We report our experience with two cases of situs inversus totalis, both involving patients diagnosed with gastric cancer. These were a 52-year-old male with a preoperative staging of cT1bN0M0 and a 68-year-old male with a staging of cT2N0M0, both of whom underwent surgery. The former was found to have vascular anomalies in the preoperative computed tomography, so we performed a computed tomography angiography with three-dimensional reconstruction. Laparoscopy-assisted distal gastrectomy with Billroth I anastomosis was performed with D1+ lymph node dissection, and a small laparotomy was made for extracorporeal anastomosis. In contrast, the latter case showed no vascular anomalies in the preoperative computed tomography, and totally laparoscopic distal gastrectomy with delta anastomosis was performed with D1+ lymph node dissection. There were no intraoperative problems in either patient and they were discharged without postoperative complications. Histopathological examination revealed a poorly differentiated adenocarcinoma (pT2N0M0) and a well-differentiated adenocarcinoma (pT1aN0M0), respectively.

Purpose :The breast papillary neoplasm was constituted approximately less than 10% of benign breast tumor and 0.5-20% of breast malignancy. The role of excisional biopsy for papillary neoplasm was diagnosed by core biopsy has been debated yet. The aims of this study were to evaluate the predictive factors of breast cancer after the pathologic result of core biopsy revealed papillary neoplasm. Materials and Methods :We analyzed the clinical and pathologic data of 97 patients who underwent breast excisional biopsy after the pathologic result of core biopsy revealed papillary neoplasm between June 2009 and June 2012 at the Guro Hospital of the Korea University Medical Center. Results :We found statistically significant differences of excisional biopsy results for malignancy between papillary neoplasm and atypical papillary neoplasm diagnosed by core biopsy (P=0.001). Malignancy was found to be significantly related to be palpable mass, Breast Imaging Reporting and Data System (BIRADs) when papillary neoplasm without atypia was present in the core biopsy (P=0.03, 0.023). There were no significant differences of tumor size between benign and malignancy which was measured by ultrasonogram in the papillary neoplasm without atypia. However, there were statistically significant differences of pathologic tumor size in the papillary neoplasm without atypia (P=002). All of pathologic and ultrasonogram tumor size were larger than in the malignancy with atypical papillary neoplasm diagnosed core biopsy. In the multivariate analysis, There was significantly higher in the case of ultrasonogram measured tumor size more than 1.5cm (P=0.45, OR=2.4 95% CI 0.16-0.95). Conclusion :The excisional biopsy should be considered if the core biopsy had revealed atypical papillary neoplasm. We might suggest that excisional biopsy underwent in the papillary neoplasm without atypia with the case of the ultrasonogram measured tumor size more than 1.5cm and the existence of dis-concordance between radiologic findings and core biopsy pathologic result.