A total of 211 patients with gastric cancer in the upper third of the stomach were clinicopathologically evaluated. Of the 211 patients, 82 had esophageal infiltration and 129 did not. These two groups were compared. The study on patients who had undergone resection and radioisotope (99mTc-phytate) uptake testing revealed that it was important to dissect the lymph nodes (predominantly nodes 7, 9, 11, and 16) during surgery in the patients with gastric cancer plus esophageal infiltration. When cancer infiltration of the esophagus exceeds 1 cm, the preferred surgical procedure is lower esophagectomy and total gastrectomy with abdominal and intrathoracic lymphadenectomy via the left thoracoabdominal approach. When residual cancer is suggested in the more proximal esophageal stump due to intramural metastasis from vascular invasion, rapid pathologic diagnosis should be made by frozen sections during surgery and then subtotal esophagectomy by blunt removal of the esophagus proximally from the aortic arch using a left thoracotomy considered.

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Recklinghausen's disease is an inherited condition in which multiple neurofibromas are associated with spots of pigmentation of the skin, so-called Cafe au lait spots and often with malignant neoplasm. A case of advanced breast cancer with R's disease is reported.A 46-year-old female was admitted to our hospital because of a left breast tumor with serous discharge. Metastasis to axillary lymph nodes, invasion to the chest wall and multiple metastasis of the bone were noted. The patient was diagnosed as having an advanced breast cancer (T4cN1bM1 Stage IV). After chemoendocrine therapy (per os), radical mastectomy and bilateral oophorectomy were performed.In the literature, breast cancers with R's disease are commonly in an advanced stage more than stage II. The reason why this disease is found in an advanced stage, seems to lie in the existence of diffuse neurofibromas of the whole body skin. This case seems a good illustration suggesting the effectiveness of preoperative chemoendocrine therapy for advanced breast cancers.

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