ABSTRACT
INTRODUCTION: Ganglioneuromas are well-differentiated benign tumors that arise from sympathetic ganglion cells. In ganglioneuromas of the retroperitoneum, nonadrenal cases are resected by laparotomy due to the proximity to major vessels. There have been few reports of laparoscopic resection for retroperitoneal paraaortic ganglioneuromas. We experienced a case in which laparoscopic resection was required for a 90-mm ganglioneuroma adhered to the aorta and inferior mesenteric artery. PRESENTATION OF CASE: A 49-year-old female patient presented with epigastric pain. Computed tomography showed a 90 mm retroperitoneal tumor, partially located between the aorta and inferior mesenteric artery. A definitive diagnosis was not obtained, and laparoscopic excision of the retroperitoneal tumor was performed transabdominally. The patient recovered without postoperative complications and left the hospital on postoperative day 8. Postoperative pathological findings revealed a ganglioneuroma from the abdominal periaortic plexus. DISCUSSION: We searched the literature for nonadrenal ganglioneuromas resected laparoscopically using a transabdominal approach and summarized the tumor locations. The median age was 33 years, and the median tumor size was 50 mm. Regarding the surgical results, the median operative time was 170.5 min, median blood loss was 21.5 mL, and median postoperative stay was 7 days. CONCLUSION: Laparoscopic resection of nonadrenal ganglioneuromas is feasible even when a tumor adheres to major blood vessels.
ABSTRACT
INTRODUCTION: Anus-preserving surgery for a large rectal gastrointestinal stromal tumor (GIST) may be difficult because of the location of the tumor in the pelvis. Therefore, rectal GIST might require extensive surgery, such as abdominoperineal resection. In recent years, preoperative imatinib therapy has been used to reduce tumor size and preserve the anus in some cases. However, there have been few reports of laparoscopic anal-preserving surgery for giant rectal GIST. PRESENTATION OF A CASE: We present the case of a 55-year-old man who was referred to our hospital for examination of a 10-cm pelvic mass in the lower rectum. Endoscopic ultrasound with fine needle aspiration was performed, and the pathological findings resulted in a diagnosis of GIST. The mass had spread to the prostate and left levator ani muscles, and as a result, surgery was deemed difficult to perform without damaging the pseudo-capsule. Therefore, preoperative chemotherapy with imatinib mesylate (IM) was performed for 8 months. The mass was reduced to 7.8 cm, and laparoscopic intersphincteric resection (ISR) was performed. DISCUSSION: We also review prior cases of rectal GIST where patients had undergone anal-preserving surgery following preoperative chemotherapy with IM. Our case represented the largest tumor size in a review of cases of patients who had successful anal-preserving laparoscopic surgery following preoperative chemotherapy with IM. CONCLUSION: Preoperative chemotherapy with imatinib mesylate was effective for reducing the rectal GIST, and laparoscopic ISR was useful for anal preservation, even when a tumor is large.
ABSTRACT
A 69-year-old man underwent single-incision laparoscopic colectomy for a colon tumor. He had comorbid relapsing polychondritis, an uncommon and intractable chronic inflammatory disease that shows various symptoms and systemically invades the cartilaginous tissue throughout the body. In this case, the bronchial wall was edematous and the glottis was incompetent. Steroids were also administered. Although the patient had high-risk factors for surgical complications, none occurred during the perioperative period. Once the C-reactive protein value returned to within the normal range after surgery, we reduced the steroid dose. This is the first report of single-incision laparoscopic colectomy for a patient with relapsing polychondritis.
