先天性第VII因子欠乏症（以下，第VII因子欠乏症と略記）は，まれな疾患である．第VII因子欠乏症併存胃癌症例に対し，遺伝子組換え活性型第VII因子製剤（以下，rFVIIaと略記）を投与し胃切除術を施行した．症例は58歳の男性で，B型肝炎治療のため検査を施行し，第VII因子欠乏症併存胃癌と診断された．プロトロンビン時間が18.0秒（control 12.7秒）と延長し，第VII因子活性は10%と低下していた．上部消化管内視鏡検査では胃角部前壁に胃癌を認めた．以上より，第VII因子欠乏症併存胃癌と診断し，術直前にrFVIIa 1.2 mg（18 μg/kg）を静脈注射し幽門側胃切除術を施行した．術後も第VII因子活性を測定しながら第4病日までにrFVIIa 1.2 mgを計13回静脈注射した．第VII因子欠乏症の手術報告例は少なく，第VII因子活性の測定およびrFVIIaの投与により安全に施行できた．

An 85-year-old man was diagnosed with esophagogastric junctional adenocarcinoma, E=G, Type 2, por, 6 cm in size, cT4aN1M0, cStage ⅢA. He had a history of atherosclerosis obliterans and thoracoabdominal aortic aneurysm. Considering the comorbidities and life expectancy, we decided to perform chemotherapy without tumor resection. Although the renal function was poor, we chose SP therapy(S-1 80mg/kg/day for 14 days, followed by 7-day rest, CDDP 30mg/kg/day on day 1)because the current status of the patient was satisfactory. The primary tumor remarkably shrank after 2 courses of SP therapy and completely disappeared after 5 courses of SP therapy. There were no adverse events during the entire course of treatment. We detected clinical CR and provided the S-1 monotherapy for another 2 years. The patient has survived with no recurrences for 7 years since the initial chemotherapy. Although intensive chemotherapy regimens are avoided in elderly patients, the patient, in this case, showed a favorable prognosis from powerful chemotherapy.

BACKGROUND Currently, 3 molecular targeted drugs are available for the treatment of unresectable and recurrent gastrointestinal stromal tumors (GISTs), and result in improved prognoses and rare occurrence of bone metastases. However, there is no established treatment guideline for bone metastases of GIST. CASE REPORT The patient was a 56-year-old male who was diagnosed with leiomyosarcoma in 1997. Partial resection of the small bowel was performed. As part of post-operative follow-up in 2004, a computed tomography scan showed metastatic lesions in the liver and the right femoral neck. Accordingly, partial hepatectomy was performed, followed by artificial femoral head replacement. In 2006, bone metastases were detected in the sternum, cervical and thoracic vertebra, and the right upper arm; therefore, the patient was subjected to radiotherapy. However, further histopathological examination revealed positive findings for CD34+ and KIT cells, prompting a diagnosis of GIST. Imatinib was started. The disease remained stable. However, in 2010, metastasis to the right ilium was detected, after which there was an increase in metastatic lesions in the thoracic vertebra, prompting a diagnosis of progressive disease. Thus, treatment with sunitinib was initiated. In 2012, the patient experienced spinal paralysis due to metastasis in the eighth thoracic vertebra. In 2013, metastases in the right ilium, lungs, and liver were detected. In 2014, the patient died. CONCLUSIONS Multidisciplinary treatment via radiotherapy and surgery for GIST with bone metastases indicates the possibility of extending the overall survival further.

The patient was a 72-year-old man who exhibited an abnormal shadow in the stomach in a series of medical check-ups of the upper gastrointestinal in August 20XX. It was diagnosed as gastric cancer(type 1)of the greater curvature of the MU region. Total gastrectomy, D2-11p dissection, and Roux-en-Y reconstruction were performed in October 20XX. The tumor was p-T1bN3aM0, Stage ⅡB, Pap, Ly1c, V1a, 90×70mm, HER2 score 3. Six courses of S-1/CDDP were administered as adjuvant chemotherapy after consultation. Two years and 8 months after the surgery, PET-CT scan showed distant lymph node metastasis(left axilla, para-aortic)and left lung metastasis. Three courses of XP-Her after 2 years and 11 months, 19 courses of X-Her after 3 years and 2 months, and 7 courses of trastuzumab alone after 4 years and 4 months to 4 years and 9 months were canceled. Three years and 4 months after the surgery, the tumor showed PR, and it showed CR, 3 years and 8 months after the surgery. Eight years and 3 months after the surgery, the tumor continued to show CR. The adverse events were blood toxicity, WBC reduction Grade 1, neutropenia Grade 3, and anemia Grade 2. There have only been a few reports on CR after chemotherapy with XP-Her for lung metastasis of gastric cancer, with a review of the literature.

We experienced 2 cases in which strontium chloride was used for pain associated with gastric cancer bone metastasis. Case 1 was of a 69-year-old woman. In 2015, she underwent surgery for advanced gastric cancer followed by adjuvant chemotherapy with S-1 for 1 year. Multiple bone metastases were confirmed 2 years and 3 months after surgery. Obvious pain relief was obtained after 89Sr was administered, and SOX therapy was started. Case 2 was of a 62-year-old man. In 2016, he underwent curative surgery for stomach cancer. Chemotherapy with S-1 was performed for approximately 6 months, but 9 months after surgery multiple LN metastases, liver metastasis, and multiple bone metastases were observed . In case 2, 89Sr was administered, but good pain control was not obtained. The use of 89Sr for pain relief against multiple bone metastases should be based on the previous literature.

The patient was a 56-year-oldwoman. She presentedto a nearby doctor with a chief complaint of dysphagia andwas diagnosed with esophageal cancer by upper gastrointestinal endoscopy, resulting in a referral to our hospital. Upper gastrointestinal endoscopy revealeda semicircular type 1 lesion 29 to 32 cm from the incisors, andshe was diagnosedwith squamous cell carcinoma by biopsy. Computedtomography (CT)andpositron emission tomography(PET)scans revealedthe enlargement and accumulation of lymph nodes along the lesser curvature of the stomach; thus, she was diagnosed with metastasis. In addition, multiple accumulations were found in the 7th cervical vertebrae as well as in the 1st, 3rd, 4th, and 8th thoracic vertebrae, leading to the diagnosis of bone metastasis. She was finally diagnosed with middle intrathoracic esophageal cancer T2N1M1, Stage Ⅳ; thus, we performedchemorad iotherapy(CRT)with 5-FU andCDDP (FP). The main lesion was markedly reduced in upper gastrointestinal endoscopy after CRT, and no apparent malignancy was found in endoscopic biopsy, so the diagnosis was endoscopic complete response. The CT scan also showed marked reductions in both the main lesion and the lymph nodes. As for the bone metastasis, some areas of bone consolidation remained, but they were diagnosed as partial responses since they were shrunk. Since then, FP has been continuously administeredon a regular basis andit has been about 2 years without any appearance of new lesions or re-exacerbation.

Case 1: A 69-year-old man underwent distal gastrectomy in September 2007 for type 2 gastric cancer with liver metastasis (S5). After the operation, we administered chemotherapy. After that, we performed partial hepatectomy in July 2008. After hepatectomy, liver metastases appeared as 2 lesions in February 2009. Thus, we administered another type of chemotherapy. The effect of the chemotherapy was not favorable. Therefore, SBRT was performed for the liver metastases in December. After SBRT, he did not present with any recurrent tumors. Case 2: A 67-year-old woman underwent distal gastrectomy in March 2015. In August 2015, hepatic metastasis(S5 single shoot)was confirmed. Although chemotherapy was administered and SD was continued, it was ceased due to the patient's request. Thus, SBRT was performed in July 2016. However, from October 2016, multiple liver metastases developed and she died in January 2017.

A 79-year-old man with cStage II A(T2N1H0P0CYXM0)advanced gastric cancer in angle. Distal gastrectomy was performed and liver metastasis was recognized during the operation. The pathological diagnosis was shown as neuroendocrine carcinoma(NEC). Chemotherapy(S-1/cisplatin[CDDP]: 1 course, etoposide/CDDP: 5 courses)was administered. After chemotherapy, liver metastasis disappeared for 9months.

Background: In a recent study, it was reported that transcatheter arterial embolization with spherical embolic material for life-threatening hemorrhages in various cancer patients was safe and effective. Calibrated microspheres are able to access distal regions of the target arteries, which results in the disappearance of tumor staining. However, there are few reports on the pathological behavior of EmboSpheres in gastric cancer specimens. In this case, we succeeded in salvage embolization for advanced gastric cancer with hemorrhagic shock using spherical embolic material. To our knowledge, this is the first report of a pathological evaluation of spherical embolic microspheres in a gastric cancer specimen. Case Report: A 70-year-old man with scirrhous gastric cancer was admitted to our hospital for staging laparoscopy. Unfortunately, he had a sudden onset of hematemesis and melena leading to hemorrhagic shock due to bleeding from the gastric cancer. While undergoing a rapid blood transfusion, he underwent emergent embolization to achieve hemostasis. The left gastric and right gastroepiploic arteries were embolized with spherical embolic material, and the patient survived. Two days later, the patient was able to undergo gastrectomy. A large number of microspheres were observed in areas of hemorrhage. The range and median diameter of the minor axis were 177–1048 μm and 281 μm, respectively. Conclusions: Transcatheter arterial embolization using spherical embolic material could become one of safe and effective options, especially when there is no extravasation or pseudoaneurysm but only tumor staining from the clinical and pathological point of view.

A 70-year-old man with cStage III A(cT3N2H0P0CYXM0)advanced gastric cancer in the lesser curvature with esophageal invasion and bulky lymph nodes was treated with S-1/CDDP. After 4 courses of chemotherapy, the tumor and lymph nodes were found to be reduced in a CT examination. Total gastrectomy with lymph node dissection(D2)was performed. Histopathological examination revealed no cancer cells in the stomach or lymph nodes, indicating Grade 3.

We examined the effectiveness of partial gastrectomy in the elderly. Twelve patients who underwent partial gastrectomy for gastric cancer in our hospital had an average of 2.75 comorbidities before surgery. Two patients relapsed, and 2 patients died from other diseases. The depth of the gastric tumor was T2 in patients with recurrence. Partial gastrectomy should be considered carefully for advanced stage cancer. There were only small changes in weight, PS, and nutrition before and after surgery, suggesting that partial gastrectomy is effective.

We retrospectively considered the validity of radiotherapy for patients with bone metastases from esophageal cancer. Eight patients have received radiotherapy in our hospital since 2007. The median age of the patients was 63 years, with 5 men and 3 women. Bone metastatic sites were 4 to the vertebrae, 3 to the ribs, 3 to the femur and 1 each to the humerus, ulna, and radius, respectively. All of the patients had other unresectable sites of metastasis. Radiotherapy reduced pain of 3 patients of PS 1 clearly. Median survival time from the start of radiation therapy was 50 days. When PS was relatively good, the possibility of easing pain and improving QOL was suggested by our data. There is a possibility that radiation therapy for patients with bone metastases from esophageal cancer can improve the QOL and alleviate pain.

We examined the effectiveness of chemoradiotherapy for esophageal cancer patients aged 80 years or older, 9 of whom were treated after 2010. Treatment consisted of cisplatin 35 mg/m² (day 1 and 29) and 5-FU 350 mg/m² (days 1-4 and 29- 32) combined with 50.4 Gy radiotherapy (1.8 Gy/day, 5 days/week, days 1-42). We administered 50% of the normal dose of chemotherapy. Median survival was 387 days, and there were 6 PRs, 1 SD, and 2 PDs. The toxicities related to the chemoradiotherapy were manageable (7 patients had toxicities worse than Grade 2, of whom 6 died and 3 were alive at the time of reporting). This treatment may be effective and safe for elderly esophageal cancer patients.

To determine if the POSSUM, SOFA, MPI, and SAS scores provide a better measure of severity for patients with prognostic factors undergoing surgery for colorectal perforation.Fifty-nine patients who underwent surgery between 1996 and 2012.We retrospectively reviewed background factors, blood and physiological test results, and intraoperative findings of patients who survived and those who died. We also compared the POSSUM, SOFA, MPI, and SAS scores. Multivariate analysis was performed for factors that were significant by univariate analysis, and selected factors were used to produce a predictive prognostic model.Univariate analysis revealed significant differences in age, anticoagulant/steroid administration, serum creatinine level, PF ratio, base excess (BE), chest radiography, pulse rate, and severity of peritoneal soiling. Age, serum creatinine level, pulse rate, and severity of peritoneal soiling were selected for multivariate analysis; only pulse rate was significantly different. There were significant differences between the two groups in POSSUM PS, OSS, SOFA, and MPI scores, and a comparison in terms of the ROC curve showed that our model had the highest peak; the area under the curve was 94.8% compared with 70-80% for the other systems, suggesting that our model is better than those systems.POSSUM and SOFA are valid methods of evaluating risk from colorectal perforation, but our study revealed addition risk factors: (1) the PF ratio and BE, which are not included in POSSUM; (2) the pulse rate and severity of peritonitis, which are not included in SOFA; and (3) anticoagulant/steroid hormone administration.

症例は67歳，男性，健診にて異常を指摘され上部消化管内視鏡検査施行しUlを伴う0-Ⅱc型の早期胃癌と診断された．術前検査として下部消化管内視鏡検査を施行したS状結腸癌を確認した．内視鏡的粘膜切除（EMR）施行し粘膜下層に1,200μm浸潤する早期S状結腸癌と診断した．今回，われわれは早期胃癌と早期S状結腸癌に対し一期的に腹腔鏡下幽門側胃切除術と腹腔鏡下S状結腸切除術を施行したので報告する．

脾膿瘍は稀な疾患である．症例は66歳，男性．悪寒，動悸を主訴に来院した．39.8度の高熱と腹部全体に圧痛，筋性防御を認めた．血液学的検査では貧血と炎症の所見があり，腹部CTでは腹水の貯留と脾臓の裂傷がみられた．また胃壁は肥厚しており胃原発の悪性疾患を疑う所見を認めた．汎発性腹膜炎または脾臓破裂による腹腔内出血を疑い緊急手術を施行した．開腹所見は脾膿瘍による脾破裂による汎発性腹膜炎を呈していた．また，胃体部大彎を中心とした腫瘍性病変が触知され，この腫瘍と脾臓と膵臓は一塊となっていた．胃癌もしくは胃悪性リンパ腫が疑われ胃全摘，D1郭清，膵脾合併切除，Roux-Y再建施行した．病理所見から胃癌の脾臓浸潤と穿通が確認された．今回われわれは胃癌の脾臓浸潤による穿通のため脾膿瘍を合併し，膿瘍穿破による汎発性腹膜炎を発症した１例を経験したので報告する．

S-1 is a key drug for advanced, recurrent gastric cancer. It is difficult to administer S-1 for inoperable gastric cancer with stenosis. We report that a simple suspension method allows administration of S-1 for improved quality of life. The patient was a 65-year-old woman. She consulted a doctor regarding her poor food intake, and had a medical examination with chest-abdominal CT and gastrofiberscopy. She was diagnosed as type 4 gastric cancer with esophageal invasion. It was difficult for her to drink a cup of water due to the stenosis, but we could insert a 6 Fr-Elemental Diet (ED) tube into her stomach. S-1 was dissolved by the simple suspension method. She received combination chemotherapy of S-1 100mg/body (day 1-21) and CDDP 80 mg/body (day 8). After two courses, her intake was much improved; she was able to eat rice porridge and was discharged with improved quality of life. S-1 suspension with ED tube was effective for advanced gastric cancer with stenosis.