Gastric lymphangioma is a rare benign gastric tumor composed of unilocular or multilocular lymphatic spaces. On gastrofiberscopy a submucosal tumor covered with smooth transparent normal mucosa is revealed in the stomach with or without a stalk. Endoscopic ultrasonography has become an indispensable tool for differentiating these gastric tumors. Treatment of lymphangioma depends on its size, location, and presence of complications. Endoscopic resection is safe and easy and plays an important role in confirming the diagnosis and treatment of the tumors especially of small-sized ones. We report a case of gastric lymphangioma in a 68-yr-old woman who presented with nausea and vague epigastric discomfort for two months. She was diagnosed by gastrofiberscopy with endoscopic ultrasonography and treated successfully with endoscopic resection by strip biopsy method.
Aged ; Biopsy ; Endoscopy, Gastrointestinal ; Endosonography ; Female ; Human ; Lymphangioma/*pathology/surgery/ultrasonography ; Stomach Neoplasms/*pathology/surgery/ultrasonography

OBJECTIVE: To explore the effects of ultrasound-guided stellate ganglion block (SGB) on perioperative stress response, gastrointestinal hormones and postoperative gastrointestinal function recovery in patients undergoing laparoscopic radical gastrectomy for gastric cancer. METHODS: This study was conducted among 60 American Society of Anesthesiologists (ASA) class II-III patients with gastric cancer (regardless of gender, aged 35-75 years with BMI of 18.5-26 kg/m²) undergoing elective laparoscopic radical gastrectomy. The patients were randomized into experimental group (S group, n=30) and control group (NS group, n=30). In S group, SGB at the C₆ level of the right cervical spine was performed under ultrasound guidance 15 min before induction of anesthesia by injection of 7 mL 0.5% ropivacaine; the patients in NS group received injections of normal saline in the same manner. Peripheral venous blood samples were collected before SGB (T1), after surgery (T2), and on the 2nd and 6th days after surgery (T3 and T4) for determination of the levels of motitin (MOT), vasoactive intestinal peptide (VIP), cortisol (COR), and blood glucose (GLU). Intraoperative usage of sufentanil, recovery rate of intestinal sounds at 36, 48, 60, 72, 84 and 96 h after operation and the time of first passage of flatus were recorded and compared between the two groups. RESULTS: There was no significant difference in the total amount of sufentanil consumption between the two groups. Compared with those in NS group, the patients in S group had significant lower COR and VIP levels (P < 0.05) and higher MOT level (P < 0.05) at T2, T3 and T4. Glu level at T2 and T3 was also significantly lower in S group (P < 0.05). The recovery rates of intestinal sounds at 36, 48, 60, 72 and 84 h after surgery were significantly higher (P < 0.05) and the time of the first passage of flatus was earlier in S group than in NS group (P < 0.05). CONCLUSION In patients with gastric cancer undergoing laparoscopic radical gastrectomy, ultrasound-guided SGB can reduce postoperative stress level, promote the recovery of gastrointestinal hormone secretion, and accelerate postoperative recovery of gastrointestinal functions.
Adult ; Aged ; Gastrectomy ; Humans ; Laparoscopy ; Middle Aged ; Recovery of Function ; Stellate Ganglion ; Stomach Neoplasms/surgery* ; Ultrasonography, Interventional

No abstract available.
Aged ; Carcinoma, Medullary/*diagnosis/surgery/ultrasonography ; Epstein-Barr Virus Infections/diagnosis ; Gastric Mucosa/pathology/surgery ; Gastroscopy ; Humans ; Immunohistochemistry ; Keratins/metabolism ; Male ; Stomach Neoplasms/*diagnosis/surgery/ultrasonography

An inverted hyperplastic polyp (IHP) found in stomach is rare and characterized by downward growth of hyperplastic mucosal component into the submucosa. Because of such characteristic, IHP can be misdiagnosed as subepithelial tumor or malignant tumor. In fact, adenocarcinoma was reported to have coexisted with gastric IHP in several previous reports. Because only 18 cases on gastric IHP have been reported in English and Korean literature until now, pathogenesis and clinical features of gastric IHP and correlation with adenocarcinoma have not been clearly established. Herein, we report a case of gastric IHP which was initially misdiagnosed as gastrointestinal stromal tumor and resected using endoscopic submucosal dissection. Literature review of previously published case reports on gastric IHP is also presented.
Adult ; Gastric Mucosa/pathology/surgery ; Humans ; Hyperplasia/*diagnosis/diagnostic imaging ; Male ; Polyps/pathology/surgery ; Stomach/diagnostic imaging ; Stomach Neoplasms/diagnosis/diagnostic imaging/pathology ; Tomography, X-Ray Computed ; Ultrasonography

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment of early gastric cancer (EGC). However, the indication of ESD in undifferentiated-type EGC was controversial. The aim of this study was to evaluate the therapeutic outcomes of ESD in undifferentiated-type EGC according to expanded indication. METHODS: At Soonchunhyang University Bucheon Hospital, a total of 82 lesions in 81 patients with undifferentiated-type EGC were treated with ESD. The therapeutic outcomes of ESD were evaluated by resection method (en bloc resection; piecemeal resection), histologic curative resection, complications and recurrence rates after ESD. RESULTS: The rate on en bloc resection and complete resection rate were 87.8% (72/82) and 80.5% (66/82), respectively. In signet ring cell carcinoma, the complete resection rate was higher than those in poorly differentiated adenocarcinoma and poorly differentiated adenocarcinoma with signet ring cell features, but there was no statistical significance (89.3% vs. 75.0%, 76.7%; p=0.347). The lateral margin positivity rate in poorly differentiated adenocarcinoma, signet ring cell carcinoma and poorly differentiated adenocarcinoma with signet ring cell features were 12.5%, 3.6% and 13.3%, respectively (p=0.395). The vertical margin positivity rate were 12.5%, 3.6% and 10.0%, respectively (p=0.485). The overall recurrence rate was 3.0% during a mean follow-up period of 37.4 months. CONCLUSIONS: ESD may be considered as a feasible treatment for undifferentiated-type EGC according to expanded indication. The therapeutic outcome of ESD in undifferentiated-type EGC is likely to be favorable, though further longer follow-up studies are needed.
Adenocarcinoma/pathology/*surgery/ultrasonography ; Adult ; Aged ; Carcinoma, Signet Ring Cell/pathology/*surgery/ultrasonography ; Early Detection of Cancer ; Female ; Follow-Up Studies ; Gastroscopy ; Humans ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Stomach Neoplasms/pathology/*surgery/ultrasonography ; Tomography, X-Ray Computed ; Treatment Outcome

Gastritis cystica profunda (GCP) is an uncommon hyperplastic benign lesion, and histologically characterized by hyperplasia and cystic dilatation of the gastric glands extending into the submucosal layer. GCP usually occurs at a gastroenterostomy site, although it can occasionally be found in an unoperated stomach. GCP is thought to be a possible precancerous lesion, since a few early gastric cancers associated with it were reported. Herein, we report a case of gastric adenoma associated with GCP in an unoperated patient. The sizes of both the GCP and adenoma overlying it have increased during a 10 year follow-up period. Adenoma on the latest biopsy showed low grade dysplasia, and it was successfully treated by endoscopic submucosal dissection.
Adenoma/complications/*diagnosis/surgery ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gastritis/complications/*diagnosis/ultrasonography ; Gastroenterostomy ; Humans ; Precancerous Conditions ; Stomach Neoplasms/complications/*diagnosis/surgery ; Tomography, X-Ray Computed

Anemia, Pernicious ; complications ; surgery ; Biopsy ; Endoscopy ; methods ; Humans ; Male ; Middle Aged ; Stomach Neoplasms ; complications ; surgery ; Tomography, X-Ray Computed ; methods ; Treatment Outcome ; Ultrasonography ; methods

OBJECTIVE: To explore the application value of intraoperative ultrasound (IU) in laparoscopic lymphadenectomy of gastric cancer. METHODS: Patients with gastric cancer undergoing laparoscopic radical D2 gastrectomy at General Surgery of the Second Affiliated Hospital of Anhui Medical University between August 2016 and May 2018 were prospectively enrolled and were randomly divided into IU group (n=78) and conventional group (n=91). The conventional group underwent laparoscopy only. In IU group, the laparoscopy examination was followed with intraoperative ultrasound by ultrasound specialist. The lesser curvature, peripheral gastric organs and gastric lymph nodes were scanned. Lymph nodes were considered positive if maximum diameter was greater than 10 mm or internal hyperechoic features and normal oval shape were lost. The postoperative pathological results were used as the gold standard to analyze the sensitivity of positive lymph nodes by IU detection [true positive lymph nodes/(true positive lymph node+false negative lymph nodes)×100%], specificity [true negative lymph nodes/(true negative lymph nodes+false positive lymph nodes)×100%] and the accuracy rate[(true positive lymph nodes+ true negative lymph nodes/total lymph nodes)×100%]. A consistency check between N staging diagnosed by IU and by postoperative pathology was performed with Kappa test(Kappa>0.75 indicating good consistency). Number of dissected lymph node, number of positive lymph node detected by pathology and the operation time were compared between the IU group and the conventional group. RESULTS: Among 169 gastric cancer patients, 95 were males and 74 were females with age of (63±8) years. Among 1 794 lymph nodes detected by IU from 78 patients in IU group, predicted positive lymph nodes were 832 and 740 positive nodes were confirmed by postoperative pathology. True positive lymph nodes were 679 and true negative lymph nodes were 901 by IU, and a total of 1 580 lymph nodes were accurately diagnosed by IU. The sensitivity and specificity of IU for N staging of gastric cancer were 91.8%(679/740) and 85.5%(901/1 054), respectively. Overall accuracy was 88.1%(1 580/1 794), which was in good accordance with postoperative N staging(Kappa=0.758). There was no significant difference in number of lymph node detected between the IU group and conventional group during laparoscopic gastric cancer surgery(23.0±6.9 vs. 22.0±7.7, t=0.880, P=0.380). However, the numbers of lymph nodes in the third station (No.10, No.11, No.12) in the IU group were significantly higher than those in the conventional group [No.10: median 1 (0-1) vs. 0 (0-1), Z=-6.307, P<0.001; No.11: median 1(0-2) vs. 0(0-1), Z=-5.895, P<0.001; No.12: median 1 (0-1) vs. 0 (0-1), Z=-6.693, P<0.001]. There was no significant difference in the number of positive lymph node between IU group and the conventional group(P>0.05), but the number of positive lymph nodes dissected in stage III patients of IU group was significantly higher than that in stage III patients of conventional group (14.6±4.8 vs. 14.0±3.6, t=2.531, P=0.011). The operative time of IU group was(272.0±12.0) minutes, which was significantly longer than (249.0±7.0) minutes of conventional group (t=14.638, P<0.001). However, with the increase of patients undergoing IU, the operation time of IU showed a downward trend. The average operation time of the last 20 patients was 264 minutes, and the average IU time was 15 minutes. CONCLUSIONS Intraoperative ultrasound is more accurate N-staging of gastric cancer. Although increasing operation time, it is helpful for lymph node dissection in laparoscopic gastric cancer surgery, especially by providing good support for laparoscopic No.10, No.11 and No.12 lymph nodes dissection.
Aged ; Female ; Humans ; Intraoperative Period ; Laparoscopy ; Lymph Node Excision ; Lymph Nodes ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; diagnostic imaging ; surgery ; Ultrasonography

BACKGROUND/AIMS: The accurate preoperative prediction of the risk of malignancy of gastrointestinal stromal tumors (GISTs) is difficult. The aim of this study was to determine whether tumor size and endoscopic ultrasonography (EUS) features can preoperatively predict the risk of malignancy of medium-sized gastric GISTs. METHODS: Surgically resected, 2 to 5 cm gastric GIST patients were enrolled and retrospectively reviewed. EUS features, such as heterogeneity, hyperechoic foci, calcification, cystic change, hypoechoic foci, lobulation, and ulceration, were evaluated. Tumors were grouped in 1 cm intervals. The correlations of tumor size or EUS features with the risk of malignancy were evaluated. RESULTS: A total of 75 patients were enrolled. The mean tumor size was 3.43+/-0.92 cm. Regarding the risk of malignancy, 51 tumors (68%) had a very low risk, and 24 tumors (32%) had a moderate risk. When the tumors were divided into three groups in 1 cm intervals, the proportions of tumors with a moderate risk were not different between the groups. The preoperative EUS features also did not differ between the very low risk and the moderate risk groups. CONCLUSIONS: Tumor size and EUS features cannot be used to preoperatively predict the risk of malignancy of medium-sized gastric GISTs. A preoperative diagnostic modality for predicting risk of malignancy is necessary to prevent the overtreatment of GISTs with a low risk of malignancy.
Aged ; *Endosonography ; Female ; Gastrointestinal Stromal Tumors/*pathology/surgery/*ultrasonography ; Humans ; Male ; Middle Aged ; Mitotic Index ; Predictive Value of Tests ; Preoperative Period ; Retrospective Studies ; Risk Assessment ; Stomach Neoplasms/*pathology/surgery/*ultrasonography ; Tumor Burden

BACKGROUND/AIMS: We evaluated the effectiveness of an endoscopic ultrasonography (EUS)-based treatment plan compared to an endoscopy-based treatment plan in selecting candidates with early gastric cancer (EGC) for endoscopic submucosal dissection based on the prediction of invasion depth. METHODS: We reviewed 393 EGCs with differentiated histology from 380 patients who underwent EUS from July 2007 to April 2010. The effectiveness of the EUS-based and endoscopy-based plans was evaluated using a simplified hypothetical treatment algorithm. RESULTS: The numbers of endoscopically determined mucosal, indeterminate, and submucosal cancers were 253 (64.4%), 56 (14.2%), and 84 (21.4%), respectively. Overall, the appropriate treatment selection rates were 75.3% (296/393) in the endoscopy-based plan and 71.5% (281/393) in the EUS-based plan (p=0.184). For endoscopic mucosal cancers, the appropriate treatment selection rates in the endoscopy-based plan were 88.1% (223/253), while the use of an EUS-based plan significantly decreased this rate to 81.4% (206/253) (p=0.036). For endoscopic submucosal cancers, the appropriate selection rates did not differ between the endoscopy-based plan (46.4%, 39/84) and the EUS-based plan (53.6%, 45/84) (p=0.070). CONCLUSIONS: EUS did not increase the likelihood of selecting the appropriate treatment in differentiated-type EGC. Therefore, EUS may not be necessary before treating differentiated-type EGC, especially in endoscopically presumed mucosal cancers.
Adult ; Aged ; Aged, 80 and over ; Algorithms ; Clinical Decision-Making/*methods ; Early Detection of Cancer ; Endoscopy, Gastrointestinal/*statistics & numerical data ; Endosonography/*statistics & numerical data ; Female ; Gastric Mucosa/ultrasonography ; Humans ; Male ; Middle Aged ; *Patient Selection ; Prospective Studies ; Retrospective Studies ; Stomach Neoplasms/surgery/*ultrasonography