Surgical Case Reports

Our medical research library holds 13 studies published in Surgical Case Reports (2017–2026). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 13 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: Japan Surgical Society
• Published: 2015 to the present, Japan
• Language: English
• ISSN: 2198-7793 (electronic)
• Its record in the NLM Catalog

2020s

• A Case of Primary Leiomyoma of the Chest Wall Showing High Uptake on FDG-PET. T. Sakaguchi, M. Takahashi, S. Cho, et al. 2026;12(1). Case report PubMed · Publisher · Free full text

  Abstract

  Introduction: Primary leiomyoma of the chest wall is a rare entity. We report a case of primary chest wall leiomyoma with intense uptake on fluorodeoxyglucose PET (FDG-PET), requiring differentiation from malignancy.

  Case Presentation: An 82-year-old man with a history of asbestos exposure underwent annual chest CT surveillance. A 19-mm nodule was newly identified on the right chest wall and had not been present on CT the previous year. Although the lesion had well-defined margins on CT, FDG-PET demonstrated intense uptake with a maximum standardized uptake value of 11.8, raising suspicion for malignancy. Surgical resection was performed for diagnostic and therapeutic purposes. Histopathological examination revealed fascicular proliferation of spindle-shaped cells. Immunohistochemical analysis suggested a smooth muscle tumor, and retention of BRCA1-associated protein 1 and methylthioadenosine phosphorylase excluded mesothelioma. Based on these findings, the tumor was diagnosed as a primary leiomyoma of the chest wall.

  Conclusions: Primary leiomyomas of the chest wall are rare and may show high FDG uptake on PET imaging, making differentiation from malignant tumors challenging. A comprehensive evaluation incorporating imaging, intraoperative findings, and pathological assessment is essential for accurate diagnosis.

  © 2026 The Author(s). Published by Japan Surgical Society.

• Jejunal Metastasis from Malignant Pleural Mesothelioma during Long-Term Nivolumab Therapy: A Case Report and Literature Review. H. Minagi, H. Aoki, M. Nosaka, et al. 2026;12(1). Case report PubMed · Publisher · Free full text

  Abstract

  Introduction: Gastrointestinal metastasis from malignant pleural mesothelioma (MPM) is exceedingly rare and lacks a standardized diagnostic work-up.

  Case Presentation: An 87-year-old man with asbestos exposure and a 5-year history of left-sided MPM, radiographically stable on long-term nivolumab therapy, presented with melena and anemia. Contrast-enhanced CT revealed a circumferential jejunal lesion near the duodenojejunal flexure with enlarged mesenteric nodes. Double-balloon enteroscopy confirmed a 40-mm obstructive tumor, but biopsies were non-diagnostic. Partial jejunectomy with targeted mesenteric lymph-node dissection was performed. Histology with a mesothelioma-oriented immunohistochemical panel-negative for CEA and BerEP4 and positive for broad-spectrum cytokeratins-supported a diagnosis of metastatic MPM; nodal metastases were present. Given his age, no further systemic therapy was administered; the patient died 20 months postoperatively from progression of MPM.

  Conclusions: In MPM receiving immune-checkpoint inhibitor therapy, unexplained gastrointestinal bleeding should prompt comprehensive gastrointestinal evaluation, including small-bowel assessment. Surgery can secure symptom relief and a definitive diagnosis.

  © 2026 The Author(s). Published by Japan Surgical Society.

• Necrotizing Fasciitis Extending from the Left Iliopsoas to the Left Thigh Due to Retroperitoneal Penetration of the Descending Colon: A Case Report. Y. Matsuo, N. Kawahara, S. Tanizawa, et al. 2026;12(1). Case report PubMed · Publisher · Free full text

  Abstract

  Introduction: Necrotizing fasciitis is a severe soft tissue infection characterized by rapid destruction of the fascia and subcutaneous tissue, with a high mortality rate of 20%-40%. Although trauma and insect bites are common causes, gastrointestinal perforation as an etiology is exceedingly rare.

  Case Presentation: We report the case of a 70-year-old man receiving combination immunotherapy with nivolumab and ipilimumab for malignant pleural mesothelioma. The patient had been taking 12.5 mg of prednisolone daily for 6 months to manage immunotherapy-induced adrenal insufficiency and enteritis. He presented with lower abdominal pain and chills and was diagnosed with septic shock upon hospital arrival. CT revealed extensive gas extending from the left abdominal wall to the retroperitoneum and left thigh, confirming necrotizing fasciitis. Emergency surgery revealed feculent fluid near the left iliopsoas muscle, indicating retroperitoneal perforation of the descending colon. The patient underwent a left hemicolectomy and double-barrel ileostomy, followed by multiple surgical debridement and drainage procedures. After infection control, he recovered and was transferred for rehabilitation.

  Conclusions: Immunosuppressed patients receiving prolonged steroid therapy may be at a higher risk of developing necrotizing fasciitis due to gastrointestinal perforation. Timely infection control and aggressive surgical management are essential for improving patient outcomes.

  © 2026 The Author(s). Published by Japan Surgical Society.

• Benign Cystic Mesothelioma of the Peritoneum Arising at the Greater Omentum in a 14-Year-Old Boy. Y. Hirayama, N. Higashidate, K. Nakaya, et al. 2025;11(1). Case report PubMed · Publisher · Free full text

  Abstract

  Introduction: Mesothelioma arises from mesothelial cells. This tumor is very rare among pediatric abdominal neoplasms. We herein report an extremely rare case of acute abdomen with cystic mesothelioma of the peritoneum in a child.

  Case Presentation: A 14-year-old boy was referred to our hospital for emergency surgery. Surgery revealed a primary tumor arising from the greater omentum. The tumor was macroscopically diagnosed as a benign omental lymphangioma and was resected en bloc with the greater omentum. A histopathological examination of the tumor revealed a simple columnar epithelium-like mesothelioma with poor cell-atypia. Immunohistochemical examination showed antibody reactivity in the cyst epithelium, including an anti-calretinin antibody. The final pathological diagnosis was a mesothelioma originating from the peritoneum.

  Conclusions: In pediatric cases diagnosed with cystic lymphatic malformation, the possibility of peritoneal mesothelioma needs to be considered and carefully confirmed or ruled out.

  © 2025 The Author(s). Published by Japan Surgical Society.

• Chest Wall Reconstruction Using a Titanium Mesh Plate and an Expanded Polytetrafluoroethylene Sheet: A Case Report. T. Toyoda, T. Suzuki, Y. Hirai, et al. 2025;11(1). Case report PubMed · Publisher · Free full text

  Abstract

  Introduction: The integrity and stability of the chest wall (CW) are major factors that ensure the protection of the thoracic organs and proper respiratory function. In cases requiring extensive CW resection for tumor control, reconstruction using autologous tissue or synthetic materials is often performed. However, the optimal approach remains undetermined. We report a case of successful CW reconstruction using a combination of a titanium mesh plate and a dual-surface expanded polytetrafluoroethylene (ePTFE) sheet.

  Case Presentation: A man in his 70s presented for referral with a CW tumor in the left anterior chest. The tumor was located in the left anterior CW and was suspected to have pulmonary, thymic, and pectoralis major and minor invasions. Surgical resection included removal of the 2nd through the 4th ribs, partial left upper lobectomy, and partial thymectomy. The large CW defect was reconstructed via rigid reconstruction using a titanium mesh plate with a dual-mesh ePTFE sheet sewn inside. Pathological examination revealed a sarcomatoid malignant pleural mesothelioma. Three years after surgery, the patient remained recurrence-free. Despite radiographic evidence of titanium plate cracking, the pulmonary function and thoracic mechanics were preserved.

  Conclusions: The combination of ePTFE sheets, which have a smooth surface to protect the lungs and excellent tissue affinity, and titanium mesh plates, which are sufficiently rigid to maintain thoracic function, is an excellent method of rigid reconstruction that takes advantage of the strengths of each material. This technique is feasible and versatile and ensures short-term postoperative stability. Nevertheless, the long-term safety and potential complications warrant further clinical evaluation.

  © 2025 The Author(s). Published by Japan Surgical Society.

• Rare Metastatic Mesothelioma Occupying Intra-Atrial Cavity, Released by an Emergency Surgery: A Case Report and Literature Review. T. Takano, S. Sato, I. Ito, et al. 2025;11(1). Case report PubMed · Publisher · Free full text

  Abstract

  Introduction: Cardiac surgery for cardiovascular-associated mesothelioma has a poor prognosis. However, life-saving surgery is unavoidable to maintain circulation. This report describes a case in which metastatic intracardiac mesothelioma triggered sudden respiratory failure, which was reduced by surgical resection.

  Case Presentation: An 81-year-old man with a history of asbestos exposure presented to our hospital with sudden onset of dyspnea. Prior to this event, the pleura was involved in an epithelial malignancy, which was immunohistochemically negatively stained with anti-D2-40, WT-1, or anti-calretinin antibodies, which are positive markers of mesothelioma. Transthoracic echocardiography revealed a fragile and mobile tumor occupying the right atrium, and the patient was admitted for surgical tumorectomy. The operation was performed urgently using a cardiopulmonary bypass via a full sternotomy. The pericardium is grossly intact and does not adhere to the heart. A 3 × 5 cm tumor was tightly attached to the right atrium and was large enough to fit into the tricuspid valve. Therefore, the entire margin of the tumor stem attachment was resected from the lateral wall of the right atrium. Although the resected tumor was not positive for any of the three histopathological markers of mesothelioma, CDKN2A co-deletion revealed by fluorescence in situ hybridization led to a diagnosis of malignant mesothelioma.

  Conclusions: Surgical removal of intracardiac tumors that cause circulatory and respiratory instability is essential for the prevention of sudden death, regardless of prognostic determinants. This case demonstrates that mesotheliomas can metastasize to the endocardium. Even when nuclear atypia and negative results for immunohistochemical tests for the three mesothelioma markers suggest carcinoma, mesothelioma should still be considered and p16/CDKN2A co-deletion should be evaluated.

  © 2025 The Author(s). Published by Japan Surgical Society.

• Successful Complete Laparoscopic Resection of Benign Peritoneal Multicystic Mesothelioma Adherent to the Ascending Colon: A Case Report. Y. Kitamura, M. Miguchi, R. Nagao, et al. 2025;11(1). Case report PubMed · Publisher · Free full text

  Abstract

  Introduction: Benign peritoneal multicystic mesothelioma (BPMM) is a rare mesothelial tumor with a high local recurrence rate and potential for malignant transformation. It predominantly affects women of reproductive age and is often associated with prior abdominal surgery or inflammation. Complete surgical resection is the standard treatment; however, tumor recurrence remains a concern. BPMM occurring outside the pelvis is extremely rare, and lesions requiring colectomy because of adherence to the gastrointestinal tract are infrequent.

  Case Presentation: A 63-year-old woman presented with right lower abdominal pain. She had undergone cervical cancer surgery 20 years ago. Contrast-enhanced CT and MRI revealed multiple well-defined cystic lesions adjacent to the ascending colon. Colonoscopy revealed extrinsic compression, and 18F-fluorodeoxyglucose (18F-FDG)-PET/CT showed no abnormal uptake of 18F-FDG. Given the patient's symptoms, a laparoscopic right hemicolectomy with intracorporeal anastomosis was performed. The cystic lesions were firmly adhered to the appendix, cecum, and ascending colon, requiring en bloc resection. Histopathological and immunohistochemical analyses confirmed a diagnosis of BPMM. The patient had an uneventful postoperative course and was discharged on POD 7. No recurrence was observed during the 1-year follow-up period.

  Conclusions: A laparoscopic approach may be a feasible and safe option for complete resection of BPMM as it allows for magnified visualization and careful handling of cystic lesions, avoiding their intraoperative rupture. Given the high recurrence rate of BPMM, close postoperative surveillance is essential. This case illustrates the feasibility of laparoscopic resection for BPMM.

  © 2025 The Author(s). Published by Japan Surgical Society.

• Sarcomatoid malignant pleural mesothelioma: a case of long-term recurrence-free survival following curative intent surgery alone. M. Kanayama, M. Takenaka, K. Yoshimatsu, et al. 2024;10(1):134. PubMed · Publisher · Free full text

  Abstract

  Background: Curative intent surgery may be indicated for some patients with resectable early stage malignant pleural mesothelioma (MPM). However, sarcomatoid MPM is a highly aggressive subtype for which curative intent surgery is generally not recommended.

  Case Presentation: We present the case of a 63-year-old man who presented with dyspnea and chest tightness. Computed tomography revealed pleural thickening and nodular lesions. A pleural biopsy confirmed lymphohistiocytoid MPM (cT1N0M0, stage IA), prompting surgical intervention. The patient underwent left extrapleural pneumonectomy (EPP), and the final diagnosis was sarcomatoid MPM (pT2N0M0, stage IB). Although post-operative chemotherapy was planned, the patient refused additional treatment, because of the introduction of home oxygen therapy, and has remained recurrence-free for 10 years after the surgery.

  Conclusions: This case presents a noteworthy instance of achieving long-term recurrence-free survival solely through curative intent surgery for sarcomatoid MPM. It highlights the potential efficacy of surgical intervention in managing this aggressive subtype, offering a glimmer of hope for improved outcomes. Further research is warranted to better define the role of surgery in the treatment of sarcomatoid MPM.

  © 2024. The Author(s).

• Benign multicystic peritoneal mesothelioma occurring in bilateral inguinal canals metachronously: a case report. H. Oshikiri, Y. Ozawa, O. Suzuki, et al. 2022;8(1):44. PubMed · Publisher · Free full text

  Abstract

  Background: Benign multicystic peritoneal mesothelioma (BMPM) is a benign tumor that usually occurs in middle-aged females. Although several published studies have reported the occurrence of this tumor in the abdominal cavity, few have documented its development in the inguinal region.

  Case Presentation: We present a case of a 48-year-old female presenting with a bulge in her left inguinal region. Physical examination revealed a golf ball-sized nodule in the left inguinal region that could not be pushed back into the abdominal cavity. Contrast-enhanced computed tomography showed a multicystic tumor; therefore, the patient was diagnosed with inguinal hernia or hydrocele of the Nuck's canal. We performed surgical resection and hernia repair using the mesh plug method. The resected specimen was 80 mm in length and contained a multicystic tumor. Pathological examination showed that the cyst wall was lined by a single layer of cuboidal to single layer squamous epithelium. Immunohistochemistry revealed positivity for calretinin in the epithelial cells, for which a diagnosis of BMPM was established. The patient returned to our hospital after 5 years with symptoms similar to the previous episode, but this time in the right inguinal region. Imaging studies showed a tumor in the right inguinal region with the same characteristics as the previous one. The patient underwent tumor resection and hernia repair using the same technique. The resected tumor was 45 mm in length and had characteristics similar to the previously resected tumor. The presence of calretinin and D2-40 on immunohistochemistry led to the diagnosis of BMPM. There was no recurrence of BMPM for 33 months after the secondary surgery.

  Conclusions: Here we present the first report of metachronous BMPM occurring in bilateral inguinal canals. Although the pathogenesis of BMPM remains unclear, reactive changes have been suggested to cause tumors originating from the groin. The treatment of choice for BMPM is surgical resection. For diagnosis, pathological examination with immunostaining can be useful. The most appropriate postoperative follow-up for inguinal BMPM is controversial, and the accumulation of more inguinal BMPM cases is needed.

  © 2022. The Author(s).

2010s

• Vascular leiomyosarcoma originating from the right ovarian vein: a case report and literature review. T. Hirano, H. Okumura, S. Maeda, et al. 2019;5(1):120. PubMed · Publisher · Free full text

  Abstract

  Background: Primary leiomyosarcoma (LMS) of vascular origin is a rare lesion, and patients with LMS of vascular origin have poorer prognoses than patients with LMS of other origins. The inferior vena cava is the most commonly affected vessel and accounts for 60% of all vascular cases. However, LMS originating from the ovarian vein is extremely rare, and we are only aware of 15 reported cases. Therefore, we report our experience with a case of LMS originating from the right ovarian vein and review the related literature.

  Case Presentation: A 71-year-old Japanese woman with no symptoms was admitted to our hospital because of abnormal findings in a routine abdominal ultrasonography check-up. Contrast-enhanced computed tomography of the abdomen revealed a well-defined, lobulated solid mass with a diameter of 5.5 cm in the right retroperitoneal space. The mass exhibited relatively low uptake during 18F-fluorodeoxyglucose positron emission tomography. Based on these findings, the differential diagnosis included a retroperitoneal tumor, such as a desmoid tumor, leiomyoma, LMS, and malignant mesothelioma. Operative findings confirmed that the mass had originated from the right ovarian vessels, and en bloc excision was performed for the mass and the right ovarian vessels. The final pathological diagnosis was LMS originating from the right ovarian vein, and the surgical resection margins were free from tumor cells. After histological findings confirmed the LMS diagnosis, the patient underwent adjuvant radiation therapy and has not exhibited signs of local recurrence or metastasis in the 6 months after surgery.

  Conclusions: We encountered a 71-year-old woman with LMS originating from her right ovarian vein. The prognosis of vascular LMS is generally poor. Therefore, careful follow-up will be required for our patient.

• Large primary pleural synovial sarcoma with severe dyspnea: a case report. M. Yamaki, S. Yonehara, T. Noriyuki. 2017;3(1):29. PubMed · Publisher · Free full text

  Abstract

  Background: Synovial sarcoma is a malignant neoplasm of soft tissues. It occurs mainly in the extremities and is closely related to tendons, tendon sheaths, and bursal structures. Primary synovial sarcoma of the pleura and lungs is extremely rare.

  Case Presentation: We present the case of a 62-year-old man with a large synovial sarcoma of the left pleura. He presented with general fatigue and severe dyspnea. Chest computed tomography (CT) revealed a 20-cm tumor in the left thoracic cavity. We first diagnosed the tumor as a sarcomatoid mesothelioma based on CT-guided needle biopsy. We speculated that his severe dyspnea was because of ventilation-perfusion mismatch due to the left pulmonary collapse. Furthermore, we thought that there was a discrepancy between the CT findings and the pathological findings from the biopsy specimen. We performed pleuropneumonectomy through an anterior approach with median sternotomy and 5th-intercostal thoracotomy. The resected specimen contained a 22-cm pleural tumor with parenchymatous hemorrhage. We diagnosed the tumor as monophasic synovial sarcoma based on its morphologic and immunohistochemical features. We suspected there was microscopic residual tumor in the left diaphragm and therefore performed radiation therapy. After radiotherapy, he received adjuvant chemotherapy with ifosfamide and Adriamycin. One year after surgery, the patient is alive with no signs of tumor recurrence.

  Conclusions: We report a case of a large synovial sarcoma of the pleura in a patient with severe dyspnea. He was treated with pleuropneumonectomy, radiotherapy, and adjuvant chemotherapy. Although the best treatment for this rare condition has not been defined, we thought that tumor resection and adjuvant therapy were appropriate to control the disease in this case.

• Multiple malignant epithelioid mesotheliomas of the liver and greater omentum: a case report and review of the literature. K. Minami, H. Okumura, K. Hiwatashi, et al. 2017;3(1):66. PubMed · Publisher · Free full text

  Abstract

  Background: Malignant mesothelioma commonly arises from the pleura, but can also arise from the peritoneum, pericardium, and tunica vaginalis testis. However, malignant mesothelioma of the liver is extremely rare and coexistence with malignant mesothelioma of the greater omentum has not been described in the literature. In this case report, we present a case of multiple malignant mesothelioma of the liver and greater omentum.

  Case Presentation: A 36-year-old woman was admitted to our hospital for the evaluation of an elastic hard mass in the right upper abdomen. Abdominal contrast computed tomography showed a cystic mass measuring 13 × 14 × 11 cm in the right liver lobe with enhanced mural nodule. Abnormal accumulation was identified in the liver and lower abdominal area on 18F-fluorodeoxyglucose positron emission tomography. The patient underwent hepatectomy of the posterior segment and partial resection of the omentum. The final pathological diagnosis was low-grade multiple malignant epithelioid mesothelioma based on characteristic immunohistochemical findings. As of 6 months postoperatively, the patient has shown no disease recurrence.

  Conclusions: We present the first case of a 36-year-old woman with multiple malignant mesothelioma of the liver and greater omentum.

• Successful lung-sparing resection of synchronous pleural mesothelioma and contralateral lung cancer. N. Imanishi, Y. Nabe, M. Takenaka, et al. 2017;3(1):64. PubMed · Publisher · Free full text

  Abstract

  Background: Malignant pleural mesothelioma (MPM) is an uncommon malignant tumor, and its synchronous occurrence with primary lung cancer is extremely rare. Here, we report the first surgical case of synchronous MPM and contralateral lung adenocarcinoma. Extrapleural pneumonectomy (EPP) combined with surgery for contralateral lung cancer may not be tolerated, and a lung-sparing procedure including pleurectomy/decortication (P/D) can be an alternative to achieve complete resection.

  Case Presentation: A 69-year-old male with right MPM and lung adenocarcinoma in the left upper lobe presented. Two lesions were judged to be synchronous MPM and lung cancer that were both potentially resectable clinical stage I diseases, and complete resection of both tumors was successfully achieved with right P/D following left upper division segmentectomy.

  Conclusions: P/D, not EPP, is a less invasive surgical procedure for MPM with curative intent and can be performed in combination with contralateral lung resection.

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