Rationale:Malignant myopericytoma is extremely rare, with a few cases described in the English literature.Patient concerns:This novel study aimed to report a case of malignant myopericytoma with cancer cachexia arising in the left armpit. Also, it presented a review of the English literature regarding primary malignant myopericytoma, aiming to clarify the clinical features and potentially curative treatment. A 56-year-old male presented with an ulcerated and smelly mass involving her left armpit. The patient had obvious symptoms of cancer cachexia, including emaciation, anemia, and lower extremity edema.Diagnoses:Computer tomography (CT) scan demonstrated a mass in the left armpit, with no evidence of metastasis according to the chest CT, abdominal ultrasound, and emission CT. The patient underwent a core biopsy of the mass, and a diagnosis of malignant myopericytoma was rendered.Interventions:He received 2 standard courses of theprubicin combined with ifosfamide chemotherapy regimen with no tumor response. Then, he subsequently underwent complete excision of the tumor.Outcomes:The symptoms of cancer cachexia disappeared gradually after operation. Recurrence and metastasis were not shown during follow-up for 5 years.Lessons:Myopericytoma are generally considered benign with an indolent clinical course, and a few reports have described malignant myopericytoma in the literature. No standard treatment is available, and complete surgical excision of the lesion may be the only potentially curative treatment. The efficacy of chemotherapy and radiation is uncertain.

By introducing minimally invasive surgery the rate of postoperative morbidity in esophageal cancer patients could be reduced. But esophagectomy is still associated with a relevant risk of postoperative morbidity and mortality. Patients often present with nutritional deficiency and sarcopenia even at time of diagnosis. This study focuses on the influence of skeletal muscle index (SMI) on postoperative morbidity and mortality. Fifty-two patients were included in this study. SMI was measured using computer tomographic images at the time of diagnosis and before surgery. Then, SMI and different clinicopathological and demographic features were correlated with postoperative morbidity. There was no correlation between SMI before neoadjuvant therapy (p = 0.5365) nor before surgery (p = 0.3530) with the short-term postoperative outcome. Regarding cholesterol level before surgery there was a trend for a higher risk of complications with lower cholesterol levels (p = 0.0846). Our findings suggest that a low preoperative SMI does not necessarily predict a poor postoperative outcome in esophageal cancer patients after esophagectomy but that there are many factors that influence the nutritional status of cancer patients. To improve nutritional status, cancer patients at our clinic receive specialized nutritional counselling during neoadjuvant treatment as well as after surgery.

INTRODUCTION: Selective internal radiation therapy (radioembolization) with yttrium-90 (Y-90) resin microspheres is an effective and increasingly popular treatment option for unresectable primary and metastatic liver malignancies. Gastric complications are detected in 4% to 27% of liver radioembolization cases. Most of these cases arise from non-targeted flow of microspheres with aberrant deposition into various non-selected organs. The gastroduodenal artery is routinely embolized prior to deposition Y-90 microspheres to decrease the risk of non-targeted dissemination of the microspheres. We present a rare case of duodenal ulcer which developed as a result of ischemia induced by embolization of the gastroduodenal artery. CASE DESCRIPTION/METHODS: A 68 year-old woman with a history of stage IV colon adenocarcinoma with metastasis to the liver presented to the hospital with a several week history of severe abdominal pain two months after receiving radioembolization therapy with Y-90 microspheres. She was found to have a duodenal ulcer and was treated with acid suppression therapy. She was re-evaluated six months later for severe abdominal pain. Repeat endoscopy showed a larger duodenal ulcer with multiple coils eroding through the center of the ulcer bed suggesting ischemic injury caused directly from the embolization coils. She was treated with acid suppressive therapy with resolution of her symptoms. DISCUSSION: Radioembolization with Y-90 microspheres is now a widely performed locoregional treatment for primary and metastatic liver lesions not amenable to resection. Our case is unique because the patient’s duodenal ulcer was likely ischemia-induced from mechanical occlusion of and direct injury to the gastroduodenal artery from the embolization coils. It is imperative that clinicians caring for patients who have received radioembolization therapy be familiar with the many gastrointestinal complications associated with this therapy. There is increasing awareness of radiation-induced mucosal injury in the literature. However, providers should also know that despite the presence of multiple collaterals in the gastroduodenal territory, chronic coil-induced ischemia can also form ulcers as a complication of selective embolization of the gastroduodenal artery.