Experience of surgical treatment in a granular cell tumor in the qscending colon: a case report

We report a case about successful surgical treatment of a granular cell tumor in the ascending colon. A 36-year-old man underwent screening colonoscopy. An endoscopic examination revealed a 10-mm yellowish and hemispheric mass in the ascending colon, and lower endoscopic ultrasonography revealed a hypoechoic-to-isoechoic mass invaded the submucosal layer. The mass was suspected to be a colonic carcinoid tumor. Based on the preoperative evaluation, endoscopic complete resection was considered difficult. Therefore, the lesion was removed via laparoscopic right hemicolectomy. Histological examination revealed that the tumor consisted of nests of polygonal cells with abundant granular eosinophilic cytoplasm. Immunohistochemical staining revealed diffuse positivity for S100 and CD68. Therefore, the tumor was diagnosed as a granular cell tumor. We suggest that surgical resection should be considered if it is located in the thin-walled ascending colon prone to perforation, difficult to rule out malignant tumor due to submucosal invasion, or to remove endoscopically.

Ileocolonic intussusception caused by epithelioid leiomyosarcoma of the ileum: a report of case and review of the literature

Small intestinal malignant tumor accounts for about 3% of all malignant tumors in the gastrointestinal tract, among which 13% are leiomyosarcoma (LMS). In addition, epithelioid LMS is of very rare occurrence. As small intestinal malignant tumors are initially asymptomatic and nonspecific, diagnosis is often delayed, and this can lead to large tumor at the time of detection and lead to intussusception. We observed ileocolonic intussusception in an 80-year-old male patient who was admitted to the hospital with a complaint of abdominal pain and palpable mass on right lower quadrant. The laparoscopic ileocecectomy was performed by the emergency operation because of obstruction. The pathologic examination revealed that the epithelioid LMS developed in the terminal ileum was the leading point of intussusception. To the best of our knowledge, laparoscopic surgery for ileocolonic intussusception with epithelioid LMS has not yet been reported.

Laparoscopic Local Resection through Subserosal Dissection with Endoscopic Air-Insufflation for Submucosal Tumors Located Near the Esophagogastric Junction

Purpose@#A novel resection method, namely, laparoscopic local resection through subserosal dissection with endoscopic air-insuff lation (LRSDEA) was used for submucosal tumors located near the esophagogastric junction (SMT-EGJ) to avoid major gastric resection. @*Methods@#A total of 9 cases underwent LRSDEA. We sequentially performed: laparoscopic dissections around EGJ, subserosal dissections around SMTs using laparoscopic electrocautery and ultrasonic shears, and finally, enucleation of SMTs. During these procedures, intraoperative endoscopic tumor localization, as well as endoscopic air-insufflation allowed for safe resection. These procedures are shown in the supplementary video clip. The clinicopathological characteristics and surgical results were analyzed. @*Results@#All laparoscopic procedures were successfully performed without requiring a major gastrectomy.The mean operation time was 126.1 minutes, and estimated blood loss was 12.0 ml. There were no postoperative complications. Pathological diagnoses were 6 leiomyomas, 2 gastrointestinal stromal tumors, and 1 gastric duplication. @*Conclusion@#LRSDEA is an effective and safe treatment option for SMT-EGJ, as major resection of the stomach is avoided.

Laparoscopic Local Resection through Subserosal Dissection with Endoscopic Air-Insufflation for Submucosal Tumors Located Near the Esophagogastric Junction

Purpose@#A novel resection method, namely, laparoscopic local resection through subserosal dissection with endoscopic air-insuff lation (LRSDEA) was used for submucosal tumors located near the esophagogastric junction (SMT-EGJ) to avoid major gastric resection. @*Methods@#A total of 9 cases underwent LRSDEA. We sequentially performed: laparoscopic dissections around EGJ, subserosal dissections around SMTs using laparoscopic electrocautery and ultrasonic shears, and finally, enucleation of SMTs. During these procedures, intraoperative endoscopic tumor localization, as well as endoscopic air-insufflation allowed for safe resection. These procedures are shown in the supplementary video clip. The clinicopathological characteristics and surgical results were analyzed. @*Results@#All laparoscopic procedures were successfully performed without requiring a major gastrectomy.The mean operation time was 126.1 minutes, and estimated blood loss was 12.0 ml. There were no postoperative complications. Pathological diagnoses were 6 leiomyomas, 2 gastrointestinal stromal tumors, and 1 gastric duplication. @*Conclusion@#LRSDEA is an effective and safe treatment option for SMT-EGJ, as major resection of the stomach is avoided.

Safety of subtotal or total colectomy with primary anastomosis compared to Hartmann procedure for left-sided colon cancer obstruction or perforation

PURPOSE: Whether subtotal or total colectomy with primary anastomosis (PA) is safer than Hartmann procedure (HP) for left-sided colon cancer obstruction or perforation remains controversial. The purpose of this study was to compare postoperative morbidity, mortality, and defecation frequency between PA and HP for left-sided colon cancer obstruction or perforation.METHODS: This retrospective study enrolled 54 patients from January 2014 to February 2018 who underwent emergency surgery due to left-sided colon cancer obstruction or perforation.RESULTS: PA was carried out in 20 patients while HP was performed for 34 patients. Thirty-day mortality did not show significant difference between the two groups (15.0% vs. 14.7%, P=1.000). No anastomotic leakage occurred in PA group while three (8.8%) cases of stump leakage occurred in HP group. Stoma repair was performed for 13 cases (44.8%) and stoma reformation was performed for one case in HP group (7.7%). Stoma related complications occurred in five cases (17.24%). For patients after stoma repair, defecation frequency at 3 months after operation was 2.91±2.88 times per day in PA group and 2.86±2.63 times per day in HP group. At 1 year after operation, defecation frequency was changed to 1.40±1.12 times per day in PA group and 1.17±0.39 times per day in HP group.CONCLUSION: Primary ileosigmoid or ileorectal anastomosis for left-sided colon cancer obstruction or perforation is safe, and shows similar outcome of defecation frequency compared to HP.

Comparison of long-term oncologic outcomes of laparoscopic gastrectomy and open gastrectomy for advanced gastric cancer: A retrospective cohort study

PURPOSE: We investigated the long-term oncologic outcomes of laparoscopic gastrectomy (LG) and open gastrectomy (OG) for advanced gastric cancer (AGC) with a 5-year follow-up period.METHODS: Clinical data of 180 patients (109 LG and 71 OG) who underwent radical D2 gastrectomy for AGC at Gyeongsang National University Hospital between 2007 and 2009 were included. Survivals and predictors of these outcomes were analyzed.RESULTS: The mean follow-up period was 54.3 months. Recurrence was observed in 68 patients (37.8%). The 5-year disease-free survival (DFS) rate was 52.2% for all patients, 39.4% in the OG group, and 60.6% in the LG group. The 5-year DFS rates for OG and LG with respect to pathological stage were stage I, 87.5% and 84.2%, respectively (P=0.684); stage II, 55.0% and 77.3%, respectively (P=0.032); and stage III, 23.3% and 34.8%, respectively (P=0.265). The 5-year overall survival (OS) rate was 52.8% for all patients, 40.8% in the OG group, and 60.6% in the LG group. The 5-year OS rates for OG and LG with respect to pathological stage were stage I, 87.5% and 84.2%, respectively (P=0.753); stage II, 55.0% and 77.3%, respectively (P=0.034); and stage III, 25.6% and 34.8%, respectively (P=0.302). For survival, TMN cancer stage was statistically independent prognostic factors.CONCLUSION: Our analysis revealed that LG for AGC had acceptable long-term oncologic outcomes comparable to the outcomes of conventional OG. Cancer stage was independent risk factors associated with survival.

The prognosis factors among breast cancer patients with extensive axillary lymph node metastasis

PURPOSE: This study was designed to retrospectively identify prognostic factors of survival among breast cancer patients with 10 or more metastatic lymph nodes (LNs).METHODS: The study included 58 patients with 10 or more metastatic LNs who received standard treatment from January 2005 to December 2015. To identify the prognostic factors, we analyzed the difference of disease-free survival (DFS) according to clinicopathologic factors.RESULTS: The 5-year DFS and overall survival rates in all patients were 55% and 69%, respectively. Tumor size, number of metastatic LNs and ratio of metastatic to total LNs were associated with poorer prognosis. DFS was significantly poorer in patients with >15 than ≤15 metastatic LNs (hazard ratio [HR], 4.60; 95% confidence interval [CI], 1.38–15.32) and with LN ratio >0.64 than ≤0.64 (HR, 26.13; 95% CI, 3.16–215.80) A scoring system based on these factors was significantly prognostic of survival outcomes.CONCLUSION: This study identified factors of survival in breast cancer patients with extensive LN metastasis. Patients with unfavorable factors may require modified management to improve their clinical outcomes.

Toxocara canis Mimicking a Metastatic Omental Mass from Sigmoid Colon Cancer: A Case Report

Toxocara canis is an important roundworm of canids and a fearsome animal parasite of humans. Human infections can lead to syndromes called visceral larva migrans (VLM), ocular larva migrans, neurotoxocariasis, and covert toxocariasis. VLM is most commonly diagnosed in children younger than 8 years of age, but adult cases are relatively frequent among those infected by ingesting the raw tissue of paratenic hosts in East Asia. This research reports the case of a 59-year-old man with sigmoid colon cancer, who visited our institution for surgery. An intraperitoneal mass was found on preoperative computed tomography, and it was thought to be a metastatic mass from sigmoid colon cancer. A postoperative histologic examination and serum test showed eosinophilic granuloma due to toxocariasis. Diagnosis of VLM is often difficult and highly suspicious in adults. Researchers suggest, although rarely, that VLM be included in the differential diagnosis as a cause of intraperitoneal tumors.

Unsuspected Duplicated Gallbladder in a Patient Presenting with Acute Cholecystitis

Duplicated gallbladder (GB) is a rare congenital disease. Surgical management of a duplicated GB needs special care because of concurrent bile duct anomalies and the risk of injuring adjacent arteries during surgery. An 80-year-old man visited an emergency room with right upper quadrant abdominal pain. Computed tomography (CT) revealed cholecystitis with a 2-bodied GB. Because of this unusual finding, magnetic resonance choledochopancreatography was performed to detect possible biliary anomalies. The 2 GB bodies were unified at the neck with a common cystic duct, a so-called V-shaped duplicated GB. The patient's right posterior hepatic duct joined the common bile duct (CBD) near the cystic duct. The patient underwent laparoscopic cholecystectomy without adjacent organ injury, and was discharged uneventfully. Surgeons should carefully evaluate the patient preoperatively and select adequate surgical procedures in patients with suspected duplicated GB because of the risk of concurrent biliary anomalies.

Lateral Lymph Node Metastasis Prediction in Papillary Thyroid Cancer Patients with Suspicious Preoperative Imaging Findings / 대한내분비외과학회지

PURPOSE: Lateral lymph node metastasis of papillary thyroid cancer (PTC) is indicative of tumor aggressiveness and can determine treatment strategies. However, the role of prophylactic lateral lymph node dissection in the management of PTC is unclear. This study evaluated factors predictive of lateral lymph node metastasis in patients with suspicious lymph node enlargement in preoperative imaging. METHODS: This retrospective study included 728 patients with newly diagnosed PTC who underwent therapeutic surgery. Clinicopathologic results were reviewed, and factors predictive of lateral lymph node metastasis were analyzed. RESULTS: Of the 242 patients with lymph node metastasis, 50 had lateral lymph node metastasis. Lateral lymph node metastasis was associated with sex, tumor size, preoperative thyroid stimulating hormone (TSH) concentration and presence of central lymph node metastasis. Among patients with suspicious lateral lymph node metastasis by ultrasonography, high TSH level (odds ratio 3.833, P=0.031) and number of metastatic central lymph nodes (odds ratio 3.68, P=0.025) were significantly predictive of lateral lymph node metastasis. CONCLUSION: High serum TSH level and central lymph node metastasis were predictive of lateral lymph node metastasis in PTC patients with suspicious preoperative imaging findings. These predictive factors might help reduce unnecessary therapeutic lateral lymph node dissection.

A case of gallbladder cancer combined with ectopic individual opening of pancreatic and bile ducts to the duodenal bulb

Ectopic opening of the pancreatic and bile ducts (EOPBD) into the duodenal bulb is an extremely rare congenital anomaly with unknown clinical implications. We presented a case of gallbladder cancer with EOPBD into the duodenal bulb. A 57-year-old male was referred to our hospital with intermittent right upper abdominal pain. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography showed individual EOPBD into the duodenal bulb with no papillary structure, and a focal nodular lesion in the gallbladder. A follow-up abdominal computed tomography scan 9 months later revealed a slight increase in the size of the fundal nodule, which was suspected as gallbladder cancer. An intraoperative frozen biopsy identified the nodular lesion as adenocarcinoma involving the cystic duct, and the patient underwent radical cholecystectomy including bile duct resection with hepaticojejunostomy. EOPBD is an extremely rare condition that can be associated with gallbladder malignancy as well as benign disease. Clinicians should follow up carefully and consider surgical treatment for suspected malignant lesions.

Surgical Strategy for Colonic Intussusception Caused by a Giant Colonic Lipoma: A Report of Two Cases and a Review of the Literature

A colon lipoma is a remarkably rare tumor. In most cases, the tumors are asymptomatic and small in size, need to be differentiated from malignant tumors, and do not need any special treatment. Selection of the right surgical strategy depends on the status of bowel, as well as the size and the location of tumor. We encountered two patients with giant submucosal lipomas that had induced intussusceptions: one with a lipoma in the transverse colon and the other with a lipoma in the ascending colon. The diagnoses were made by using histological examinations. We report the clinical features, diagnoses, and treatments of, as well as our experience with, these two uncommon cases, and we present a review of the literature on this subject.

Niti CAR 27 Versus a Conventional End-to-End Anastomosis Stapler in a Laparoscopic Anterior Resection for Sigmoid Colon Cancer

PURPOSE: The Niti CAR 27 (ColonRing) uses compression to create an anastomosis. This study aimed to investigate the safety and the effectiveness of the anastomosis created with the Niti CAR 27 in a laparoscopic anterior resection for sigmoid colon cancer. METHODS: In a single-center study, 157 consecutive patients who received an operation between March 2010 and December 2011 were retrospectively assessed. The Niti CAR 27 (CAR group, 63 patients) colorectal anastomoses were compared with the conventional double-stapled (CDS group, 94 patients) colorectal anastomoses. Intraoperative, immediate postoperative and 6-month follow-up data were recorded. RESULTS: There were no statistically significant differences between the two groups in terms of age, gender, tumor location and other clinical characteristics. One patient (1.6%) in the CAR group and 2 patients (2.1%) in the CDS group experienced complications of anastomotic leakage (P = 0.647). These three patients underwent a diverting loop ileostomy. There were 2 cases (2.1%) of bleeding at the anastomosis site in the CDS group. All patients underwent a follow-up colonoscopy (median, 6 months). One patient in the CAR group experienced anastomotic stricture (1.6% vs. 0%; P = 0.401). This complication was solved by using balloon dilatation. CONCLUSION: Anastomosis using the Niti CAR 27 device in a laparoscopic anterior resection for sigmoid colon cancer is safe and feasible. Its use is equivalent to that of the conventional double-stapler.

The nutritional risk is a independent factor for postoperative morbidity in surgery for colorectal cancer

PURPOSE: The authors evaluate the prevalence of malnutrition and its effect on the postoperative morbidity of patients after surgery for colorectal cancer. METHODS: Three hundred fifty-two patients were enrolled prospectively. Nutritional risk screening 2002 (NRS 2002) score was calculated through interview with patient on admission. Clinical characteristics, tumor status and surgical procedure were recorded. RESULTS: The prevalence of patients at nutritional risk was 28.1 per cent according to the NRS 2002. The rate of postoperative complication was 27%. There was a significant difference in postoperative complication rates between patients at nutritional risk and those not at risk (37.4% vs. 22.9%, P = 0.006). Nutritional risk was identified as an independent predictor of postoperative complications (odds ratio, 3.05; P = 0.045). Nutritional risk increased the rate of anastomotic leakage (P = 0.027) and wound infection (P = 0.01). CONCLUSION: NRS may be a prognostic factor for postoperative complication after surgery for colorectal cancer. A large scaled prospective study is needed to confirm whether supplementing nutritional deficits reduces postoperative complication rates.

A Stercoral Perforation of the Rectum

A stercoral perforation of the rectum due to a fecaloma is a rare disease with a high mortality rate. Although multiple case reports of colonic perforations have been published, the data regarding rectal perforations are limited. This case report will highlight one such case of a stercoral rectal perforation that was successfully treated with a laparoscopic operation.

Adenocarcinoma arising from Meckel's diverticulum in the ileum with malrotation of the midgut / 대한외과학회지

Meckel's diverticulum (MD) is a true congenital diverticulum that is remnant by incomplete obliteration of the omphalomesenteric duct. It is the most common congenital anomaly of the gastrointestinal tract, with an estimated prevalence of 2% (0.3% to 3% in autopsy studies). About 90% of MD occurs within 100 cm of the ileocecal valve. A primary malignant tumor arising within an MD is extremely uncommon. Malignancies are reported to account for only 0.5% to 3.2% of the complications. Carcinoids are the most common malignant tumors occurring in MD. Adenocarcinomas are extremely uncommon and very poor prognosis has been reported. We report a case of radiographically diagnosed chronic inflammatory mass caused by adenocarcinoma arising from MD in the ileum with malrotation of the midgut incidentally discovered at exploration.

Identification of Prognostic Factors for In-Hospital Mortality in Acute Mesenteric Ischemia / 대한혈관외과학회지

PURPOSE: The purpose of this study was to determine the prognostic factors and risk scorings that could have an impact on the in-hospital mortality of acute mesenteric ischemia (AMI). METHODS: Forty consecutive patients received an operation due to AMI between January 2001 and June 2009. The hospital medical charts and clinical records were retrospectively reviewed. Clinical features, laboratory findings, operative findings, surgical procedure, and prognostic scoring system were collected and assessed as possible the prognostic factors for in-hospital mortality. RESULTS: The overall hospital mortality rate was 32.5% (13/40). In a univariate analysis, significant predictors of in-hospital mortality were decreased mentality (P=0.029), shock at admission (P=0.006), symptom duration (P=0.011), blood urea nitrogen (P=0.029), serum creatinine (PII) (P=0.02) were identified as independent prognostic factors of in-hospital mortality. CONCLUSION: In conclusion, the prognostic factors in AMI who have hyperglycemia (>200 mg/dL) and high ASA grading (>II) are truly associated with very high in-hospital mortality.

The Risk Factors of Reflux Complication after Gastrectomy for Proximal Gastric Cancer

PURPOSE: The aim of this study was to investigate the risk factors of reflux associated complications (reflux symptoms, reflux esophagitis, and esophageal stricture) after gastrectomy for proximal gastric cancer. METHODS: 150 patients with proximal gastric cancer were included from January 2005 to December 2008. Their medical and surgical records were retrospectively analyzed concerning clinical and pathologic characteristics, operation methods, morbidity, reflux associated complications and nutritional states. RESULTS: Tumor sizes and operation methods were statistically significant in univariate analysis of risk factors for reflux associated complications (P0.05). However, reflux complications were significantly more common in proximal gastrectomy groups (72.4%) than in total gastrectomy groups (29.5%). Severe reflux esophagitis (LA classification C or D) was found in only proximal gastrectomy groups. CONCLUSION: Total gastrectomy is favorable for proximal early gastric cancer in terms of reduced esophageal reflux complications.

Immunohistochemical Study of Glucose Transporters 1 and 3 in the Mouse Hippocampus after Kainic Acid Treatment / 대한해부학회지

Seizure activity increases glucose utilization within the brain in response to neuronal injury. In this study, we investigated the expression of two brain glucose transporter (GLUT) proteins, GLUT1 and GLUT3, in the mouse hippocampus after kainic acid (KA) treatment. Forty-eight hours after KA (30 mg/kg) injection, mice were sacrificed and a histological evaluation of KA-treated hippocampus revealed cell death using cresyl violet staining and immunohistochemistry for caspase-3. In KA-treated hippocampus, reactive astrocytic changes were confirmed by increased immunoreactivity of glial fibrillary acidic protein (GFAP). Enhanced GLUT1-positive endothelial cells were present in the hippocampus after KA treatment. However, GLUT3-positive neurons were not localized to the KAtreated hippocampus. In particular, although GLUT-3 was not expressed in the hippocampus, pronounced GLUT3- positive cells were observed in the hypothalamic paraventricular nucleus (PVN), which controls energy metabolism. Thus, these results indicate that changes in endothelial GLUT1 and neuronal GLUT3 levels in response to neural injury may play important roles in neuroprotection against brain excitotoxicity.