ABSTRACT
Introduction: Sarcomatoid carcinoma of the stomach is a very rare type of malignant gastric tumor characterized by distinct cell morphology.Only six cases have been reported in the literature. We report a case which illustrates the great rapidity of evolution and the aggressiveness of this histological type. Case presentation: A 80-year-old patient was explored for loss of 20 kg and epigastralgia. The explorations showed a non-metastatic antral sarcomatoid carcinoma with celiac necrotic lymphe node. The oncologic comitee decision was surgery straight away without perioperative chemotherapy.4 weeks after his first CT scan the patient was admitted for preparation for surgery. Clinical and morphological examination showed a clear increase in tumor size with associated tumor infection.The patient had distal gastrectomy. The tumor was perforated and locally advanced.The final pathological exams confirmed the histological type. Surgery was R0, but 4 months after surgery, local recurrence compressing gastro intestinal anastomosis was occurred. Clinical discussion: Operative difficulties and rapid recurrence after surgery would have been avoided by faster surgery after diagnosis. However, the surgery time was only 1 month, which illustrates the rapid evolution of sarcomatoid tumors. Conclusion: Sarcomatoid carcinoma is a rare tumor. These tumors can be aggressive with a large tumoral voulume and high rate of locoregional lymph node involvement. Our case illustrate the aggressiveness of this tumor. The benefit of peri-operative treatment is unknown.
ABSTRACT
INTRODUCTION: Many cases of gallbladder cancer (GBC) were made incidentally after cholecystectomy for presumed benign disease. The aim of this review is to assess the preoperative predictor factors of gallbladder cancer. METHODS: This systematic review was conducted according to PRISMA guidelines when it was applicable. We conducted bibliographic researches on October 2nd, 2019, in the following sources: The National Library of Medicine through PubMed, Cochrane database, and Google scholar. We have assessed the univariate and multivariate analysis outcomes. RESULTS: We included ten studies. Incidence of incidental GBC was 0.36%. Seven studies reported age as a significant predictive factor of iGBC. Comorbidities were the second significant predictor. One study found that iGBC group was more likely to have elevated TB, DB, PAL, and ALT. Another study reported a significantly higher rate of TB, PAL, and AST. One study concluded that elevated CA19-9 combined with CEA or CA-125 was significantly more frequent in the group with iGBC. Polyps, porcelain GB, GB wall thickness, and CBD dilation were reported to be associated with iGBC. iGBC group were more likely to have solitary and larger GS and gallbladder wall thickening, essentially focal. CONCLUSION: Incidence of iGBC was 0.365% varying between 0.19 and 1.6% of laparoscopic cholecystectomy and about 50% of GBC cases. This highlights the deficiency of preoperative diagnostic features. Despite the efforts made, the rate of this condition is still high, underlining the need of new radiological technologies.
