Gastrothorax: A case of mistaken identity.

INTRODUCTION: Acute wrap failure post fundoplication is a rare but recognized complication and can be due to patient factors, disease factors and surgical factors. Herniation of the stomach into the thorax can mimic a pneumothorax clinically and radiologically and thus lead to bad outcomes for patients. PRESENTATION OF CASE: We report the case of a 20-year-old male who presented to the emergency department with progressively worsening upper abdominal pain, nausea and vomiting followed by acute onset dyspnoea, six days post a laparoscopic repair of a small hiatus hernia and a Nissen fundoplication. His chest x-ray was consistent with that of a left sided pneumothorax and was therefore, appropriately resuscitated and treated with an intercostal catheter (ICC). A subsequent CT scan of the chest revealed a left gastrothorax. The patient was taken to theatre for the surgical reduction of the paraoesophageal hernia. DISCUSSION: Patients with a recent history of anti-reflux surgery, who present with a pneumothorax and respiratory distress or a tension pneumothorax should always be treated with an ICC. However, follow up imaging with a CT scan is essential to confirm diagnosis. Good control of post- operative nausea and vomiting is essential in avoiding wrap failure and ensuing complications. CONCLUSION: A high index of suspicion for a gastrothorax mimicking a pneumothorax is important in the setting of recent anti-reflux surgery.

Aggressive Angiomyolipomas: the Clandestine Epithelioid Variant.

Epithelioid angiomyolipoma is a rare mesenchymal derived neoplasm of the kidney. Thought to be a variant of classical angiomyolipoma, a benign tumour, its malignant potential has been highlighted by case reports of loco-regional and distant metastasis. Given the potentially adverse clinical course associated with epithelioid angiomyolipoma compared to classical angiomyolipoma, the distinction and comprehensive histological characterisation of this rare entity is essential.

Is it really an abscess? An unusual case of metastatic stromal cell sarcoma of the prostate.

INTRODUCTION: Prostatic stromal sarcomas account for about 0.1% of all prostatic malignancies. Local recurrence into bladder, seminal vesicles and rectum has been documented. Distal metastasis, has so far only been reported in lung and bone. PRESENTATION OF CASE: We report the case of a 42 year old man with a subcutaneous metastatic deposit of a prostatic stromal cell sarcoma 5 years after radical prostatectomy. Additional staging with CT- and PET-scan showed lymph node involvement in the neck and left axilla. A core biopsy of the skin lesion was undertaken, of which the histology revealed a low grade spindle cell tumour that was morphologically identical to a previously diagnosed prostatic stromal sarcoma. DISCUSSION: In literature distant metastases to the lung and bone have been documented before. This is the first documented case of a subcutaneous metastasis of prostatic stromal cell sarcoma. CONCLUSION: The preferred treatment for prostatic stromal cell sarcoma is surgery by radical prostatectomy or cystoprostatectomy. There is currently not enough literature on the topic to elucidate the role of chemo- or radiotherapy in loco-regional or distant spread.