HighlightsIntraductal papillary neoplasm of the bile duct (IPNB) is a newly-recognized disease concept and its long-term prognosis and pattern of recurrence are poorly understood so far.We report a case of IPNB patient with early stage carcinoma who had multicentric recurrence in the remnant hepatic bile duct around 2 years after R0 resection.We should bear in mind multicentric remnant intrahepatic bile duct recurrence in IPNB patients with multiple lesions.Endoscopic approach using double balloon enteroscopy is useful in diagnosis of recurrence and palliation of symptoms in selected patients.

Background Eosinophilic gastrointestinal disorders (EGIDs) are a rare group of inflammatory disorders that can occur anywhere along the gastrointestinal tract, from the esophagus to the rectum. In particular, those with malignant or benign tumors are extremely rare. Case presentation A 62-year-old man was referred to our hospital with a chief complaint of abdominal fullness. The peripheral white blood cell count was 19,400/µL, and the eosinophil count was 13,300/µL. Abdominal computed tomography showed massive ascites. Cytology of the ascitic fluid showed a large amount of eosinophils and no malignancy. Upper and lower gastrointestinal endoscopies were performed on the suspicion of EGIDs, and colon cancer with no other abnormalities was found. The biopsies of the cancer lesions and non-cancer lesions also showed significant differences in eosinophil counts per high-power field (HPF) between the cancer and non-cancer lesions (median 77.5 [IQR 52–115] vs. 40.5 [35–56]/HPF, P < 0.05). Exploratory laparoscopy showed cloudy massive ascites and thickening of the mesentery. Pathological examination of the mesentery showed a large amount of eosinophils (median 177.5 [IQR 91–227]/HPF) and no malignancy. Based on these findings, it was suspected that the massive ascites due to eosinophilic peritonitis could be associated with colon cancer. Steroid administration resulted in immediate disappearance of the ascites, and laparoscopic left hemicolectomy was safely performed 6 weeks after steroid administration. Conclusion This report presented a case of eosinophilic peritonitis that could be related to colon cancer. Exploratory laparoscopy was useful to detect the cause of ascites. The possibility that eosinophilic peritonitis was associated with colon cancer is discussed based on the histopathological findings.

Background: There have been few reports on the development of acute myocardial infarction (AMI) during chemotherapy, therefore the causes and preventive measures have not been fully evaluated. We report a case of pancreatic undifferentiated carcinoma in a patient who suffered cardiopulmonary arrest (CPA) during paclitaxel and carboplatin (TC) therapy. The cause of death was diagnosed as AMI at autopsy. Case: A 69-year-old man was diagnosed with stage IVb pancreatic tail cancer with a histology of suspected undifferentiated carcinoma. It was associated with invasion to stomach and transverse colon, and multiple metastases to liver and peritoneum. He took medications for hypertension, hyperlipidemia, diabetes, and prior cerebral infarction, while he had no history of heart disease. We started the first cycle of TC therapy. We performed both electrocardiography and echocardiography at baseline, and detected atrial fibrillation, right bundle branch block, and mild diffuse hypokinesis. On the fifth day, he began to complain of nausea and appetite loss, which worsened gradually. On the seventh day, he suffered CPA after vomiting at home. He was transported by ambulance but was pronounced dead after a failed resuscitation. Initially, we assumed that he died from suffocation from aspiration. However, our final diagnosis of the direct cause of death was AMI, according to autopsy findings of fresh and extensive MI at the interventricular septum and a high possibility that the aspiration occurred after death. The histological diagnosis of the pancreatic tumor was confirmed undifferentiated carcinoma. Discussion: We speculated that an underlying coronary arteriosclerosis and subsequent toxicities such as volume depletion and anemia might have caused the AMI. Special attention should be given to the management of coronary risk factors and toxicities, regardless of the prevalence of cardiotoxicity, when chemotherapy is administered to patients with multiple coronary risk factors.

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