A gastric sarcoma from 3000 years ago: paleopathological diagnosis at the field

OBJECTIVE

Ancient remains tell a lot to those who can solve their mysteries. Mummified remains of individuals have the potential to tell their life stories. Pathological conditions in mummies are identified, commonly, thorough macroscopic inspection and radiological techniques.

PATIENTS AND METHODS

In 2017, a hypogeum tomb was excavated close to the courtyard of Djehuty's tomb (TT11) at the archaeological site of the Spanish Djehuty Project in Luxor (Egypt). In Sector 10, a set of at least 10 mummies were recovered. All showed clear signs of plundering and were found scattered at the site. Wrappings and associated goods indicated that the individuals were from the first half of the 20th dynasty (922 to 888 BCE).

RESULTS

All the individuals were male and from a high social status. Upon removing the individuals for study, two dried stomachs were found. There were clear macroscopic differences. A field histological analysis was performed which revealed that the stomach that showed no alterations, at first glance, presented a pathological pattern that was compatible with gastric sarcoma.

CONCLUSIONS

Malignant diseases are seldom described in Paleopathology; to our knowledge, this is the oldest and most unique case of this type of pathology in mummies worldwide.

Primary Gastric Synovial Sarcoma in a Young Male: a Rare Case Report and Review of Literature

We are reporting a rare case of primary gastric synovial sarcoma in a young male. Synovial sarcoma of the stomach is a very rare tumor. The common involved sites of occurrence of synovial sarcomas are upper and lower extremities. In the English literature, only 47 cases of primary synovial sarcoma of stomach have been reported. Spindle-shaped tumor cells are the basic content of synovial sarcomas with varying degrees of epithelial differentiation. The basic classification of synovial sarcoma depends on the histological pattern and the degree of differentiation and it is classified as monophasic, biphasic, and poorly differentiated. Synovial sarcoma presents with classical chromosomal translocation where they form fusion genes of SS18-SSX1, SS18-SSX2, and SS18-SSX4. Fluorescence in situ hybridization (FISH) and reverse transcription polymerase chain reaction (RT-PCR) are the molecular analysis techniques to detect these fusion genes. As the available literature support is limited, the role of adjuvant chemotherapy, radiation therapy, and intra-operative lymphadenectomy is still unclear. However, surgical resection with clear margin is the gold standard treatment.

Laparoscopic intragastric resection of gastric synovial sarcoma: report of the first ever case with video demonstration

BACKGROUND

Synovial sarcoma (SS) is a rare soft tissue tumor. Among different anatomical locations where it can be found, gastric localization is a very uncommon one. Based on soft tissue sarcoma guidelines, complete tumor excision is considered the main treatment approach. Depending on size and localization of the tumor, both wedge and major gastric resections have been performed in the past for the treatment of this condition.

CASE PRESENTATION

We present the case of a 43-year-old woman who underwent a laparoscopic intragastric excision of a gastric 10-mm SS located nearby the esophagogastric junction. Pathology examination confirmed the presence of a SS. The resected specimen confirmed margin-free excision of a monophasic spindle cell neoplasm invading the submucosa and presenting the rearrangement of SS18 gene at fluorescence in situ hybridization (FISH). No adjuvant treatment was offered, and 18 months after surgery, the patient was alive and disease free.

CONCLUSIONS

This represents the first case reported in literature of a laparoscopic intragastric resection for a gastric SS. This approach allowed to obtain a full thickness radical tumor resection with the advantages of minimally invasive and organ preserving surgery.

Aortic sarcoma mimicking a mycotic aneurysm in the thoracoabdominal aorta

Aortic sarcoma is a rare primary tumor with dismal prognosis. Here, we report a case involving a 74-year-old female patient with aortic sarcoma masquerading as a mycotic aneurysm in the thoracoabdominal aorta. She underwent aortic resection with Dacron prosthetic graft replacement because of rapid growth. The postoperative pathological findings of the resected specimen confirmed the diagnosis of aortic mural sarcoma, which was an unexpected result based on repeat computed tomography angiography performed within 2 months preoperatively. The preoperative diagnosis of aortic sarcoma is often difficult because of its rarity, and this case demonstrates some of the diagnostic pitfalls.