Yasushi Sekino

Pseudolymphoma with atrophic parenchyma of the liver: Report of a case

Highlights • Pseudolymphoma of the liver is usually diagnosed after surgical resection, and long term observation is rarely reported.• We present a case of pseudolymphoma demonstrating slight enlargement during two year follow-up.• The present case is probably the first to be reported with long term follow-up.

Laparoscopy Assisted Transduodenal Resection of a Periampullary Tumorat the Inferior Duodenal Angulus

Background: Duodenal adenoma is a rare lesion that requires resection because of its malignant potential. Minimally invasive surgery is desirable for such lesions. Case summary: A 52-year-old man underwent esophagogastroduodenoscopy, which revealed a 30-mm 0-IIalike lesion at the inferior duodenal angulus. Examination of the biopsy specimen revealed a Group IV adenoma. The tumor was treated by laparoscopic transduodenal ampullectomy, which was performed under general anesthesia and via 5 trocars. After laparoscopic mobilization of the duodenum and pancreas head, the duodenum was externalized through a mini-laparotomy. A longitudinal incision was placed in the duodenum, and the tumor was excised extracorporeally under direct vision; submucosal dissection was achieved with an electrocautery device. The mucosal defect and duodenal wall were closed with interrupted sutures. The tumor measured 26 mm × 25 mm and was diagnosed histologically as a tubular adenoma with low grade atypia. The surgical margin was adenomanegative. The postoperative course was uneventful. Conclusion: From our experience in this case, we deem laparoscopy-assisted transduodenal ampullectomy to be a feasible and safe procedure for a periampullary duodenal tumor.

Commentary on Laparoscopic-Endoscopic Cooperative Surgery for Duodenal Lesions

Laparoscopic wedge resection of gastric submucosal tumors is an established method, but the tumor is usually resected to an excessive extent [1,2]. Hiki et al. first reported laparoscopic-endoscopic cooperative surgery (LECS) for gastric tumors [3]. Under the LECS approach, the tumor can be resected with minimal but adequate surgical margin. We reported LECS for duodenal lesions in 2010 [4], but other such reports limited. Although LECS enables resection of the tumor with minimal but adequate surgical margin and without postoperative deformity or stenosis, the procedure is still not fully established.