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BackgroundRenal cell carcinoma is well-known for its propensity to metastasize to unusual sites. However, metastasis to the gallbladder has been rarely reported in the literature.Case presentationA 75-year-old Japanese (Asian) woman presented for further evaluation of a gallbladder polyp, 15 years after right radical nephrectomy for renal cell carcinoma. Computed tomography revealed a 12 mm enhancing pedunculated tumor in the gallbladder fundus. Open simple cholecystectomy was performed and the tumor was histologically confirmed as a metastasis of renal cell carcinoma to the gallbladder. Our patient is alive and has been disease-free for 3 years after cholecystectomy.ConclusionsAlthough metastasis of renal cell carcinoma is a rare differential diagnosis of gallbladder tumors, simple cholecystectomy is likely to offer a chance of long-term survival for patients with gallbladder metastases of renal cell carcinoma.

We describe a case of primary mucinous (colloid) adenocarcinoma of the lung. The patient was a 61-year-old male with a peripheral mass of the left lung. Retrospectively, the mass, which showed slow growth later, could be seen in a chest X-ray 3 years before surgery. The tumor was filled with a gelatinous substance resembling strawberry jelly, macroscopically. Microscopically, it was mucin with a small amount of malignant cells (adenocarcinoma). Diagnosis was mucinous (colloid) adenocarcinoma, which is a very rare intrapulmonary neoplasm. Mucinous (colloid) adenocarcinoma is suspected when a gelatinous substance like strawberry jelly is observed intraoperatively in the lung.

BackgroundThe number of patients who have difficulty with mutual understanding has been increasing recently due to an aging society. This emerging issue needs to be addressed. We report an instructive case of a patient who had communication difficulties due to dementia and sequelae of alcoholic encephalopathy.Case presentationA 66-year-old man of Mongolian race presented with coronary arteriosclerosis, spinal canal stenosis, transverse colon cancer, and alcoholic encephalopathy. We had been requested to remove wires that had been used for the closure of his chest in a coronary artery bypass grafting procedure. However, on admission, a tortured expression and abdominal distention were observed, along with emaciation. We diagnosed terminal stage cancer, and palliative care was offered. An abdominal computed tomographic scan revealed rectal cancer with stenosis and invasion to the adjacent tissues. A metallic stent was inserted, leading to reduction of the abdominal distention and an improvement of tachycardia. However, the patient’s tortured expression was not completely relieved; therefore, an assessment of cancer pain was considered. The Abbey Pain Scale was applied. On the basis of the patient’s score, analgesics and an opioid, among other medications, were administered. These led to relief of the patient’s tortured expression and reduced his Abbey Pain Scale score. Following this, the patient’s vital signs continued to be stable, and he was transferred to the referral institution.ConclusionsManagement of cancer pain in elderly patients with mutual understanding difficulties must be performed carefully. In the case of our patient, staff at the referral institution informed us of the patient’s latent torture, and we applied the Abbey Pain Scale. There was some confusion and uncertainty regarding clinical management throughout the patient’s care; however, his condition eventually stabilized. We believe the application of the Abbey Pain Scale assists in the relief of cancer pain. However, accumulation of further cases and experiences to verify this assessment is required.

The development of CT scanning has been beneficial for clinical medicine. In this case, virtual bronchoscopy (VB) was of clinical benefit. A 71-year-old woman with suspected lung cancer in the upper left lobe remained undiagnosed after investigation at another hospital. VB was used to confirm the location of the tumour, which facilitated an appropriate trans-bronchial lung biopsy being performed. The volume-rendering technique yielded information regarding an arterial anomaly, allowing high-quality and safe medical treatment to be provided. VB assists navigation in bronchoscopy, and the volume-rendering technique is effective in finding congenital anomalies of the vessels during preoperative assessment.