Gastric balloon: A rare cause of lumbar radiculopathy

Background: Factors that are known to cause lumbar epidural venous plexus (EVP) engorgement include inferior vena cava (IVC) obstruction, portal hypertension, vascular agenesis, morbid obesity, and/or hypercoagulable states. Here, we present a 32-year-old female admitted with the new onset of lumbar radiculopathy attributed to a gastric balloon causing compression of the IVC and engorgement of the EVP. Case Description: A 32-year-old female was admitted with a left L5 radiculopathy. She had a history of morbid obesity and had undergone intragastric balloon insertion 4 months ago. The abdominal/pelvic CT documented an intragastric balloon producing a voluminous gastric mass with resultant compression of the IVC. The lumbar MRI showed the resultant marked multilevel engorgement of the lumbar EVP. Here, following balloon removal, the patient was immediately symptom free and remained asymptomatic over the next postoperative year. Conclusion: An intragastric balloon can produce a voluminous gastric mass that can result in IVC occlusion and engorgement of the EVP, leading to lumbar radiculopathy. Removal of the balloon results in immediate and permanent resolution of the compressive symptoms.

Heavily Calcified Gastrointestinal Stromal Tumour of Stomach: A Diagnostic Dilemma

Gastrointestinal stromal tumours (GIST) are the most common mesenchymal tumour of gastrointestinal tract and the stomach being the most commonly involved organ. Focal calcification may be seen in GIST but prominent or heavy calcification is rare. Gastric mass with prominent calcification on imaging may create a diagnostic dilemma. We present a rare case of gastric GIST with heavy calcification in a 55 years old female presenting with abdominal lump. Computed tomography (CT) showed a large heterogenous juxta gastric mass with solid-cystic component with heavy calcification. She underwent laparotomy and en-bloc gastric sleeve resection with the mass. Microscopic examination showed tumour with spindle cell and calcification with mitotic index of 6/50 High power field. Immunoreactivity with Vimentin, CD34 and DOG 1 confirmed diagnosis of GIST. Dystrophic calcification of necrotic or degenerative tissue is thought to be cause of calcification in GIST. Very few cases of heavily calcified GIST have been reported in literature, our case is of interest because presence of solid cystic component and a huge size ~ 14 cm (longest diameter).

Synchronous gastric cancer and primary lymphoma of right adrenal gland: a case report

This report presents an extremely rare case of synchronous gastric cancer and primary adrenal diffuse large B-cell lymphoma (DLBCL). An 82-year-old man underwent computed tomography, which revealed a heterogeneous appearing and hypodense adrenal mass and a gastric mass with no enlarged lymph nodes in the neck, mediastinum, abdomen, and inguinal region. Upper gastrointestinal endoscopy revealed a protruding gastric tumor. The specimens obtained from endoscopic biopsy were histologically confirmed to be adenocarcinoma. The hormonal findings eliminated functional adrenal tumor. The patient underwent distal gastrectomy with regional lymph node resection for gastric cancer and incisional biopsy of the adrenal mass. Based on the pathological findings, diagnoses of mixed mucinous and tubular adenocarcinomas of the stomach and adrenal DLBCL were confirmed. Postoperation, the patient received rituximab combined with low-dose doxorubicin, cyclophosphamide, vincristine, and prednisone (R-miniCHOP). Six courses of R-miniCHOP were planned, but were completed in only one course at the patient’s request. The patient died 2 months after surgery.

Gossypiboma - A Diagnostic Dilemma

A surgical sponge is the most common type of retained foreign body (RFB) also known as a gossypiboma (gossypium = cotton, boma = concealment). It is mostly asymptomatic but can lead to a host of symptoms in the patient ranging from pain in the abdomen to anorexia and weight loss. It poses a diagnostic challenge not just for the surgeon but also the radiologist as it can mimic an intraabdominal mass. Here we present a case of a 58 yrs old male who presented with dysphagia and abdominal pain on and off who was radiologically diagnosed as a case of gastric mass and subsequently underwent exploratory laparotomy where it was proven to be a gossypiboma. The case attempts to highlight the importance of keeping gossypiboma as a differential diagnosis for patients with vague abdominal pain and history of a surgery in the past. Key words: gossypiboma, sponge, abdominal pain, computed tomography, foreign body.

Rare Case Report of Primary Gastric Melanoma

Gastric melanomas are usually metastatic, and primary is almost rare entity. Present case is a rare malignant melanoma of the gastric region with barely reported cases in the literature. A 65 year old male presented with pain abdomen and melena He was evaluated with relevant investigation. UGI endoscopy and PETCT shows large polypoidal irregular gastric mass in the proximal curvature extending upto gastroesophageal junction. Endoscopic biopsy a ulcero-infiltrating tumour, Individual cells are large, round, having moderately pleomorphic, hyperchromatic nuclei with prominent eosinophilic nucleoli and moderate eosinophilic cytoplasm. Immunohistochemistry of S100 and HMB45 was positive and negative for CK7 and CK20. Early diagnosis of primary gastric melanoma allows for better prognosis of the patient from the right intervention.