[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.

[A case of adenocarcinoma occurring at colostomy site 7 years after abdominoperineal resection for rectal cancer resected after preoperative mFOLFOX6 chemotherapy].

A 78-year-old man had undergone abdominoperineal resection for rectal cancer in 2003. After 7 years, he visited our hospital with complaints of turbid discharge from the stoma. A tumor 11 cm in diameter was shown at the site of the stoma. A partial resected biopsy revealed moderately-differentiated adenocarcinoma. We diagnosed metachronous multiple carcinoma or recurrent cancer at the colostomy site. After loop colostomy of the ascending colon was performed, systemic chemotherapy with mFOLFOX6 was performed. After 5 courses, the tumor revealed a significant reduction in its size. Afterwards, the stoma including the tumor and remaining left-side colon with adjacent abdominal wall was resected, keeping the surgical margin free. In the resected specimen, histological evaluation of the treatment with chemotherapy was assessed to be Grade 1a. As a result of preoperative chemotherapy, we finally were able to resect the minimal area of the adjacent skin and abdominal wall, and succeed in primary closure of the surgical wound. This case suggests that preoperative chemotherapy is a good option for treating cancer occurring at a colostomy site.

Non-islet cell tumor hypoglycemia at the second recurrence of malignant solitary fibrous tumor in the retroperitoneum and pelvis: a case report.

An 83-year-old man underwent complete resection of a large malignant solitary fibrous tumor in the retroperitoneum in 2006 and of a local recurrent tumor in 2010. In 2011, he was admitted to our hospital because of hypoglycemia. His serum glucose level was very low, and his levels of insulin and C-peptide were low. Furthermore, he had a recurrent tumor in the retroperitoneum and pelvis. Immediately after the third surgery for complete resection, he had no hypoglycemic episodes and his serum glucose level was within the normal range. Immunoblotting analysis revealed a high-molecular-weight form of insulin-like growth factor II in the patient's serum and in the protein extract obtained from the resected specimen in 2011. To our knowledge, this is the first report of non-islet cell tumor hypoglycemia caused by a malignant solitary fibrous tumor secreting a high-molecular-weight form of insulin-like growth factor II at the second recurrence.

Transfusion-related acute lung injury or acute chest syndrome of sickle cell disease? - A case report.

PURPOSE: To describe how to differentiate transfusion-related acute lung injury from acute chest syndrome of sickle cell disease. CLINICAL FEATURES: A neurosurgical patient with sickle cell disease received two units of packed red blood cells postoperatively. Four hours later she developed progressive respiratory distress, diffuse geographical airspace disease and bilateral pulmonary edema. The patient recovered sufficiently to be transferred from the intensive care unit within four days. The temporal relationship to transfusion, features on computerized tomographic scan, and the rapid resolution of severe edema point to a diagnosis of transfusion related acute lung injury. Granulocyte or human leukocyte antigen antibodies in donor plasma may confirm a diagnosis of transfusion injury. CONCLUSION: The clinician should appreciate that erythrocyte transfusion to prevent or treat acute chest syndrome may cause transfusion related acute lung injury, a condition that mimics, exacerbates or possibly triggers the syndrome it was intended to treat.