Extraskeletal mesenchymal chondrosarcoma of the abdomen: A rare clinical presentation

Extraskeletal mesenchymal chondrosarcoma (EMCS) is a rare malignant soft tissue tumor of chondroprogenitor cell origin. Originally, it was restricted to the bone only but that is no longer the case. Recent literature reports that 20–33% of these tumors occur at the extraskeletal sites. We report one such case, in which the tumor involved the anterior abdominal wall muscles and also had a large intra-abdominal mass that covered a large part of the peritoneal cavity. The clinical features and computed tomography findings suggested the diagnosis of a malignant desmoid tumor with intra-abdominal extension; however, the histopathological examination and the immunohistochemistry proved the tumor to be EMCS. The case is reported due to the dilemma in diagnosis, its rarity, large size, parietal, and intra-abdominal extension with multiple site involvement.

Index Admission Laparoscopic Cholecystectomy for Gall Stone Pancreatitis.

Background: Timing of Laparoscopic Cholecystectomy (LC) after gallstone pancreatitis varies considerably between surgeons.We examined outcomes at JN Medical College and hospital where most patients underwent LC following initial management of gallstone pancreatitis. Methods: This prospective study is carried out between June2009 to June 2013 in J.N.M.C.H. Patients with signs and symptoms of acute pancreatitis were admitted and evaluated. All patients admitted were provided the standard care. After exclusion of some patients, remaining underwent laparoscopic cholecystectomy irrespective of severity of disease in index admission, although patients with severe biliary pancreatitis were operated after stabilization of general condition. Results: A total of 134 patients with gallstone pancreatitis were identified of whom 90 underwent laparoscopic cholecystectomy (LC) in the index admission.77 patients were of mild pancreatitis while 13 were of severe pancreatitis. Out of 77 patients with mild pancreatitis 8 patients and 6 out of 13 patients with severe pancreatitis had a difficult dissection (p value<0.05).In terms of hospital stay mean duration of stay was 8.7 days in mild pancreatitis group, whereas it is 19.8 days in severe pancreatitis group (p value <0.05). Of these 90 patients79 (88%) underwent LC successfully while 11 (12%) required conversion to open cholecystectomy where 8 were of mild and 3 were of severe pancreatitis. 14 (15%) had a difficult dissection, where 8 were of mild and 6 were of severe pancreatitis There were 6 (6.7%) postoperative complications in form of wound infection and bile leak overall. The difference in terms of variables like conversion rate to open surgery, need of drain placement, bile leak and wound infection was statistically not significant.Conclusion: LC should be used for GSP during the same hospital admission with favorable outcome with complications and conversion rate compared to elective LC. All patients of mild pancreatitis and patients of severe pancreatitis with no local and systemic complications could undergo laparoscopic cholecystectomy in index admission.