Acute abdomen: Rare and unusual presentation of right colic xanthogranulomatosis

Xanthogranulomatous inflammation(XGI)is a disease of unknown origin,most frequently described in the kidney and gallbladder;its localization in the colorectal tract is extremely rare.The extension of the typical inflammatory process to the surrounding tissues may lead to misdiagnosis as cancer.We report the case of a 56-year-old woman presenting to the Emergency Department with pain,increased levels ofα1 andα2proteins and C-reactive protein(17.5 mg/dL;normal value 0-0.5),and a palpable mass,localized in the right lower quadrant of the abdomen.A computed tomography scan showed a large right cecal mass with necrotic areas,local inflammation of retroperitoneal fat,and enlargement of local lymph nodes.Because of the high suspicion of colic abscess as well as malignancy and worsening of the clinical condition,the patient underwent right colectomy after 4 d of antibiotic treatment.Pathology revealed xanthogranulomatous inflammation involving the ileocecal valve.We review the reports of large bowel tract XGI in the international literature.

Follow-up after curative resection for gastric cancer: Is it time to tailor it?

There is still no consensus on the follow-up frequency and regimen after curative resection for gastric cancer.Moreover,controversy exists regarding the utility of follow-up in improving survival,and the recommendations of experts and societies vary considerably.The main reason to establish surveillance programs is to diagnose tumor recurrence or metachronous cancers early and to thereby provide prompt treatment and prolong survival.In the setting of gastric malignancies,other reasons have been put forth:(1)the detection of adverse effects of a previous surgery,such as malnutrition or digestive sequelae;(2)the collection of data;and(3)the identification of psychological and/or social problems and provision of appropriate support to the patients.No randomized controlled trials on the role of follow-up after curative resection of gastric carcinoma have been published.Herein,the primary retrospective series and systematic reviews on this subject are analyzed and discussed.Furthermore,the guidelines from international and national scientific societies are discussed.Followup is recommended by the majority of institutions;however,there is no real evidence that follow-up can improve long-term survival rates.Several studies have demonstrated that it is possible to stratify patients submitted to curative gastrectomy into different classes according to the risk of recurrence.Furthermore,promising studies have identified several molecular markers that are related to the risk of relapse and to prognosis.Based on these premises,a promising strategy will be to tailor follow-up in relation to the patient and tumor characteristics,molecular marker status,and individual risk of recurrence.

Breast cancer metastasis to the stomach

Aim: This study focuses on the stomach as an unusual but not rare site of metastasis of breast cancer. Methods: We performed a literature search on gastric metastasis from breast cancer searching for reviews from 2000 to 2018 and case reports from 2013 to 2018. We found 11 reviews and 36 case reports and we compared their findings about important aspects of gastric metastasis, such as disease free survival, overall survival, symptoms, endoscopic findings, therapy, histology, and immunohistochemistry. Results: The incidence of stomach as site of metastasis of breast cancer ranges from 5% to 18%. Reviews and case reports reached similar conclusions about several of the aforementioned aspects: invasive lobular breast cancer (ILC) is mainly responsible for gastric metastases;disease free survival can vary greatly ranging from 0.5 months to 30 years;gastric metastases usually present with non-specific symptoms, even though five patients in case reports were asymptomatic;linitis plastica is the most common endoscopic finding;immunohistochemistry is essential for differentiating primary gastric cancer from metastasis;the preferred treatment is systemic therapy, but surgery is still an option in case of emergency;median overall survival of patients with gastric metastasis from breast cancer is 24 months. Conclusion: Breast metastasis to the stomach should be considered in any patient suspecting gastric neoplasm previously treated for breast carcinoma, especially if the treated carcinoma was ILC.