1/64. An uncommon presentation of a common disease: the importance of the history in medicine.A 32-year-old recent Russian immigrant, mother of a 20-month-old son, presented with right hip pain. She had a history of peptic ulcer disease and a positive helicobacter pylori serology. Her pain was not relieved by analgesics. spine and pelvic films were unremarkable. A bone scan was consistent with metastatic disease. She underwent several diagnostic tests including computed tomography of the chest and abdomen, magnetic resonance imaging of the spine, mammogram, and breast ultrasound. A bone marrow biopsy revealed adenocarcinoma, primary site unknown. An upper endoscopy performed eight weeks after her initial presentation showed an ulcerating gastric carcinoma. She was treated with chemotherapy but died two months after diagnosis. Our patient had an uncommon presentation of a common disease. Recognizing her country of origin, and other risk factors, may have facilitated an earlier diagnosis.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
2/64. A case of gastrointestinal stromal tumor of the stomach.In a 55-year-old man, a tumor about 3 cm in diameter was detected in the upper abdomen by abdominal ultrasound screening during follow-up of chronic hepatitis c discovered in 1990. There were no symptoms and no abnormalities on physical examination. Tests for tumor markers were negative. By barium meal and gastroscopy, submucosal tumor was found on the lesser curvature of the stomach, with bridging fold in the absence of central ulceration. biopsy revealed no tumor tissue. Under the diagnosis of submucosal tumor of the stomach, either a leiomyoma or leiomyosarcoma, partial resection of stomach was performed. Direct invasion of the surrounding organs, lymph node metastasis or distant metastasis was not observed grossly in the operation. Histologic examination of the resected specimen revealed proliferation of spindle cells and oval cells in an interlacing pattern. immunohistochemistry for CD34, vimentin and c-kit protein was strongly positive, while smooth muscle actin, S-100 protein, desmin and p53 protein were negative. The proliferating cell nuclear antigen index was about 50%, while the MIB-1 index was < or = 1%. From these findings, this tumor was diagnosed as a gastrointestinal stromal tumor of the uncommitted type.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
3/64. Recurrent gastric carcinoma causing pseudoachalasia: case report.We report the case of a patient with a gastric remnant relapse of an antral carcinoma resected 5 years before and presenting with the clinical feature of a secondary achalasia (pseudoachalasia). In spite of the patient's 4-month history of dysphagia and weight loss that suggested a malignant lesion, barium swallow, repeated endoscopic biopsies and computed tomography (CT) scan of the upper abdomen did not reveal any abnormalities to indicate a recurrence. However, in the following months, because of worsening symptoms, a further CT scan was performed and revealed thickening of the cardia and gastric wall. The patient underwent an exploratory laparotomy that showed an unresectable lesion involving the gastric fundus, the diaphragm and penetrating into the mediastinum, and therefore a palliative jejunostomy was performed.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
4/64. Multiple tumors and a novel E2F-4 mutation. A case report.Defects in the dna mismatch-repair are known to cause microsatellite instability (MSI) in hereditary nonpolyposis colorectal cancer (HNPCC) as well as sporadic colorectal cancer (CRC). We previously reported that the E2F-4 gene, which encodes an important transcription factor in cell cycle control, had frequent tumor-specific mutations at the trinucleotide coding region microsatellite (CAG)n in a subset of human sporadic CRC with MSI. We report a 65-year-old man with triple tumors in the abdomen, including colon cancer, stomach cancer, and lipoma of the retroperitoneum, with the analysis of E2F-4 mutation. We report the first case of colon cancer with a homozygous E2F-4 mutation along with a detailed analysis of other cancer related genes as well as a prognosis.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
5/64. adenocarcinoma of the stomach in an adolescent presenting as pneumoperitoneum: a brief report.BACKGROUND: adenocarcinoma of the stomach is rare in children and adolescents. A unique case, presenting as an acute abdomen with pneumoperitoneum, is discussed. methods: Case presentation and literature review. RESULTS: A 13-year-old girl with perforated gastric adenocarcinoma treated by wedge resection developed metastatic disease within two months and died within six months despite chemotherapy. CONCLUSION: Frozen section of all perforated gastric ulcers, with resection/postoperative chemotherapy for adenocarcinoma. SUMMARY: A 13-year-old girl with gastric adenocarcinoma presented with pneumoperitoneum. Within two months of wedge resection widespread metastatic disease was documented by computerized tomography scan and laparoscopy and despite chemotherapy, the patient died within six months. Frozen section of all perforated gastric ulcers, even in children, and definitive formal gastrectomy with postoperative chemotherapy, offer the only chance of cure.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
6/64. A spontaneously ruptured gastric stromal tumor presenting as generalized peritonitis: report of a case.Among the diverse clinical presentations of gastrointestinal stromal tumor (GIST), spontaneous rupture with peritonitis is extremely rare. We report herein the unusual case of a 75-year-old man found to have a spontaneously ruptured gastric stromal tumor after presenting with generalized peritonitis. The patient was brought to the emergency department of our hospital by ambulance, with generalized severe abdominal pain. On examination, his abdomen was extensively distended with generalized severe rebound tenderness. Abdominal computed tomography scan showed a giant mass arising from the anterior gastric wall with an irregular internal low-density area and a small amount of ascites. An emergency laparotomy revealed a ruptured gastric tumor with dissemination of its necrotic tissue throughout the peritoneal cavity. The tumor was excised together with normal gastric tissue around its base. The tumor, which was 15 x 11 x 4.4cm in size, had a coarse laceration over its well-capsulated smooth serosal surface with massive necrosis and clotted blood inside. Immunohistochemical examination revealed positive reactivity to C-kit protein, which was consistent with the newly introduced diagnostic criteria of GIST. The patient had an uneventful postoperative course and remains well.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
7/64. Primary choriocarcinoma of stomach.A 45 year old patient wad admitted with pain abdomen and a palpable mass in the epigastrium of 3 months duration. endoscopy revealed growth in the stomach and biopsy showed poorly differentiated Carcinoma. Distal radical subtotal gastrectomy was done. Histopathology revealed choriacarcinoma with Syncytiotrophoblastic and cytotrophoblastic and foci of adenocarcinoma. Postoperatively urine and serum had very high levels of beta-human chorionic gonogotrophins (B-HCG). immunochemistry showed positivity for B-HCG. Clinically and on scan both the testis were normal. Because of its rarity, we are presenting this case with brief review of literature.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
8/64. Advanced gastric cancer with multiple lymph node metastasis successfully treated with etoposide, adriamycin and cisplatin.Gastric cancer usually shows poor sensitivity to chemotherapy, and the presence of lymph node metastases is associated with extremely poor prognosis, especially when the number of such nodes is more than 10. We report here a case of advanced gastric cancer with histopathologically confirmed metastases in 15 regional lymph nodes, in which the recurrent tumor was sensitive to combination chemotherapy. Distal gastrectomy with lymphadenectomy was performed for the primary tumor. A hard (recurrent) tumor was detected in the upper abdomen 5 months postoperatively. Abdominal CT revealed two tumors measuring 3.5 x 1.8 and 3.3 x 2 cm in diameter at the front of the pancreatic head, which suggested recurrence. etoposide, adriamycin and cisplatin (EAP) chemotherapy (20 mg/kg adriamycin, 100 mg/kg etoposide and 50 mg/kg cisplatin (CDDP)) was administered every 6 weeks. The tumors regressed and became undetectable on CT after four cycles. At that stage, CDDP was replaced with 400 mg/kg carboplatin, which was administered every 1 or 2 months. The patient had no recurrence 8 years after surgery. For treatment of advanced gastric cancer with multiple lymph node metastases, a wide resection of the tumor should be performed followed by treatment of the residual tumor cells with a suitable combination chemotherapy taking into consideration the characteristics of the tumor and the condition of the host. We present a patient with gastric cancer and histopathologically confirmed metastases in 15 regional lymph nodes, who was successfully treated by surgery followed by EAP adjuvant chemotherapy. The patient remains alive and well at 8 years after surgery.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
9/64. An elderly patient with gastric carcinoma developing multiple metastasis in skeletal muscle.We present a 70-year-old man with gastric carcinoma developing multiple metastasis in skeletal muscle. He had a right supraclavicular lymph node swelling. brain, chest and abdomen CT scans revealed metastatic lesions in the brain, lung, liver and bilateral adrenal glands. Further, CT showed a ring enhanced soft-tissue mass in the left lumbar muscle. Needle aspirate of the mass in both the left lumbar muscle and the right enlarged supraclavicular lymph node revealed cells suggestive of poorly differentiated adenocarcinoma. Upper gastrointestinal endoscopic evaluation demonstrated an advanced gastric carcinoma. Two months after admission, the tumor in the left lumbar muscle had grown and some new lesions in the left iliopsoas muscles appeared. Intramuscular metastasis from gastric carcinoma is an extremely rare phenomenon.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
10/64. Uncommitted gastrointestinal stromal tumour. Case report.Gastrointestinal Stromal Tumours (GIST) are mesenchymal tumours with uncertain prognosis. Malignant variety represents about 2.0% of malignant gastroenteric tumours. The Authors report a clinical case of malignant gastric and duodenojejunal GIST, in which the only surgical treatment seems to be definitive. R. S., a 69-year-old female, was admitted for asthenia and fever in January 1997. Endoscopic exploration, ultrasonography and CT-scan of the abdomen demonstrated an exophytic tumour in the greater gastric curvature and one tumour of 5.5 cm of diameter in the Treitz's angle. We performed a resection of the gastric tumour and the duodenojejunal angle. Postoperative course was uneventful and the patient was discharged after 14 postoperative hospital days. Histological analysis showed two spindle cells stromal tumours with mitotic rate > 20/10 HPF. The immunohistochemistry demonstrated the uncommitted origin of tumour cells. The patient refused the chemotherapy treatment. There was no local recurrence or metastasis at a follow up of 47 months, in spite the high malignancy degree. For this reason and because of the uncertain behaviour of benign GIST, the authors propose a lifelong follow up of the patients managed with potentially curative surgical resection.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
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