Median arcuate ligament syndrome: a rare cause of abdominal pain.

MALS, also called celiac artery compression syndrome, celiac axis syndrome, or Dunbar syndrome, is a rare entity caused by progressive stenosis of the celiac trunk secondary to extrinsic compression of the fibers of the median arcuate ligament. The prevalence is unknown, but it is estimated that it is a casual finding in up to a third of autopsies2,3, being more prevalent in women between 30 and 50 years of age4. Symptoms and signs include postprandial abdominal pain, exercise-induced pain, nausea, vomiting, and weight loss3. However, most cases are asymptomatic. The case that we present was a 56-year-old man, with a history of dyslipidemia, type 2 diabetes mellitus, and chronic ischemic heart disease. He was a former smoker. He reported a history of recurrent abdominal pain, especially postprandial.

Gastric Adenomyoma: The Unexpected Mimicker.

Gastric adenomyoma is a rare benign tumor composed of epithelial structures and smooth muscle stroma. Here, we report an unusual case of gastric adenomyoma mostly composed of smooth muscle that was incidentally found during a laparoscopic intervention. On radiology, it mimicked an acquired hypertrophic pyloric stenosis in an adult patient, and pathologically it resembled a pure smooth muscle hamartoma. Complete submission of the lesion for histology was necessary to find the epithelial component and make the right diagnosis. As a mimicker of benign and malignant entities, gastric adenomyoma is usually an unexpected finding after surgery. The aim of this report is to analyze this adenomyoma variant in the setting of an unexplained thickening of the gastric wall, with explanations concerning histogenesis and biological potential.

O Adenomioma gástrico é um tumor benigno raro composto por estruturas epiteliais e por um estroma muscular liso. Aqui apresenta-se um caso invulgar composto maioritariamente por músculo liso, que foi identificado acidentalmente no decurso de uma intervenção laparoscópica. Na imagiologia a lesão simulava uma estenose pilórica hipertrófica adquirida do adulto e na anatomia patológica assemelhava-se a um hamartoma de músculo liso puro. A inclusão total da lesão para análise histológica permitiu encontrar o componente epitelial e o diagnóstico correto. Sendo um imitador de doenças benignas e malignas, o adenomioma gástrico é habitualmente um achado inesperado após a cirurgia. O objetivo da apresentação deste caso é reconhecer esta variante de adenomioma no contexto de um espessamento inexplicável da parede gástrica, com comentários sobre a sua histogénese e potencial biológico.