Two laparoscopic techniques for resection of leiomyoma in the stomach.

We report two surgical treatments by laparoscopic techniques of a leiomyoma in the stomach, each for one patient. The patients, one a 59-year-old man and the other a 28-year-old woman, were found to have an asymptomatic submucosal tumor in the stomach in an annual medical screening. One tumor, 1.5 cm in maximum diameter, was located on the anterior wall of the gastric body and was excised extracorporeally by laparoscopy-guided surgery. The other was 1.9 cm in maximum diameter, on the anterior wall of the antrum, and was excised intracorporeally using only laparoscopic surgery. Their postoperative courses were uneventful. They drank clear liquid after the removal of a nasogastric tube on the first postoperative day and had a solid meal on the second postoperative day. They were discharged from the hospital on the seventh and eighth postoperative days.

Invisible cardia cancer metastasis to the diaphragm.

The best surgical procedure to treat a carcinoma in the gastric cardia remains a controversy because the carcinoma is often advanced and there are other unknown factors. In this article the incidence of invisible metastasis from cardia cancer to the diaphragm will be analyzed using an experimental cardia cancer model and clinical studies. An experimental cardia cancer was induced by an endoscopic injection of VX2 cancer cells into the submucosal layer of the esophago-gastric junction in rabbits using a 27G needle and an Olympus BF-4B2 bronchofiberscope. A total of 26 cardia cancer models for Borrmann type 2 or 3 were produced. Of these, six (23%) had visible cancer metastases in the diaphragm, including 4 cases with direct invasion and 2 cases with peritoneal dissemination on the surface of the diaphragm. Four (20%) of the remaining 20 were histologically found to have macroscopically-invisible cancer metastases mainly in the lymph vessels of the left hemidiaphragm. From 1985 to 1988, 22 clinical cases of cardia cancer were managed by a combined total gastrectomy with a partial diaphragm resection through a left thoracoabdominal approach. When widely resected, reconstruction was performed using a latissimus dorsi muscle flap. Six (27%) of these 22 were also histologically found to have macroscopically-invisible cancer metastases to the diaphragm, including 1 (11%) of the 9 well-differentiated type and 5 (39%) of 13 poorly-differentiated type adenocarcinomas.(ABSTRACT TRUNCATED AT 250 WORDS)

[Experimental and clinical study for spread of cardiac cancer to the diaphragm].

We investigated the route of lymphogenous metastasis of cardiac cancer to the diaphragm, making a model of cardiac cancer using VX2 tumor of rabbit. Metastasis ratio of each lymph node in the experimental model indicated a correlation with clinical cases. Histological investigation of the diaphragm indicated floating of VX2 cancer cells in the lymph vessels in the diaphragm in 4 of 20 cases (20%). After, injection of CH44 at the oral side of the tumor, the presence of CH44 in the lymph vessels in the diaphragm were seen in 6 of 16 cases (37.5%). Clinically, the left diaphragm was excised as wide as possible in 22 cases of cardiac cancer with esophageal invasion by left thoraco abdominal approach. Histologically, embolic of the tumor or floating tumor cells in the lymph vessels in the diaphragm were seen in 6 of 22 cases (27.3%). These results revealed that carcinoma proliferating in the cardia can apparently spread to the diaphragm more extensively than has been previous believed.

Leiomyosarcoma of the rectum with sarcoid-like reaction--a case report.

A 57 year-old man was admitted to the hospital because of bloody stools. A barium enema and coloscopy disclosed a tumor of the rectum. The resected tumor was diagnosed as a leiomyosarcoma, histologically. Many epithelioid granulomas with Langhans type giant cells were found in the tumor, and there was no evidence suggestive of generalized sarcoidosis, tuberculosis or mycosis. Thus, the epithelioid granulomas seen in the leiomyosarcoma were interpreted as a sarcoid-like reaction. As far as could be determined, there has been no reported case of a sarcoid-like reaction associated with a leiomyosarcoma. The occurrence of the sarcoid-like reaction in the present case could be due to the reaction to the metabolites or a degenerative substance of the leiomyosarcoma, or to host resistance to the tumor itself.