[A Resected Case with Early Gastric Cancer That Was Overdiagnosed as Scirrhous Gastric Cancer].

We experienced a case of early gastric cancer. A 69-year-old woman with a thick gastric wall, thickened folds, and undifferentiated cancer cells in biopsy was diagnosed with scirrhous gastric cancer. The patient underwent total gastrectomy for scirrhous gastric cancer and was found to have only an early gastric cancer lesion located on the upper gastric wall. The thick wall diagnosed before surgery was diagnosed as angiodysplasia occupying the submucosal layer.

[A Patient with Scirrhous Gastric Cancer Diagnosed and Resected Subsequently by Laparotomy Examination Due to Difficulty to Take Cancer Specimen by Endoscopic Biopsy].

Some of scirrhous gastric cancer are difficult to diagnose on the surface view or to take correct biopsy specimen.A 85-yearold man with dysphagia was diagnosed scirrhous gastric cancer endoscopically, but could not be taken a biopsy specimen showing cancer.We informed cases of scirrhous gastric cancer difficult to take correct biopsy specimen and recommended surgical operation to take correct specimen and to start a treatment.Patient underwent total gastrectomy after cancer diagnosis( P0CY0cT4aN0).He can eat more food and survive longer than 1 year without any chemotherapies.Scirrhous gastric cancer needs early diagnosis and treatment to improve patient prognosis.

[A Case of Gastric Remnant Cancer after Proximal Gastrectomy with Jejunum Pouch Interposing Reconstruction].

A 83-year-old man was diagnosed an earlygastric remnant cancer on the site of jejuno-gastrostomyafter proximal gastrectomywith jejunum interposing reconstruction 23 years ago. A total gastrectomywas performed due to the difficultyof endoscopic submucosal resection. The surgical operation took 200 minutes and the blood loss was 180 mL. Histologically, tumor size was 28×22mm invading to submucosal layer with a lymph node metastasis. To reduce the risk of surgical operation for gastric remnant cancer of aged patients, a simple reconstruction method is important for proximal gastrectomy, like a esophagogastrostomyplacing a gastric tube in the mediastinum.

[Successful Multidisciplinary Treatment of Metastatic Ovarian Cancer after Perforative Peritonitis of the Rectum Due to Disseminated Ovarian Cancer].

A72 -year-old woman who complained of abdominal pain and distention visited the emergency clinic of our hospital in April 2014. Computed tomography(CT)showed an omental mass and a pelvic mass with massive ascites. The fluid was removed by abdominal aspiration, and the patient showed perforative peritonitis next day. An emergency operation was performed. The surgical operation showed that the rectum was perforated due to stenosis covered by the ovarian cancer metastases. Aleft colectomy combined with a transverse colostomy was performed. After 4 weeks of rest, 6 courses of tri- weekly TC chemotherapy were administered, and the CA125 level decreased from 140 U/mL to 11.8 U/mL. She underwent a complete cytoreductive surgery in February 2015. She was histologically diagnosed with Grade 2b serous adenocarcinoma. After these 2 surgical operations, she underwent a splenectomy to remove a single metastasis in February 2016 and consecutive chemotherapy. For ovarian cancer, if dissemination occurs, rectal perforation can be a treatment target with a gastrointestinal surgeon's help.

The retroperitoneal interfascial planes: current overview and future perspectives.

Recently, the concept of interfascial planes has become the prevalent theory among radiologists for understanding the retroperitoneal anatomy, having replaced the classic tricompartmental theory. However, it is a little known fact that the concept remains incomplete and includes embryological errors, which have been revised on the basis of our microscopic study. We believe that the concept not only provides a much clearer understanding of the retroperitoneal anatomy, but it also allows further development for diagnosis and treatment of retroperitoneal injuries and diseases, should it become an accomplished theory. We explain the history and outline of the concept of interfascial planes, correct common misunderstandings about the concept, explain the unconsciously applied therapeutic procedures based on the concept, and present future perspectives of the concept using our published and unpublished data. This knowledge could be essential to acute care physicians and surgeons sometime soon.

Preliminary embryological study of the radiological concept of retroperitoneal interfascial planes: what are the interfascial planes?

PURPOSE: Recently, the radiological concept of retroperitoneal interfascial planes has been widely accepted to explain the extension of retroperitoneal pathologies. This study aimed to explore embryologically based corroborative evidence, which remains to be elucidated, for this concept. METHODS: Using serial or semi-serial transverse sections from 29 human fetuses at the 5th-25th week of fetal age, we microscopically observed the development of the retroperitoneal fasciae and other structures in the retroperitoneal connective tissue. A hypothesis for the formation of the interfascial planes was generated from the developmental study and analysis of retroperitoneal fasciae in computed tomography images from 224 patients. RESULTS: Whereas the loose connective tissue was uniformly distributed in the retroperitoneum by the 9th week, the primitive renal and transversalis fasciae appeared at the 10th-12th week, as previous research has noted. By the 23rd week, the renal fascia, transversalis fascia, and primitive adipose tissue of the flank pad emerged. In addition, the primitive lateroconal fascia, which runs parallel to and close to the posterior renal fascia, emerged between the renal fascia and the adipose tissue of the flank pad. Conversely, pre-existing loose connective tissue was sandwiched between the opposing fasciae and was compressed and narrowed by the developing organs and fatty tissues. CONCLUSION: Through this developmental study, we provided the hypothesis that the compressed loose connective tissue and both opposed fasciae compose the interfascial planes. Analysis of the thickened retroperitoneal fasciae in computed tomography images supported this hypothesis. Further developmental or histological studies are required to verify our hypothesis.