Background: Recently, double cancer is no longer uncommon. It is Particularly difficult to determine whether swollen lymph nodes (LNs) indicate malignant lymphoma or metastasis of other carcinoma. We experienced a case of rectal carcinoma complicated with adult T-cell leukemia/lymphoma (ATLL). Case presentation: We encountered a 77-year-old woman who had visited a previous hospital due to bloody stool. Colonoscopy revealed a 10-cm tumor in the lower rectum. Given its pit pattern and surface and vessel pattern, she was suspected of having adenocarcinoma in situ. However, enhanced computed tomography (CT) showed LN swelling around the rectum, and her bilateral inguinal LNs were palpable. Colonoscopy and a biopsy performed at our hospital showed adenoma (Group 3) with no malignant findings. We performed an inguinal LN biopsy and diagnosed her with ATLL. We suspected the rectal mass either be rectal carcinoma or ATLL invasion. We performed chemotherapy for ATLL. The inguinal LNs became no longer palpable, but the rectal mass did not shrink, so we performed operative resection for diagnostic treatment. Thereafter, we diagnosed her with double cancer of rectal adenocarcinoma and ATLL. Conclusion: It is difficult to determine whether swollen LNs indicate malignant lymphoma or metastasis of other carcinoma without performing an LN biopsy. However, a diagnosis of metastasis or non-metastasis does not influence either the staging of the carcinoma or the treatment plan.

BACKGROUND:IgG4-related disease (IgG4-RD) is a pathological condition that is characterized by an infiltrate composed of IgG4-positive plasma cells and recently recognized as an immune-mediated condition. It causes tissue throughout the body to become stiff and thickened due to autoimmune reactions that cause fibrosis and scarring. Disease-related changes commonly occur in the salivary glands, bile duct, pancreas, and lungs, but are seldom seen in the small bowel. A diagnosis of IgG4-RD is suspected if a high level of IgG4 is found on a blood test. The ideal diagnostic method is pathological examination, but because the clinical manifestations of IgG4-RD are very diverse and nonspecific, the disease may often go undiagnosed until an unrelated biopsy or resection specimen is obtained. The most common treatment for IgG4-RD is steroid use. However, tapering or stopping steroid administration is seen to result in recurrence in approximately 50% of cases. A complete cure is therefore considered extremely difficult.CASE PRESENTATION:A 69-year-old man with gastrointestinal obstruction underwent small bowel resection for two lesions. On histopathological examination, the specimen showed features of IgG4-RD. We performed several tests to detect other characteristics of IgG4-RD, but were unable to find any. The patient is being followed up regularly for a year and is being observed for any symptoms of recurrence.CONCLUSIONS:We present a case of IgG4-RD wherein the ileum wall was significantly sclerosed, leading to gastrointestinal tract obstruction; therefore, we resected two sections of the ileum. We believe that resection of IgG4-RD lesions can help avoid long-term steroid use in patients, because the surgery completely eliminates the pathological origins of the condition.

Peripheral arterial (PA) aneurysms show a frequency of 20% of whole aortic aneurysms, and deep femoral artery (DFA) aneurysms account for 0.5% of PA aneurysms. We report a case of a ruptured aneurysm of the medial circumflex femoral artery (MCFA) a branch of the DFA. A 76-year-old woman noticed swelling and pain of the right femur. We diagnosed aneurysmal rupture and performed an emer-gency operation because of the risk of compartment syndrome. DFA aneurysms are rare because : 1) PA are rarely affected by arteriosclerosis, 2) the DFA is surrounded by adductor muscles, and 3) DFA dilata-tion is rare because the vessel is composed of a muscle layer rather than elastic fibers. Thus, DFA aneurysms remain silent until they rupture. This patient revealed no history of trauma, catheter intervention, infection, or collagen disease ; thus, the cause of the MCFA aneurysm was unclear. An addition of further cases to the literature may reveal the mechanism underlying the development of DFA aneurysms and the associated risk factors, which could help to establish appropriate treatment guidelines.