RESUMO
Pneumopericardium (PPC) is a clinical entity defined by the presence of air in the pericardial sac. It occurs mainly in patients who sustain blunt or penetrating chest trauma and may coexist with pneumothorax, hemothorax, rib fractures, and pulmonary contusions. Although it is a strong indicator of cardiac injury and therefore requires immediate attention for possible surgical treatment, it still remains a commonly misdiagnosed condition in the trauma bay. Only a few cases of isolated PPC associated with penetrating chest trauma have been reported to date. We present the case of a 40-year-old man who was stabbed in the anterior chest, specifically in the left subxiphoid area and left forearm. Imaging, which included chest x-ray, chest computed tomography, and cardiac ultrasound, demonstrated the presence of rib fractures in addition to isolated PPC, with no pneumothorax or active bleeding. The patient was managed conservatively and actively monitored for three days and remained hemodynamically stable upon discharge. PPC is an uncommon clinical entity, suggestive of severe thoracic trauma. Clinical features may include chest discomfort and dyspnea, while asymptomatic patients have also been reported. Since it can be monitored by electrocardiograms and cardiac ultrasound, its presence is not an absolute indicator for surgical intervention, while the treatment plan should be based on the patient's clinical indications and symptoms.
RESUMO
BACKGROUND/AIM: Early-stage gastric cancer has a high risk of recurrence, despite trimodality therapy with surgery, chemotherapy and radiation. To improve patient selection for adjuvant chemoradiotherapy, we evaluated the prognostic significance of immunohistochemical and genetic biomarkers in patients with resected gastric adenocarcinoma. PATIENTS AND METHODS: Tumors from 119 patients were subjected to immunohistochemistry for 12 protein biomarkers, as well as next-generation sequencing. Clinical and biomarker data were available for 91 patients. RESULTS: EBV-positive tumors and tumors with mutations had higher intratumoral CD8 tumor-infiltrating lymphocyte density (p=0.009 and p=0.017, respectively). PIK3CA mutations were correlated with VEGFA overexpression (p=0.042), while KRAS mutations and HER2 expression were mutually exclusive (p=0.036). PTEN expression univariately confirmed longer overall survival (HR=0.27; p=0.046), while there was a trend between the presence of KRAS mutations and inferior disease-free and overall survival. CONCLUSION: PTEN protein expression and KRAS mutations may predict disease outcome in early-stage gastric cancer. These results need to be further validated in larger cohorts.
