[Upper Gastric Poorly Differentiated Adenocarcinoma with a Giant Ulcer That Regressed Due to the Malignant Cycle-A Case Report].

This case is that of an 84‒year‒old woman in whom upper gastrointestinal endoscopy revealed a giant ulcerative lesion with irregular margins on the upper curvature of the stomach. Abdominal contrast computed tomography(CT)showed marked thickening of the stomach wall in contact with the pancreatic body and enlargement of the regional lymph nodes, suggesting a tumor metastasis to the lymph nodes. At the patient's request, she was followed‒up without surgery, and 8 months later, upper gastrointestinal endoscopy revealed that the ulcerative lesion was scarred and covered with a non‒ tumor mucosa. Contrast CT showed an improvement in the thickening of the stomach wall and shrinking the enlarged lymph nodes. She is currently being followed‒up in an outpatient clinic with no progression since 1 year 8 months. Total gastrectomy for the elderly is associated with perioperative complications and postoperative loss of appetite, which may lead to a decreased QOL. For gastric cancer cases with giant ulcers, it is necessary to carefully consider the surgical indications, bearing in mind the malignant cycle and perforation complications.

[Gastrectomy of a GIST with Diaphragmatic Repair Utilizing the Fascia Lata-A Case Report].

A 73-year-old man was admitted with the chief complaint of upper abdominal discomfort.After close examination, he was diagnosed with a huge stomach gastrointestinal stromal tumor(GIST)that occupied the upper left abdomen with a maximum diameter of 150 mm.The patient was referred to our department for surgery.The border between the tumor and spleen was unclear on CT images.As the diaphragm was thinned due to compression by the tumor, gastrectomy with splenectomy and partial resection of the diaphragm was planned.For the diaphragmatic defects, a simple closure was considered at first. However, artifacts have a high risk of infection when the defect holes are too large.Therefore, in this case, we attempted to repair the diaphragm hole with the autologous fascia lata.Intraoperatively, while the tumor was resected with 1 more layer of the diaphragm, the diaphragm itself was thinned, resulting in a defect hole of about 60×80 mm.Therefore, an 80×110mm fascia lata was harvested, and the diaphragm was repaired.Fascia lata can be conveniently harvested as a free graft.In addition, the fascia of the thigh has the advantage of being more resistant to infection than artificial materials.In addition, there was no functional failure due to collection, and special plastic surgery techniques and tools were unnecessary.Thus, it is a useful reconstruction material for general surgeons.Here we report the details of the surgery along with a review of the literature.