Ewing's sarcoma (SE) / primitive neuroectodermal tumor (PNET) occurs most often in soft tissues of the extremities and in the paravertebral areas. As far as we know, there are only two other reports in the gallbladder SE / PNET literature, however, this is the first metastatic case in a 58-year-old man. Microscopically, small round cell neoplasms showed intense positive immunoreactive activity for CD99, as well as for neuron-specific enoase and synaphysophine.

Abstract

Background: Acalculous cholecystitis makes up only 5-10% of all acute cholecystitis presentations and typically occurs in unwell patients with comorbidity.

Simpson et al. describe a case of necrotising sialometaplasia – a rare but benign, self-limiting, inflammatory condition that can resemble malignant lesions both clinically and histopathologically.

In this report, Bosa et al. present a case of primary Ewing's Sarcoma in the gallbladder with hepatic metastasis diagnosed via immunohistochemical findings. This primitive neuroectodermal tumor is a rare metastatic finding in the gallbladder in adults.

Cotard syndrome features nihilistic delusions about one’s body or existence and is typically related to severe depression though is rarely associated with medical or neurological insults. The patient was a 62-year-old male with no past psychiatric history and a past medical history of congestive heart failure and consequent renal failure who presented for scheduled heart and kidney transplantation. He was started on routine post-transplant ganciclovir and steroids. Due to postoperative hypotension, empiric cefepime was initiated to cover for septic shock. One week postoperatively, the patient stated “I am dead.”

Necrotising fasciitis is a rapidly progressing soft tissue infection associated with significant morbidity and mortality. We present a case of cervical necrotising fasciitis with mediastinal extension in a diabetic young male who was COVID-19 positive. He presented with a five-day history of left-sided neck swelling which was fluctuant, red and painful. Subsequent debridement and management of the wound were complicated by the comorbid SARS-CoV2 infection due to potential need for proning. This case highlights the complex interplay between the management of two significant conditions; the surgical approach to necrotising fasciitis and the concern of deterioration due to COVID-19.

This report highlights the management challenges in patients with severe inherited bleeding disorders who develop an indication for anticoagulation or anti-platelet treatment in the context of the relativity uncommon entity of carotid artery dissection.

Arnold and Cameron describe a squamous cell carcinoma of the oral cavity in a patient with lower limb arteriopathy. The impact of comorbidities on surgical management of diseases such as cancer is an exigent discussion due to ageing populations.

Fernando and Kelly report a paediatric case of a 6-year-old girl with neurofibromatosis type 1 (NF1) who presented with easy bruising and gum bleeding. Following diagnosis and treatment as pre-B cell acute lymphoblastic leukaemia (pre-B ALL) the patient developed an acute myeloid leukaemia (AML) which was refractory to all available curative therapies.

An 81-year-old Chinese lady complained about worsening shortness of breath, paroxysmal nocturnal dyspnoea and dyspnoea at rest since 3 days before admission from nursing home. The symptoms were relieved by sublingual glyceryl trinitrate and oxygen.