Gastric GIST: A Rare Cause of Upper GI Bleeding

Gastrointestinal stromal tumours are the most common mesenchymal tumours of the gastrointestinal tract. This case report highlights the necessity of early surgical intervention in such cases to avoid mortality due to bleeding and to raise the awareness of rare causes of upper gastrointestinal bleed and their management. A 19 year old male presented in the surgery department of Shaheed Suhrawardy medical College Hospital with complaints of recurrent episodes of melena with anorexia and weight loss for 6 months. Apart from anaemia no significant findings were noted on physical examination. Investigations including upper GI endoscopy was not conclusive. So he underwent laparotomy which revealed an exophytic growth along the lesser curvature. Lower partial gastrectomy was done and histopathological and immunohistochemistry report showed evidence of benign low risk GIST. As the tumor was benign with no malignant potential imatinib therapy was not advocated. J Shaheed Suhrawardy Med Coll 2020; 12(2): 119-122

Bilateral renal metastases from extraskeletal mesenchymal chondrosarcoma of thigh

Mesenchymal chondrosarcoma (MC) is a rare cartilaginous tumour that occurs in the extraskeletal locations in about one-third of cases. It is aggressive in behaviour and may involve the lower extremities, central nervous system or spine. Mesenchymal tumours are known for distant metastasis; however, metastasis to bilateral kidneys after treatment has not been reported earlier. We present a case of a soft-tissue intramuscular MC of the thigh in a 38-year-old patient which had been surgically excised after neoadjuvant chemotherapy. The patient presented with bilateral dense calcified renal masses after 6 years, which were cytologically proven as MC metastases. In the evaluation of bilateral calcified renal masses in patients with a history of MC, metastasis should be considered.

Analysis of the Diagnostic Effect of EUS-RTE on Giant Cystic Tumours of the Oesophagus Based on Cluster Analysis

This paper presents an in-depth analysis and study of the diagnostic effectiveness of EUS-RTE in giant cystic tumours of the oesophagus utilizing cluster analysis. A new form of interval data expression was designed based on the cluster analysis algorithm, as well as a new way of updating the cluster radius and cluster centre. Feature triads are defined, eliminating the need to access all historical data at the time of update. It also prevents the case of overfusion of clusters and outputting only one cluster. If there exist a very low number of clusters, the newly merged clusters are reclustered according to the density clustering method for the internal data objects based on the cluster segmentation so that the data objects in the same cluster have a high similarity as possible. All accumulated electronic files of oesophageal cancer cases were collected and comprehensively organized, and all clinical data of 129 eligible cases with a total of 356 consultations were screened in strict accordance with inclusion and exclusion criteria. A database of oesophageal cancer cases was established using Visual FoxPro software, and frequency distribution, cluster analysis, association rule, and chi-square test were used to focus on mining the association between symptoms, disease mechanisms, prescriptions, and medications. The results were analysed and summarized. Overall, the therapeutic efficacy and safety of the three groups of treatment modalities for gastric mesenchymal tumours were positive, and the preoperative endoscopic treatment modalities should be selected based on the EUS-RTE characteristics of the tumour, the site, and the operator’s skill level in a comprehensive manner.

Management of Lower Limb Soft Tissue Sarcomas with Major Neurovascular Involvement: Current and Future Perspectives

Lower limb soft tissue sarcomas are a group of rare mesenchymal tumours that may grow in close anatomical proximity to major neurovascular structures, leading to significant oncological and surgical challenges for treating physicians. This article reviews the current literature on the multidisciplinary approach of treating lower limb soft tissue sarcomas with neurovascular involvement and describes the increasing shift towards limb-sparing surgeries, with an emphasis on improved functional outcomes based on a multimodal treatment approach. In addition to identifying the histological subtype of the tumour, classifying the neurovascular involvement precisely is key in planning the appropriate treatment. Existing classification systems for both vascular and neural involvement are discussed, and a combined neurovascular classification is proposed together with a general treatment algorithm.

A rare case of rectal bleeding and Fusobacterium mortiferum sepsis due to solitary fibrous tumour originating from the mesentery

Solitary fibrous tumours (SFTs) are rare mesenchymal tumours that are mostly seen in the pleura. Lately, they have also been described in other locations. Recent discovery of the NAB2-STAT6 fusion gene which is specific for SFTs has led to an accurate diagnosis of SFTs. The occurrence of SFTs in the mesentery is very rarely reported in the literature. We report a case of a 63-year-old female who presented with abdominal pain, rectal bleeding and Fusobacterium bacteraemia, who was ultimately found to have a mesenteric SFT.

Application of first-order feature analysis of DWI-ADC in rare malignant mesenchymal tumours of the maxillofacial region

Background To research the first-order features of apparent diffusion coefficient (ADC) values on diffusion-weighted magnetic resonance imaging (DWI) in maxillofacial malignant mesenchymal tumours. Methods The clinical data of 12 patients with rare malignant mesenchymal tumours of the maxillofacial region (6 cases of sarcoma and 6 cases of lymphoma) treated in the hospital from May 2018 to June 2020 and were confirmed by postoperative pathology were retrospectively analyzed. The patients were all examined by 1.5T magnetic resonance imaging. PyRadiomics were used to extract radiomics imaging first-order features. Group differences in quantitative variables were examined using independent-samples t-tests. Results The voxels number of ADCmean and ADCmedian of sarcoma tissues were 44.9124 and 44.2064, respectively, significantly higher than those in lymphoma tissues (ADCmean (− 68.8379) and ADCmedian (− 74.0045)), the difference considered statistically significant, so do the ADCkurt and ADCskew. Conclusions The statistical difference of ADCmean and ADCmedian is significant, it is consistent with the outcome of the manual measurement of the ADC mean value of the most significant cross-section of twelve cases of lymphoma. Development of tumour volume based on the ADC parameter map of DWI demonstrates that the first-order ADC radiomics features analysis can provide new imaging markers for the differentiation of maxillofacial sarcoma and lymphoma. Therefore, first-order ADC features of ADCkurt combined ADCskew may improve the diagnosis level.

Patients with mesenchymal tumours and high Fusobacteriales prevalence have worse prognosis in colorectal cancer (CRC)

ObjectivesTranscriptomic-based subtyping, consensus molecular subtyping (CMS) and colorectal cancer intrinsic subtyping (CRIS) identify a patient subpopulation with mesenchymal traits (CMS4/CRIS-B) and poorer outcome. Here, we investigated the relationship between prevalence of Fusobacterium nucleatum (Fn) and Fusobacteriales, CMS/CRIS subtyping, cell type composition, immune infiltrates and host contexture to refine patient stratification and to identify druggable context-specific vulnerabilities.DesignWe coupled cell culture experiments with characterisation of Fn/Fusobacteriales prevalence and host biology/microenviroment in tumours from two independent colorectal cancer patient cohorts (Taxonomy: n=140, colon and rectal cases of The Cancer Genome Atlas (TCGA-COAD-READ) cohort: n=605).ResultsIn vitro, Fn infection induced inflammation via nuclear factor kappa-light-chain-enhancer of activated B cells/tumour necrosis factor alpha in HCT116 and HT29 cancer cell lines. In patients, high Fn/Fusobacteriales were found in CMS1, microsatellite unstable () tumours, with infiltration of M1 macrophages, reduced M2 macrophages, and high interleukin (IL)-6/IL-8/IL-1β signalling. Analysis of the Taxonomy cohort suggested that Fn was prognostic for CMS4/CRIS-B patients, despite having lower Fn load than CMS1 patients. In the TCGA-COAD-READ cohort, we likewise identified a differential association between Fusobacteriales relative abundance and outcome when stratifying patients in mesenchymal (either CMS4 and/or CRIS-B) versus non-mesenchymal (neither CMS4 nor CRIS-B). Patients with mesenchymal tumours and high Fusobacteriales had approximately twofold higher risk of worse outcome. These associations were null in non-mesenchymal patients. Modelling the three-way association between Fusobacteriales prevalence, molecular subtyping and host contexture with logistic models with an interaction term disentangled the pathogen–host signalling relationship and identified aberrations (including NOTCH, CSF1-3 and IL-6/IL-8) as candidate targets.ConclusionThis study identifies CMS4/CRIS-B patients with high Fn/Fusobacteriales prevalence as a high-risk subpopulation that may benefit from therapeutics targeting mesenchymal biology.

Cytogenetic Study Of Peripheral Blood Leukocytes In Patients With Uterine Mesenchymal Tumors

According to the World Health Organization, uterine tumours rank second in the structure of oncological morbidity in women. Epithelial tumours account for 95% of all genital tumours and only 5% are mesenchymal tumours. Malignant mesenchymal tumours include uterine sarcomas. Annually, 10 cases of uterine sarcomas are diagnosed in 1 million women worldwide. The problems of early diagnosis and screening of malignant uterine mesenchymal tumours (sarcomas) have not yet been solved. Due to the fact that this disease is rare and the treatment of uterine sarcomas remains a pressing problem.