Heterotopic ossification within the gallbladder - First reported Australian case.

INTRODUCTION: We report the rare and unusual case of heterotopic ossification within the gallbladder secondary to chronic calculi debris. PRESENTATION OF CASE: A 35-year-old female underwent routine laparoscopic cholecystectomy for recurrent intermittent right upper quadrant pain which had persisted for three months and was worse post prandial with associated nausea. Abdominal ultrasound prior to surgery was reported by a consultant radiologist as demonstrating a thin-walled gallbladder and cholelithiasis, without features of cholecystitis. At four-week review, she had recovered well with no concerns. The histopathology report revealed fibromuscular hyperplasia and patchy chronic inflammation. Rokitansky-Aschoff sinuses were present and cholesterosis was noted. Additionally, there was a focus of eroded mucosa showing adherent microlithiasis with an incidental focus of heterotopic ossification within the mucosa, there was no evidence of dysplasia or malignancy. DISCUSSION: Gallbladder heterotopic ossification is exceedingly rare, with few cases reported. To our knowledge this is the first reported case in Australia. CONCLUSION: In conclusion, we report the rare and unusual finding of heterotopic ossification of the gallbladder, and suspect that inflammation secondary to calculous debris initiated the ossification. Current technical limitations preclude diagnosis prior to surgery. Appropriate follow-up is unclear, but we feel a single report associated the finding with adenocarcinoma was sufficient to warrant follow-up.

Intra-abdominal desmoplastic small round cell tumour in a 56-year-old female: Case report of a very rare presentation of an unusual tumour.

INTRODUCTION: This case report discusses the rare diagnosis of intra-abdominal desmoplastic small round cell tumour (DSRCT) in a 56-year-old female. PRESENTATION OF CASE: An incidental intra-abdominal lesion was found during investigation of joint pain. Ultrasound-guided biopsy suggested desmoid tumour, after undergoing laparotomy and en-bloc excision of the tumour due to concerning radiological progression, the final histology was desmoplastic small round cell tumour. At six-week follow-up imaging, no recurrence or metastatic disease was noted. She declined chemotherapy and specialist follow-up, electing to have routine follow up with her General Practitioner only. DISCUSSION: Intra-abdominal DSRCT is rare and mainly seen in young males. To our knowledge, this is the only reported case of DSRCT in a female over the age of 50. CONCLUSION: There should be timely discussion between different surgical units to provide efficient care. Any disparity between radiological and histological appearance should prompt further review and investigation in order to ensure misdiagnosis is avoided and appropriate treatment is provided. Despite cytoreductive surgery, survival is dismal due to the aggressive nature of the tumour, and its low numbers limiting adequate study into post diagnosis care.