[A case of colon tumor evaluated by laparoscopy from the appendix].

Generally, a colon lesion is evaluated by endoscopy. In many cases, total colonoscopy is often difficult to perform due to postsurgical adhesion. Here, we described a case of a colon tumor that could not be recognized by colonoscopy and palpation under laparotomy. Nonetheless, this tumor could be observed by laparoscopy from the appendix root after appendectomy. Eventually, this tumor was locally resected. The patient was a 79-year-old male who had PET-CT examination to explore distant metastasis before the rectal cancer surgery. In this examination, the ascending-colon lesion was suspected as a malignant tumor. This tumor could not be observed by colonoscopy because of the adhesion from the past history of right pneumonectomy and open cholecystectomy. Nevertheless, the contrast enema at the hepatic flexure of the colon was normal. We then suspected an early colon carcinoma and subsequently performed laparotomy. However, the tumor was not detected by palpation at the ascending colon. Thus, we observed the colon tumor by laparoscopy from the appendix root after appendectomy, followed by local excision of the colon tumor. Therefore, observation by laparoscopy from the appendix root was useful for the diagnosis and treatment of the ascending-colon lesion that could not be recognized by colonoscopy and palpation under laparotomy.

Gastrointestinal stromal tumor coexisting with disseminated peritoneal leiomyomatosis.

BACKGROUND: A case of gastrointestinal stromal tumor (GIST) coexisting with disseminated peritoneal leiomyomatosis (DPL) is rare. We report a case of GIST coexisting with DPL. CASE PRESENTATION: A 50-year-old woman underwent exploratory laparoscopy under a preoperative diagnosis of gastric GIST with an ovarian tumor or peritoneal dissemination in the pelvic space. Laparoscopy showed multiple peritoneal masses in the pelvic space. Intraoperative frozen sectioning of the pelvic tumors showed multiple spindle cells, suggesting leiomyomas or retroperitoneal tumors; however, it was difficult to rule out peritoneal dissemination from GIST. No disseminated lesion was noted near GIST, and hence, we believed that GIST and pelvic lesions had different origins. We achieved R0 resection by partial resection of the stomach, total hysterectomy, and bilateral salpingo-oophorectomy. The postoperative immunohistopathological examination confirmed the final diagnosis of GIST and DPL. The patient has been recurrence free for 10 years. CONCLUSIONS: Immunohistochemical examination is essential for correct diagnosis for GIST and DPL. R0 curative resection should be scheduled after immunohistochemical examination of specimens obtained from exploratory laparoscopy.