RESUMO
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.
RESUMO
INTRODUCTION: Esophageal perforation is a rare and severe complication following transesophageal echocardiography (TEE) that carries high morbidity and mortality rates. Management of these perforations usually requires complex open surgeries. We present the case of an esophageal perforation following TEE treated with a combined approach of upper endoscopy and left cervicotomy. PRESENTATION OF CASE: An 80 y/o male patient underwent a diagnostic TEE for mitral regurgitation. After discharge patient consulted back on the same day to the Emergency Department and a perforation of the cervical esophagus was diagnosed associated to an air-fluid collection in the mediastinum. The patient was treated with endoscopic closure of the perforation and left cervicotomy for mediastinal drainage. Patient was discharged home on POD 31 after full recovery. A written consent was previously obtained, and Institutional Review Board approval was not needed. DISCUSSION: Although not frequently seen, complications following TEE can be devastating if not diagnosed and treated early. Endoscopic closure of an esophageal perforation is a safe and feasible option with the already known advantages of a minimally invasive approach. Surgeons should have high suspicion if a patient present with characteristic symptoms after an uneventful procedure. CONCLUSION: Esophageal perforation is a very rare complication of TEE. High suspicion is mandatory to reach prompt diagnosis and install effective treatment. Primary closure of the perforation is the treatment of choice, and the endoscopic approach is a safe and feasible option in high volume centers.
