Abstract
Acute appendicitis is one of the most common emergency surgical procedure, yet atypical presentation sometimes can be challenging for clinician. I present a case of 19-year-old gentleman that initially presented with 1day history of bilateral testicular pain and lower abdominal pain. His past history includes a positive sexual history. Initial ultrasound of the testis showed bilateral orchitis and an equivocal appendix. With a significantly raised inflammatory marker and highly suspicious for appendicitis, a CT scan was obtained which showed perforated appendicitis and the patient underwent laparoscopic appendicectomy with resolution of symptoms after that. We encourage clinician to be aware of this clinical pitfall as patient can sometimes be managed in other department to minimise any delayed diagnosis or any unnecessary procedure
Highlights
Sarcomatoid carcinomas of the lung (SCL) are characterized by a malignant mesenchymal component concurrent with a malignant epithelial component [1]
In 2017, a locally advanced sarcomatoid carcinoma was diagnosed in a 57-year old man (Figure 1)
In a propensity matched model, 63 patients were compared to 62 patients with non-small cell lung cancer (NSCLC) and the 5-year survival for SARC was 24.5% compared to 46.3% in the NSLC group
Summary
Sarcomatoid carcinomas of the lung (SCL) are characterized by a malignant mesenchymal component concurrent with a malignant epithelial component [1]. In 2017, a locally advanced sarcomatoid carcinoma was diagnosed in a 57-year old man (Figure 1) He presented with anemia and melena and was initially diagnosed with a gastric ulcer. Multiple other lesions observed intraoperatively were not observed on the PET scan and emphasize how the true disease burden was underappreciated preoperatively To determine if these lesions were metastases, histopathologic analysis identified a markedly pleomorphic dyshesive neoplasm displaying atypical mitotic figures (Figure 3). Immunohistochemistry of the small bowel segments were found to be diffusely positive for p63 and focally positive for pancytokeratin OSCAR, pancytokeratin AE1/AE3, and EMA staining, while negative for caudal-related homeobox 2 (CDX2), cytokeratin 20 (CK20) and desmin These findings in the staining pattern of the lesions were consistent with the primary lung biopsies, confirming metastatic sarcomatoid carcinoma. The patient is currently alive with disease and his most recent scan demonstrates stable disease for 13 months after bowel resection
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