An 86-year-old woman with a subcutaneous nodule in her left axilla visited our hospital. She had no gastrointestinal symptoms, but contrast-enhanced computed tomography revealed a cecal mass and systemic metastasis, including cutaneous, bone, peritoneal dissemination and ascites. Colonoscopy revealed a circumferential, elevated cecal lesion. She underwent right hemicolectomy to prevent colon obstruction. The pathological diagnosis was poorly differentiated adenocarcinoma (por1>tub2>muc) arising from the appendix with a BRAFV600E mutation and microsatellite instability-high. Chemotherapy was administered, and she is currently still alive and undergoing chemotherapy. We describe a rare case of advanced appendiceal cancer without gastrointestinal symptoms diagnosed due to cutaneous metastasis.

Background and study aimsTreatment of superficial cancer in the remnant esophagus after esophagectomy is highly invasive, and early detection and minimally invasive treatment are considered necessary. We performed endoscopic submucosal dissection (ESD) for superficial cancer in the remnant esophagus and evaluated its safety and efficacy.Patients and methodsThis study involved 28 patients (33 lesions) who underwent ESD for superficial esophageal cancer in the remnant esophagus after esophagectomy from January 2007 to December 2018. The safety and efficacy of ESD were evaluated retrospectively.ResultsThe average age of all 28 cases (24 men and 4 women) was 69.6 ± 5.3 years. The average duration of ESD from esophagectomy was 2826 ± 2197 days. Twenty-six of the 28 cases were treated under general anesthesia. All 33 lesions were resected en bloc. The complete resection rate was 81.8% (27/33). There were no serious adverse events such as perforation, intraoperative bleeding, postoperative bleeding, and pneumonia. The overall survival rate was 78.6% (22/28) with a mean observation period post-ESD of 1793 ± 1148 days. There was no local recurrence, lymph node metastasis, or distant metastasis.ConclusionsThe ESD procedure for superficial cancer of the remnant esophagus was performed with high rate of complete resection without serious complications. In addition, there was no local recurrence and lymph node metastasis, and so ESD for superficial cancer of the remnant esophagus can be considered a safe and effective treatment.