Gastrointestinal stromal tumors (GISTs) are rare. Although most commonly found in the stomach, GISTs in the jejunum are among the rarest subtypes. A 46-year-old woman presented to the surgical department with proximal jejunal mass found in the examinations after abdominal pain and melena. Computed tomography imaging showed a 2.3 cm sized well-defined heterogenous enhancing mass in the proximal jejunum, and GIST was strongly suspected. The jejunal mass was identified 5 cm below the ligament of Treitz intraoperatively. She underwent robotic-assisted jejunal resection with intracorporeal robot-sewn anastomosis. The patient’s postoperative course was uneventful, and she was discharged on the seventh postoperative day. A robotic approach for GIST in the proximal jejunum is a safe and feasible procedure with good surgical outcomes.

Background: As life expectancy increases, a growing number of elderly patients are considered for curative hepatectomy for hepatocellular carcinoma (HCC). However, perioperative outcomes in elderly patients in the contemporary era of minimally invasive liver surgery remain incompletely defined. Methods: We retrospectively reviewed 277 consecutive patients who underwent elective curative hepatectomy for HCC between 2019 and 2023. Outcomes were compared using age thresholds of ≥75 and ≥80 years. The primary endpoints were 90-day mortality and major postoperative complications (Clavien–Dindo grade ≥ III). Multivariable logistic regression identified predictors of major complications. Results: Elderly patients had more comorbidities, whereas liver function, tumor characteristics, and extent of resection were comparable across age groups. Laparoscopic hepatectomy was performed more frequently in patients aged ≥80 years. Major complication rates and 90-day mortality were similar regardless of age, with no deaths among patients aged ≥75 or ≥80 years. Age ≥75 years, higher ALBI score, major comorbidities, and longer Pringle maneuver time were independently associated with major postoperative complications. Conclusions: Hepatectomy for hepatocellular carcinoma may be performed with acceptable short-term outcomes in carefully selected elderly patients, including octogenarians. Chronological age alone should not be considered an absolute contraindication to surgery, although findings should be interpreted with caution.

Background: Epstein–Barr virus (EBV)-related primary splenic tumors are exceptionally rare and encompass a heterogeneous group of entities, including inflammatory pseudotumor (IPT), IPT-like follicular dendritic cell (FDC) tumors or sarcomas, and EBV-positive diffuse large B-cell lymphoma (DLBCL). Because clinical presentation and imaging findings are often nonspecific, establishing a definitive diagnosis remains challenging and frequently necessitates splenectomy for histopathologic confirmation. Methods: We retrospectively reviewed patients who underwent laparoscopic splenectomy for suspected primary splenic lesions at a single tertiary institution between June 2014 and August 2025. Among 67 patients, five consecutive patients were pathologically confirmed as EBV-related primary splenic tumors. Clinical characteristics, imaging features, histopathologic and immunophenotypic findings, EBV in situ hybridization results, treatment, and follow-up outcomes were analyzed. Results: This case series comprised four spindle cell–predominant EBV-related tumors (IPT or IPT-like FDC tumors/sarcomas) and one EBV-positive DLBCL. All patients presented with splenic masses that could not be definitively characterized by preoperative imaging alone and therefore required splenectomy. EBV in situ hybridization was positive in tumor cells in all cases. Patients with non-lymphomatous tumors achieved durable disease control following splenectomy alone, with disease-free survival of up to five years. In contrast, the patient with EBV-positive DLBCL required postoperative systemic immunochemotherapy. Conclusions: EBV-related primary splenic tumors represent a diagnostically challenging and clinically diverse disease spectrum. This case series highlights the pivotal role of splenectomy in establishing definitive diagnosis and guiding subsequent management, particularly for isolated splenic lesions with indeterminate imaging findings.

Inflammatory myofibroblastic tumors (IMTs) of the duodenum are exceptionally uncommon, and their epidemiologic and clinical characteristics remain poorly defined because of the limited number of reported cases. We previously reported a case of duodenal IMT in the Korean Journal of Gastroenterology in 2018, with follow-up data available only up to 12 months. IMTs typically behave in a benign manner, but they may occasionally demonstrate local invasiveness and recurrence; therefore, achieving complete surgical excision is crucial, followed by long-term surveillance. In the present manuscript, we provide a subsequent long-term follow-up report of the same patient, offering an extended 88-month postoperative course and additional radiologic and pathologic details not included in the earlier publication. This follow-up report highlights the long-term benign behavior of the tumor despite positive surgical margins and anaplastic lymphoma kinase (ALK)-negative immunohistochemistry, contributing meaningful information to the scarce literature on adult duodenal IMTs.

Liver resection is a curative treatment for selected patients with hepatocellular carcinoma. As laparoscopic techniques have advanced, laparoscopic liver resection has been increasingly used. However, its long-term oncologic adequacy compared with open liver resection remains debated. We retrospectively analyzed patients who underwent liver resection for hepatocellular carcinoma at Pusan National University Hospital between August 2019 and December 2022. Patients were divided into laparoscopic and open liver resection groups. Perioperative outcomes and long-term survival outcomes were compared. In total, 257 patients were included, with 209 undergoing laparoscopic and 48 undergoing open liver resection. Liver function and tumor stage were similar between groups. Estimated blood loss was lower in the laparoscopic group, whereas operative time and hospital stay were comparable. Major postoperative complications were more frequent after open surgery, while 90-day mortality was similar. During follow-up, disease-free and overall survival did not differ between groups. Multivariable analysis showed that oncologic outcomes were associated with tumor-related factors, resection margin status, and liver cirrhosis, but not with surgical approach. Laparoscopic liver resection achieved perioperative and oncologic outcomes comparable to those of open liver resection. It may be considered an acceptable surgical option in appropriately selected patients.

Immunoglobulin G4 (IgG4)-related disease is a fibroinflammatory condition that can involve multiple organs. Isolated involvement of the gallbladder is exceptionally uncommon and often radiologically indistinguishable from gallbladder carcinoma, resulting in diagnostic uncertainty before surgery. A 77-year-old man presented with right upper abdominal discomfort lasting 1 month. Cross-sectional imaging revealed irregular gallbladder wall thickening with contrast enhancement, raising suspicion for resectable gallbladder cancer. The patient underwent a radical cholecystectomy with partial hepatectomy. Histopathological analysis demonstrated dense lymphoplasmacytic infiltration, storiform fibrosis, and marked infiltration of IgG4-positive plasma cells exceeding established diagnostic thresholds, consistent with IgG4-related cholecystitis. The postoperative course was uneventful, and no additional treatment was required. IgG4-related cholecystitis should be considered in the differential diagnosis of gallbladder malignancy, particularly in atypical or indeterminate cases. However, when imaging findings strongly suggest carcinoma, radical surgical resection remains an appropriate oncologic approach.