Is Bleeding Gastrointestinal Stromal Tumor Associated With Higher Mortality and Morbidity?

Introduction Gastrointestinal stromal tumor (GIST) is the most common primary mesenchymal tumor of the gastrointestinal tract. The clinical presentation of GIST varies widely and ranges from being asymptomatic to being a life-threatening emergency in the form of gastrointestinal bleeding or bowel obstruction. Multiple prognostic factors have been identified for GIST, including, most importantly, larger tumor size (>5 cm), higher mitotic activity (>5 per 50 high-power fields), rupture of the mass, site of the mass, and personal history of GIST. Objective In this paper, we aim to study bleeding in gastrointestinal tumors as a predictor for morbidity and mortality and investigate possible factors influencing bleeding in GIST. Method A retrospective study design was used. Electronic medical records of 39 patients diagnosed with GIST in Prince Sultan Military Medical City in Riyadh between January 2015 and December 2020 were retrieved. Normal variables were presented as mean and standard deviation, while non-normal variables were presented as median and interquartile range. Student t-test or Mann-Whitney test was used to compare quantitative data when appropriate. The distribution of recurrence and survival was plotted with the Kaplan-Meier curve and compared between the two groups (bleeding and non-bleeding groups) with the log-rank test. Factors affecting recurrence and mortality were assessed using univariable Cox regression. Result A total of 39 cases of GIST tumors were included in this study. Patients were categorized according to the presentation into two groups: patients with no bleeding (n= 28) and those presented with bleeding (n= 11). The gender distribution was equal. The mean age was 58.14± 12.46 in patients with non-bleeding GIST and 58.18± 16.01 in patients with bleeding GIST. The most common location of GIST was the stomach (22 cases, 56%). Neither group had any significant differences regarding age (P-value = 0.993), gender (P-value = 0.648), tumor location (P-value = 0.057), size (P-value = 0.250), cluster of differentiation (CD) markers, histological types (P-value = 0.692), and shape (P-value = 0.079). There was no significant difference in recurrence between both groups (log-rank P = 0.972). There was no significant difference in survival between both groups (Log-rank P = 0.506). Conclusion We concluded that bleeding GIST was not a significant predictor for recurrence rate or higher mortality. This can help in the debate of whether bleeding GIST should be added as an independent factor in risk stratification. Despite that, further studies are needed to identify more variables that can add more accuracy to the pre-existing risk stratification systems.

Air GunPellet Embolization to common femoral vein: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Intraluminal migration of pellet has a wide range of manifestations. It can be asymptomatic or present with devastating outcomes such as ischemia, sepsis, or pulmonary embolism. CASE PRESENTATION: We present a case of 57-year-old male who had a shot from air gun to his thigh, with antegrade migration to left proximal common femoral vein. CLINICAL DISCUSSION: He was taken to operating room for open exploration and retrieval of the pellet. CONCLUSION: In summary, this case emphasizes the significance of stepwise approach in diagnosing and management of intra-vascular missiles. After establishing the diagnosis counselling for the patient in details for the risk and benefit of intervention is needed to choose either retrieval of the pellet or more of a conservative approach.

A 20-Year-Old Gossypiboma Causing Small Bowel Obstruction.

Retained foreign bodies including gossypiboma could be silent for years. However, in some cases, it can lead to major complications. Gossypiboma is not frequently reported for multiple reasons, including nonspecific presentation clinically and radiologically, and ethical issues. We present a case of a gossypiboma that was retained for more than 20 years causing a severe intestinal obstruction for an elderly female. The intestinal obstruction was initially thought to be adhesive in nature and was managed initially conservatively, but with failure to improve, the patient was taken for exploratory laparotomy, and the foreign body was found attached to the root of the mesentery posterior to the transverse colon. This case sheds light on the fact that although surgical tools are of great utility, they must be managed with utmost care to prevent complications and secure patients' safety.

A case report of spindle cell lipoma.

Spindle cell lipoma (SCL) is an uncommon benign tumor. A 67-year-old male with multiple comorbidities, presented with a complain of swelling in the neck, which was excised, and the diagnosis of spindle shape lipoma was made based on pathological examination.

A case report of retroperitoneal Ewing sarcoma requiring adrenalectomy.

INTRODUCTION AND IMPORTANCE: Ewing's sarcoma is a rare entity of malignant in both skeletal and extra-skeletal sites. There are few patients reported as Extra-Skeletal Sarcoma, and fewer reported cases for Extraskeletal Ewing sarcoma involving the retroperitoneal region. Reporting such a rare entity will add to literature in helping the diagnosis and management of such cases. CASE PRESENTATION: We present a case of 26 year old previously healthy female complaining of a vague abdominal pain and discovered to have retroperitoneal Ewing sarcoma adherent to left adrenal gland. CLINICAL DISCUSSION: She was managed with a combination of neoadjuvant chemotherapy and resection through exploratory laparotomy. CONCLUSION: In short, Ewing sarcoma should be considered in the differential diagnosis for young patient who is presenting with a retroperitoneal mass.

Peritoneal Tuberculosis in a Young Healthy Male Resembling Intra-Abdominal Malignancy.

Intra-peritoneal tuberculosis is a rare disease, accounting for 1-2% of all tuberculosis cases. The absence of characteristic clinical picture of intra-peritoneal tuberculosis makes the diagnosis rarely easy for clinicians as it mimics malignancy. We present a case of a young male patient who presented with peritoneal tuberculosis, aiming to contribute to a better understanding of peritoneal tuberculosis in the literature.