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Pure primary gastric squamous cell carcinoma (PGSCC) is a notably rare gastric malignancy. We present the case of a 51-year-old woman with advanced gastric squamous cell carcinoma characterized by a 7.6 cm necrotic mass invading the proximal stomach, liver metastasis, and lymphadenopathy at diagnosis. Despite the lack of standardized treatment protocols, we review tumor markers and potential management strategies, including surgical and chemotherapeutic interventions. The rarity and aggressive nature of PGSCC necessitates further research to develop effective detection and treatment methods to improve patient prognosis and survival outcomes.
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Hepatic hemangiomas are commonly benign liver tumors, typically asymptomatic and predominantly located in the right lobe. This case report details an exceptional instance of a left-lobe hepatic hemangioma manifesting as an exophytic, pedunculated mass resembling a gastric tumor. A 77-year-old woman with a history of melanoma presented with a mass incidentally discovered during evaluations for chest pain. Advanced imaging techniques, including computed tomography (CT) and endoscopic ultrasound (EUS), identified this mass as a benign, pedunculated hemangioma extending from the left hepatic lobe toward the gastric fundus. Given the tumor's benign nature and the patient's lack of symptoms, a conservative management approach was adopted. This case emphasizes the importance of accurate imaging and diagnostic assessment in managing atypical hepatic hemangiomas, highlighting the need to carefully consider rare growth patterns and locations in differential diagnoses to avoid unnecessary interventions. Such cases reinforce the complexity of diagnosing and managing unusual presentations of common benign tumors.
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The link between the Epstein-Barr virus (EBV) and the development of certain types of lymphomas in patients with human immunodeficiency virus (HIV) is of noteworthy clinical importance. Their immunocompromised state increases the risk of cancers such as lymphomas. Gastrointestinal (GI) lymphomas, though, can occur due to the immunosuppression caused by HIV, with diffuse large B-cell lymphoma (DLBCL) being common in this group. This case report describes a case of a patient with a newly diagnosed HIV who initially presented with symptoms associated with EBV-associated DLBCL and with esophageal candidiasis. This case report highlights the need for increased awareness of HIV-related complications and the importance of close follow-up. In addition, despite advancements in highly active antiretroviral therapy (HAART), acquired immunodeficiency syndrome (AIDS)-related lymphomas continue to be a concern requiring treatment approaches.
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Objective: Gastroblastoma is an extremely rare gastric tumor. Its pathogenesis remains unclear and there is a lack of specific clinical symptoms. The aim of this paper is to report a case of gastroblastoma and provide references for the diagnosis, treatment, and prognosis of this disease. Methods: The diagnosis and treatment of a 51-year-old female patient with gastroblastoma were retrospectively reported. Analyzing this case by combining the clinical data such as imaging and pathological results of patients with the relevant literature. Results: The patient's chief complaint was the presence of melena persisted for over two weeks. Abdominal contrast-enhanced CT showed gastric antral nodules, and micro-probe endoscopic ultrasonography was considered as "gastric antral protruding lesions". The initial diagnosis of "gastric stromal tumor" was made after admission, and surgical treatment was performed on September 23, 2021. Postoperative pathology showed that gastric mixed epithelial and stromal tumor, combined with immunohistochemical staining, was suggestive of gastroblastoma. No signs of tumor recurrence or metastasis were observed during the 2-year follow-up. Conclusion: Combined with the existing literature reports, the incidence of gastroblastoma is mainly higher in young men, and the predilection site is gastric antrum. The biological behavior of the tumor tends to be indolent, and the prognosis of most cases is favorable. However, due to the extremely small number of cases, this conclusion still needs a large number of cases and follow-up data to support. Postoperative pathological and immunohistochemical examination results are the only methods for definite diagnosis at present, and surgery is the first choice for treatment.
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Gastroduodenal intussusception is a rare presentation in adults. A mass lesion in the stomach typically acts as a lead point that invaginates into the pylorus and duodenum causing intussusception. In a subset of these cases, episodic symptoms of obstruction occur because of intermittent prolapse of the lesion, termed "ball-valve syndrome." We present a 73-year-old woman with intermittent abdominal pain and nausea who was discovered to have gastroduodenal intussusception secondary to a large prolapsing fundic adenoma through the pylorus and into the duodenum. The case highlights this rare complication from gastric lesions along with the importance of surgical intervention for definitive management.
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Introduction: The purpose of this case series was to review a rare subset of tumors known as gastric lipomas, which are typically found incidentally. The motivation for this study arose from the identification of 2 cases within our institution in a short period. Case Presentation: The study involved a review of the diagnosis and management of 2 patients presenting with gastric lipomas at our institution after symptoms of gastrointestinal bleeding. With the advent of new radiologic investigations such as computed tomography and magnetic resonance imaging and advances in endoscopy, there are new approaches to identifying and managing these tumors. On further evaluation of the literature, we found that despite the availability of minimally invasive endoscopic techniques such as mucosal resection and submucosal dissection in the setting of large tumors, most patients tend to have to resort to surgical management. Conclusion: This case series underscores the rarity of gastric lipomas and their often-incidental discovery. Further investigation into endoscopic approaches for managing these tumors is needed, and additionally, there is a need to explore a potential association between gastric lipomas and malignancy, as chronic inflammation of the overlying mucosa may play a significant role.
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Most gastric cancers are adenocarcinomas, but other malignancies can arise in the stomach. Patients with leukemia may develop myeloid sarcoma (MS) in the gastrointestinal tract. Our patient was a 68-year-old woman who was initially diagnosed with acute myeloid leukemia and underwent a matched unrelated stem cell transplantation. She was in remission for 10 years before developing a rare case of gastric MS without acute myeloid leukemia. She had partial response to chemotherapy but ultimately died because of infection. Gastric MS has an incidence of less than 1%. Gastrointestinal involvement usually involves the small intestine and rarely the stomach.
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BACKGROUND: Lymphoepithelioma-like carcinoma of the stomach (LELC), also known as carcinoma with lymphoid stroma of the stomach, is a rare type of gastric cancer, accounting for approximately 1-4% of all gastric cancers. It is mainly associated with Epstein-Barr virus (EBV) infection. Here, we report a case of gastric lymphoepithelial-like carcinoma presenting as a submucosal mass that tested negative for EBV. CASE DESCRIPTION: a 70-year-old patient was diagnosed with a gastric mass through routine endoscopy. There was no abdominal pain, fever, hematemesis, chills, or other discomfort, and the patient had a history of hypertension. The complete blood count, blood chemistry, and tumor indices were normal, and the results for EBV infection were also negative. According to EUS, it was diagnosed as a gastric stromal tumor. The patient underwent endoscopic submucosal dissection (ESD). Pathological exams suggested that it was a low-differentiated carcinoma, and surgical dissection was performed. CONCLUSION: Cases of gastric LELC are rare, and clinicians need to improve their understanding of the disease to avoid misdiagnosis. The etiology and pathogenesis of this disease need further investigation.
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Gastric subepithelial tumors (SETs) are often incidentally found during examinations of the gastrointestinal tract. Able to arise from any layer of the stomach, these tumors are predominantly asymptomatic and are classified as either benign or malignant based on size, consistency, shape, and mobility as determined by endoscopic evaluation. We present the first reported case of a gastric SET presenting as a chronic organizing hematoma. In doing so, we discuss the necessity of multimodal imaging techniques and multidisciplinary management in identifying often obscure gastric SETs to intervene on potentially malignant masses early.
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This case documents a previously undescribed presentation of Helicobacter spp. gastritis. An 8-year-old female spayed golden retriever with chronic vomiting was found to have a cluster of multiple, round, well-defined, hypoechoic foci of varying sizes surrounded by gas within the lumen of the stomach on ultrasonographic examination. Further endoscopic examination revealed multiple raised mass-like lesions in the fundus on endoscopic examination. Histopathological findings were consistent with Helicobacter spp. infection. The dog was treated with both amoxicillin 400 mg and clarithromycin 180 mg BID for 21 days and omeprazole 20 mg SID for 34 days. After the treatment, the vomiting and fundic lesions were resolved on ultrasonographic examination. This case represents a novel gross morphologic presentation for Helicobacter spp. gastritis that responded to appropriate therapy and highlights how early intervention with advanced imaging can aid in diagnosis and treatment.
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A bezoar is a solid mass of indigestible material that usually forms in the gastrointestinal (GI) tract. Gastric bezoars, located in the stomach, can present variably. They can be asymptomatic or present with GI symptoms like nausea, vomiting, abdominal pain, or more serious complications, such as GI obstruction or perforation. Diagnostic modalities are mainly radiological, and treatment may either be conservative or interventional. Herein, we disclose the case of a 47-year-old female who presented with a two-week history of abdominal pain with an incidental finding of a possible gastric phytobezoar, co-existing with gallbladder disease. Although not previously reported, this study highlights the possibility of an association between gallbladder disease and the formation of a bezoar.
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BACKGROUND: Mass lesions located in the wall of the stomach (and also of the bowel) are referred to as "intramural." The differential diagnosis of such lesions can be challenging in some cases. As such, it may occur that an inconclusive fine needle aspiration (FNA) result give way to an unexpected diagnosis upon final surgical pathology. Herein, we present a case of an intramural gastric nodule mimicking a gastric gastrointestinal stromal tumor (GIST). CASE SUMMARY: A 47-year-old Caucasian woman, who had undergone splenectomy for trauma at the age of 16, underwent gastroscopy for long-lasting epigastric pain and dyspepsia. It revealed a 15 mm submucosal nodule bulging into the gastric lumen with smooth margins and normal overlying mucosa. A thoraco-abdominal computed tomography scan showed in the gastric fundus a rounded mass (30 mm in diameter) with an exophytic growth and intense enhancement after administration of intravenous contrast. Endoscopic ultrasound scan showed a hypoechoic nodule, and fine needle FNA was inconclusive. Gastric GIST was considered the most probable diagnosis, and surgical resection was proposed due to symptoms. A laparoscopic gastric wedge resection was performed. The postoperative course was uneventful, and the patient was discharged on the seventh postoperative day. The final pathology report described a rounded encapsulated accumulation of lymphoid tissue of about 4 cm in diameter consistent with spleen parenchyma implanted during the previous splenectomy. CONCLUSION: Splenosis is a rare condition that should always be considered as a possible diagnosis in splenectomized patients who present with an intramural gastric nodule.
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BACKGROUND: Gastric schwannomas are uncommon among a broad range of possible diagnoses in the work up of a gastric mass. Regional lymphadenopathy associated with gastric schwannoma is an even less common occurrence and one would otherwise suspect a malignant neoplasm. CASE PRESENTATION: We present two non-consecutive cases from a signle academic center depicting Caucasian females in their 5th and 6th decades of life with gastric schwannoma and adjacent lymphadenopathy. Multiple lymph node excisions were performed without evidence of neoplasia. DISCUSSION: Lymphadanopathy in the presence of a gastric mass typically represents malignant neoplasm. A less than likely presentation of gastric schwannoma with reactive regional lymph nodes poses a challenge to adequate preoperative diagnosis and increases risk for a more aggressive than necessary surgical approach with lymphadenectomy. CONCLUSION: While the correlation between gastric schwannoma and lymphadenopathy is uncertain, this ought to be considered. If diagnosis can be confirmed preoperatively, omission of lymphadenectomy is appropriate.
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Melanoma is the most deadly form of skin cancer. While the jejunum, ileum, colon, and rectum are common gastrointestinal sites of metastasis, metastatic melanoma to the stomach is rare and usually not discovered until late in the disease. We report a patient who presented with weight loss and hematemesis; on esophagogastroduodenoscopy, a gastric mass was found, and pathology was consistent with melanoma.
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BACKGROUND: Plexiform fibromyxoma (PF) is a rare gastric tumor often confused with gastrointestinal stromal tumor. These so-called "benign" tumors often present with upper GI bleeding and gastric outlet obstruction. It was recently demonstrated that approximately one-third of PF have activation of the GLI1 oncogene, a transcription factor in the hedgehog (Hh) pathway, via a MALAT1-GLI1 fusion protein or GLI1 up-regulation. Despite this discovery, the biology of most PFs remains unknown. METHODS: Next generation sequencing (NGS) was performed on formalin-fixed paraffin-embedded (FFPE) samples of PF specimens collected from three institutions (UCSD, NCI and OHSU). Fresh frozen tissue from one tumor was utilized for in vitro assays, including quantitative RT-PCR and cell viability assays following drug treatment. RESULTS: Eight patients with PF were identified and 5 patients' tumors were analyzed by NGS. An index case had a mono-allelic PTCH1 deletion of exons 15-24 and a second case, identified in a validation cohort, also had a PTCH1 gene loss associated with a suspected long-range chromosome 9 deletion. Building on the role of Hh signaling in PF, PTCH1, a tumor suppressor protein, functions upstream of GLI1. Loss of PTCH1 induces GLI1 activation and downstream gene transcription. Utilizing fresh tissue from the index PF case, RT-qPCR analysis demonstrated expression of Hh pathway components, SMO and GLI1, as well as GLI1 transcriptional targets, CCND1 and HHIP. In turn, short-term in vitro treatment with a Hh pathway inhibitor, sonidegib, resulted in dose-dependent cell killing. CONCLUSIONS: For the first time, we report a novel association between PTCH1 inactivation and the development of plexiform fibromyxoma. Hh pathway inhibition with SMO antagonists may represent a target to study for treating a subset of plexiform fibromyxomas.
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Fibroma/genética , Genes Supresores de Tumor , Receptor Patched-1/genética , ARN Largo no Codificante/genética , Adolescente , Adulto , Anciano , Proteínas Portadoras/genética , Deleción Cromosómica , Ciclina D1/genética , Exones , Femenino , Proteínas Hedgehog/genética , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Masculino , Glicoproteínas de Membrana/genética , Persona de Mediana Edad , Estudios Retrospectivos , Receptor Smoothened/genética , Adulto Joven , Proteína con Dedos de Zinc GLI1/genéticaRESUMEN
INTRODUCTION: Alimentary tract cystic duplication is a rare congenital anomaly predominantly affecting females, and diagnosed mostly in the early years of life. CASE REPORT: We present here a case of a 51-year-old man presenting with a 2-day history of melena. Gastroscopy showed fresh blood, as well as a mass lesion and cavity at the fundus. Biopsies of the mass edge reported the occurrence of moderately differentiated adenocarcinoma and mild chronic gastritis. Computed tomography imaging showed a 5.1×6.5 cm cystic mass in the gastric greater curvature. The patient received six cycles of epirubicin, capecitabine, and oxaliplatin, followed by uncomplicated total gastrectomy. LITERATURE REVIEW: Data from all 11 reports of similar cases were reviewed and pooled. The result shows male predominance and variable symptoms, as well as a wide age range (25-76 years) at presentation. The cysts are commonly located along the greater curvature and are unilocular. Surgery was the treatment in most cases. CONCLUSION: Alimentary tract cystic duplication is rare and may predispose to malignancy. Early diagnosis and prompt surgical intervention is important for the best outcome.
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INTRODUCTION: Rapunzel syndrome is a rare intestinal condition that starts with the ingestion of a trichobezoar. The condition is predominately found in females and can be associated with trichotillomania, or the compulsive urge to pull one's own hair out. There are less than 40 cases described in the literature with the prevention of recurrence aimed at psychological treatment. PRESENTATION OF CASE: The patient is a 7 year-old girl with a history of trichotillomania with trichophagia as a young child who presented with abdominal pain, nausea, and vomiting, consistent with a gastric outlet obstruction. She had an exploratory laparotomy with gastrostomy performed revealing a 18cm by 18cm trichobezoar with extension into the small bowel. DISCUSSION: Bezoars, an already rare entity, can occasionally lead to gastric and small bowel obstructions. Small collections of ingested hair build up in the intestinal tract causing significant symptoms. These obstructions can sometimes be treated through minimally invasive techniques but, in our case described, it is unlikely to have been treated any other way due to the substantial size of the trichobezoar. CONCLUSION: Early consideration of Rapunzel syndrome is important in young females presenting with a gastric outlet obstruction.
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Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal tract. The stomach is the most common site of origin. Management of GISTs changed after the introduction of molecularly targeted therapies. Although the only potentially curative treatment of resectable primary GISTs is surgery, recurrence is common. Patients with primary GISTs at intermediate or high risk of recurrence should receive imatinib postoperatively. Imatinib is also first-line therapy for advanced disease. Cytoreductive surgery might be considered in advanced GIST for patients with stable/responding disease or limited focal progression on tyrosine kinase inhibitor therapy. GIST requires multidisciplinary management.