RESUMEN
Endoscopic mucosal resection (EMR) is increasingly being utilized in the management of early gastric cancer. Metastatic cancer of the stomach is uncommon. We report a case of solitary gastric metastasis from renal cell carcinoma (RCC) that was successfully excised with EMR. A 71-year-old man presented with iron deficiency anemia, he had undergone a radical nephrectomy for RCC 3 years previously. Upper gastrointestinal endoscopy revealed a malignant-appearing 10 × 12 mm polyp in the stomach. Histopathology of the biopsy revealed that it was a metastasis from RCC, confirmed by immunohistochemistry with Vimentin and CAM 5.2 positivity. Computed tomography and bone scanning revealed no other metastases. Simultaneous laparoscopy and upper gastrointestinal endoscopy revealed that the lesion was localized to the gastric mucosa. EMR of the tumor en bloc was performed successfully. Histology confirmed a complete excision. He had an uneventful postoperative course and is well 15 months after surgery, without any tumor recurrence.
Asunto(s)
Carcinoma de Células Renales/cirugía , Gastroscopía/métodos , Neoplasias Renales , Neoplasias Gástricas/cirugía , Anciano , Carcinoma de Células Renales/secundario , Mucosa Gástrica/cirugía , Humanos , Masculino , Neoplasias Gástricas/secundario , Tomografía Computarizada por Rayos XRESUMEN
We report a case of Fournier's gangrene, where we used the greater omentum as a free flap for scrotal reconstruction and outline the advantages over previously described methods. The greater omentum was harvested using a standard open technique. The deep inferior epigastric vessels were passed through the inguinal canal into the scrotal area as recipient vessels. The detached greater omental flap was prefabricated into a three-dimensional sac prior to inset and microvascular anastomoses. The flap was then covered by skin graft. The reconstruction had shown good early results with complete survival of the flap, as well as good functional and esthetic outcome at six months. The greater omentum can therefore be used as a free flap for scrotal reconstruction. It allows easy prefabrication and flap inset. The deep inferior epigastric vessels are also suitable recipient vessels.
