Acase of stomach carcinoma showing features of submucosal tumor is reported. The patient was a 50-year-old man presenting with hematemesis. Endoscopic examination was performed and revealed a submucosal tumor-like lesion with central ulceration in the fornix of the stomach. The biopsy specimen from this lesion showed poorly differentiated adenocarcinoma, and surgery was performed. The tumor, measuring 3.5 x 2.7 cm in size, invaded to the muscularis propria with proliferation of the interstitial connective tissue and lymphoid follicles consisting mainly of B lymphocytes in the submucosal layer. In situ hybridization of tumor tissue for Epstein-Barr virus (EBV)-encoded small RNA1 as target revealed negative results. In stomach carcinoma simulating submucosal tumor, as in this patient, preoperative diagnosis is important to plan treatment strategies.
Hepatocellular carcinoma (HCC) is often treated most effectively by resection. Although improved surgical procedures and perioperative care have made hepatic resection safe, the prognosis of patients with HCC is still poor because of the high incidence of postoperative recurrence. The most common site of extrahepatic recurrence is the lung. However, because of its multiplicity and concurrent recurrence in the liver remnant, resection of pulmonary metastases form HCC is rarely beneficial. We report two cases of long-term survival after repeated pulmonary resection of metastasis from HCC. At the time of this report the two patients were free of disease, 110 months and 107 months, respectively, after their initial hepatectomy. These case reports show that pulmonary metastases from HCC can be successfully resected in selected patients.
We performed elective laparoscopic adhesiolysis in 21 patients with small bowel obstruction. The procedure was completely laparoscopic or laparoscopy assisted in 17 patients, but 4 patients required full laparotomy due to internal hernia in 2, perforation of the small bowel associated with dense adhesions in 1, and carcinoma of the cecum in 1. In patients with a laparoscopic or laparoscopy-assisted procedure, the mean operating time, mean time until the return of bowel function, and mean postoperative stay were 94 minutes, 3.3 days, and 9.9 days, respectively. During follow-up for 14 to 44 months, 3 patients developed recurrent obstruction, 1 patient suffered from catheter-induced thrombosis, and 1 patient died from lung cancer. Elective laparoscopy can be performed safely and effectively in selected patients with intermittent small bowel obstruction.
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