Kagoshima City Hospital

Pancreaticoduodenal artery aneurysms (PDAAs) are associated with celiac axis stenosis and occlusion. PDAAs carry a risk of sudden rupture and therefore require prompt treatment. Sjögren’s syndrome (SS), a systemic autoimmune disease, has recently been reported in association with various arterial aneurysms. To our knowledge, no previous report has described concurrent PDAAs and cerebral aneurysms (CAs) associated with SS. Here, we present a rare case of PDAAs and CAs associated with SS. A 69-year-old Japanese woman with a history of chronic hepatitis was referred to our hospital. She had a 20-year history of dry mouth, a one-month history of taste disturbance, and joint pain. Laboratory tests revealed she was SS. Abdominal ultrasonography performed for chronic hepatitis incidentally revealed aneurysms around the pancreas. Contrast-enhanced computed tomography (CECT) demonstrated multiple PDAAs, including two anterior superior PDAAs, three anterior inferior PDAAs, one inferior PDAA, and two dorsal pancreatic artery aneurysms. The origin of the celiac axis was occluded. CECT also revealed three CAs: an anterior communicating artery (AcomA) aneurysm with a bleb, a right middle cerebral artery aneurysm, and a right M1 bifurcation aneurysm. We planned a three-stage treatment strategy. First, an aorto-hepatic bypass using a reversed great saphenous vein graft was performed. The graft was proximally anastomosed to the abdominal aorta 15 mm above the inferior mesenteric artery, routed through the mesocolon near the ligament of Treitz, and passed between the stomach and pancreas. It was then distally anastomosed to the common hepatic artery. The gastroduodenal artery (GDA) was ligated to prevent competitive flow between the GDA and the graft. The postoperative course was uneventful, and the patient was discharged on postoperative day 9. Twenty days later, coil embolization of the PDAAs was performed as the second treatment. Fifty days thereafter, stent-assisted coil embolization of the AcomA aneurysm was performed as the third treatment. Twelve months after the aorto-hepatic bypass, the graft remained patent, and the sizes of the remaining CAs were unchanged. Our case highlights the potential for systemic aneurysm formation in patients with SS and demonstrates that staged multidisciplinary treatment can be safely and effectively performed.

Abstract Background: Tumor-infiltrating lymphocytes (TILs) reflect host immune response and are associated with prognosis and treatment response in HER2-positive and triple-negative breast cancer (TNBC). While the International Immuno-Oncology Biomarker Working Group recommends evaluating stromal TILs in tumor areas, intratumoral heterogeneity and small sample size in core needle biopsy (CNB) specimens limit consistent assessment. It remains unclear whether central tumor (CT) or invasive margin (IM) regions should be prioritized and what cut-off values are clinically relevant. Ultrasonographic (US) features may also reflect the immune microenvironment. We previously proposed a TILs-US score based on three US features that predicts lymphocyte-predominant breast cancer (LPBC). This study evaluated the clinical utility of TILs assessment from CT and IM regions, appropriate cut-off values for predicting response in HER2-positive and TNBC using CNB, and explored optimal biopsy targeting through pathologic and US comparisons. Methods: In this multicenter retrospective study, we analyzed 239 patients (124 HER2-positive, 115 TNBC) with cT1-3/cN0-2 breast cancer who underwent surgery after neoadjuvant chemotherapy (NAC). TILs were evaluated using CNB specimens obtained before NAC and assessed separately in the central tumor (CT) and invasive margin (IM) regions. The IM was defined as a 1-mm-wide area centered on the interface between the tumor and surrounding stroma, while the CT was defined as the remaining intratumoral area within the IM boundary. TILs were analyzed using binary cut-offs of 30% and 50%, as well as a three-tier classification: low (0-10%), intermediate (11-49%), and high (≥50%). Pre-treatment ultrasound (US) findings included tumor shape (scored 0-2), internal echo (0-2), and posterior echo (0-3), which were used to calculate a composite TILs-US score ranging from 0 to 7. Associations between TIL levels, US features, and pathological complete response (pCR) were analyzed. Results: Overall, 104 patients achieved pCR (HER2-positive: 39; TNBC: 65). Using a 30% cut-off, TILs were evenly distributed both CT and IM, while ≥50% cases were relatively rare especially CT (CT: 10%; IM: 20%). CT TILs ≥30% was significantly associated with pCR (p=0.001), whereas the ≥50% cut-off was not (p=0.128). In contrast, both 30% and 50% cut-offs in the IM region were predictive of pCR (p<0.001 and p=0.009, respectively). Subtype analysis revealed that in TNBC, TILs ≥30% in both CT and IM regions were significantly correlated with pCR. In HER2-positive cases, however, only IM TILs ≥30% was predictive of pCR. Similar trends were observed with the three-tier classification. Among US features, a small lobulated shape was associated with high TILs levels in both CT and IM regions, while an enhanced posterior echo was correlated with high TILs in the IM region. Conclusion: Our findings suggest that TILs assessment should include the IM in addition to the CT, especially in CNB specimens as provide valuable information. Given the limited tissue area available in CNB specimen, using a 30% cut-off for TILs may offer a clinically meaningful threshold to predict treatment response. In cases where US findings suggest central fibrosis, targeting only the tumor center may result in sampling fibrotic areas with sparse immune and tumor cells, potentially hindering proper evaluation. Therefore, selecting the biopsy target based on US imaging is essential. Especially in HER2-positive breast cancer, as well as TNBC, it is important for operators to consider the optimal needle insertion angle and sampling site to ensure appropriate sampling of viable tumor tissue and immune microenvironment for accurate pathological and immunological evaluation. Citation Format: Y. Kimura, R. Yamaguchi, K. Fukui, A. Kanou, M. Noma, S. Akashi-Tanaka, K. Arihiro, N. Iwamoto, Y. Ohta, T. Okuno, S. Kashiwagi, Y. Kamei, Y. Tanada, S. Nakano, A. Nagata, A. Murakami, Y. Mochitomi, A. Yamakawa, M. Yamaguchi, H. Shima, A. Emi. Ultrasound-guided biopsy-based tils assessment at tumor margins as a predictive biomarker of neoadjuvant treatment response in early her2-positive and triple-negative breast cancer: a multicenter study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-13-18.

Abstract Background Three types of Janus kinase (JAK) inhibitors are currently available for the treatment of ulcerative colitis (UC) in Japan. Although several studies have reported their efficacy and safety in clinical practice, real-world data remain limited. Therefore, we investigated treatment outcomes across multiple local medical institutions. Methods This was a multicentre, retrospective study including patients with UC who were prescribed a JAK inhibitor between July 2007 and December 2025. The primary outcomes were clinical remission and response at 4 weeks, 52 weeks, and at the most recent follow-up. The efficacy and safety profiles of each JAK inhibitor were compared descriptively. Results A total of 74 patients with UC were treated with JAK inhibitors during the study period: 23 with tofacitinib, 29 with filgotinib, and 22 with upadacitinib. Clinical remission rates at 4 and 52 weeks were 70.0% and 47.6% for tofacitinib, 86.2% and 60.7% for filgotinib, and 95.2% and 72.2% for upadacitinib, respectively. Among patients who underwent JAK inhibitor intraclass switching, tofacitinib was used in 4.4% (1/23), filgotinib in 6.9% (2/29), and upadacitinib in 68.2% (15/22). Upadacitinib demonstrated higher efficacy than the other JAK inhibitors, including in patients who had previously received a different JAK inhibitor. One case of herpes zoster infection occurred in a patient treated with tofacitinib; however, there was no significant difference in the incidence of adverse events among the three JAK inhibitors. No cases of death, malignancy, or major acute cardiovascular events were observed. In this study, JAK inhibitors were more frequently prescribed for patients intolerant to 5-aminosalicylic acid (5-ASA) (35.1%). Conclusion Upadacitinib demonstrated favourable therapeutic efficacy even in community-based medical settings. The accumulation of further detailed real-world data will help optimise the selection of the most appropriate JAK inhibitor for individual patients with ulcerative colitis. Conflict of interest: Dr. Mori, Statoshi: No conflict of interest Maeda, Nobuhisa: No conflict of interest Kuwazuru, Kosuke: No conflict of interest Sameshima, Yoichi: No conflict of interest Tanaka, Akihito: No conflict of interest Komaki, Yuga: No conflict of interest Kanmura, Shuji: No conflict of interest

We report a rare case of a large presacral fistula that developed after proton beam therapy for locally recurrent colorectal cancer and was successfully closed using a posterior thigh flap. A woman who had been treated with sigmoidectomy at age 45 years and subsequently underwent surgery for pelvic and peritoneal recurrence developed a pelvic abscess that left a fistula. At age 48 years, she developed a sacral recurrence and underwent proton beam therapy. The fistula progressed to a presacral cavity with exposure of the small intestine and bladder, causing severe pain that prevented sitting. The fistula was surgically debrided, with staged closure using a posterior thigh flap. Postoperatively, the fistula was closed without bladder or intestinal leakage, the pain resolved, and the patient regained her ability to sit comfortably. Coverage of the exposed viscera with a well-vascularized flap resulted in reliable wound closure and markedly improved quality of life.

Introduction: Patient-facing websites operated by medical societies are crucial for disseminating reliable health information; however, their real-world usage and effectiveness are often unquantified. This study investigated the user engagement and demographics of "Scoliosis Town," a patient education website developed by the Japanese Scoliosis Society, to evaluate its performance.

ABSTRACTObjectivesEndoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS) is useful in cases of endoscopic retrograde cholangiopancreatography failure. However, the procedure has a high incidence of procedure‐related early adverse events (PRAEs). This study retrospectively evaluated risk factors for such events post‐EUS‐HGS.MethodsThis multicenter study included 222 patients (120 males and 102 females; median age = 73 years) who underwent initial EUS‐HGS. The clinical success rate and PRAE incidence, and risk factors were analyzed. PRAEs were defined as AEs occurring within 2 weeks.ResultsThe median procedure time was 41 min. Metal or plastic stents were used for EUS‐HGS in 107 and 115 patients, respectively. Fistula dilation and concomitant antegrade stenting (AGS) were performed in 166 and 45 patients, respectively. The clinical success rate and PRAE incidence were 85.1% and 22.1%, respectively. Identified PRAEs included acute peritonitis (9.5%), fever (6.8%), abdominal pain (2.3%), and acute pancreatitis (1.4%). Multivariate analysis identified dilation device use (p = 0.01) and AGS (p = 0.03) as PRAE risk factors. AGS in patients who underwent fistula dilation (p = 0.02) and procedure time ≥41 min in those who underwent EUS‐HGS with AGS (p = 0.01) were PRAE risk factors.ConclusionsFistula dilation and AGS are associated with an increased risk of PRAEs post‐EUS‐HGS. Careful postoperative follow‐up for such events is required in patients undergoing fistula dilation for EUS‐HGS with AGS and prolonged procedure time.

Chemotherapy-induced neutropenia has been identified as a potential prognostic marker for multiple cancers. However, only one retrospective study, NN-2301, has investigated the relationship between neutropenia and treatment effects of nanoliposomal irinotecan/5-fluorouracil/folinic acid (NFF) in pancreatic cancer. In this prospective study, we aimed to clarify whether NFF-induced neutropenia could serve as a prognostic marker in pancreatic cancer. Data were analyzed from the prospective cohort of the NAPOLEON-2 trial, an observational study involving patients with unresectable pancreatic cancer treated with NFF. Neutropenia severity was categorized into three cutoffs: Cutoff A (Grade [Gr] 0 vs. Gr 1-4), cutoff B (Gr 0-1 vs. Gr 2-4), and Cutoff C (Gr 0-2 vs. Gr 3-4), using the Common Terminology Criteria for Adverse Events version 5.0, owing to conformity with previous studies and simplicity. The primary endpoint was overall survival (OS); progression-free survival (PFS) was the secondary endpoint. The neutropenic groups included Gr 1, 2, 3, and 4, with 79, 23, 34, and 7 patients, respectively. At each cutoff, OS and PFS were significantly better in the severe neutropenia groups. Higher neutropenia grades correlated with improved OS (log-rank trend test: χ2 = 8.62, p < .01). Multivariate Cox regression analysis revealed significant differences for all cutoffs: adjusted hazard ratios were 0.57 (95% confidence interval [CI] 0.40-0.83) (Cutoff A), 0.53 (95% CI 0.36-0.78) (Cutoff B), and 0.52 (95% CI 0.34-0.80) (Cutoff C). NFF-induced neutropenia is a valuable prognostic marker in pancreatic cancer and may guide treatment selection.

Abstract Purpose This study aimed to evaluate the clinical efficacy of the herbal medicine Eppikajyutsuto (TJ-28) as monotherapy for isolated lymphatic malformations (LM) in pediatric patients.Methods A retrospective review was conducted on 33 LM patients treated with TJ-28 at three pediatric surgery departments between 2009 and 2023. All patients underwent ultrasound and/or magnetic resonance imaging before and after treatment. LM lesions were classified as macrocystic, microcystic, or mixed macro-microcystic based on the International Society for the Study of Vascular Anomalies classification. The LM area index (LAI) was calculated as the product of longitudinal width and depth (mm²), and the LAI ratio was defined as post-treatment LAI divided by pre-treatment LAI.Results The median age at treatment initiation was 20 months, with a median treatment duration of 12 months. Significant reductions in LAI were observed in macrocystic (n = 23; p &lt; 0.001) and mixed (n = 8; p = 0.01) types, while microcystic LM (n = 2) showed no significant change (p = 0.525). The median LAI ratio was 0.36 for macrocystic, 0.41 for mixed macro-microcystic, and not improve for microcystic.Conclusions TJ-28 appears to be effective for reducing lesion size in macrocystic and mixed macro-microcystic LM.Level of evidence a prognosis study of level Ⅳ