In stage IV colorectal cancer (CRC), initial resection of the primary tumor is considered to be an important strategy for improving disease outcome. However, there is no consensus on the timing as to when the surgical intervention of the primary tumor should occur. The present study hypothesizes that genetic profiles in CRC may indicate the appropriate treatment strategies for patients with stage IV CRC, and a cohort of 113 patients with stage IV CRC resected primary lesions at various periods were analyzed for the presence of mutations in the KRAS, exon 2, and BRAF genes, exon 15, and for the microsatellite instability status of the tumor. These data were additionally correlated with various clinicopathological features. Although BRAF-mutant was revealed to be an independent negative prognostic factor in stage IV CRC (HR, 8.42; 95% confidence interval, 2.72–26.02), BRAF-mutant samples exhibited better prognoses if they were treated with chemotherapy prior to tumor resection. Thus, the presence of BRAF mutations provides a compelling rationale for the establishment of intensive upfront chemotherapy to improve survival in stage IV CRC.

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Background Undifferentiated carcinoma of the biliary tree is extremely rare, and biliary undifferentiated carcinoma mostly originates from the gallbladder. We herein present a case of anaplastic undifferentiated carcinoma of the hilar bile duct and reviewed the literature. Case presentation The patient was an 81-year-old male with obstructive jaundice. Contrast-enhanced computed tomography (CT) showed a protruded tumor located at the hepatic hilum. Obstructive jaundice was relieved by endoscopic drainage. Endoscopic biopsy revealed carcinoma without glandular differentiation, and the patient was diagnosed with resectable hilar undifferentiated carcinoma. During the 5-week preoperative examination, the tumor increased in size from 23 to 45 mm. Left hemi-hepatectomy and extrahepatic bile duct resection were performed, and there were no postoperative complications. Histological findings demonstrated that the tumor was mainly composed of non-cohesive polygonal neoplasms with pleomorphic nuclei, and was diagnosed as anaplastic undifferentiated carcinoma of the common hepatic duct (T2a N0 M0 Stage II). One month after surgery, the patient was readmitted to our hospital with pyrexia due to cholangitis, and liver nodules suggestive of multiple liver metastases were detected by CT. Three months after surgery, the patient died of multiple liver metastases. Conclusions This is the first case report of undifferentiated cholangiocarcinoma with anaplastic features. Anaplastic undifferentiated carcinoma of the hilar bile duct showed preoperative rapid growth and early relapse despite a cancer-negative surgical margin.

An 81-year-old man was referred to our hospital for hepatic dysfunction that was identified in an outpatient visit to another hospital. Abdominal contrast-enhanced CT revealed a tumor extending from the hepatic portal region to the left hepatic duct. Thus, the patient was diagnosed with hilar cholangiocarcinoma. Before surgery, EBD tube placement was performed because of obstructive jaundice. Subsequently, pancreatitis developed. CT revealed an inflammatory thrombus from the main trunk to the right branch of the portal vein. Thrombolytic therapy through the superior mesenteric artery was ineffective, with concurrent postoperative bleeding from the papilla. Four days after thrombus formation, catheterization was performed via the ileocolic vein under laparotomy for intraportal thrombus aspiration. Thirty days after the start of thrombosis treatment, left hepatectomy and bile duct resection were performed because portal vein blood flow resumed. The patient was diagnosed with carcinosarcoma. He has survived without recurrence for three years after surgery. We herein report this case of portal thrombosis in the remnant liver, for which radical surgery was performed postoperatively.

IIc 病変を指摘され，生検で Group 5 signet ring cell carcinoma の診断となり，手術目的に紹介となった． 現症：身長 171 cm，体重 91 kg，BMI 31．