• Journal of Gastric Cancer
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• v.21 no.2
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• pp.111-121
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• 2021

Laparoscopic endoscopic cooperative surgery (LECS) refers to the endoscopic dissection of the mucosal or submucosal layers with laparoscopic seromuscular resection. We recommend a treatment algorithm for the LECS procedure for gastric benign tumors according to the protruding type. In the exophytic type, endoscopic-assisted wedge resection can be performed. In the endophytic type, endoscopic-assisted wedge resection of the anterior wall is relatively easy to perform, and endoscopic-assisted transgastric resection, laparoscopic-assisted intragastric surgery, or single-incision intragastric resection in the posterior wall and esophagogastric junction (EG Jx) can be attempted. We propose an algorithm for the LECS procedure for early gastric cancer according to the tumor location. The endoscopic submucosal dissection (ESD) procedure can be adapted for all areas of the stomach, and single-incision ESD can be performed in the mid to high body and the EG Jx. In full-thickness gastric resection, laparoscopy-assisted endoscopic full-thickness resection can be adapted for the entire area of the stomach, but it cannot be applied to the pyloric and EG Jx. In conclusion, surgeons need to select the LECS procedure according to tumor type, tumor location, the surgeon's individual experience, and the situation of the institution while also considering the advantages and disadvantages of each procedure.

• Journal of Gastric Cancer
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• v.2 no.2
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• pp.101-104
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• 2002

Schwannoma of the stomach is a rare controversial neoplasm which requires extensive studies to clarify its nature as a stromal tumor or leiomyoma. We describe the pathologic, immunohistochemical, and ultrastructural characteristics of schwannoma of the stomach in a 33-year-old woman. The tumor was a well-circumscribed submucosal mass located in the posterior wall of the midbody of the stomach. Microscopically, the cells were made up of fasciculating bundles of spindle cells featured with peripheral lymphoid cell cuffing. The tumor cells revealed a diffuse, strong immunoreactivity to S-100 protein and vimentin, but were negative to desmin and smooth muscle actin. They also had a focal positive reaction to glial fibrillary acidic protein. Ultrastructurally, many tumor cells showed a number of thin, elongated and interdigitating dendritic-cell-like processes, distinctly uniformed basal laminae, frequent cellular attachments, and microfilaments. These findings support the schwannian nature of the tumor.

• Journal of Gastric Cancer
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• v.21 no.4
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• pp.426-438
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• 2021

Purpose: While the incidence of Barrett's neoplasia has been increasing in Western countries, the disease remains rare in Asian countries. Therefore, very few studies have investigated the endoscopic treatment for Barrett's neoplasia in Korea. Endoscopic submucosal dissection (ESD) enables en bloc and complete resection of gastrointestinal neoplastic lesions. This study aimed to evaluate the therapeutic outcomes of ESD for Barrett's neoplasia in a single center in Korea and to examine the predictive factors for incomplete resection. Materials and Methods: We conducted a retrospective observational study of 18 patients who underwent ESD for superficial Barrett's neoplasia (dysplasia and early cancer) between January 2010 and December 2019 at Pusan National University Hospital. The therapeutic outcomes of ESD and procedure-related complications were analyzed. Results: En bloc resection, complete resection, and curative resection were performed in 94%, 72%, and 61% of patients, respectively. Histopathology (submucosal or deeper invasion of the tumor) was a significant predictive factor for incomplete resection (P=0.047). Procedure-related bleeding and stenosis were not observed, whereas perforation occurred in one case. During the median follow-up period of 12 months (range, 6-74 months), local recurrence occurred in 2 patients with incomplete resection, one patient underwent repeat ESD, and the other patient received concurrent chemoradiotherapy. The 3-year overall and disease-specific survival rates were 73% and 93%, respectively. Conclusions: ESD seems to be an effective and safe treatment for superficial Barrett's neoplasia in Korea. Nevertheless, the suitability of ESD for Barrett's cancer cases should be determined considering the high risk of deep submucosal invasion.

• Journal of Gastric Cancer
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• v.15 no.4
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• pp.278-285
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• 2015

Purpose: Gastric submucosal tumors (SMTs) located very close to the esophagogastric junction (EGJ) are a challenge for gastric surgeons. Therefore, this study reports on the experience of using endoscopic and laparoscopic full-thickness resection (ELFR) with laparoscopic two-layer suturing in such tumors. Materials and Methods: Six patients with gastric SMTs very close to the EGJ underwent ELFR with laparoscopic two-layer suturing at Kyungpook National University Medical Center. With the patient under general anesthesia, the lesser curvature and posterior aspect adjacent to the EGJ were meticulously dissected and visualized using a laparoscopic approach. A partially circumferential full-thickness incision at the distal margin of the tumor was then made using an endoscopic approach under laparoscopic guidance. The SMT was resected using laparoscopic ultrasonic shears, and the gastric wall was closed using two-layer suturing. Thereafter, the patency and any leakage were checked through endoscopy. Results: All the ELFR procedures with laparoscopic two-layer suturing were performed successfully without an open conversion. The mean operation time was $139.2{\pm}30.9$ minutes and the blood loss was too minimal to be measured. The tumors from four patients were leiomyomas, while the tumors from the other two patients were gastrointestinal stromal tumors with clear resection margins. All the patients started oral intake on the third postoperative day. There was no morbidity or mortality. The mean hospital stay was $7.7{\pm}0.8$ days. Conclusions: ELFR with laparoscopic two-layer suturing is a safe treatment option for patients with an SMT close to the EGJ, as major resection of the stomach is avoided.

• Korean Journal of Bronchoesophagology
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• v.6 no.1
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• pp.7-15
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• 2000

Background and Objectives:Submucosal spread of hypopharyngeal canceris frequently incriminated for the high incidence of local recurrence after resection. Although mucosal spread is better detected by means of direct visualization, submucosal spread is better evaluated by using cross-sectional imaging rather than endoscopy. This study was designed to evaluate the efficacy of MRI in diagnosing involvement of inferior margin of hypopharyngeal cancer. Materials and Method : Eight patients with hypopharyngeal cancer underwent MRI prior to surgery. And postoperative histopathopogic involvement of tumor was compared with the preoperative MRI axial scan. Results : In preoperative MRI findings, involvement of pyriform sinus apex was 6 cases(definitive 5 cases, probable 1 cases), that of esophageal inlet was 1 case(probable), that of cervical esophagus was 1 case(probable). In postoperative histopathologic findings, the results were same. Conclusion : MRI evaluation for patient with hypopharyngeal cancer ensures accurate staging and provides essential information about the tumor involvement of inferior margin. And there is needed to be thin section thickness in evaluation of inferior margin of hypopharyngeal cancer.

• Journal of Chest Surgery
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• v.38 no.8 s.253
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• pp.589-593
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• 2005

Esophageal schwannoma is very rare and almost of all cases are diagnosed as esophageal submucosal tumor preoperatively. Final diagnosis is made by postoperative immunohistochemical (IHC) staining of the surgical specimen. We experienced two cases of esophageal submucosal tumor, one was 63 year old female suffering from three months of dysphagia and another was 39 year old female complaining of two months of intermittent dysphagia. Two esophageal tumors were completely removed by esophagectomy and enucleation through right thoracotomy respectively. Postoperative IHC staining demonstrated S-100 positive without mitotic figures and confirmative diagnosed was made as benign esopphageal schwannoma.

• Journal of Yeungnam Medical Science
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• v.33 no.1
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• pp.21-24
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• 2016

Esophageal schwannoma is a very rare submucosal tumor. We report successful management of esophageal schwannoma in a 41-year-old man who complained of progressively worsening dysphagia. A huge submucosal tumor was found via endoscopy and a chest computed tomography scan. Esophagectomy was performed with no post-operative complications. Post-operative immunohistochemistry staining showed a positive result for S-100 and negative results for c-kit and CD34. The post-operative mild dysphagia persisted, and the follow-up endoscopic findings revealed anastomosis site stenosis. Approximately 2 months later, we performed endoscopic balloon dilatation. We report herein a case of esophageal schwannoma with reviews.

• Journal of Chest Surgery
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• v.39 no.11 s.268
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• pp.875-878
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• 2006

A 39-year-old man presented with a esophageal submucosal tumor on regular check up examination. Preoperative exams showed the typical submucosal tumor as leiomyoma and operative procedure was enucleation for complete resection. Postoperative pathologic diagnosis including histologic and immunohistochemical study was compatible with plexiform schwannoma. Plexiform schwannoma is one of the least common variant of schwannoma that typically shows a plexiform or multinodular pattern. To our knowledge, there is rare case report of plexiform schwannoma originating in the esophagus and we report ore case with related literature.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.2
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• pp.196-201
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• 1994

One case of an unusual form of carcinoma involving the submucosal gland and duct of tongue was reported and reviewed. According to Gerughty et al(1968) four distinct component parts were classified : ductal carcinoma in situ(involvement of the ductal epithelium by in situ carcinomatous changes), squamous cell carcinoma, and a mixed carcinoma(combination of glandular and squamous characteristics and occasionally consisted of large nests composed of "glassy" cell). This tumor was fond to be extremely aggressive and highly malignant. The histopathologic features and the clinical behavior of this tumor were sufficiently distinctive to warrant the designation adenosquamous carcinoma : exhibit concomitant glandular and squamous neoplasm. The mode of therapy was evaluated and the treatment of choice appears to be radical surgery. So, we has done the radical neck dissection and partial glossectomy. However, the limited number of cases indicated that collection and subsequent analysis of additional cases must be performed before any definitive conclusion can be drawn.

• Investigative Magnetic Resonance Imaging
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• v.17 no.2
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• pp.154-157
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• 2013

We report an unusual case of ectopic pancreas that appeared on radiologic images as a lobulated, submucosal mass enclosed by fat component in the gastric lower body. Although, ectopic pancreas including fat component is extremely rare, in the setting of gastric submucosal mass with containing perilesional fat, these findings should be considered in ectopic pancreas as part of the differential diagnosis.