Merkel Cell Carcinoma with Gastric Metastasis, a Rare Presentation: Case Report and Literature Review.

INTRODUCTION: Merkel cell carcinoma (MCC) is an infrequent, but highly aggressive neuroendocrine neoplasm of the skin with a propensity for recurrence and metastasis. We report a rare case of gastric metastatic localization of this cancer by focusing on the diagnostic, clinical, and surgical approach to the patient. CASE REPORT: Clinical presentation begins with a peripheral lymphadenopathy whose immunohistochemical characterization identifies the lymphatic dissemination of the disease. Gradually, the patient develops a severe anaemic state which requires several blood transfusions and surgical gastric resection to remove a large bleeding lesion of the antral region. The histopathological analysis of the specimen confirms the metastatic origin from MCC, but the primitive lesion remains unknown. DISCUSSION: Since this clinical situation is very rare, we conducted a review of the literature selecting the few cases reported, in order to evaluate the current knowledge on this topic. Metastatic involvement of the stomach from Merkel cell carcinoma is a rare presentation of this disease progression with a frequent delay in formulating the correct diagnosis and in further treatment which may be life-threatening for the patient. As regards the local treatment, there is no specific guideline, and the therapeutic indication should be tailored on the specific case.

The rare Ogilvie's Syndrome in pregnancy. How to manage? A case report and literature review.

Acute colonic pseudo-obstruction, or Ogilvie's syndrome (OS), is a complication in gynaecology and obstetrics. Its occurrence during pregnancy is rare, redefining the therapeutic decision-making and treatment options. In this review we describe the case of a 37-year-old pregnant patient who developed OS at the 30th week of gestation. A laparotomy with colonic decompression was performed. Foetal condition, regularly monitored throughout the hospital stay, remained normal. The patient experienced an uncomplicated, natural delivery at 40 weeks. A comprehensive literature search, describing the occurrence of OS during pregnancy, was conducted. We identified six cases of OS arising during pregnancy. Demographic, clinical, diagnostic and therapeutic features were analysed. Non-surgical management is generally the first-line option, with intravenous drug administration, rectal and nasogastric tube positioning and colonoscopic decompression the treatments of choice. Surgical decompression in usually performed in cases of failure of the first-line treatments. Including our own experience, in all cases, neither maternal nor foetal mortality was reported. A conservative approach is mandatory as first-line treatment, but when prompt resolution is not achieved, a multidisciplinary team, involving the gynaecologist/obstetrician, the surgeon, the radiologist and the intensivist is mandatory to avoid diagnostic delays, thereby reducing morbidity and mortality rates.

Duodenal Obstruction in a Patient Previously Treated With EndoVascular Aneurysm Sealing System Repair.

The Nellix® endovascular aneurysm sealing system (EVAS) is a relatively novel approach for the treatment of abdominal aortic aneurysms (AAAs). We present herein a case of duodenal obstruction (DO) which occurred following an EVAS treatment for the repair of an AAA. A 77-year old man was admitted to our hospital with acute abdominal pain and recurrent vomiting. Computed tomography (CT) revealed a retroperitoneal 66 × 59 × 90 mm (antero-posterior, AP; latero-lateral, LL; cranio-caudal: CC) solid mass located in the epigastrium, corresponding to the infrarenal abdominal aortic aneurysm sac, previously treated by EVAS. An exploratory laparotomy was performed, which revealed a retroperitoneal mass compressing the third and fourth parts of the duodenum. A gastroenteroanastomosis was performed in order to bypass the duodenal obstruction. An extensive search of biomedical literature databases was conducted to identify similar cases. To our knowledge, this is the first reported case of DO following an AAA repair with EVAS.