A 45-year-old woman was found to have a pancreatic tumor by abdominal ultrasound performed for a medical check-up. Abdominal contrast-enhanced computed tomography showed a hypovascular tumor measuring 30 mm in diameter in the pancreatic tail. Endoscopic ultrasound-guided fine needle aspiration was performed. An extragastric growing gastrointestinal stromal tumor was thereby diagnosed preoperatively, and surgical resection was planned. Laparoscopic surgery was attempted but conversion to open surgery was necessitated by extensive adhesions, and distal pancreatectomy, splenectomy, and partial gastrectomy were performed. The histological diagnosis was an intra-abdominal desmoid tumor. A desmoid tumor is a fibrous soft tissue tumor arising in the fascia and musculoaponeurotic tissues. It usually occurs in the extremities and abdominal wall, and only rarely in the abdominal cavity. We experienced a case with an intra-abdominal desmoid tumor that was histologically diagnosed after laparotomy, which had been preoperatively diagnosed as an extragastric growing gastrointestinal stromal tumor. Although rare, desmoid tumors should be considered in the differential diagnosis of intra-abdominal tumors. Herein, we report this case with a literature review.

Abstract. Background: The aim of this study was to clarify the impact of the horizontal width of tumor invasion into the subserosal layer on prognosis in patients withIn Japan, gastric cancer is treated according to the Japanese gastric cancer treatment guidelines 2014 (1). According to the guidelines, the standard treatment for curatively resectable advanced gastric cancer with invasion of the subserosa (T3) and no lymph node metastasis (N0) is surgery alone. However, a certain proportion of these patients develop recurrence, and nearly all patients with recurrence die of their disease. Therefore, it is considered to be of crucial clinical importance to identify the subset of patients with poor prognosis in this group.Tumor diameter, lymphatic invasion, venous invasion, etc., have been considered as prognostic factors in patients with T3N0 gastric cancer (2-6). Opinions regarding the prognostic factors are divided, and no consensus has been reached. Therefore, in this study, we paid attention to the status of tumor invasion at the invasive front. Many studies of the status of tumor invasion at the invasive front have investigated changes in the serosal surface in patients with gastric cancer invading the serosa (7-10). However, there have been few studies investigating the status of tumor invasion into the subserosal layer in gastric cancer with invasion of the subserosa (11). Therefore, in the present study, we assessed the status of tumor invasion into the subserosal layer in T3N0 gastric cancer and investigated the possibility of its being a prognostic factor. Patients and MethodsPatients. Between January 2006 and December 2015, 884 consecutive patients with gastric cancer underwent curative gastrectomy at the Department of Gastroenterological Surgery of Tokai University School of Medicine. Of these patients, the data of 72 in whom the histological examination revealed pT3N0 were analyzed in this retrospective study. The gross classification and histopathological classification were based on the Japanese Classification of Gastric Carcinoma published by the Japanese Gastric Cancer Association (JCGC) (12). Staging was performed according to the American Joint Committee on Cancer staging manual seventh edition (13). Patients were mainly followed-up on an outpatient basis at our hospital; however, those who had moved to other institutions were asked relevant questions by telephone. Follow-up was continued until June 2016, with a median duration of follow-up of 1574 days (range=82-4373 days). Diagnosis of tumor recurrence was based on clinical grounds. In patients with suspected recurrence, further investigations were performed. In some patients, the initial recurrence was diagnosed at two or more sites, and in such patients, all of the sites were counted as sites of initial recurrence.Definition of width of subserosal invasion and clinicopathological parameters. The resected stomach was opened and placed on a flat board with the mucosal side up, and fixed in 10% formalin. After 409

The Torricelli-Bernoulli sign is a computed tomography (CT) finding that occurs when ulceration/necrosis of a submucosal gastrointestinal tumor releases a stream of air bubbles into the intestinal lumen. A 75-year-old man developed acute abdominal pain at night and presented to a local doctor. Acute abdomen was diagnosed and he was referred to the Emergency Department at Tokai University Oiso Hospital. On CT scans, disseminated intestinal tumor-like lesions were seen in the right lower abdomen. The Torricelli-Bernoulli sign and free intraabdominal gas were observed, so perforation of an intestinal tumor was diagnosed and emergency surgery was performed. At operation, there was scanty opaque ascites in the right lower abdomen and an ileal tumor associated with nodules that suggested peritoneal dissemination. Partial resection of the ileum was performed and peritoneal lavage was conducted. The patient was discharged on postoperative day 11. Histopathological examination revealed a high risk gastrointestinal stromal tumor. The abdominal nodules were metastases, indicating that the tumor was Stage IV. The patient is currently on treatment with an oral tyrosine kinase inhibitor (imatinib).

Background/Aim: Several studies have investigated prognostic factors in patients with T2 gastric cancer, but no consensus has been reached to date. The aim was to investigate the clinicopathological significance of the status of tumor invasion into the muscularis propria (MP) in T2 gastric cancer patients. Patients and Methods: A total of 113 patients with T2 cancer were enrolled. The status of caner invasion was analyzed according to width (extent of horizontal invasion) and depth (extent of vertical invasion). Results: The prognosis of the group with wide width of invasion (≥1.5 cm) was significantly poorer than that of the group with narrow width of invasion (<1.5 cm) (p=0.001). Multivariate analysis identified the width, and not the depth, as an independent prognostic factor. The analysis according to AJCC N stage showed that the width, and not the nodal status, was an independent prognostic factor in the N2-N3 patients (p=0.005). Conclusion: Measurement of the width of tumor invasion into the MP was useful to understand the malignant potential of T2 gastric cancer. Advanced gastric cancer confined to the muscularis propria (T2 gastric cancer) is as an intermediate-stage carcinoma, between early and advanced cancer (1, 2). Therefore, it is considered to have a better prognosis than more advanced cancer, and recently minimally-invasive surgical procedures, such as laparoscopic gastrectomy, have been actively adopted (3, 4). However, although at a low frequency, recurrences do occur, and it is clinically important to investigate prognostic factors for T2 gastric cancer. Several studies have investigated prognostic factors in patients with T2 gastric cancer. While studies have been conducted to determine the influence of age (5, 6), tumor diameter (7, 8), lymph node metastasis (9, 10) and macroscopic type (11) on the prognosis, no consensus has been reached yet. Therefore, in this study, we investigated the clinicopathological significance of the status of tumor invasion at the invasive front, namely, in the muscularis propria (MP), in patients with T2 gastric cancer.

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