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Gastrointestinal stromal tumors (GISTs) rarely occur in the esophagus. Surgical approaches for such tumors have not been established, since the standard wedge or segmental resection that is used for intra-abdominal GIST is not possible in the esophagus. We report two cases of small esophageal GIST in which thoracoscopic enucleation was performed. Both patients underwent the thoracoscopic surgery using four trocars. The tumor size was 43 and 32 mm in patients 1 and 2, respectively. The operating time was 240 and 238 min. The fi nal diagnosis was as low-risk GIST in both patients. Postoperative course was uneventful and both patients have been disease-free at a follow-up of 40 and 32 months. Considering the special case of the esophagus and the very good prognosis of low-risk tumors, enucleation under the thoracoscopic technique may be feasible for small-sized esophageal GIST as a minimally invasive surgery. We also review the literature in this report.

A case of solitary fibrous tumor (SFT) in the pelvic cavity with hypoglycemia is reported. The patient was a 60-year-old man who was referred to our hospital for a closer examination of hypoglycemia. Computed tomography demonstrated a mass, measuring 14 x 9 cm in size, in the pelvic cavity. Magnetic resonance imaging showed the mass to have a low signal intensity on T1-weighted images and a high intensity on T2-weighted images. Laparotomy revealed no peritoneal dissemination nor lymph node metastasis. An en bloc excision of the tumor was performed with a good recovery, and the hypoglycemia disappeared. Histologically, the tumor was composed of spindle-shaped and oval cells in sarcoma, based on a moderate mitotic rate and cellularity. Immunohistochemically, the tumor was positive for CD34 and negative for keratin, alpha-smooth muscle actin, desmin, S100 protein, c-kit protein, and epithelial membrane antigen. Based on these findings, the tumor was diagnosed to be malignant SFT in the pelvic cavity.

PurposeThe use of mesh in the surgical repair of adult indirect inguinal hernias is widely recommended in Western countries, but no randomized controlled trials have so far been reported in Japan. The purpose of the present randomized prospective trial was to compare a mesh method with non-mesh method for surgical repair of primary adult indirect inguinal hernias in which the diameter of the internal inguinal ring was up to 3.0 cm (I-1 or I-2 of Japanese Hernia Society Classification).MethodsPatients with a primary unilateral inguinal hernia and I-1 or I-2 surgical findings were randomized to undergo either Marcy repair or Prolene Hernia System® repair. Primary endpoints were recurrence, infection, and pain, with follow-up continued for 3 years postoperatively.ResultsNinety-one of 479 patients with an inguinal hernia during the study period did not meet the exclusion criteria, and 46 were allocated to Marcy repair and 45 were allocated to Prolene Hernia System® repair. No recurrence was observed in either group, and no significant differences were identified between the groups in any of the primary endpoints.ConclusionThis randomized prospective trial of I-1 and I-2 inguinal hernias suggests that Marcy repair is not inferior to PHS repair. A large-scale randomized controlled trial appears warranted to confirm whether to use mesh for Japanese adult I-1 and I-2 hernias.

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