The survival probability in patients with resected bile duct cancer was not significantly different between the gemcitabine adjuvant chemotherapy group and the observation group. Registration number: UMIN 000000820 (http://www.umin.ac.jp/).

Hepatopancreatoduodenectomy has the potential to improve both survival and the quality of life for carefully selected patients with advanced gallbladder carcinoma.

Background and Aims:A national survey of photodynamic therapy (PDT) was carried out in order to understand the present situation in Japan and the efficacy of PDT for gastric cancer. Materials and Methods: A questionnaire concerning with PDT was sent to all hospitals performing or previously performed PDT. The answers were collected and analyzed. An additional investigation about efficacy of PDT for gastric cancer was conducted for the main 3 hospitals. Results: In 18 of 19 responded hospitals, PDT was performed for 386 cases of superficial early gastric cancer and for 27 cases of advanced gastric cancer. In the 3 main hospitals, a complete response was achieved in 42 of 57 patients (73.7%) of superficial early gastric cancer not indicated for surgery or other endoscopic treatments such as endoscopic submucosal dissection. No serious complication occurred. Conclusions: PDT has been shown to be a safe and effective treatment for early gastric cancer, not only for the intramucosal type, but also for the submucosal invasion. PDT will be one of the important endoscopic treatments for gastric cancer especially in a super ageing society like Japan.

Background Solitary fibrous tumors (SFTs) are rare tumors, mostly derived from connective tissue mesenchymal cells that arise from the pleura. There are very few reports of primary pancreatic SFT. Preoperative diagnosis is difficult owing to the lack of distinctive radiological findings. We report a case of pancreatic SFT with particularly rare malignant findings. Case presentation A 60-year-old man was referred to the hospital because of a right upper quadrant mass and abnormal liver function test results. Contrast-enhanced computed tomography (CT) showed a well-defined enhanced tumor measuring approximately 8 cm in the pancreatic head. Magnetic resonance imaging (MRI) showed T1WI hypointensity, T2WI hyperintensity, and DWI hyperintensity. The main pancreatic duct and common bile duct were dilated owing to obstruction by the tumor. The following tumor markers were mildly elevated: carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), SPan-1, and DUPAN-2. The histological diagnosis obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was negative for pancreatic ductal carcinoma, malignant lymphoma and neuroendocrine tumor, suggesting the possibility of mesenchymal tumor, but the diagnosis was not confirmed. The patient was judged suitable for surgery and underwent subtotal stomach-preserving pancreatoduodenectomy with D2 lymph node dissection. On histopathological examination of the resected specimen, infiltrating spindle-shaped cells had proliferated, containing numerous mitotic figures, with necrotic findings inside the tumor. Immunostaining was positive for cluster of differentiation-34 (CD34), B cell CLL/lymphoma-2 (Bcl-2), and signal transducer and activator of transcription (STAT6). On the basis of these findings, a diagnosis of malignant pancreatic SFT was made. The patient remains free of recurrent disease after 12 months of follow-up without adjuvant therapy and he is being carefully followed up as an outpatient. Conclusions We experienced a case of malignant pancreatic head SFT. Immunohistochemical staining of the extracted specimens was useful for diagnosis.

Recently we treated three patients with gallbladder volvulus within a short period. All three patients were examined preoperatively using computed tomography (CT). The first two cases were not diagnosed accurately before laparotomy. A precise diagnosis was made for the third one prior to surgery, based on our former experiences. Typical images, with marked edema and thickened wall of the gallbladder volvulus were shown on CT. We discuss six consecutive cases of the disease experienced at Hamamatsu Medical Center (i.e., the three patients rofed above, and three who did not have preoperative CT).