Middle colic artery aneurysms are rare and most have been reported with rupture or symptom. We report the successful elective treatment of a middle colic artery aneurysm without symptom, which is very rare. It failed to perform transcatheter arterial embolization for anatomical reasons, and, thus, the patient, a 77-year-old man, underwent surgical resection in spite of a history of laparotomy. Although a common cause of middle colic artery aneurysms is segmental arterial mediolysis, the present pathological findings indicated that fragmented or degenerated elastic fibers may also play an important role like aortic aneurysms.

Primary squamous cell carcinoma of the breast is a rare disease for which no definite treatment or prognosis has been established. This report describes our experience with one case of primary squamous cell carcinoma of the breast that ended in death after rapid progression. The patient was a 58 year old woman who visited our hospital complaining of a growing tumor and pain in the right breast. Ultrasonographically the tumor consisted of solid tumor and a large cyst. Squamous cell carcinoma was diagnosed by fine-needle aspiration cytology. Neoadjuvant CEF was given, but the tumor continued to grow, so CEF was discontinued after one course and modified radical mastectomy was performed subsequently. There was no evidence of metastasis to lymph nodes. About 5 months post operatively CT of the head and chest X-ray demonstrated metastatic lesions in the brain and lungs. Resection of the cerebral tumor was performed. About 1 month after the operation, however, a new metastatic brain tumor was found and the patient later died.

Deep femoral artery (DFA) aneurysms are rare. DFA is protected by the adductor canal, which may delay the diagnosis. Then, its early diagnosis may be difficult and it is possible to be misdiagnosis with incarcerated inguinal hernia, which occurs more often in elderly people. We report a very rare case of a treatment of an advanced elderly patient with an isolated ruptured DFA aneurysm that was preoperatively confused with an incarcerated inguinal hernia.A 97-year-old man was admitted to a neighboring hospital due to a painful mass of the right groin after transient consciousness loss and the patient was diagnosed with right incarcerated inguinal hernia by a nonenhanced computed tomography (CT). Although he was observed for 3 days, he suddenly lost consciousness again with a decrease in blood pressure. Thus, he was referred to our hospital due to the painful pulsatile inguinal mass after resuscitation from shock. As we diagnosed a ruptured DFA aneurysm by an enhanced CT, we emergently performed an excision of the aneurysm with revascularization of the right DFA. The postoperative course was uneventful without ischemic change of the lower leg.

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Upper extremity aneurysms are relatively rare compared with other peripheral arterial aneurysms, and most are false aneurysms.1 Especially, true brachial artery (BA) aneurysms are rare. Although the majority of the BA aneurysms are thought to be the result of trauma, 2 their natural history and incidence are still unclear. Case ReportAlthough a 65-year-old man underwent the creation of a radiocephalic arteriovenous fistula at the left wrist in 2004 at another hospital, the fistula was occluded and so he underwent fistula creation at the right wrist in 2005. Moreover, he noticed a mass just above the left elbow joint that had slowly grown since 2010. However, he was referred to our hospital due to the mass measuring approximately 4 Â 4 cm with rest pain and slight ulceration of the left second and third fingers in 2015. He underwent hemodialysis three times a week and had a medical history of cerebral hemorrhage, type B aortic dissection, hypertension, atrial flutter, and chronic pancreatitis. The patient's height was 171 cm and body weight was 54 kg. The patient's blood pressure in the left upper arm was 122/79 mm Hg and pulse was 75/minute, while the pressure in the left forearm was not measured. Physical examination was unremarkable except for the mass just above the left elbow joint and left hemiplegia as well as no pulse of the left BA, radial, and ulnar arteries, respectively. Laboratory examination showed amylase, 198 IU/L; alkaline phosphatase, 583 IU/L; lactate dehydrogenase, 260 IU/L; total cholesterol, 266 mg/dL; blood urea nitrogen, 47.8 mg/dL; creatinine, 8.23 mg/dL, prothrombin time and international normalized ratio, 1.63, and C-reactive protein, 3.80 mg/dL. Ultrasound showed a left upper limb thrombosed mass just above the left elbow joint. Enhanced computed tomography revealed the left patent proximal BA and ulnar artery as well as the fusiform thrombosed mass measuring 3 Â 3 cm at the distal BA (►Fig. 1A-C). Cardiac ultrasound showed an almost normal left ventricular function (ejection fraction: 52%) and mild aortic regurgitation. Thus, we diagnosed him with a left BA aneurysm with severe upper limb ischemia. In a supine position, after we harvested the left great saphenous vein (GSV) of a medial thigh, the proximal and distal BAs were exposed (►Fig. 2). As the distal BA mostly showed a calcified intima, excision of the aneurysm and BA replacement were performed with a GSV graft after endarterectomy at the distal anastomosis. The wall of the fusiform aneurysm measuring 3.4 Â 2.0 cm was solid without adhesion around the tissues (►Fig. 3A). Keywords► upper limb ischemia ► true brachial artery aneurysm ► arteriovenous fistula AbstractBrachial artery (BA) aneurysms are rare, and most are false aneurysms. Although true BA aneurysms have been reported, most have been reported without symptoms. A 65-yearold man was referred due to a left upper limb mass with rest pain and slight ulceration of the left second and third fingers. As enhanced computed tomography revealed the patency of only the left proxi...

Background: High-grade neuroendocrine carcinoma (HGNEC) of the lung, which includes small cell lung cancer (SCLC) and large cell neuroendocrine carcinoma (LCNEC), is an aggressive form of lung cancer.Although lobectomy followed by adjuvant chemotherapy is regarded as the standard therapy for this disease, it would be an uphill struggle for HGNEC patients to receive that multidisciplinary therapy perfectly. This study aimed to examine recurrence and survival outcomes in surgically treated patients with HGNEC of the lung. Methods:The medical records of 104 HGNEC patients who underwent surgical treatment in five institutions were retrospectively analyzed. Standard treatment (ST) was defined as lobectomy, bilobectomy, or pneumonectomy with mediastinal lymph node dissection followed by adjuvant platinum-doublet chemotherapy with more than two cycles.Results: Patients in the ST group (n=31; 30%) were younger and had fewer respiratory complications than those in the non-standard treatment (NST) group (n=73; 70%). A significantly higher proportion of patients in the NST group developed ipsilateral lymph node recurrence (21% vs. 3%; P=0.035) and ipsilateral or contralateral lung recurrence (15% vs. 0%; P=0.031). Five-year overall survival (OS) was 64.2% in the ST group and 38.3% in the NST group (P=0.038). NST was independently associated with worse OS in multivariate analysis (hazard ratio, 2.044; 95% confidence interval, 1.016-4.113; P=0.045).Conclusions: Surgically treated HGNEC patients who received ST had a more favorable outcome than those who received NST. Patients who receive NST may require additional treatment.

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