Gastric leiomyosarcoma is a rare type of tumour that is far less prevalent than gastrointestinal stromal tumours. We describe a case of a 42-year-old male patient who consulted for upper abdominal pain. Blood work revealed low haemoglobin levels, requiring red blood cell transfusions. An esophagogastroduodenoscopy was performed, showing a submucosal tumour with central ulceration in the greater gastric curvature. The patient underwent an endoscopic ultrasound with fine needle biopsy and the sample showed a spindle cell neoplasia. Computed tomography scan demonstrated absence of distant metastases. Upon multidisciplinary consensus, it was decided to perform surgery. A laparoscopic approach was conducted, where no peritoneal lesions were observed. Transgastric resection of the tumour was performed. Free tumour margins were achieved following oncologic criteria (minimum tumour manipulation and one-piece resection without damaging the tumour capsule). After exhaustive sampling, the final pathology report informed an 11 × 9 × 5 cm gastric leiomyosarcoma. Immunohistochemical examination showed positivity with smooth muscle actin, muscle-specific actin, calponin and desmin. The patient had an uneventful recovery, and 6 post-operative months' clinical, tomographic and endoscopic control informed no disease recurrence. To the best of our knowledge, there are less than 20 published cases of patients with diagnosis of gastric leiomyosarcoma. This study highlights the importance of reporting this entity, in order to contribute to the available literature concerning this topic.
Highlights
Thoracic complications after spilled gallstones are rare
Thoracic consequences of a spilled gallstone should be considered in every patient with thoracic symptoms and history of cholecystectomy
Dropped stones are associated with a low risk of complications but of high morbidity, especially in immunosuppressed patients
Documentation and a high index of suspicious are fundamental to speed diagnosis and treatment
Introduction
Adrenal glands are a common site of metastasis for several types of malignancies. Nevertheless, bilateral metastasis leading to adrenal insufficiency is a very rare presentation.
Presentation of case
We present a 62-year-old woman with previous history of colorectal cancer and bilateral adrenal metastasis associated with primary adrenal insufficiency. The patient underwent bilateral open adrenalectomy after a multidisciplinary tumour board evaluation.
Conclusion
The incidence of adrenal insufficiency may be underestimated in patients with a history of cancer. Adrenal function must be evaluated in those patients presenting with bilateral adrenal masses and hormonal replacement therapy should be considered, if appropriate. In selected cases, bilateral adrenalectomy can give a possible therapeutic option for patients with confined disease to the adrenal glands.
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