Surgical Case Reports

Effusion Reduction after Early Trastuzumab Deruxtecan Therapy for Unresectable HER2-Low Breast Cancer in an Older Patient: A Case Report

Ayaka Akabane, et al.

INTRODUCTION: In recent years, HER2-low breast cancer has emerged as a distinct subtype, and the anti-HER2 antibody–drug conjugate trastuzumab deruxtecan (T-DXd) has become a promising treatment option. We report the case of an older patient with advanced HER2-low breast cancer resistant to endocrine therapy, who demonstrated a favorable clinical response to the early introduction of T-DXd.

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A Case of Unresectable Advanced Esophageal Cancer with Recurrent Pneumatosis Intestinalis and Portal Venous Gas during Chemotherapy with Immune Checkpoint Inhibitors

Hiroki Tashiro, et al.

INTRODUCTION: Esophageal squamous cell carcinoma is an aggressive malignancy often diagnosed at an advanced stage. Immune checkpoint inhibitors (ICIs), such as pembrolizumab, have shown promising outcomes for improving survival. Although rare, immune-related adverse events (irAEs) associated with ICI therapy, such as pneumatosis intestinalis (PI) and portal venous gas (PVG), can be fatal.

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Successful Bentall Surgery in a Moyamoya Disease Patient with Intraoperative Brain Protection via IABP-Induced Pulsatile Flow and CO2 Management during Cardiopulmonary Bypass

Kazuma Handa, et al.

INTRODUCTION: Moyamoya disease is an occlusive cerebrovascular disorder in which maintaining cerebral blood flow during cardiac surgery is challenging. No reports have described Bentall surgery in such patients. We present a successful case using an integrated brain protection strategy combining intra-aortic balloon pumping (IABP)-induced pulsatile flow, carbon dioxide management, and moderate hypothermia.

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Extended Thymectomy via Thoracoscopy and Cervical Incision in a Child with Anterior Mediastinal Mixed Germ Cell Tumor and Paraneoplastic Precocious Puberty

Masaya Yamoto, et al.

INTRODUCTION: Anterior mediastinal germ cell tumors are uncommon in children, and mixed germ cell tumors containing malignant components are particularly rare. These tumors may occasionally present with endocrine manifestations such as gonadotropin-independent precocious puberty caused by ectopic human chorionic gonadotropin (hCG) secretion. Complete resection is the mainstay of treatment, and extended thymectomy is recommended when the tumor involves or is inseparable from the thymus. Minimally invasive techniques such as video-assisted thoracoscopic surgery (VATS) have been increasingly applied, and in some adult cases, a cervical incision has been combined to ensure removal of the cranial thymic extension. However, pediatric reports of VATS combined with a cervical incision for extended thymectomy are lacking.

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Occult Breast Cancer Diagnosed from a Solitary Scalp Metastasis without Axillary Lymph Node Involvement: A Case Report

Tomoka Ushio, et al.

INTRODUCTION: Occult breast cancer (OBC) is defined as metastatic breast carcinoma without detectable breast lesions on clinical or imaging evaluation. Most cases are diagnosed from axillary lymph node metastasis (ALNM), while presentation from other sites is rare.

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Primary Extragastrointestinal Stromal Tumor of the Dorsolateral Anorectum Resected via a Posterior Approach: A Case Report

Makoto Hasegawa, et al.

INTRODUCTION: Gastrointestinal stromal tumors (GISTs) can arise anywhere along the gastrointestinal tract. When they originate outside the gastrointestinal tract, they are referred to as extragastrointestinal stromal tumors (EGISTs), which are rare. In particular, EGISTs arising in the perianorectal region are extremely rare. We report the case of a primary perianorectal EGIST, which was initially diagnosed preoperatively as a rectal GIST.

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Endoscopic Management of Crayfish (Procambarus clarkii) Aspiration: A Case Report

Guo-Qiang Song and Guo-Qiang Hu

INTRODUCTION: Airway foreign bodies are time-sensitive otolaryngologic emergencies that can occur in persons of any age. We describe a unique case of complete aphonia caused by the impaction of a crayfish (Procambarus clarkii) claw at the level of the vocal cords.

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Spontaneous Closure of Bronchopleural Fistula after Right Upper Lobectomy without Invasive Interventions—A Case Report

Taketo Kato, et al.

INTRODUCTION: A bronchopleural fistula (BPF) is a serious and potentially life-threatening complication of pulmonary resection, with a particularly high incidence following pneumonectomy. Although surgical repair is the mainstay of treatment, conservative management with bronchoscopic intervention also results in complete resolution in some cases. Spontaneous closure of the BPF, especially after full dehiscence of the bronchial stump, remains exceptionally uncommon.

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Fournier’s Gangrene Treated with Perianal Loop Drainage and Aggressive Surgical Debridement while Preserving Postoperative Anal Sphincter Function: A Case Report

Ryosuke Aoki, et al.

INTRODUCTION: Fournier’s gangrene is a rapidly progressive necrotizing fasciitis affecting the external genitalia and perineal region, with a poor prognosis and mortality rate of up to 20%. Prompt infection control, typically through extensive debridement, is essential for survival but may impair anal sphincter function and patient’s QOL. In the present case, infection control and anal sphincter preservation were successfully achieved using the loop drainage as the initial treatment strategy.

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Thoracoscopic Removal of a Fish Bone Retained in the Lung for Five Years without the Need for Lung Resection: A Case Report

Takaaki Nakatsukasa et al.

INTRODUCTION: The accidental ingestion of fish bones is a common clinical occurrence, especially in regions with high fish consumption. While most foreign bodies pass uneventfully or are removed endoscopically, sharp objects such as fish bones may perforate the gastrointestinal tract and migrate to adjacent organs, occasionally leading to severe complications. Migration into the lung parenchyma is extremely rare.

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Mitral Valve Repair for Mitral Regurgitation Associated with Antiphospholipid Syndrome: A Case Report

Masaru Yoshikai, et al.

INTRODUCTION: Antiphospholipid syndrome (APS) is a multisystem autoimmune disorder of hypercoagulability, characterized by arterial and venous thrombosis, recurrent fetal losses, thrombocytopenia, and circulating antiphospholipid antibodies. Among valvular manifestations associated with APS, mitral regurgitation (MR) is the most common, followed by aortic regurgitation. Surgical interventions for APS-related valvular diseases carry high perioperative morbidity and mortality. There are no established guidelines regarding the surgical management of APS-related MR.

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Esophageal Perforation Following Pneumatic Dilation in Esophageal Achalasia Successfully Managed with Two-Stage Laparoscopic Surgery

Yuki Sakai, et al.

INTRODUCTION: Endoscopic treatment frequently results in minimal gastrointestinal content leakage and mild symptoms. However, surgical intervention may become necessary when the patient’s general condition is unstable. Further management of the underlying disease is required in cases where esophageal perforation occurs during endoscopic treatment. This report presents a case of esophageal perforation that occurred during the treatment of achalasia, underscoring the success of a two-stage laparoscopic approach.

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