Open Access Case Report

Sarcomatoid Carcinoma of Mid Thoracic Esophagus – A Rare Variant in Esophageal Cancers

Niaz Hussain Soomro, Umm-e-Habiba Abdul Rauf, Mehwish Haneef, Qurratulain Chundriger, Karim Rizwan Nathani

Asian Journal of Case Reports in Surgery, Page 6-11

Aims: Sarcomatoid squamous cell carcinoma is the rarest variant of squamous cell carcinoma, which is more common at layrnx, hypopharynx, nasal cavity or oral cavity and only rarely encountered in the esophagus. Hence we present a case of sarcomatoid squamous cell carcinoma of mid esophagus which was difficult to diagnose and manage because of its rarity in our region.

Case Presentation: We report a case of sarcomatoid squamous cell carcinoma of mid esophagus which was initially diagnosed as gastrointestinal stromal tumor (GIST) of esophagus on endoscopic biopsy. After discussion with the multidisciplinary team of tumor board, McKeown esophagectomy was done. Final histopathology of the resected specimen turned out to be a sarcomatoid squamous cell carcinoma of the esophagus.

Discussion: Sarcomatoid carcinoma (SC), also known as polypoid squamous cell carcinoma or spindle cell carcinoma (SpCC), is a rare variant. It has dual histopathological appearances, i.e., either dysplastic squamous epithelium with an invasive spindle cell component, or dual epithelial and spindle cell morphology within the invasive tumor. Data published till date mostly have described this variant of squamous cell carcinoma according to histopathological perspectives. In this case report, we have described this rare variant, which will add to the current knowledge of clinical presentation and treatment of this rare entity.

Conclusion: Limited data regarding management and prognosis of this disease, increases the necessity of further investigation on the risk factors and prognostic indicators of this disease.

Open Access Case Report

Kikuchi Fujimoto Disease – A Diagnostic Challenge

Sushil Deshpande, Dinesh Kulkarni

Asian Journal of Case Reports in Surgery, Page 17-20

Kikuchi-Fujimoto Disease is an extremely rare entity characterized by subacute necrotizing lymphadenitis and frequently associated with fever. It is known to have a worldwide distribution with higher prevalence among Japanese and other Asiatic young individuals. The clinical, histopathological and immunohistochemical features appear to point to a viral etiology, a hypothesis that still has not been proven and the cause remains uncertain. It is generally diagnosed on the basis of an excisional biopsy of affected lymphnodes. Early diagnosis with excisional lymph node biopsy is crucial as this disease can be mistaken for Systemic Lupus Erythematosus (SLE) or lymphoma and to avoid unnecessary investigations. The treatment is only symptomatic unless complicated, where steroid therapy is considered. Kikuchi’s disease has an excellent prognosis with almost no risk. Because of the rarity and difficulty in diagnosis, we thought of publishing the case.

Open Access Case Study

Thoracic Ectopia Cordis: Cardiothoracic Surgeon’s Perspective

Klein Dantis, Vineet Mahajan

Asian Journal of Case Reports in Surgery, Page 1-5

Thoracic ectopia cordis is a rare congenital abnormality with a complete partial displacement of the heart outside the thoracic cavity. Prognosis is poor and depends on the severity of intracardiac defects. With its high mortality and <5% survival rate, management is challenging. Here we report a case of ectopic cordis in a pre-term newborn presented with a heart totally outside the thoracic cavity without pericardium protection. Due to the lack of antenatal diagnosis, cardiopulmonary complications and poor prognosis, we accepted masterly inactivity. This approach was best for the family, society and other available resources. Unfortunately, Neonate succumbed to death within 24 hours of life.

Open Access Case Study

Ileo-Sigmoid Knot: A Case Report

Mounir Bouali, Abdessamad Elazhary, Abdelilah Elbakouri, Khalid Elhattabi, Fatimazahra Bensardi, Abdelaziz Fadil

Asian Journal of Case Reports in Surgery, Page 12-16

Introduction and Importance: The ileo-sigmoid knot is a rare entity of intestinal occlusion by strangulation. It is a surgical emergency whose delay in management exposes to digestive necrosis and high mortality. 

Materials and Methods: Our work is a retrospective case report with a descriptive aim concerning a patient operated for retrocecal hernia within the department of general surgery of CHU Ibn Rochd Casablanca      

Case presentation: We report the case of a 53-year-old male, who has an occlusive syndrome with abdominal pain. On physical examination, we noted a slightly distended abdomen with generalized abdominal tenderness. Abdominal CT scan detected a moderate amount of intraperitoneal fluid effusion. The first jejunal loops were flat and well raised by contrast injection, while the downstream small intestine was distended and poorly raised. The straight, transverse and descending segments of the colon, as well as the rectum, were normally positioned and aerated, but the sigmoid colon was not clearly visualized. The patient was operated, surgical exploration had found a liquid of intestinal suffering of medium abundance which was evacuated and removed; with a volvulus of the last hail and the cecum around the sigmoid in the form of a knot. Since the hail and the sigmoid colon were viable the patient benefited from a simple detorsion with sigmoidopexy.

Clinical discussion: The ileo-sigmoid volvulus, or ileo-sigmoid knot (NIS) is a "knot" created by a volvulus of the sigmoid colon and small intestine, specifically the ileum. It was first described by Parker in 1845 to explain the development of the ISK. Treatment is based on the resection of necrotic intestinal segments with anastomosis or stoma, detorsion and sigmoidopexy are recommended in the rare cases where there is no necrosis.

Conclusion: The ileo-sigmoid knot is a rare but potentially fatal cause of acute intestinal obstruction. Lack of knowledge of the condition and diagnostic difficulties have contributed to high morbidity and mortality. Only early diagnosis and prompt management can optimize the survival of these patients.

Open Access Case Study

Fungal Gastric Ulcer Perforation in an Immunocompetent Individual: A Rare Case Report and Review of Literature

Vishal Salam, Dhanabir Thangjam

Asian Journal of Case Reports in Surgery, Page 21-26

Fungal infection of gastrointestinal tract is frequent in immunocompromised patients and rare in an otherwise healthy individual. Gastric perforation commonly occurs as a complication of peptic ulcer disease. Other causes include  prolonged intake of Nonsteroidal Anti-inflammatory Drugs, steroid abuse, neoplastic diseases. Gastric perforation due to secondary Candida albicans  infection is exceedingly rare. We  present a hypertensive 70 year old lady presenting in emergency department with peritonitis. She was taken up for emergency laparotomy. Intra-operatively gastric ulcer perforation was found and repaired with Graham’s omental patch repair. Edge biopsy findings was consistent with fungal etiology showing hyphae of Candida albicans. We concluded that fungal infection can cause gastric ulcer perforation beside a much-discussed H. pylori infection. So, a high index of suspicion is needed to rule out fungal infection as a possible etiology.