Tumor Size is Associated with Long-term Outcomes after Resection of Gastric Gastrointestinal Stromal Tumors / 계명의대학술지

The clinical outcomes after surgical resection of gastrointestinal stromal tumors (GISTs) vary widely due to the differences in tumor size and mitotic index. To analyze the long-term outcomes and prognosis of surgically resected gastric GISTs according to tumor size. We retrospectively analyzed the medical records of 269 patients who underwent surgery for GISTs at Keimyung University Dongsan Hospital from March 2000 to March 2017. We surveyed tumor size, mitotic index, recurrence after surgery, time to recurrence, treatment for recurrence, and mortality. The risk of recurrence of gastric GISTs was classified as very low, low, intermediate, and high risk according to the 2007 Journal of the national comprehensive cancer network (JNCCN). After excluding 69 patients who had simultaneous gastric adenocarcinoma, the outcomes of 200 patients were analyzed. Recurrence was observed in 7 patients: 1 in the very low risk group (1-2 cm), 2 in the very low risk group (less than 5 cm), and 3 in the high risk group. Death due to gastrointestinal bleeding occurred in 1 patient in the high risk group who had a tumor >10 cm. While the recurrence rates after surgical resection of GIST are very low, careful monitoring and regular follow-up are warranted, even for low risk patients.

Huge Hepatocellular Carcinoma Exhibiting a Complete Response after Stereotactic Body Radiation Therapy

To date, there are limited data and little consensus on treatment strategies for huge hepatocellular carcinoma (HCC). Surgical resection provides significantly better survival than other modalities for single large HCC regardless of tumor stage. Recently, with technological advances in radiation therapy, stereotactic body radiation therapy (SBRT) is considered an alternative treatment option for HCC. Herein, we present a case of huge HCC that was successfully managed by SBRT. Transarterial embolization, previously performed in Russia, was incomplete. It was also not suitable for resection and transarterial chemoembolization. Although the rationale for radiotherapy in huge HCC was insufficient, SBRT was performed because no other treatment options were available. Additional radiofrequency ablation was performed for small HCC in a different segment, and radiological complete response (CR) was achieved. The CR was maintained over 4 years. Therefore, SBRT may be an alternative treatment option for large HCC that is not suitable for curative treatment.

Primary Hepatic Tuberculosis Mimicking Hepatocelluar Carcinoma in Patient with Chronic Viral Hepatitis B and C / 계명의대학술지

Hepatic tuberculosis (TB) is usually associated with pulmonary or miliary TB, but primary hepatic TB is rare less than 1% of all cases of TB. Because hepatic TB lacks typical clinical manifestations as well as typical imaging findings, it is difficult to differentiate TB from the malignancies such as hepatic metastasis, intrahepatic cholangiocarcinoma and hepatocellular carcinoma. A 76-year-old woman was presented with single liver mass detected on routine examination. She was clinically diagnosed with hepatocellular carcinoma and underwent surgical excision of the lesion. However, histologic examination revealed caseous necrotizing granuloma and the PCR test for Myco-bacterium tuberculosis was positive. The final diagnosis was primary hepatic TB. Here we report the case with primary hepatic TB who was initially misdiagnosed with hepatocellular carcinoma and underwent surgical excision.