In the digestive system, mesenchymal origin of tumors is quite rare; in general, they are recognized as gastrointestinal stromal tumors (GISTs). The incidence of GISTs is very low (2 in 100,000), while jejunal GISTs are extremely rare, accounting for 0.1–3% of all gastrointestinal (GI) tumors. Small intestinal GISTs are the second most common (25%) site in the GI tract, usually occurring in the duodenum. We present the case of a 62-year-old Bangladeshi female with a history of GI bleeding 3 years earlier; the cause of the bleeding had not been found despite extensive investigations. In the meantime, the patient had developed occasional abdominal pain and lumpy feelings in the right side of the abdomen without any GI bleeding. Exploratory laparotomy was carried out in view of a small intestinal mesenteric mass in a computed tomography scan. On midline incision there was a 6 × 6 cm mass in the antimesenteric border of the jejunum approximately 30 cm from the duodenojejunal flexure, which was resected followed by anastomosis. The presentation of GISTs ranges from asymptomatic to mild abdominal pain and mass (5–50%) and mechanical obstruction (5%) as well as hemorrhage – perforation having rarely been reported (0.8%) – making the diagnosis difficult. Exophytic growth of these tumors has been noted in 18–30% of cases. In view of intermediate risk of malignancy, the patient was started with adjuvant imatinib 400 mg once daily due to probability of disease recurrence (24%).

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A 62-year-old man, active smoker with a past history of prolonged occupational exposure to asbestos, has an incidental identification of unilateral exudative pleural effusion associated with massive thickening of the costodiaphragmatic pleura. The conducted study confirmed the diagnosis of an unresectable malignant epithelioid pleural mesothelioma. The patient was initially submitted to pleural decortication by uniportal VATS and first-line chemotherapy with pemetrexed and carboplatin, which was suspended after six treatment cycles due to disease progression with worsening of the performance status (ECOG 2) and development of left posterolateral thoracic mass, painful on palpation and needing antalgic radiation therapy. Imaging studies also reported dimensional lesion increase and invasion of the chest wall. In this context, immunotherapy anti-programmed cell death 1 (PD-1) monoclonal antibody was administered as an off-label rescue strategy, with single agent intravenous nivolumab 3mg/Kg, every two weeks. Initial outpatient reassessments were performed on a 14 day schedule. It was possible to witness a progressive improvement in symptoms and weight recovery; after seven weeks the chestcomputed tomography showed complete remission of the neoplastic lesion. The patient has been maintained on 3 mg/kg nivolumab infusions every two weeks, with an excellent sustained therapeutic response and significant improvement in quality of life, without unacceptable pharmacological toxicity, maintaining the benefits that came from immunotherapy throughout subsequent evaluations and well more than 24 months after malignant disease was diagnosed. Conclusion: This clinical case reveals the progressive character of malignant mesothelioma despite current standard therapeutic options and emphasizes the promising role of nivolumab in the treatment of recurrent malignant epithelioid pleural mesothelioma, where therapeutic alternatives have remained elusive in recent years.

This article has no abstract. The first 100 words appear below: A 12-year-old immunized girl with only issue of non-consanguineous parents presented with the complaints of severe, agonizing, and continued upper abdominal pain which radiated to the back, aggravated after taking food and partially relieved on leaning forward for the last 4 days. The pain was associated with several episodes of vomiting. She had a history of similar types of 3 attacks within the last 1 year and in between attacks, she was comparatively well. On query, the mother gave a history of gradual weight loss.

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