Consumption of raw and mildly processed seafood, in the context of modern Western world eating trends, is recognized as a major driver for human fish-borne infections. However, these zoonoses and their unfamiliar risks remain neglected and underappreciated among European diagnosticians. In contemporary Europe anisakidosis is one of the most important fish-borne zoonoses. It is caused by ingesting the third-stage infective larvae of the nematode parasites that belong to the family Anisakidae. The case described herein, is an intestinal and ectopic form of anisakiosis (Anisakis spp.), causing symptoms of subacute abdomen and masquerading as an intraperitoneal malignancy. It is the first anisakidosis case reported in Greece, affecting a young patient who had been repeatedly exposed to the parasite by consuming homemade raw fish. Right hemicolectomy, omentectomy and excision of a descending colon nodule were uneventfully performed. The pathology report confirmed granulomatous tissue with eosinophilic infiltration and parasites that were morphologically and molecularly identified as Anisakis spp. Although challenging, acquiring an accurate diagnosis of anisakidosis can prevent unnecessary surgery, as the infection typically is self-resolving, and if treatment is deemed necessary, it can be limited to antiparasitic medication. However, in rare cases, extra-gastrointestinal migration of larvae can cause severe damage with practically unknown risks, posing a diagnostic and therapeutic dilemma. In such a clinical case scenario, surgical exploration can decisively contribute to a definitive diagnosis and early identification of intraabdominal complications necessitating surgical intervention.

Extra-gastrointestinal stromal tumors (EGISTs) are rare mesenchymal tumors accounting for less than 1% of total gastrointestinal tumors. They tend to be aggressive and have a poor prognosis. Unfortunately, there is a lack of data or controversial data due to its scarcity. Therefore, we report a case of pelvic EGIST misdiagnosed as retroperitoneal sarcoma. We opted for surgical management followed by adjuvant oral chemotherapy with imatinib.

Malignant gastrointestinal neuroectodermal tumor (GNET) is an extremely rare soft tissue sarcoma and has been designated as a new entity recently. At present, GNET virtually exclusively occurs in the gastrointestinal tract. Here we report a case of extra-GNET that arose in the right heart. A 62-year-old male complained of chest distress and breathing difficulty while lying down at night for over 1 month at admission. The radiological findings revealed an occupying lesion involving the right atrium and the right ventricle without any abdominal abnormalities. The patient then underwent a surgical resection. Microscopically, neoplastic cells proliferated in the pattern of nests and sheets with fibrous separation. Focal areas with cellular dyscohesion imparted a vague pseudopapillary pattern. These tumor cells were small to medium in size with fine chromatin and predominantly pale eosinophilic cytoplasm. The nuclei were typically round to oval with somewhat irregular contours and contained small nucleoli. The mitotic figures were easily found. Immunohistochemically, the neoplastic cells were positive for S100 and SOX-10 but negative for HMB-45, A103, and CD99. EWSR1-AFTF1 rearrangement was detected by fluorescence in situ hybridization and further confirmed by whole-transcriptome sequence analysis. The patient had pulmonary metastasis 8 months later and soon died of the disease. The overall survival of the patient was 20 months. In summary, we reported an extremely rare case of cardiac GNET, indicating that the location of GNET should not be confined to the GI tract as initially defined. Due to the lack of a specific effective treatment and the occurrence of early metastasis, cardiac GNET conferred a poor prognosis. More clinical and experimental studies are warranted to better manage this disease in the future.

UNASSIGNED: Extra-gastrointestinal stromal tumors are group of soft tissue neoplasm, which originates outside the gastrointestinal tract comprising of less than 5% of the total gastrointestinal stromal tumors.
METHODS: A 67 years old male came with a history of vague abdominal pain, discomfort and loss of appetite. Per abdominal examination showed a palpable firm mass which was filling both the flanks. Radiological imaging revealed a large abdomino-pelvic mass with central necrotic areas. Exploratory laparotomy was done and the mass was excised intact from the sigmoid mesocolon. Histopathological diagnosis was given as extra-gastrointestinal stromal tumors.
UNASSIGNED: Extra-gastrointestinal stromal tumor was first described by Miettinen et al. in 1999. The tumor can arise from the pleura, omentum, mesentery, retroperitoneum and prostate. The clinical presentation of the tumor depends on its location and the size of tumor. Patients with these tumors present with abdominal pain, followed by abdominal mass and distention. These tumors show pathological, immunohistochemical and molecular biological characters similar as that of gastrointestinal stromal tumor.
CONCLUSIONS: Extra-gastrointestinal stromal tumor is a rare tumor and can reach to a considerable large size before presenting with clinical symptoms especially if the tumor arises from the mesocolon. IHC study plays an important role to reach to the final diagnosis as the tumor can mimic mesothelioma in routine staining.

Gastrointestinal stromal tumors (GISTs) are uncommon tumors; accounts for 0.1% to 3% of all gastrointestinal neoplasm. Most common site of involvement is stomach (60-70 %), small intestine (20-30 %) and rarely at extra-gastrointestinal sites like omentum and mesentery called as extra-gastrointestinal stromal tumor (EGIST). Diagnosis is based on characteristic histological findings and expression of transmembrane receptor tyrosine kinase protein (CD 117) derived from activated c-kit gene. Herein, we report a case of GIST of small intestine presented as mesenteric mass in a 35- year-old female and discuss review of literature.