Nodular Fasciitis of the breast – An uncommon benign reactive proliferative lesion

Nodular fasciitis is rarely reported in breast. It is benign reactive proliferative lesion of fibroblast. A 65 year old female presented to surgical department for left breast mass since 2 months duration, rapidly enlarging without any regional lymphadenopathy. Mammography showed hyperdensity masses with irregular margin. On FNAC reported as benign spindle cell lesion. Left sided two breast masses measuring 4 x 3.3 x 2.5cm and 2.0 x 1.6 x 0.5cm were excised and on histopathology reported as Nodular Fasciitis of left breast. We are presenting this extremely rare case of nodular fasciitis of breast for its clinical, radiological and histopathological findings.

EP.FRI.986Life threatening bleeding duodeno-jejunal flexure GIST successfully managed with surgery- Case report

Introduction Gastrointestinal stromal tumours (GISTs) are sarcomas and the most common non-epithelial cancers of the GI tract. Patient A 77-year old man with life threatening melaena, drop in haemoglobin from 109 to 71 in 24 hours and hypotension. Co-morbidities included COPD, chronic microcytic anaemia, type 2 Diabetes mellitus and hypertension. Anaemia for 9 years had been investigated with OGD and colonoscopy showing no pathology. Calculated Rockall score was 6. An Urgent Oesophagogastroduodenoscopy showed normal findings with no source of bleeding identified. An urgent CT angiography demonstrated a vascular blush at duodenojejunal (DJ) flexure identified as the source of bleeding. Four units of was blood transfused preoperatively. The bleeding source was not embolisable. He underwent an initial diagnostic laparoscopy to confirm the site of the lesion and ascertaining whether resection and anastomosis would be visible. Findings at laparoscopy included a DJ flexure lesion. A midline mini-laparotomy, wedge resection of the lesion with a hand-sewn anastomosis was performed. He had a prolonged hospital stay with gastroparaesis and high nasogastric tube output. Histology showed a well-demarcated, lobulated bland spindle cell lesion. The tumour is composed of cells with mainly blunt ended nuclei. There is strong positive staining to CD117 and DOG-1. There is focal positive staining to Desmin and SMA. The tumour is negative for S100 AND but Pankeratin. Overall, MDT felt that this was a 30mm DJ flexure GIST with less than 5 mitoses per 50mm2. R1 achieved resection but with a low risk (4.3%) of recurrence based on the histological characteristics.

Double-Stage Complete Removal of Dumbbell-Shaped Trigeminal Schwannoma: 3-Dimensional Operative Video

Intracranial trigeminal schwannomas are rare tumors.1-4 The aim of this 3-dimensional operative video is to present a double stage complete removal of a dumbbell-shaped trigeminal schwannoma. This is a 25-yr-old male with headaches, diplopia, and facial pain. The MRI shows a big tumor located at the level of the cerebellopontine angle, petroclival region, and middle fossa. Because of the size of the tumor and its growth within the cerebellopontine angle, we decided to operate the patient in two stages. For the first surgery, the patient was in a semi-sitting position, and a retrosigmoid approach was performed. The second surgery was performed 2 mo after the first operation in a supine position for a pretemporal transzygomatic approach. The pathological study was reported as a schwannoma, and the histological findings were spindle cell lesion with a storiform pattern and histiocytes. The patient evolved without neurological deficit after the surgeries, and the postoperative MRI shows a complete resection of the tumor. The patient gave the consent to use the images and surgical video. Preoperative imaging plays an important role in diagnosis and surgical planning.3-6 For these cases of trigeminal schwannomas with a large extension in the posterior fossa and middle fossa, we believe that the most prudent thing is to perform the surgery in 2 stages.3

Multiple Gastric Antrum Mucosal Schwann Cell Hamartoma on Incidental Screening Gastroscopy: A Case Report

Background：Mucosal Schwann cell hamartoma (MSCH) is a newly recognized neural lesion of the gastrointestinal (GI) tract. MSCHs are mostly solitary and occur in the colon and rectum. We present a case with multiple MSCHs arising in gastric antrum.Case presentation：A 49-year-old woman with atrophic gastritis was accidentally found to have multiple mucosal protrusion lesions in the gastric antrum during endoscopic follow-up. Biopsy specimens revealed a spindle cell lesion in the lamina propria with positive reaction to the S-100 and SOX-10 protein. The final diagnosis was MSCH.Conclusions: MSCH is a benign mucosal spindle cell lesion of the GI tract and does not associate with inherited syndromes. It is most commonly seen in the colorectum, but can also be found in stomach and gallbladder. In this case, MSCH occurred in gastric antrum with multiple lesions. MSCH is benign lesion and successive treatment, work-up and follow-up are unnecessary.

Histomorphological spectrum of gastrointestinal stromal tumors – An institutional experience in a series of seven cases

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the abdominal area. They can involve any portion of GI tract, omentum, mesentery, retroperitoneum, and other sites. The tumor is seen to be arising from interstitial cell of Cajal, the pacemaker cells of the GI muscularis propria. About 60% of GISTs occur in stomach. More than 95% of GISTs are positive for immunohistochemical marker Crohn’s disease (CD) CD117. Still in 5% of cases, CD117 expression is not found. Although, in these cases, staining with discovered on GIST-1 (DOG1, also known as ANO1) can be helpful in confirming the diagnosis of GIST histomorphological diagnosis remains the gold standard diagnostic modality with CD 117 positivity leading to more confirmation. Tumor size and mitotic count remain the main factors in the risk categorization of tumors. Furthermore, every spindle cell lesion should undergo CD117 immunohistochemistry markers as an initial workup.