Lymphoepithelioma-Like Gastric Carcinoma and Gastric Involvement of Chronic Lymphocytic Leukemia: Two Rare Identities Coexisting in One Patient.

Lymphoepithelioma-like gastric carcinoma (LELGC) constitutes 1-4% of all gastric carcinomas and gastrointestinal involvement in leukemia can be present in up to 25%, being more common in acute than chronic leukemia, affecting most frequently the stomach, ileum, and proximal colon. LELGC is usually associated with a better prognosis than other gastric carcinomas, generally presenting with low T and N stages. The reports of chronic lymphocytic leukemia (CLL) involving infiltration of the gastrointestinal tract are relatively rare in the literature, and the estimated incidence ranges from 5.7% to 25%. We present the case of a 77-year-old female, on surveillance by a known CLL that was diagnosed with gastric carcinoma on an esophagogastroduodenoscopy (EGD) performed for epigastric pain. A subtotal gastrectomy was performed and the surgical specimen revealed simultaneous involvement of the stomach by LELGC and CLL. To the best of our knowledge, this is the first reported case of a LELGC and CLL simultaneously involving the stomach.

Distal Pancreatectomy for Solid Pseudopapillary Tumor of the Pancreas: A Case Report.

Solid pseudopapillary tumor (SPT) of the pancreas is a rare tumor, sometimes asymptomatic, mainly affecting young females. It has a low malignant potential, and its complete surgical resection with free margins is the treatment of choice, offering an excellent prognosis. We present the case of a 43-year-old healthy female who was referred to the surgery department for a large abdominal mass found in the abdominal ultrasound. In the course of the study of this mass, an abdominal CT with fine needle aspiration (FNA) was performed, revealing a solid pseudopapillary tumor of the tail of the pancreas. A laparotomic distal pancreatectomy with total splenectomy was performed. A grade B pancreatic fistula occurred on the third postoperative day, and she was released on postoperative day 11. Histopathology study revealed a 10 cm solid pseudopapillary tumor of the pancreas, with cavities filled with hematic content and limited by a partially calcified capsule. SPT is a rare and indolent tumor. Prognosis is highly favorable after an adequate surgical resection, hence the importance of a precise preoperative diagnosis. Therefore, it is important to choose the most appropriate surgical strategy for each patient.

Transvaginal Resection of a Rectal Gastrointestinal Stromal Tumor: A Case Report.

Gastrointestinal stromal tumors (GISTs) are a type of mesenchymal tumors. They are rare in rectum. This location is a surgical challenge due to the high morbidity after aggressive surgeries. We present the case of an 81-year-old female with a high-grade GIST treated with transvaginal excision and adjunctive therapy with imatinib. The postoperative period was uneventful without anal dysfunction. Within the types of surgical treatment available, transvaginal excision is an acceptable procedure in lesions located in the rectovaginal region.

Hemoperitoneum secondary to mesenteric laceration after abdominal trauma - Case report.

Mesenteric laceration is an uncommon cause of hemoperitoneum, with nonspecific signs and symptoms and frequently is camouflaged by the signs of other traumatic lesions. There is a high risk to go unnoticed increasing morbidity and mortality. We report a case of a 43-year-old man, who was involved in a motorcycle accident, with thoraco-abdomino-pelvic trauma, but without evidence of intra-abdominal lesions on exams, with exception of hemoperitoneum. Due to hemodynamic instability, it was performed an exploratory laparotomy. Intraoperative findings were mesenteric lacerations affecting a small bowel segment. This case demonstrates that a high index of suspicion is necessary to diagnose and treat lesions like mesenteric laceration, not visible early on imaging but potentially fatal, with high risk of complications.

Case series of Fournier's gangrene: Affected body surface area - The underestimated prognostic factor.

OBJECTIVES: Identifying the factors affecting the outcome of patients with Fournier's Gangrene and assaying the accuracy of the Fournier Gangrene Severity Index (FGIS), the Uludag score (UdS), affected Body Surface Area (BSA) and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) model as prognostic tools. MATERIALS AND METHODS: Retrospective study involving all patients with Fournier's gangrene treated in our Hospital between January 2008 and December 2015. The epidemiological, clinical, biochemical and management data of these patients was obtained and analyzed. RESULTS: The series includes 19 patients, 14 male and 5 female, with a median age of 70 (62; 78,5) years. The mortality rate was 21%. From the data analyzed, only the affected BSA (BSA>3.25%) was associated with mortality (p = 0.016). None of the established scores (FGSI; UdS; LRINEC) proved to be a useful tool for predicting mortality. The combination of affected BSA and FSGI (FGSI≥9 or BSA>3.25%), (p = 0.004) and the combination of the affected BSA and the LRINEC model (LRICEC≥8 and BSA>3.25%), (p = 0.004) led to a major improvement in these scores. CONCLUSIONS: Affected BSA is a useful prognostic factor in Fournier's gangrene. The existing prognostic scores can be improved with the introduction of this factor.