Giant dedifferentiated liposarcoma of the gastrocolic ligament:A case report

BACKGROUND Dedifferentiated liposarcoma(DDLS)has a worse prognosis and occurs most commonly in the retroperitoneal region and rarely in the intraperitoneal region.Histological diagnosis was revolutionized by the combined contributions of histoimmuno-chemistry and molecular biology.Aside from surgery,there is no consensus on the optimal treatment for this chemoresistant cancer.CASE SUMMARY A thirty-year-old black female presented with a large painful abdominal mass occupying nearly the entire abdomen and progressive weight loss was admitted for surgery.Abdominal computed tomography showed a large heterogeneous mass of the mesentery that was sized 18 cm×16 cm in size and had heterogeneous contrast enhancement.During laparotomy,en bloc excision of the large and multilobulated gastrocolic ligament mass was performed.The initial postoperative histopathological diagnosis was undifferentiated sarcoma.Finally,the results of immunohistochemistry and molecular biology allowed us to confirm the diagnosis of DDLS.The tumour followed an aggressive evolution with diffuse metastasis,causing the death of the patient less than 5 mo after the operation.CONCLUSION Dedifferentiated liposarcomas are rare tumours that typically originate in the retroperitoneum but may arise in unexpected locations.

Gastrocolic fistula in Crohn’s disease detected by oral agent contrast-enhanced ultrasound: A case report of a novel ultrasound modality

BACKGROUND Fistulas are common complications of Crohn’s disease(CD).Gastrocolic fistulas(GFs)are rare,occult and potentially life-threatening complications.Few cases of GFs have been reported.Oral agent contrast-enhanced ultrasound(OA-CEUS)is a novel technique of ultrasound(US)for gut.Contrast agent made by Chinese yam is taken orally to dilate the lumen of the upper gastrointestinal tract.Thus,the impediment of gas inside gastrointestinal tract is removed and a good acoustic window is provided for gastroin-testinal tract scanning.This paper describes a case of GF secondary to CD detected by OA-CEUS when it was missed by endoscopy and computed tomography(CT).To our knowledge,this is the first report of GF secondary to CD detected by OA-CEUS up to date.CASE SUMMARY A 29-year-old woman with a 6-year history of CD was admitted to our hospital for abdominal pain and diarrhea for 5 months without obvious predisposing causes.Initial gastroscopy failed to show any evidence of lesions.Colonoscopy revealed multiple erosions,mucosal nodularity,linear ulcers and a cobblestone appearance.A CT scan of her abdomen showed a complex multilocular structure adherent to the greater curvature of the stomach in her left lower abdomen,with fluid,gas and significant surrounding inflammation.CT also demonstrated an abdominal abscess,which was later treated with US-guided drainage.Colonoscopy,gastroscopy and CT missed the presence of a GF.OA-CEUS was performed.A contrast agent made from Chinese yam was taken orally to dilate the lumen of the gastrointestinal tract.A good acoustic window was provided for gastrointestinal tract scanning and the impediment of gas inside the gastrointestinal tract was removed.With the aid of the“window”,a canal with hypoechoic wall was identified connecting the greater curvature of stomach to the splenic colon flexure in free sections.We also observed the hyperechoic gas flowing dynamically inside the canal.Thus,a GF was suspected.US is the first imaging modality taking GF into account.At the same time,OA-CEUS identified the site of the fistula and its two orifices.Gastroscopy was performed again,revealing a small ulcer approximately 5 mm in diameter,which was considered as an orifice.On the basis of OA-CEUS and other examinations,the patient was diagnosed with a GF secondary to CD.Then,laparoscopic exploration,partial stomach resection,transverse colostomy and abdominal abscess drainage were performed.The patient recovered uneventfully.CONCLUSION GFs are rare,occult and potentially life-threatening complications in CD.US is one of the first-line modalities to evaluate CD and its complications.OA-CEUS,a novel technique of US for gut,may be helpful in reducing the possibility of a missed diagnosis of GF.

Endoscopic closure of a gastrocolic fistula using the over-the-scope-clip-system

Gastrointestinal (GI) defects such as fistulas and leaks can be potentially closed endoscopically using hemo-clips and loops. However, hemoclips may not allow for closure of large defects and they do not exert enough tensile force to keep fibrotic defects larger than 5 mm approximated. Herein we present a case of successful endoscopic closure of a gastrocolic fistula in a severely malnourished patient with complex post-surgical upper GI anatomy. We strongly believe that this device is a major breakthrough for the management of various types of discontinuity defects or fistulas. In addition, we show the usefulness of placing a direct jejunostomy using the double balloon enteroscopy (DBE) technique during the same procedure. The concept of providing direct jejunal feedings while allowing for upper gas-trointestinal bowel rest to promote the healing of the minimally invasive endoscopic operation is novel. Thus, our case is unique and exemplifies the utility of mini-mally invasive endoscopic endoluminal surgery.

Evaluation of the diagnostic value of tumor markers with ROC and logistic regression in gastrocolic tumors

Objective: The aim of the study was to evaluate the clinical significance of multiple tumor markers (CEA, AFP, CA72-4 and CA19-9) in patients with gastrocolic tumors by receiver operating characteristic (ROC) curve and stepwise logistic regression (LR) analysis. Methods: The serum concentrations of CEA, AFP, CA72-4 and CA19-9 were measured with electrochemiluminescence immunoassay in 126 patients with gastrocolic tumors, 137 patients with benign gastrocolic disorders and 109 healthy controls. The area under the ROC curve (AUC) of CEA, AFP, CA72-4 and CA19-9 and stepwise LR results were compared by sensitivity, specificity, Youden's index and positive likelihood ratio/negative likelihood ratio. Results: The levels of four tested tumor markers in patients with gastrocolic tumors were significantly higher than those in benign gastrocolic group and normal controls. In the benign gastrocolic group, the AUC from stepwise logistic regression was larger than the AUC of four tumor markers respectively. Sensitivity, Youden's index and positive likelihood ratio/negative likelihood ratio were the highest in the combination assay of CA72-4, CEA, and CA19-9, as compared with one of the tumor markers alone. Conclusion: The use of ROC established by LR analysis model improved the diagnostic accuracy of gastrocolic tumors. For the screening of gastrocolic tumors, the AUC value of the combination probability index (sensitivity and specificity) was significantly higher than the values of the different tumour markers.