Two Cases of Advanced Gastric Carcinoma Mimicking a Malignant Gastrointestinal Stromal Tumor

Gastric cancer that mimics a submucosal tumor is rare. This rarity and the normal mucosa covering the protuberant tumor make it difficult to diagnosis with endoscopy. We report two cases of advanced gastric cancer that mimicked malignant gastrointestinal stromal tumors preoperatively. In both cases, the possibility of cancer was not completely ruled out. In the first case, a large tumor was suspected to be cancerous during surgery. Therefore, total gastrectomy with lymph node dissection was performed. In the second case, the first gross endoscopic finding was of a Borrmann type II advanced gastric cancer-like protruding mass with two ulcerous lesions invading the anterior wall of the body. Therefore, subtotal gastrectomy with lymph node dissection was performed. Consequently, delayed treatment of cancer was avoided in both cases. If differential diagnosis between malignant gastrointestinal stromal tumor and cancer is uncertain, a surgical approach should be carefully considered due to the possible risk of adenocarcinoma.

Factors Related to Morbidity in Elderly Gastric Cancer Patients Undergoing Gastrectomies

PURPOSE: The prevalence of gastric cancer in the elderly is increasing. The purpose of this study was to clarify factors related to morbidity following gastric cancer surgery in elderly patients. MATERIALS AND METHODS: For this study, data from 411 patients who underwent curative gastrectomies with lymph node dissections between March 2010 and January 2013 were retrospectively studied using a prospectively designed database. Patients were divided into 2 groups ( or =70 years). For each group, perioperative factors were analyzed to determine if they were associated with postoperative morbidity and mortality. RESULTS: Comorbidities were more prevalent in the elderly group (> or =70 years). Intraoperative and postoperative transfusions were also more frequently required in the elderly group. There was no significant difference in the number of retrieved lymph nodes between the 2 groups (44.3 vs. 46.6 nodes). In a comparison of the elderly versus non-elderly groups, the postoperative morbidity rates were 22.7% versus 8.9% (P<0.001) and the postoperative mortality rates were 4.2% versus 0% (P=0.002), respectively. Of the possible non-surgical complications, pulmonary problems were predominately found in the elderly group (P<0.001). Surgical complications were evenly distributed between the 2 groups (P=0.463). Postoperative morbidity was significantly associated with older age and postoperative transfusion. Multivariate analysis showed that higher body mass index (BMI) and postoperative transfusion were important factors associated with postoperative complications in the elderly group. CONCLUSIONS: Pulmonary complications were frequently problematic in elderly patients. Higher BMI and postoperative transfusion were significant risk factors for postoperative complications in elderly patients with gastric cancer.

The Laterality of Deep Vein Thrombosis in the Pelvic and Lower Extremity Veins

PURPOSE: This study aimed to determine whether deep vein thrombosis (DVT) predominantly occurred on a particular side in the pelvic and lower extremity veins. MATERIALS AND METHODS: Among 259 consecutive patients with leg swelling, 65 were confirmed to have DVT in the pelvis and lower extremities, and enrolled in this study. The serum levels of initial D-dimer, antithrombin III, tissue plasminogen activator, factor VIII, proteins C and S, anticardiolipin antibodies immunoglobulin (Ig) G and IgM and lupus anticoagulant were measured and analyzed retrospectively. Lower extremity venous system was divided into 11 anatomic segments on each side, and thrombotic involvement in each segment was recorded to determine the laterality of thrombotic involvement for each patient. The presence of thrombus in a specific vein was assigned using a Thrombus Scoring System (TSS) score of 1. Predominant direction was determined based on the TpSS score for each side. RESULTS: Left-side predominat DVT (57%) was most frequent. Patients with both-side equivalent DVT had the highest total TSS score (P=0.022). The predominant side was significantly different between men (right 44.1%) and women (left 74.2%) (P=0.022). Patients with both-side equivalent DVT had the highest mean age (69.3+/-9.9 years) as well as the highest mean levels of initial D-dimer (13.8+/-20.7 microg/mL) and anticardiolipin antibody IgM (13.4+/-22.8 MPL) indicating increased coagulability. CONCLUSION: In the current study, left-side predominant DVT is most frequent in pelvis and lower extremities, and this phenomenon is more apparent in women. And both-side equivalent DVT is associated with the most advanced age and hypercoagulability.