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.

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.

Chiari 1.5 Malformation : An Advanced Form of Chiari I Malformation

The Chiari 1.5 malformation is defined as a tonsillar herniation within a Chiari I malformation with additional caudal descent of the brainstem through the foramen magnum. We describe a patient with Chiari I malformation who evolved to Chiari 1.5 malformation during longitudinal follow-up. A 15-year-old girl presented with neck pain during exercise for two years. She had been diagnosed with Chiari I malformation with mild hydrocephalus after minor cervical trauma at the age of six years. At that time, she was asymptomatic. After she complained of aggravated neck pain, neuroimaging (nine years after first imaging) revealed caudal descent of the brainstem and syringomyelia in addition to progression of tonsillar herniation. Posterior fossa decompressive surgery resulted in complete resolution of neck pain. Based on neuroimaging and operative findings, she was diagnosed as Chiari 1.5 malformation. Neuroimaging performed seven months after surgery showed an increased anterior-posterior diameter of the medulla oblongata and markedly decreased syringomyelia. This case demonstrates progressive developmental process of the Chiari 1.5 malformation as an advanced form of the Chiari I malformation.

Myoepithelial Carcinoma Originated from the Maxillary Sinus / 대한이비인후과학회지

Myoepithelial carcinoma is a very rare malignant tumor accounting for less than one percent of the salivary gland neoplasms. This uncommom tumor, showing almost exclusively tumor cells with myoepithelial differentiation, is most commonly diagnosed in the parotid gland and in the minor silivary glands of the palate. We report a 77-year-old woman with myoepithelial carcinoma originating from maxillary sinus, one of the most unusual locations. The patient presented with progressive nasal obstruction and signs of a space-occupying lesion in the left maxillary sinus. A frozen biopsy identified a malignant tumor and a radical maxillectomy was performed. Histology confirmed the presence of a malignant myoepithelial carcinoma. Patient was followed up for one year without any recurrence or distant metastasis.

Non-Functional Parathyroid Adenoma Presenting as a Massive Cervical Hematoma: A Case Report

Parathyroid adenoma usually manifests with symptoms related to hypercalcemia, such as urinary stone and bone fracture. It may also present with asymptomatic hypercalcemia. However, spontaneous cervical hematoma may occur very rarely as a result of extracapsular hemorrhage of a cervical parathyroid adenoma causing acute painful cervical swelling, bruising, dyspnea, hoarseness and dysphagia. We report a 44-year-old woman who manifested as a spontaneous cervical hematoma without any clinical evidence of hyperparathyroidism.

An Infected Median Palatine Cyst: Report of a Rare Entity / 대한이비인후과학회지

The median palatine cyst is a rare fissural cyst of nonodontogenic origin located in the midline of the hard palate, posterior to the palatine papilla. Its etiology is generally attributed to the enclavement of remnants of epithelium surrounding the two lateral maxillary processes that fuse to form the hard palate. The median palatine cyst sometimes poses challenges in the diagnosis due to the diversity and complicated classifications of the cysts originating from the maxilla and palate. We present a case of large median palatine cyst of a 50-year-old man who had purulent rhinorrhea and foul odor for 1 year. An endonasal endoscopic marsupialization was performed and pus was drained from the cyst. There was no recurrence of symptoms and the ostium was well maintained at 4 months after the operation. We report this case with a brief literature review.