, and was referred to our hospital for surgery. On arrival at the hospital, swelling, redness, and pain were noted in the right inguinal area ; however, no abnormalities were found in the abdomen. Abdominal computed tomography (CT) showed that the cecum was incarcerated in the hernial sac with fluid accumulation and air bubbles around the cecum. The patient was diagnosed with a cecal perforation and underwent emergency surgery. An incision was made above the right inguinal canal to open the hernial sac, revealing a perforated necrotic cecum and pus around the cecum. The hernia orifice was opened for observation of the abdominal cavity ; however, no abnormalities were found in the ileum or ascending colon, with no pus or infected ascites in the abdominal cavity. The patient was considered completely cured by partial resection of the cecum, including the necrotic area and the appendix, and underwent partial cecal resection. After drain placement in the abdominal cavity, the Bassini procedure was performed for the inguinal hernia and the surgery was completed. The postoperative period was uneventful, and the patient was discharged on postoperative day 11. Five years have passed since the operation and no recurrence of the inguinal hernia has been observed.

Sciatic hernia organ prolapse through the sciatic foramen is classified as a pelvic floor hernia. A 79-year-old female presented to our hospital with intermittent lower abdominal pain for the previous three months. Abdominal computed tomography revealed that the small intestine had prolapsed through the right greater sciatic foramen, and a right sciatic hernia was diagnosed. There was no evidence of compromised blood flow to the small intestine and blood test results were unremarkable. Elective surgery was performed after considering the risk of comorbidities. During surgery, a hernia orifice was observed in the right greater sciatic foramen of the pelvic cavity. The preperitoneal space around the hernial orifice was dissected and a soft mesh was placed. The small intestine was naturally released from the hernia orifice and showed no ischemic changes. Sciatic hernia is the rarest pelvic hernia, and it is difficult to diagnose because of the various symptoms caused by prolapsed organs. Reports on elective surgery for a sciatic hernia with a prolapsed small intestine are limited. Thus, we report this case with a review of the relevant literature.