Malignant fibrous histiocytoma of the stomach during pregnancy: a case report

Rapid growth of metastatic brain tumor from gastric undifferentiated pleomorphic sarcoma: A case report

Background:

Brain metastasis from undifferentiated pleomorphic sarcoma (UPS) is a rare occurrence, and its clinical course is little known. In this report, we investigate a case of a rapidly growing brain metastasis from gastric UPS.

Case Description:

An 82-year-old man with a known gastric tumor, pathologically compatible with UPS, underwent partial gastrectomy at an outside facility. 3 months later, a 4-cm brain tumor was detected, which was completely resected. The patient was diagnosed with metastatic tumor from previously treated gastric UPS. Within 2 months of the initial resection, a large recurrent mass was detected in the same location, which was again removed. Although the patient underwent radiotherapy and chemotherapy for other metastatic tumors, he died 5 months after the second craniotomy.

Conclusions:

Brain metastasis from gastric UPS is rare and difficult to treat. Although aggressive treatment, such as surgical intervention, may improve patient survival in some cases, the timing of treatment is challenging because cerebral metastasis rapidly grows and and patients frequently suffer from synchronous systematic metastasis. Therefore, early detection and close follow-up of rapidly progressing brain metastasis are important to improve treatment outcomes.

Maternal and Fetal Outcomes in Pregnancies affected by Bone and Soft Tissue Tumors

Objective  This study was aimed to describe perinatal outcome of a cohort of pregnant patients with bone and soft tissue tumors and to compare the current series with our group's previously reported experience. Methods  Pregnant women diagnosed before and during pregnancy were identified, retrospectively, for the years 2004 to 2014. Relevant maternal and neonatal data were collected. Results  Forty-eight patients were identified. Ten cases were diagnosed during pregnancy. Pelvis, abdomen, and extremities were the most common tumor locations. Osteosarcoma, liposarcoma, and Ewing's sarcoma were the most common histological types and comprise more than 50% of the cases. Metastases occurred in nine cases. Most of the cases (60%) were treated surgically during pregnancy and delivery occurred at term. Chemotherapy was delayed until after delivery. There were no perinatal or infant deaths. Patients presented with advanced maternal disease in 18% in previous report (1983-2003) versus 40% in present report (2004-2014). Metastases were present in 40% and maternal death rate was approximately 20% in both cohorts. Conclusion  Pregnant women with bone and soft tissue tumors are candidates for standard surgical management during pregnancy. Other treatments, such as chemotherapy and radiotherapy must be evaluated for each woman on a case-by-case basis. Iatrogenic prematurity was common in our findings.

A case of primary gastric undifferentiated high-grade pleomorphic sarcoma diagnosed with chief complaint of fever: a case report and literature review

BACKGROUND

Undifferentiated high-grade pleomorphic sarcoma in gastrointestinal tract is extremely rare, and its prognosis is poor.

CASE PRESENTATION

An 82-year-old man visited a previous hospital complaining of fever, general fatigue, and shaking chill, for which he received antibiotics therapy. As the fever continued, he was referred to our hospital, where computed tomography and upper gastrointestinal endoscopy showed a 6-cm gastric tumor. A preoperative biopsy was consistent with a malignant mesenchymal tumor, but could not provide a definitive pathological diagnosis nor prove a cause-and-effect relationship between the chief complaint and the gastric tumor. The gastric tumor had grown to 8 cm in diameter within a month so we performed a partial gastrectomy. The pathological postoperative diagnosis was undifferentiated high-grade pleomorphic sarcoma that produced granulocyte colony-stimulating factor. The patient's fever quickly improved, and he showed a good postoperative course.

CONCLUSIONS

We herein report a case of rapidly growing, undifferentiated, high-grade pleomorphic gastric sarcoma, which presented as a chief complaint of fever.

A case of primary malignant fibrous histiocytoma of the duodenum

BACKGROUND

Primary malignant fibrous histiocytoma (MFH) of the duodenum is rare and a distinct clinical entity.

CASE REPORT

A 55-year-old man presented with a history of upper gastrointestinal bleeding, vomiting and decreased body weight over the past 2 months. Abdominal exam showed an epigastric mass of 10 cm. An upper gastrointestinal endoscopy documented a tumor in the third part of duodenum. The histopathological examination of biopsy has concluded a MFH. Abdominal CT revealed a large and heterogeneous mass of 10 cm in the third part of the duodenum. The intervention was conducted by way of a bi-subcostal laparotomy. Exploration of the tumor revealed involvement of the third part of duodenum. This lesion adhered and invaded the inferior vena cava. A palliative procedure using a gastro-entero-anastomosis was carried out with uneventful postoperative course. Neither adjuvant chemotherapy nor radiotherapy were conducted. The patient died four months following his operation.

CONCLUSION

The biological behavior of malignat fibrous histiocytomas is extremely aggressive and mainly conditioned by size and histological grading. The treatment of choice, whenever possible, is based on early and complete surgical excision of the tumor.

Malignant fibrous histiocytoma during pregnancy: a case report

OBJECTIVE

We present a case of a 38-year-old postpartum woman who had antepartal undiagnosed sarcoma with multiple metastasis. Although the patient underwent aggressive treatment with surgery and chemotherapy, she died 3 months after the vaginal delivery of a healthy female infant weighing 2,090 g at 35 weeks of gestation.

CASE REPORT

The patient had right shoulder pain and mild chest discomfort during the last trimester of the pregnancy. Six days after delivery, she came to our emergency room because her pain had become more severe. A humeral neck tumor with bone destruction was found in the right shoulder on X-ray. After detailed evaluation, right humeral surgery, cardiac surgery, and liver biopsy were performed. All the removed specimens were sent for pathologic examination, and the results showed a sarcoma favoring malignant fibrous histiocytoma with its primary origin in the left atrium.

CONCLUSION

Obstetricians should be aware that any non-specific complaint may be due to severe disease. It is better to evaluate all symptoms and signs that persist. In this case, early intervention such as radiologic imaging of the bone or echocardiography could have been performed during pregnancy to prevent tumor spread, maternal morbidity, and even death.

Primary malignant fibrous histiocytoma of the small bowel: a report of an additional case in duodenum

AIMS

We report herein an additional case of primary malignant fibrous histiocytoma (MFH) in the duodenum and provide a review of the existing literature.

METHODS AND RESULTS

A 61-yr-old Chinese man was admitted to our hospital with symptoms of melena, anorexia, and weight loss. An abdominal computed tomography (CT) and gastrointestinal barium meal examination demonstrated a tumor of the duodenum suggestive of primary malignancy. The tumor was successfully treated by pancreaticoduodenectomy. It was histopathologically and immunohistochemically diagnosed to be a storiform-type primary MFH of the duodenum. There have been a total of 40 cases of primary malignant fibrous histiocytoma of the small bowel documented in the literature including our Chinese cases.

CONCLUSION

Primary malignant fibrous histiocytoma of the small bowel, especially in the duodenum is extremely rare. The final diagnosis is made only after pathological and immunopathological examination of the tumor. The malignant potential of such tumors is high. The prognosis may be mainly dependent on the invasion and metastasis of tumor, while tumor size is irrelevant. The treatment should be surgery if possible. Early surgical intervention may be the best form of management that may offer the patient good result.

Gastric and duodenal ulcers during pregnancy

The frequency, symptoms, and complication rate of PUD seem to decrease during pregnancy. Yet clinicians often have to treat dyspepsia or pyrosis of undetermined origin during pregnancy because the frequency of pyrosis significantly increases during pregnancy, and clinicians reluctantly perform EGD during pregnancy for pyrosis to differentiate reliably between GERD and PUD. Dyspepsia or pyrosis during pregnancy is initially treated with dietary and lifestyle modifications. If the symptoms do not remit with these modifications, sucralfate or antacids, preferably magnesium-containing or aluminum-containing antacids, should be administered. Histamine2 receptor antagonists are recommended when symptoms are refractory to antacid or sucralfate therapy. Ranitidine seems to be a relatively safe H2 receptor antagonist. If symptoms continue despite H2 receptor antagonist therapy, the patient should be evaluated for possible EGD or PPI therapy. Pregnant women with hemodynamically significant upper gastrointestinal bleeding or other worrisome clinical findings should undergo EGD. Indications for surgery include ulcer perforation, ongoing active bleeding from an ulcer requiring transfusion of six or more units of packed erythrocytes, gastric outlet obstruction refractory to intense medical therapy, and a malignant gastric ulcer without evident metastases.