https://mnclhd.intersearch.com.au/mnclhdjspui/handle/123456789/14 2026-05-23T02:02:53Z 2026-05-23T02:02:53Z Wu, M.Y. Martin, O. Kostalas, S. https://mnclhd.intersearch.com.au/mnclhdjspui/handle/123456789/715 2026-03-18T05:30:14Z 2025-08-05T00:00:00Z

Title: Endoscopic freehand full-thickness resection of a gastric leiomyosarcoma initially diagnosed as gastric leiomyoma on endoscopic ultrasound-guided fine-needle biopsy Authors: Wu, M.Y.; Martin, O.; Kostalas, S. Abstract: Background and aims: Gastric leiomyosarcoma is a rare tumor arising from the smooth muscle of the stomach that is genetically distinct from gastrointestinal stromal tumors. To date, there are only 24 documented cases of confirmed gastric leiomyosarcoma, to our knowledge. We present the case of a gastric mass initially diagnosed as gastric leiomyoma based on endoscopic ultrasound-guided fine-needle biopsy histopathology, later reclassified as a primary gastric leiomyosarcoma after endoscopic full-thickness resection. Methods: The lesion was too large to fit into a resection cup and could not be resected using an Ovesco full-thickness resection device system (Ovesco Endoscopy AG, Tübingen, Germany). Resection was subsequently completed with an endoscopic freehand full-thickness resection. Results: The patient was referred to a specialized sarcoma unit, where he underwent laparoscopic gastric fundal resection with clear margins. After complete surgical excision, the patient recovered well, and no additional surgery or adjuvant systemic therapy was required. Conclusions: Gastric leiomyosarcoma may arise from leiomyoma de novo, or through malignant transformation. This case demonstrates that it is important to consider full resection of atypical appearing, large, or enlarging gastric leiomyomas due to the risk of underlying leiomyosarcoma. A leiomyosarcoma can be misdiagnosed as a leiomyoma if the biopsy needle, angled improperly, only samples superficial tissue, and the malignant tissue may reside in deeper layers.

2025-08-05T00:00:00Z Gandy, G. Prudence, A. J. A. Levy, M. T. https://mnclhd.intersearch.com.au/mnclhdjspui/handle/123456789/682 2025-12-17T04:01:05Z 2025-10-28T00:00:00Z

Title: Severe Idiopathic Secretory Diarrhoea With a Profound Sustained Response to Somatostatin Analogues: A Case Report Authors: Gandy, G.; Prudence, A. J. A.; Levy, M. T. Abstract: Background: Chronic secretory diarrhoea is a diagnostic challenge with a broad differential and significant impact on patient's quality of life. While common causes include microscopic colitis, bile acid diarrhoea, and laxative use, rarer aetiologies such as vasoactive intestinal peptide (VIP)-secreting neuroendocrine tumours (VIPomas) must be considered when standard investigations fail. Case presentation: We present a 35-year-old woman with a two-year history of progressively worsening, fasting-persistent, high-volume watery diarrhoea leading to severe electrolyte abnormalities and weight loss requiring resuscitation in intensive care. Extensive biochemical, endoscopic, and radiological investigations-including faecal analysis, colonoscopy, neuroendocrine markers, multiphase CT, endoscopic ultrasound, and Ga-68 Dotatate PET imaging-failed to identify an underlying cause. Serum VIP levels remained within the normal range. Despite the absence of a definitive diagnosis, empirical treatment with the somatostatin analogue octreotide led to rapid and sustained symptom resolution. The patient was subsequently maintained on long-acting lanreotide with complete remission. Notably, diarrhoea recurred upon cessation of therapy, again resolving with reinitiation. After 4 years, the patient self-ceased lanreotide without symptom recurrence, and follow-up imaging remained unremarkable. Discussion: This case highlights a diagnostic dilemma: clinical and biochemical features were highly suggestive of a VIPoma, yet no tumour was identified despite repeated advanced imaging and biochemical workup. The patient's remarkable therapeutic response to somatostatin analogue therapy, in the absence of confirmed neuroendocrine neoplasia, suggests that somatostatin analogues may have a broader role in the management of idiopathic secretory diarrhoea than currently appreciated. Conclusion: We present a rare case of chronic secretory diarrhoea with suspected but unproven VIPoma, demonstrating sustained and reproducible response to somatostatin analogue therapy. This case supports the consideration of therapeutic trials of somatostatin analogues in refractory secretory diarrhoea of unknown origin.

2025-10-28T00:00:00Z Cheng, E. Petrushnko, W. https://mnclhd.intersearch.com.au/mnclhdjspui/handle/123456789/675 2025-12-10T05:35:11Z 2025-09-01T00:00:00Z

Title: Re: Anatomical and clinical variations in the mesoappendix and appendicular arteries. Classifying variations of the mesoappendix Authors: Cheng, E.; Petrushnko, W. Abstract: No abstract available

2025-09-01T00:00:00Z Cheng, E. Shamavonian, R. Mui, J. Bunjo, Z. Matar, A. Sarkar, A. Petrushnko, W. https://mnclhd.intersearch.com.au/mnclhdjspui/handle/123456789/632 2025-04-10T02:41:11Z 2025-03-01T00:00:00Z

Title: Mesoappendix position variations in laparoscopic appendicectomy; a new anatomical classification to guide surgical strategy Authors: Cheng, E.; Shamavonian, R.; Mui, J.; Bunjo, Z.; Matar, A.; Sarkar, A.; Petrushnko, W. Abstract: Dissection of the mesoappendix from the appendix is a crucial step in laparoscopic appendicectomies. Variation in the position of the mesoappendix during this common operation has not been previously described. We propose a classification system for the mesoappendix position seen laparoscopically and evaluate the impact each position has on operative difficulty and surgical approach. The mesoappendix positions in laparoscopic appendicectomies between January 2023 and January 2024 were classified into four categories from M1 to M4. Patients were grouped according to their mesoappendix positions. Outcomes evaluated included operative time, need for additional ports, use of energy devices, deviations from standard operative approach. Various mesoappendix positions were correlated with the intra-operative appendix position and histopathological findings. 104 laparoscopic appendicectomy cases were reviewed. 30 were classified as M1, 31 as M2, 27 as M3, and 16 as M4. Mean operative time was significantly longer for cases where the mesoappendix was in the M3 position (p > 0.001). This position was also more likely to require an additional port and deviate from the standard operative approach including need for retrograde dissection and staple cecectomy. We introduce a potentially surgical important classification system of the mesoappendix in laparoscopic appendicectomies. In this study, we attempt to validate the differences each position has on operative approaches and outcomes. We found that the M3 position is of greater difficulty to approach when dissecting the mesoappendix. This classification may serve as a valuable tool in guiding intra-operative surgical decision-making.

2025-03-01T00:00:00Z