An Unusual Case of Cecal Mesenteric Dedifferentiated Liposarcoma Involving the Ileocolic Artery Resected by Right Hemicolectomy.

BACKGROUND: Colonic mesenteric dedifferentiated liposarcoma is a rare entity. CASE REPORT: A 65-year-old male developed a 6 cm diameter right-side intra-abdominal mesenteric mass. A biopsy of the mass was performed and the pathology diagnosis was a spindle cell neoplasm most consistent with low-grade sarcoma. The mass was found to involve the ileocolic vessels in the mesentery on the right side of the abdomen, and therefore the patient received right hemicolectomy with mesenteric mass resection. Pathology confirmed a dedifferentiated liposarcoma (DDLPS) arising in a well-differentiated liposarcoma/atypical lipomatous tumor with myxoid changes. The tumor cells were positive for MDM2 amplification by fluorescence in situ hybridization. After 6 months of follow-up, our patient showed no sign of recurrence. CONCLUSION: We report an unusual cecal mesenteric DDLPS which was successfully resected by right hemicolectomy. The results suggest that DDLPS should be considered in the differential diagnosis of patients presenting with a spindle cell neoplasm in the mesentery.

An Unusual Case of Systemic Inflammatory Myofibroblastic Tumor with Successful Treatment with ALK-Inhibitor.

Systemic inflammatory myofibroblastic tumor is an exceedingly rare entity. A 45-year-old Hispanic female presented with a 6-month history of left-sided thigh pain, low back pain, and generalized weakness. PET/CT scan revealed abnormal activity in the liver, adrenal gland, and pancreas. MRI of the abdomen demonstrated two 6-7 cm masses in the liver. MRI of the lumbar spine demonstrated lesions in the L2 to L4 spinous processes, paraspinal muscles, and subcutaneous tissues, as well as an 8 mm enhancing intradural lesion at T11, all thought to be metastatic disease. A biopsy of the liver showed portal tract expansion by a spindle cell proliferation rich in inflammation. Tumor cells showed immunoreactivity for smooth muscle actin and anaplastic lymphoma kinase 1 (ALK1). Tissue from the L5 vertebra showed a process histologically identical to that seen in the liver. FISH analysis of these lesions demonstrated an ALK (2p23) gene rearrangement. The patient was successfully treated with an ALK-inhibitor, Crizotinib, and is now in complete remission. We present the first reported case, to our knowledge, of inflammatory myofibroblastic tumor with systemic manifestations and ALK translocation. This case is a prime example of how personalized medicine has vastly improved patient care through the use of molecular-targeted therapy.

Treatment of conjunctival papillomata with topical interferon Alfa-2b.

PURPOSE: Two patients with biopsy-proven conjunctival papillomata exhibited complete resolution after treatment with topical Interferon Alfa-2b (IFNalpha2b). DESIGN: Interventional case reports. METHODS: Two patients with monocular biopsy-confirmed conjunctival papillomata were treated with IFNalpha2b, 1 million units/cc, one drop four times daily until clinical resolution was achieved. RESULTS: (Patient 1) The lesion's size was significantly reduced at 1 month. Complete resolution was noted at the 3-month visit. No recurrences were seen 40 months post-treatment. (Patient 2) The lesion completely resolved after 6 weeks of treatment. No recurrence has occurred 18 months post-treatment. No systemic or local side effect of treatment was noted. CONCLUSIONS: Two sizable conjunctival papillomata resolved using topical IFNalpha2b alone. Interferon is usually not considered effective for large solid tumors without surgical debulking. We realize that this is a limited case series, but these cases may serve as a basis for further investigation.