A Case of Large Retroperitoneal Lipoma Mimicking Liposarcoma / 대한소화기학회지

Lipomas are the most common benign tumors of adipose tissue among adults. Lipomas can occur almost anywhere in the trunk, extremities, mediastinum, and pelvis, but retroperitoneal lipomas are extremely rare. It should be distinguished from well differentiated liposarcoma in order to provide the appropriate treatment and follow up. We experienced a case of 60-year-old patient with large retroperitoneal lipoma mimicking liposarcoma causing palpable abdominal mass and pain. Abdominal computerized tomography (CT) showed 33x22 cm sized bulky fat-containing mass with contrast enhanced solid portion in right retroperitoneum. Positron emission tomograpgy (PET) revealed increased 18F-FDG uptake at solid portion shown in abdominal CT. Imaging studies confirmed a high index of suspicion on liposarcoma. Laparotomy showed a large encapsulating tumor arising from retroperitoneum with fat necrosis. Pathologic examination of resected specimen revealed normal mature adipocytes without atypical cells, compatible with lipoma.

A case of Combined Resection for Synchronous Primary Carcinoma of Gallbladder and Duodenum

PURPOSE: The incidence of multiple primary malignant tumor has ranged from 0.7% to 11% in the medical literature. Various organs in the digestive system are the sites of multiple primary cancer (MPC). MPC may be synchronous or metachronous depending on the interval between their diagnosis. To the best of our knowledge, there are only rare reports of resected cases of synchronous primary carcinomas that developed in the GB and duodenum. METHODS: We present here a patient who underwent an operation for synchronous primary carcinomas of the GB and duodenum. A 51-year-old female was admitted for postprandial abdominal discomfort. CT scan and MRI of the abdomen showed a 3 x 2 cm sized heterogenously enhancing mass in the GB and a 3.7 x 2.7 cm sized hetrogenously enhancing mass in the 2nd portion of the duodeum. The laboratory findings, including the tumor markers, were non-specific. An elective operation was done under the impression of combined GB cancer and cancer in the 2nd portion of the deuodenum. On the operative findings, there was a 3 x 2.5 cm sized mass in the GB and a 5 x 4 cm sized duodenal mass with near complete luminal obstruction 3 cm distal from the pyloric ring. Radical cholecystectomy with wedge resection of the liver bed and Whipple's operation was performed. RESULTS: On microscopic examination, the GB mass was well differentiated adenocarcinoma and the duodenal mass was moderately differentiated adenocarcinoma, and one lymph node (a lymph node along the common hepatic artery) among the 18 dissected lymph nodes was invaded by tumor cells. The microscopic findings showed that the GB mass and duodenal mass were synchronous primary carcinomas. The patient recovered uneventfully and is alive and doing well without evidence of recurrence at 21-months of follow up evaluation. CONCLUSIONS: We report here on a case of combined curative resection for synchronous primary carcinomas of the gallbladder and duodenum.

Study of Combined Multiple Primary Cancer in Gastric Cancer Patients

PURPOSE: With recent advances in diagnostic techniques, and the increase in early cancers, the number of multiple primary cancers appears to be increasing. The recurrence of gastric cancer, after a radical operation, is the main cause of death, but the interest in the development of multiple cancers is also increasing. The purpose of this study was to evaluate the characteristics of gastric cancer with those of other combined organ cancers. METHODS: A comparison of 66 patients with multiple organ cancers, combined with gastric cancer, was made with 2, 444 of gastric cancer patients, who underwent operation at the Department of Surgery, Chonnam National University Hospital, between Jan. 1982 and Dec. 2000. RESULTS: The incidence of multiple cancers was 2.6% of the total gastric cancer patients. Of these 25.8% were detected at the same time as the gastric cancer, and 74.5% were detected before, or after, the operation for the gastric cancer. The sex ratio was 2: 1 with gastric cancer only, and 1.4: 1 with the multiple organ cancers, with a male predominance. The mean age of the multiple organ cancer patients was 57.1 years old (male: 59.4 years, female: 54.1 years), which showed no statistical difference to single gastric cancer. The location of the multiple cancers was common in the digestive tract, especially the colon. In terms of the histological types of gastric cancer, the incidence was highest in the poorly- differentiated, followed by the moderate and the well- differentiated cancers, respectively. However, the incidence of the poorly-differentiated type, in the multiple organ cancers, was lower than that in the single gastric cancer patients. There was no difference in stage between the multiple organ and gastric cancers. The 5-year survival rates were 51.6 and 50.6% in the gastric and multiple organ cancers, respectively, but with no statistical difference. The prognosis of multiple cancers wsa no different to that of single gastric cancer. CONCLUSION: This study suggests that more active treatment is needed in the treatment of gastric cancer, irrespective of involvement with other organ cancers.