Gastric schwannoma (GS) is a rare neoplasm of the stomach. It accounts for 0.2% of all gastric tumors and is mostly benign, slow-growing, and asymptomatic. Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors and up to 60-70% of GIST occur in the stomach. Schwannoma and GIST have similar radiological and endoscopic features making it extremely difficult to differentiate them preoperatively. Differential diagnosis of these two submucosal tumors is important because of the malignant potential of GIST and the relatively benign course of gastric schwannomas. This case stresses on the importance of including gastric schwannomas in the differential diagnosis of a submucosal gastric mass as it has the ability to mimic a gastrointestinal stromal tumor, which is a leading differential diagnosis because of its common occurrence at this site.
Primary hepatic lymphoma (PHL) is a very rare malignancy presenting with non specific symptoms leading to late diagnosis. Due to its ability to masquerade other liver tumors, misdiagnosis is common. Here we present a case of a 52 years old man who presented with an incidentally detected SOL in liver with features of atypical hepatocellular carcinoma on imaging and fine needle aspiration cytology. He underwent a left hepatectomy and the final histology was a surprise in the form of hepatic lymphoma. He underwent appropriate chemotherapy post surgery and is asymptomatic at follow up.
Background
The only means of achieving long-term survival in hepatocellular carcinoma (HCC) beyond transplant criteria is complete tumour resection. The limiting factor for curative resection in large HCC is an inadequate future liver remnant (FLR) that might culminate into post hepatectomy liver failure (PHLF). The most common method that has been employed thus far to increase the FLR is portal vein embolization (PVE), which has its own set of drawbacks mainly inadequate hypertrophy, longer duration to achieve adequate FLR and tumour progression in the waiting period. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel upcoming technique that aids in achieving rapid hypertrophy of FLR, thereby facilitating resection of an otherwise unresectable tumour.
Case presentation
The authors present a case of a 46-year-old female with non-metastatic large HCC with inadequate FLR unsuitable for upfront hepatectomy. A two-stage surgical resection with ALPPS technique was preferred over PVE in this patient. This facilitated early hypertrophy of FLR and complete surgical resection of the tumour was performed successfully with an uneventful perioperative period. The patient was disease free at 16 months of follow-up.
Conclusion
ALPPS is a feasible option for otherwise unresectable large HCCs in carefully selected patients with acceptable morbidity.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.