Background: Muir-Torre syndrome (MTS) is a rare autosomal dominant genodermatosis caused by mutations in mismatch repair genes. It is characterized by the presence of at least one sebaceous skin tumor associated with internal malignancies. Whether positron emission tomography/computed tomography (PET/CT) is useful for the detection of malignancies in patients with MTS has not been determined. We herein report two cases in which PET/CT was useful for the diagnosis and follow-up of internal malignancies in patients with MTS. Case presentation: In case 1, a 57-year-old woman underwent excision of a sebaceous carcinoma on the left upper eyelid. She underwent follow-up PET/CT once yearly thereafter. Forty-two months after the eyelid surgery, PET/CT showed intense tracer uptake in the right lower abdomen. An ascending colon tumor was identified, and examination of a biopsy specimen showed adenocarcinoma. In case 2, a 77-year-old man presented for evaluation of three continuous papules with telangiectasia on his right cheek. Examination of a skin biopsy specimen of the cheek papule revealed a sebaceous carcinoma. He underwent PET/CT to detect other malignancies. PET/CT showed intense tracer uptake in the sigmoid colon. A sigmoid colon tumor was identified, and examination of a biopsy specimen showed adenocarcinoma. Both patients underwent resection of their tumors, and both were still free of recurrence of the sebaceous and colon carcinomas at the time of this writing. Conclusion: PET/CT is a reliable imaging modality for the detection of internal malignancies and is useful for the diagnosis and follow-up of MTS.

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59 Background: Circulating tumor cells (CTCs) have been shown to be heterogeneous. This study aimed to identify the prognostic significance of CTCs in patients with gastric cancer, focusing on epithelial mesenchymal transition and perioperative kinetics. Methods: Peripheral blood (7.5 ml) was taken from patients (n = 54) before curative resection, and at 7 days, 1 and 6 months postoperatively. CTCs were enriched using density gradient centrifugation and magnetic-activated cell sorting (negative selection). Cell suspensions were characterized by multi-immunofluorescence staining against cytokeratin (CK) and N-cadherin, and by DAPI staining. CTCs were defined as nucleated cells expressing CK or N-cadherin. Threshold analysis identified 1 CTC/7.5 ml as an optimal cut-off value. The median observation period was 735 days. Results: CTCs were detected in seven patients (24%) with early cancer and 14 patients (56%) with advanced cancer (p < 0.05). Cells were identified as either N-cadherin+/CK−/CD45− or N-cadherin+/CK+/CD45−, but no N-cadherin−/CK+/CD45− cells were observed. The median follow-up period was 24.5 months. After 2 years, postoperative recurrence was detected in nine patients, all of whom had advanced gastric cancer and N-cadherin+/CK−/CD45− CTCs preoperatively. In terms of perioperative kinetics (just before, 7 days and 1 month after surgery), we divided patients with advanced cancer into three risk groups: A, preoperative CTCs ≥1 and increased postoperatively; B, preoperative CTCs ≥1 and decreased postoperatively; C; no preoperative CTCs. The recurrence rates in the above groups were 80% (4/5), 44% (4/9), and 0% (0/11), respectively. Conclusions: Numerous CTCs expressed N-cadherin but not CK. Perioperative measurement of CTCs may be a useful surrogate marker for recurrence risk.

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Laparoscopic surgery in patients with a ventriculoperitoneal (VP) shunt is reportedly associated with increased intracranial pressure secondary to high intraperitoneal pressure and retrograde infection due to intraperitoneal infection. We herein report the first case of transabdominal preperitoneal (TAPP) inguinal hernia repair without catheter manipulation for a patient with a VP shunt. A 69‐year‐old man with a VP shunt was suspected to have an inguinal hernia based on symptoms and examination findings. With a pneumoperitoneum pressure of 10 mm Hg, the VP shunt was not clamped and mesh was placed while confirming cerebrospinal fluid outflow from the tip of the catheter. The patient developed no shunt‐associated complications and was discharged 3 days postoperatively. TAPP inguinal hernia repair without catheter manipulation is a potential surgical option for patients with a VP shunt.