scholarly journals Gastrointestinal Stromal Tumor of the Stomach with an Abscess Excised by Laparoscopic Surgery

2016 ◽  
Vol 10 (2) ◽  
pp. 399-405 ◽  
Author(s):  
Yoshiaki Maeda ◽  
Toshiki Shinohara ◽  
Tomonari Katayama ◽  
Akihisa Nagatsu ◽  
Noriaki Futakawa ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Ct Scan ◽  
Wedge Resection ◽  
Gastric Wall ◽  
Laboratory Data ◽  
Needle Aspiration ◽  
Gastric Gist ◽  
Abdominal Abscess ◽  
En Bloc ◽  
Lesser Curvature

Gastrointestinal stromal tumors (GISTs) of the stomach presenting as an intra-abdominal abscess are extremely rare. We herein report a case that underwent successful laparoscopic resection of gastric GIST presenting with an intra-abdominal abscess. A 70-year-old man presented with a 3-day history of acute upper abdominal pain with a fever. Laboratory data showed an elevated white blood cell count and C-reactive protein level. A CT scan revealed a mass of mixed solid and fluid components, measuring 5.5 cm, in the adjacent lesser curvature of the stomach. He was diagnosed as having an intra-abdominal abscess, and antibiotic therapy was administered. Consequently, his symptoms were relieved and a CT scan on the 7th day showed that the mass reduced and became homogenous. According to the results of a fine-needle aspiration biopsy, the tumor was suspected to be a GIST. Laparoscopic surgery with the 5-port approach was performed. The tumor existed in the lesser curvature of the stomach, and was excised en bloc with the omentum and gastric wall by wedge resection. The tumor measured 3.0 cm in diameter and originated from the serosal layer of the stomach. Histological findings showed spindle cells with a stromal growth pattern that was positive for c-kit (CD 117) and CD 34. The postoperative course was uneventful, and no recurrence has been noted in the 2 years since the operation. This is the first report of a case with gastric GIST with an intra-abdominal abscess that was successfully treated by laparoscopic surgery.

scholarly journals A Case of Mucosal Cancer of the Stomach Treated by Endoscopic Submucosal Dissection after Which Nodal Metastasis Became Evident

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Takashi Obana ◽  
Naotaka Fujita ◽  
Yutaka Noda ◽  
Dai Hirasawa ◽  
Kei Ito ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Needle Aspiration ◽  
Lymphatic Invasion ◽  
Pathological Examination ◽  
Vascular Involvement ◽  
Resected Specimen ◽  
Tubular Adenocarcinoma ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Lesser Curvature

An 82-year-old male was referred to our institution for evaluation and treatment of a protruding lesion in the stomach. Esophagogastroduodenoscopy (EGD) showed a small protruding lesion and a large superficial elevated lesion on the lesser curvature of the stomach (macroscopic type: 0-I and 0-IIa, resp.). CT and endoscopic ultrasonography (EUS) visualized a small round lymph node (LN) 11 mm in size near the lesser curvature, although submucosal invasion was not evident. These two lesions were resected en bloc by endoscopic submucosal dissection (ESD). Pathological examination of the resected specimen showed moderately differentiated tubular adenocarcinoma (tub2) and well-differentiated tubular adenocarcinoma (tub1), respectively, which were limited to the mucosal layer. Because lymphatic-vascular involvement was not detected by hematoxylin and eosin (HE) staining, additional gastrectomy was not performed. Two months after ESD, follow-up EUS and CT showed an enlarged LN. EUS-guided fine needle aspiration (EUS-FNA) for the LN revealed metastasis. Therefore, total gastrectomy with LN dissection was performed. His postoperative course was uneventful. After discharge, he has been followed up at the outpatient department without any sign of recurrence for 5 years. Histological reexamination of the ESD specimen using immunohistochemistry showed lymphatic invasion of cancer cells in the lamina propria of the 0-I lesion 13 mm in size.

scholarly journals Laparoscopic Transgastric Resection of a Large Gastric GIST: A Case Report and Review of Literature

2021 ◽  
Vol 07 (04) ◽  
pp. e337-e341
Author(s):  
Eham Arora ◽  
Jaini Gala ◽  
Aditya Nanavati ◽  
Arun Patil ◽  
Ajay Bhandarwar
Keyword(s):  
Case Report ◽  
Wedge Resection ◽  
Laparoscopic Approach ◽  
Posterior Wall ◽  
Needle Aspiration ◽  
Primary Treatment ◽  
Resected Specimen ◽  
Gastric Gist ◽  
Mesenchymal Tumors ◽  
Transgastric Approach

Abstract Introduction Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Their primary treatment is surgical. Case Report Here we report a case of a 36-year-old male patient who was being evaluated for weakness, anemia, and melena. Upper GI endoscopy showed a mass projecting into the lumen and an abdominal computed tomography (CT) confirmed a well-defined mass close to the lesser curvature on the posterior wall. An endoscopic ultrasound-guided fine needle aspiration suggested a diagnosis of GIST. After optimization, the patient was taken up for a laparoscopic transgastric resection of the GIST. The resected specimen measured 9.5 × 8.5 × 7.5 cm. Postoperatively, the patient recovered well and was discharged by the fifth postoperative day. Discussion While traditionally, open surgery has been advocated for GISTs, for fear of spillage and peritoneal seeding, the role of minimal access surgery has been growing in recent years. The use of a transgastric approach avoids the potential complication of luminal stenosis following a wedge resection of a tumor close to the cardia. Because lymphadenectomies are rarely required and local invasion is uncommon, a wide local resection is usually curative. Thus, a laparoscopic approach can be considered as the first line in uncomplicated GISTs, irrespective of tumor size.

scholarly journals A Case of Gastric Heterotopic Pancreatitis Resected by Laparoscopic Surgery

2015 ◽  
Vol 100 (4) ◽  
pp. 678-682 ◽  
Author(s):  
Takatsugu Matsumoto ◽  
Nobutaka Tanaka ◽  
Motoki Nagai ◽  
Daisuke Koike ◽  
Yuki Sakuraoka ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Endoscopic Ultrasonography ◽  
Fine Needle Aspiration ◽  
Gastric Wall ◽  
Needle Aspiration ◽  
Pancreatic Tissue ◽  
Heterotopic Pancreas ◽  
Gastric Body ◽  
Fine Needle ◽  
Cystic Component

Heterotopic pancreas (HP) is a rare entity which is defined as the presence of pancreatic tissue lacking anatomical and vascular continuity with the pancreas. It is most commonly found along foregut derivatives, such as the stomach, duodenum, and jejunum. It is frequently encountered incidentally in asymptomatic patients, and symptomatic patients are rare and do not exhibit any specific symptoms. Accordingly, HP is difficult to diagnose before surgery. Here we report an unusual case of gastric heterotopic pancreatitis causing gastric outlet obstruction diagnosed preoperatively using endoscopic ultrasonography guided fine needle aspiration cytology. A 21-year-old woman was referred to our hospital because of abdominal pain, nausea, and vomiting. Gastroduodenal endoscopic examination revealed an oval-shaped submucosal tumor in the gastric body. Contrast-enhanced computed tomography (CT) revealed that the tumor had a cystic component and marked perigastric inflammation. Endoscopic ultrasonography (EUS) demonstrated a hypoechoic mass arising from the third to fourth layer of the gastric wall. Pancreatic exocrine glands were detected by EUS-guided fine needle aspiration biopsy. The lesion was diagnosed as gastric heterotopic pancreas with inflammation of the pancreatic tissue. Laparoscopic partial gastrectomy was performed, and the diagnosis was also histologically confirmed. The patient was discharged 5 days after the operation. She has remained healthy and symptom-free during 10 months of follow-up. We experienced a first case of gastric heterotopic pancreatitis which was correctly diagnosed preoperatively and resected by laparoscopic surgery. Partial resection of the heterotopic pancreatic tissue could lead to a good outcome.

scholarly journals Pleural Solitary Fibrous Tumors—A Retrospective Study on 45 Patients

Medicina ◽  
2020 ◽  
Vol 56 (4) ◽  
pp. 185 ◽  
Author(s):  
Cornel Savu ◽  
Alexandru Melinte ◽  
Radu Posea ◽  
Niculae Galie ◽  
Irina Balescu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Ct Scan ◽  
Single Case ◽  
Postoperative Mortality ◽  
Diagnostic Methods ◽  
Chest Wall Resection ◽  
En Bloc ◽  
Curative Intent ◽  
Solitary Fibrous Tumors ◽  
Thoracic Ct

Introduction: The purpose of this paper is to study the type, the clinical presentation, and the best diagnostic methods for pleural solitary fibrous tumors (PSFTs), as well as to evaluate which is the most appropriate treatment, especially as PSFTs represent a rare occurrence in the thoracic pathology. Material and Method: A retrospective study was conducted on a group of 45 patients submitted to surgery between January 2015 and December 2019. In most cases, the diagnosis was established through imaging studies—thoracic computed tomography (CT) scan with or without contrast—but also using magnetic resonance imaging (MRI) or positron emission tomography (PET) scans when data from CT scans were scarce. All patients were submitted to surgery with curative intent. Results: Most patients included in this study were asymptomatic, with this pathology being more common in patients over 60 years of age, and more common in women. The occurrence of malignant PSFT in our study was 17.77% (8 cases). All cases were submitted to surgery with curative intent, with a single case developing further recurrence. In order to achieve complete resection en bloc resection of the tumor with the chest wall, resection was performed in two cases, while lower lobectomy, pneumectomy, and hemidiaphragm resection, respectively, were needed in each case. Postoperative mortality was null. Conclusion: Thoracic CT scan remains the most important imagistic investigation in diagnosing. MRI is superior to thoracic CT, especially in cases that involved the larger blood vessels within the thorax, spinal column, or diaphragm. Complete surgical resection is the gold standard in treatment of PSFT, and the prognosis in benign cases is very good.

“LAPAROSCOPIC INTRAGASTRIC EXCISION OF POSTERIORLY LOCATED GASTRIC GIST USING CONVENTIONAL LAPAROSCOPIC INSTRUMENTS – A CASE REPORT”

2021 ◽  
pp. 29-31
Author(s):  
Kulwant Singh Bhau ◽  
Iqbal Saleem Mir ◽  
Mufti Mahmood Ahmad
Keyword(s):  
Gastric Wall ◽  
Surgical Excision ◽  
Anterior Wall ◽  
Minimal Invasive ◽  
Point Of View ◽  
Gastric Gist ◽  
Safe Procedure ◽  
Conventional Laparoscopic ◽  
Laparoscopic Instruments ◽  
Anterior Gastric Wall

Background: Gastro-intestinal stromal tumour (GIST) commonly involves stomach. Recently there has been an inclination towards managing these benign but potentially malignant lesions by minimal invasive techniques. Surgical excision of gastric GIST mostly requires anterior wall gastrostomy especially for intraluminal lesions. The size and location of the lesion are critical from technical point of view. Lesions located at gastro-esophageal junction requires larger anterior gastric wall opening to reach the site of tumour for excision. Endoscopic excision for such lesions is not always amenable. We performed excision of a posteriorly locat Methods: ed gastric GIST at GE junction by hitching the anterior gastric wall with the anterior abdominal wall and by directly creating pneumogastrium percutaneously for placing three intra-gastric trocars. Results: Patient was discharged on post-operative day 3 in a satisfactory condition. Histopathology revealed complete resection of GIST lesion with margins free from tumour. Immuno-histochemistry (IHC) conrmed it to be GIST with low malignant potential and patient was advised regular follow up. Laparoscopic intra-gastric excision of a posteriorly located gast Conclusion: ro-oesophageal junction GIST lesion after creating pneumogastrium and using conventional laparoscopic instruments is a safe procedure

scholarly journals Direct invasion of HCC to the gastric wall diagnosed by endoscopic ultrasonography-guided fine needle aspiration

2016 ◽  
Vol 89 (1) ◽  
pp. 146-147
Author(s):  
Rion Sudo ◽  
Yasumi Katayama ◽  
Akihiro Kitahama ◽  
Ikuhiro Kobori ◽  
Yoshinori Gyotoku ◽  
...  
Keyword(s):  
Endoscopic Ultrasonography ◽  
Fine Needle Aspiration ◽  
Gastric Wall ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Direct Invasion

scholarly journals SUN-180 A Case of Deoxycorticosterone-Producing Malignant Adrenocortical Tumor

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Natasha Scaranello Cartolano ◽  
Vânia Balderrama Brondani ◽  
Amanda Meneses Ferreira Lacombe ◽  
Helaine Charchar ◽  
Bruna Pessoa ◽  
...  
Keyword(s):  
Weight Loss ◽  
Arterial Hypertension ◽  
Ct Scan ◽  
Adrenocortical Carcinoma ◽  
Adrenal Mass ◽  
Laboratory Data ◽  
Pulmonary Nodules ◽  
Adrenocortical Tumor ◽  
Abdominal Ct ◽  
Weiss Criteria

Abstract Background: Hypermineralocorticism (hypertension, hypokalemia, and low plasma renin activity) due to deoxycorticosterone (DOC) excess associated with adrenocortical carcinoma is extremely rare. DOC-producing tumors cause primary aldosteronism-like symptoms presenting low plasma aldosterone with very high DOC levels, and due to weak hormonal DOC activity, its diagnostic is done lately. Generally, malignant cases are progressive with a dismal prognosis. Clinical case: A 61-year-old woman was admitted to our hospital presenting lumbar pain and weight loss of 8 kg, in 2018. Previously, arterial hypertension was diagnosed in 2015, showing a satisfactory control with two classes of antihypertensive drugs. Physical exam: The patient presented no features of Cushing syndrome, but a palpable abdominal mass was noticed in the right flank. Blood pressure was 160x100 mmHg, with sustained high levels, despite regular treatment. Laboratory data: a hypokalemia (K 2.4 mEq/L, nr 3.5 -5.0 mEq/L) and hypernatremia (Na 146 mEq/L, nr 135 to 145 mEq/L), with metabolic alkalosis (venous pH 7.46 and serum bicarbonate 32 mmol/L, nr 23-27 mmol/L) was confirmed. Hormonal tests excluded hypercortisolism and pheocromocytoma. Serum aldosterone and renin were suppressed. Mineralocorticoid precursors dosage was extremely high, DOC (654 ng/dL, nr < 25 ng/dL) and progesterone (5.0 ng/mL, nr <0.89 ng/mL), as well 11-deoxycortisol (7.2 ng/mL, nr <0.5 ng/mL). Radiological imaging: abdominal CT showed a heterogeneous hypervascular adrenal mass (13.0x13.0x21.0 cm) exhibiting central necrosis, suggesting malignancy. FDG-PET/CT scan showed a hypermetabolic adrenal mass (SUVmax=13.8). Also, two metabolically active pulmonary nodules (SUVmax=3.7) measuring 0.7 and 0.4 cm were detected. The patient underwent right adrenalectomy, and the tumor was removed (24x13x13 cm). According to Weiss criteria (8/9) and modified Weiss criteria (5/7), the tumor was considered an adrenocortical carcinoma. Immunohistochemistry revealed a low Ki-67 index (10%). After the surgical procedure, all adrenal steroid levels normalized, and mitotane was prescribed as adjuvant therapy. Although the pulmonary nodules were stable at the four-month follow-up, the abdominal CT-scan revealed a heterogeneous nodule (3.7cm) in the left adrenal gland, which was suspicious of metastasis. Conclusion: DOC-producing adrenocortical tumors are heterogeneous regarding tumor size, clinical behavior, hormonal and metabolites secretion, and disease-free and overall survival; however, it is common hypokalemia, hypertension, and other symptoms as abdominal pain, due to tumor growth, and weight loss. The association of arterial hypertension with hypokalemia and elevated 11-deoxycortisol, with normal aldosterone and renin, lead to the need for mineralocorticoid precursors evaluation in patients with adrenocortical tumor.

scholarly journals Extensive dentigerous cyst with two ectopic teeth – surgical management

2014 ◽  
Vol 19 (2) ◽  
pp. 130-134
Author(s):  
Shameem Anwarul Hoque ◽  
SM Mahede Hasan ◽  
Hritu Raj Deb ◽  
Mofakkarul Islam ◽  
Amzad Hosain ◽  
...  
Keyword(s):  
Ct Scan ◽  
General Anaesthesia ◽  
Surgical Management ◽  
Nasal Obstruction ◽  
Dentigerous Cyst ◽  
Needle Aspiration ◽  
Dental Radiography ◽  
Post Operative Period ◽  
Unerupted Teeth

Dentigerous cyst develops around impacted, unerupted or developing teeth. It is often asymptomatic. However, it can be large and cause symptoms related to expansion. Painless swelling is the main symptoms, may be painful if infected. It can be found incidentally on dental radiography. Our patient is a 15 years old girl with painless swelling in right cheek with nasal obstruction. Diagnosis was confirmed by CT scan and needle aspiration. Under general anaesthesia enucleation of the cyst with removal of unerupted teeth was performed by Caldwell- Luc procedure. Post operative period was uneventful. DOI: http://dx.doi.org/10.3329/bjo.v19i2.17637 Bangladesh J Otorhinolaryngol 2013; 19(2): 130-134

Diagnosis and Management of Occult Cervical Tuberculous Lymphadenopathy

2021 ◽  
pp. 014556132110436
Author(s):  
Wan-Xin Li ◽  
Yiyuan Zhu ◽  
Yanbo Dong ◽  
Liangfa Liu
Keyword(s):  
Positive Culture ◽  
Surgical Excision ◽  
Neck Surgery ◽  
Needle Aspiration ◽  
Lymph Node Involvement ◽  
Pcr Analysis ◽  
Consecutive Series ◽  
En Bloc ◽  
Diagnosis And Management ◽  
Friendship Hospital

Objective: Some cervical tuberculous lymphadenopathy (CTL) presents no evidence of tuberculosis (TB), even after thorough examination of a fine-needle aspiration (FNA) specimen. After the examination of excisional specimens, when the polymerase chain reaction (PCR) analysis identifies the nucleic acid of Mycobacterium tuberculosis (Mtb) or the culture results are positive, then the diagnosis of CTL is established. We refer to this condition as occult CTL (OCTL). Patient and Methods: The present work is a retrospective review of a consecutive series of OCTL cases that were treated at the Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, between June 2015 and September 2020. When the diagnosis of OCTL was established, the patients received the standard anti-TB chemotherapy. Results: Fourteen cases of OCTL, including 9 female and 5 male patients, aged 24 to 71 years (median age 42 years), were included in the present study. The most commonly observed levels of lymph node involvement were level V and level II. Each level of the involved lymph nodes was removed entirely through en bloc surgical resection. An evaluation of the excisional specimens led to positive PCR results in all 14 cases, with 2 cases presenting positive culture and 3 cases exhibiting positive acid-fast bacilli (AFB) staining. Recovery was uneventful, and the anti-TB chemotherapy was completed in all cases. The median duration of follow-up was 29 months, during which no case of TB relapse was observed. Conclusions: Wide surgical excision is crucial for the diagnosis and management of OCTL, and when used in combination with anti-TB chemotherapy, it results in satisfactory patient outcomes.

Intraconal Metastasis Leading to the Diagnosis of Hepatocellular Carcinoma

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S70-S71
Author(s):  
Irappa Madabhavi ◽  
Vinay Sakaleshpura Mallikarjuna ◽  
K S Sandeep ◽  
Malay Sarkar ◽  
Mansi Shah ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Ct Scan ◽  
Hepatitis B Surface Antigen ◽  
Needle Aspiration ◽  
Lateral Part ◽  
Orbital Metastasis ◽  
Regional Lymph Nodes ◽  
Clinical Indicators ◽  
Orbital Mass ◽  
Eosinophilic Cytoplasm

Abstract Hepatocellular carcinoma (HCC) is the most common malignant cancer of the liver, with intrahepatic and extrahepatic metastasis accounting for 50% to 75% of HCC cases. Lung and regional lymph nodes are the most common sites of metastasis; however, bone, skin, and adrenal glands are rare sites. Orbital metastasis and intracranial invasion are extremely rare and believed to occur in 2% to 3% of patients with systemic cancer. Here, we present a case report of a 72-year-old man evaluated for progressive painful proptosis of the left eye with weight loss, loss of appetite, and generalized weakness of 3 months duration. Physical examination showed a 5.5 × 3.5-cm, firm, mildly tender mass in the upper and lateral part of the left eye with proptosis and hepatomegaly with no ascites. Laboratory investigations were within normal limits except for positive hepatitis B surface antigen and HBV-DNA. CT scan of the head and neck revealed a 5.7 × 4.7-cm heterogeneously enhancing irregular extraconal mass seen in superolateral aspect of the left orbit. Abdominal CT scan showed hepatomegaly with multiple heterogeneous enhancing lesions in the liver. Fine-needle aspiration from the orbital and liver lesions showed individually scattered clusters and sheets of round to polyhedral cells with enlarged, hyperchromatic nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm. Immunohistochemistry showed tumor cells strongly positive for hepatocyte paraffin 1 (HepPar 1) and CD10 but negative for TTF-1, CEA, ALK-1, LCA, vimentin, S-100, and chromogranin, consistent with the diagnosis of HCC. Patient was started on chemotherapy and showed significant improvement with decrease in the size of the liver and orbital mass. Based on the present case and review of literature published since 2009, the current study recommends that metastasis must be considered when diagnosing retrobulbar head lesions in patients with HCC, regardless of contradictory imaging findings and other clinical indicators.

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