En bloc resection of cardia cancer and lipoma with endoscopic submucosal dissection

Diagnostic value and potential clinical significance of duodenal lipoma based on computed tomography imaging data

BACKGROUND

To explore the diagnostic value of computed tomography (CT) imaging for duodenal lipoma and the potential clinical significance of the findings.

METHODS

Clinicopathological and CT data from 57 patients, who were diagnosed with duodenal lipoma at the first affiliated Hospital of Zhengzhou University (Zhengzhou, China) between June 2014 and March 2019, were retrospectively reviewed. Data collected included location and size of the tumor, morphological manifestations (shape, density, boundary), concomitant diseases, pathology and gastroscopy results, and follow-up. Follow-up was performed via telephone, and surgical patients were followed-up for recurrence, metastasis and tumor size, and morphological changes. The follow-up period was up to January 2019.

RESULTS

Of the 57 patients with duodenal lipoma, contrast-enhanced scanning was performed in 7 cases. The tumor was located in the descending duodenum in 33 cases, the ascending in 4 cases, the horizontal in 16 cases, and the bulb in 4 cases. Mean tumor size was 13.0 ± 5.8 mm. CT morphological features of the tumor were as follows: tumor shape, round, quasi-round, or oval (n = 42); long strip (n = 3); nodular (n = 2); triangular (n = 1); and irregular lobulated (n = 9). Among the 57 patients, tumor density was homogeneous in 52 cases, inhomogeneous in 4 cases, and nodular with calcification in 1 case. The tumor boundary was classified as clear and with no capsule. Diseases concomitant with the tumor were as follows: gastritis (n = 23), gastric adenocarcinoma (n = 1), and gastric lymphoma (n = 1). Esophageal disease was found in 16 cases, including reflux esophagitis (n = 12) and esophageal cancer (n = 4). There were 13 cases of gallbladder and biliary disease, including cholecystolithiasis and cholecystitis (n = 9), common bile duct disease (n = 2), colorectal cancer (n = 4), lung cancer (n = 2), duodenal carcinoma with obstruction (n = 1), and ureteral space narrowing (n = 1).

CONCLUSION

CT was an effective, non-invasive method for diagnosis of duodenal lipoma. CT imaging could clearly discern location, size, shape, and nature of duodenal lipomas. Duodenal lipoma can be associated with digestive tract inflammatory diseases and tumors in different locations, and its diagnosis is potentially valuable for their prevention and treatment.

Giant gastric lipoma successfully removed by endoscopic submucosal dissection: case report and systematic review

OBJECTIVES

Gastric lipomas are rare adipose tumors that constitute less than 1% of gastric tumors. While lipomas generally do not need removal unless symptomatic, endoscopic resection has been proposed as safe for gastric lipomas smaller than 2 cm. Yet, there is no consensus on the optimal treatment method for larger lipomas. We report a case of a giant 7-cm gastric lipoma successfully removed by endoscopic submucosal dissection (ESD) and systematically review the literature for gastric lipomas removed by ESD.

METHODS

Systematic review was conducted by searching PubMed and Scopus databases, up to 15 February 2018, using combinations of relevant terms.

RESULTS

We report a 55-year-old male with known gastroesophageal reflux disease and asthma, who sought medical attention due to chronic heartburn and asthma exacerbations. These symptoms were attributed to a large 7 cm × 3 cm gastric lipoma that caused gastric outlet obstruction. The lipoma was safely removed by ESD, allowing quick recovery and alleviation of symptoms. In our review, we identified 20 gastric lipomas treated with ESD, with 15 (75%) being 2 cm or larger. The average size of the lipomas was 4 cm (range: 1.2-9 cm). All lipomas were limited to the submucosa, with 80% of the tumors located in the antrum. Three lipomas were removed by submucosal tunneling. All tumors were successfully removed en bloc and no major complications were reported.

CONCLUSION

Our findings support the conclusion that ESD may be a safe alternative to conventional surgery for removal of large symptomatic gastric lipomas.

Synchronous double superficial mixed gastrointestinal mucus phenotype gastric cancer with gastritis cystica profunda and submucosal lipoma: A case report

INTRODUCTION

Synchronous double superficial gastric cancer with gastritis cystica profunda (GCP) and submucosal lipoma is a rare disease and is difficult to diagnose and treat.

CASE PRESENTATION

A 61-year-old man was referred to our hospital with upper abdominal discomfort for the past 10 days. One year ago, the patient underwent surgery for duodenal ulcer and perforation. The diseases were diagnosed by magnifying endoscopy with narrowband imaging and pathological methods. Both mucosal lesions with a submucosal yellow-colored nodule were completely resected by endoscopic submucosal dissection and additional proximal gastrectomy was performed on the cancer embolus in the submucosal vena cava. The patient was finally diagnosed with synchronous double superficial well differentiated adenocarcinoma (mixed gastrointestinal mucus phenotype) with embolus in submucosal vena cava, coexisting with gastritis cystica profunda and submucosal lipoma. Final TNM classification was T1b (sm1) N0M0, and pathological stage was IA. The postoperative course was uneventful, and no recurrence or metastasis was observed during the 5-month follow-up period.

CONCLUSION

The diagnosis and treatment of synchronous double superficial gastric cancer with GCP and submucosal lipoma is challenging. In addition, elastic fiber staining and immune marker staining is effective and should be considered for diagnosis.

Early Gastric Cancer Just above a Heterotopic Pancreas

We report the first case of early gastric cancer just above a heterotopic pancreas for which the differential diagnosis was carcinoma arising from heterotopic pancreas. Routine upper gastrointestinal endoscopy in an 83-year-old man with sigmoid colon cancer revealed a gastric cancer in the lesser curvature of the antrum. Endoscopic ultrasonography (EUS) for evaluating the depth of tumor invasion revealed a hypoechoic mass in the submucosal layer. The depth of tumor invasion was diagnosed as muscularis propria. Distal gastrectomy and sigmoidectomy were performed. Histologically, the resected specimen of the stomach unexpectedly revealed a heterotopic pancreas just below the gastric cancer. They were not linked, and the heterotopic pancreas had no dysplasia. The gastric cancer had slightly invaded the submucosa. The hypoechoic mass on EUS was not the invasive tumor but the heterotopic pancreas. The preoperative staging of the gastric cancer on EUS was confounded by the presence of the heterotopic pancreas just below the gastric cancer.