Retroperitoneal blue cell round tumor (Ewing sarcoma in a 35 years old male)- case report.

INTRODUCTION: Ewing sarcoma is a highly aggressive tumor. It's common presentation is primary bone tumor, but very rarely as soft tissue sarcoma both of which are under the spectrum of Ewing sarcoma family of tumors (EFT). CASE PRESENTATION: A 35 years old male who presented with advanced locally spreading tumor. He was diagnosed after presenting with epigastric pain and melena, CT abdomen revealed the retroperitoneal mass. CT guided core biopsy taken and was diagnosed as Ewing sarcoma. The patient presented with mass already grown so he was not a surgical candidate. Patient was managed symptomatically till he was sent for palliative care in a Sarcoma centre in Jordon and passed away on October 2021. DISCUSSION: Ewing Sarcoma family of tumors are group of small round blue cell tumors that are histogenetically related. The better known is Ewing 's sarcoma (EWS). It is a malignant small blue round cell tumor with variable degree of neuroectodermal differentiation. Retroperitoneal tumor are mostly malignant and accounts for one third of soft tissue sarcoma. They usually present as large masses at the time of the diagnosis. So they do not produce symptoms until they grow large enough to compress or invade contagious structures. CONCLUSION: ES-EWS is an aggressive tumor with high incidence of local recurrence and distant metastasis that's why is was given its poor prognosis characteristic. Multimodality treatment including surgical resection, chemotherapy and High dose radiotherapy will help in better survival rate.

Intracardiac Penetrating Injury with Right Femoral Artery Embolism due to Blast Injury.

Embolization due to blast injury with projectiles entering the bloodstream from the heart is a rare event that is unlikely to be suspected during the initial assessment of trauma patients. We report a case in which a missile penetrating the heart chambers managed to embolize and occlude the right common femoral artery. This was successfully managed by means of a multidisciplinary approach that included exploration, cardiorrhaphy, and embolectomy.

Gallstone ileus obstructing within an incarcerated lumbar hernia: an unusual presentation of a rare diagnosis.

We describe an unusual case of a 74-year-old woman who presented with signs and symptoms of small-bowel obstruction and a clinically appreciable, irreducible, left-sided lumbar hernia associated with previous iliac crest bone graft harvesting. Palpation of the hernia demonstrated a small, firm mass within the loops of herniated bowel. CT scanning recognised an intraluminal gallstone at the transition point, establishing the diagnosis of gallstone ileus within an incarcerated lumbar hernia. The proposed explanatory mechanism is that of a gallstone migrating into an easily reducible hernia containing small bowel causing obstruction at the hernia neck by a ball-valve mechanism, resulting in proximal bowel dilation and thus hernia incarceration; it remains unclear when the stone entered the hernia, and whether it enlarged in situ or prior to entering the enteral tract. This is only the second reported instance in the literature of an intraluminal gallstone causing hernia incarceration.

Preoperative re-endoscopy in colorectal cancer patients: an institutional experience and analysis of influencing factors.

BACKGROUND: This study serves to establish the re-endoscopy rate in patients undergoing surgery for colorectal cancer (CRC) at a tertiary academic center and to identify significant factors that may influence the decision for preoperative re-endoscopy. METHODS: A retrospective review of 341 consecutive patients undergoing elective surgical resection for CRC was performed from January 2008 to December 2011. Descriptive statistics were used to define the patient population and to establish the institutional re-endoscopy rate. In order to identify factors associated with re-endoscopy, univariate and multivariate analysis was performed using the chi square test and logistic regression modeling. RESULTS: Patients within the two comparison groups had similar demographic profiles. Excluding patients where the primary endoscopist was the operating surgeon, 121 of 299 patients (40.5%) underwent re-endoscopy. The most common reasons for re-endoscopy included tattooing of the lesion in 55 patients (45.5%), surgical planning in 43 (35.5%), and repeated therapeutic attempts in 11 (9%). Significant factors associated with re-endoscopy included left-sided colon cancers (compared to right-sided lesions, P < 0.001), planned laparoscopic procedures (P = 0.011), and the absence of a tattoo on the first colonoscopy (P = 0.010). There was also a trend toward a reduction in re-endoscopy if the operating surgeon was consulted at the time of the initial endoscopy (P = 0.085). There was a clear trend toward increased laparoscopic procedures over the duration of the study (P < 0.001). Although this did not correlate with an increase in re-endoscopy, it did coincide with a significant increase in preoperative tattooing at the first colonoscopy (P < 0.001). CONCLUSIONS: The repeat preoperative endoscopy rate in CRC patients was 40.5%. Re-endoscopy was associated with an initial failure to tattoo the lesion, left-sided colonic neoplasms, and a planned laparoscopic resection. Further research is needed to help identify which patients would benefit from re-endoscopy and where this may be safely omitted.