A case of undifferentiated pleomorphic sarcoma of a retro-gastric origin, case report and review of literature.

INTRODUCTION AND IMPORTANCE: Undifferentiated pleomorphic sarcoma (UPS) is one of the most common sarcomas affecting elderly patients, majority of UPS usually in the extremities, trunk, and retroperitoneum. However, its rarely observed in the digestive system. There are minimal data published regarding this topic. CASE PRESENTATION: Here we present a 58 years old female patient with a rare case of the pleomorphic sarcoma of retro-gastric mass measures about (24.7 × 23.5 × 17.4 cm) who underwent exploration laparotomy founded a freely and mobile retro-gastric mass measuring 30 × 20 cm with a cystic and solid component. The mass was freely and mobile located with no true gastric relation is the first one to be reported. CLINICAL DISCUSSION: The undifferentiated pleomorphic sarcomas or MFH has been regarded as the most common soft tissue sarcoma for many years (Kabashima et al., 2017). The incidence increases with age, with an inclusive incidence of about 1-2 cases per 100,000 patients per year, predominately 1.2:1 for males. Undifferentiated pleomorphic sarcoma of the stomach is rare and counted to have a worse prognosis when compared to the other types of pleomorphic malignant fibrous histiocytoma. CONCLUSION: We present a rare case of high-grade undifferentiated pleomorphic sarcoma of the retro-gastric mass with no invasion to the surrounding structures, managed with surgical resection of the tumor.

Histo-biological comparative analysis of bilateral breast cancer.

Bilateral breast cancer occurs in approximately 7% of surviving breast cancer patients. However, a dilemma exists concerning the notion of whether this represents a de novo second primary tumor versus a breast metastasis. We analyzed 81 patients with bilateral breast cancer, 47 (58%) synchronous tumors and 34 (42%) metachronous tumors. Additionally, charts were reviewed for age, family history, full histology data and biological receptors. We found there were no significant differences in concordance between the first and second primary tumors (in both synchronous and metachronous bilateral breast cancer) with respect to histology; grade; T-category; N-category; ER, PR and HER-2 status. In addition, there was no significant difference in the strength of correlation between ER and PR in the first and secondary primary tumors. Our findings suggest that the differentiation of the origin of contralateral breast cancer based on routine histological and biological concordance is inconclusive. Furthermore, the dilemma will continue to exist until additional molecular approaches are applied routinely for research purposes to resolve the debate.

How does preoperative radiotherapy affect the rate of sphincter-sparing surgery in rectal cancer?

The use of preoperative radiotherapy has resulted in significant downstaging and downsizing of tumor, this in turn facilitated resections permitting sphincter preservation and coloanal anastomosis for patients who would otherwise have not been candidates for this type of surgery as concluded by some small studies. On the other hand, other clinical trials have shown that the effect of radiotherapy on the rate of sphincter preservation is still not clear. Moreover, different modes of radiotherapy have been tested on the rate of sphincter preservation such as pelvic irradiation with or without combination of chemotherapy, short or conventional course radiotherapy, and preoperative or postoperative radiotherapy with different timing intervals of surgery. Unfortunately, these trials didn't clearly answer the question of radiotherapy benefit for the sake of sphincter preserving of rectal cancer patients and the question remained hotly debated.

Idiopathic retroperitoneal fibrosis of the pancreas versus pancreatic carcinoma.

We report one of few cases of idiopathic retroperitoneal fibrosis of the pancreas, which is different from the classical retroperitoneal fibrosis that affects ureters and vessels that mimicking locally advanced pancreatic carcinoma at presentation.

Ileocaecal intussusception secondary to metastatic phyllodes tumour of the breast.

A patient with phyllodes tumour of the breast is discussed. During follow-up, she presented with intestinal obstruction caused by ileocaecal intussusception. The cause of the intussusception was metastatic phyllodes tumour, which is a unique presentation.

Palliative effects of an incomplete cytoreduction combined with perioperative intraperitoneal chemotherapy.

OBJECTIVES: Incomplete cytoreduction often occurs because of overwhelming burden of disease intraperitoneally that limit a successful cytoreduction. The outcome of an incomplete cytoreduction followed by administering perioperative intraperitoneal chemotherapy on whether it prolongs survival or palliates symptoms is yet to be established. METHODS: A retrospective review of a prospectively collected database was performed. Eleven patients were identified to have had an incomplete (CC2/3) cytoreduction and received either hyperthermic intraperitoneal chemotherapy or early postoperative intraperitoneal chemotherapy. The symptoms of the patients before and after treatment during follow-up consultations in clinic were noted. Survival analysis was performed using the Kaplan Meier method. RESULTS: The median follow-up period was 19 (range, 0.5-35) months. The overall median survival was 21 months with a 1- and 2-year survival rate of 72% and 36%, respectively. Five of 7 patients with pseudomyxoma peritonei and 2 of 3 patients with colorectal cancer peritoneal carcinomatosis experienced symptom improvement after treatment. Severe postoperative morbidity and achieving symptomatic improvement following treatment seems to be associated with a dismal prognosis. CONCLUSION: Our results suggest that some patients derive a survival and symptomatic benefits despite an incomplete cytoreductive surgery and perioperative intraperitoneal chemotherapy. The effects of this treatment require further investigation to determine its benefits as a palliative procedure.

Perineal hernia, another incisional hernia?

A secondary perineal hernia is a type of incisional hernia of the pelvic floor, occurring after pelvic surgery such as abdominoperineal excision of the rectum and pelvic exenteration. Our aim is to review the available literature on the subject. This report reviews a recently repaired case, followed by a review of the available literature on the presenting condition, concentrating on approaches and methods of repair. Perineal hernias are uncommon, and not many surgeons face them. It is not known if and how these hernias could be prevented. The method and approach of repair should probably be individualized, but we believe that the use of a mesh is important in the repair of such hernias because of the significant tissue defect prevailing in most of the cases, in addition to the unhealthy tissues related to the use of radiotherapy. The laparoscopic approach has been recently utilized and its use is expected to increase.