Background Gastric carcinoma (GC) with second primary malignancy (SPM) is the most frequent combination within the multiple primary malignancies (MPM) group. The presentation of a GC associated with a synchronized SPM in the kidney is extremely rare and unusual. This study presents a rare case of synchronous tumors, describes the main associated risk factors, and emphasizes the need to rule out SPM. Main body We present the case of a 63-year-old Hispanic woman with a history of smoking, weight loss, and gastrointestinal (GI) bleeding. GC was diagnosed by endoscopy, and during her workup for metastatic disease, a synchronous SPM was noted in the left kidney. The patient underwent resection of both tumors with a satisfactory postoperative course. A systematic review of the literature was performed using the Medline/PubMed, Science Direct, Scopus, and Google Scholar databases. A search of the literature yielded 13 relevant articles, in which the following main risk factors were reported: the treatment utilized, the grade and clinical stage, histopathological report, and in some cases survival. It is concluded that advanced age (> 60 years) and smoking are the main associated risk factors. Conclusion Gastric carcinoma is the second most frequent neoplasm of the GI tract and the main neoplasm that presents a SPM. MPM screening is recommended in patients with gastric cancer. The clinical discovery of MPM of renal origin is rare and hence the importance of the current report.

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Introduction: There are three treatment options for choledocholithiasis: endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy; laparoscopic exploration of the main bile duct with concomitant cholecystectomy; and open cholecystectomy with exploration of the main bile duct. Material and methods: A retrospective, descriptive, observational study was taken of patients with a diagnosis of cholecysto-choledocholithiasis that failed ERCP and who underwent laparoscopic cholecystectomy with exploration of the bile duct. Results: From January 2009 to December 2018, 2322 ERCP procedures were performed at Hospital Regional Ignacio Zaragoza, with a failed procedure rate of 3.2% which is equivalent to 75 patients; endoscopic sphincterotomy was performed on all 75 patients and 60 (80%) of these patients had cholelithiasis with choledocholithiasis. Access to the bile duct through choledochotomy was required in all 75 patients, achieving successful stone extraction and bile duct clearance in 95%. Fifteen (20%) of these patients that had had laparoscopic cholecystectomy presented choledocholithiasis de novo more than two years after cholecystectomy. Nine patients underwent laparoscopic cholecystectomy and 6 patients underwent open cholecystectomy. Patients averaged 6 hospital days post-procedure. Surgical times ranged from 150 min to 210 min. Conclusion: Laparoscopic reoperation of the biliary tract is a reasonable alternative for patients with a history of previous biliary surgery who have failed the ERCP approach. Highlights

Introduction and importance Neurofibromatosis type 1 (NF1), or Von Recklinghausen's disease, is an autosomal dominant condition that affects the central nervous system. Gastrointestinal stromal tumor (GIST) refers to non-epithelial tumors of the gastrointestinal tract lacking smooth muscle structural features and schwann cell immunohistochemical characteristics. The risk of patients with NF1 to develop a GIST is 7%. Case presentation GIST is a soft tissue sarcoma that probably arises from the interstitial Cajal cells of the intestine. GIST associated with NF1 syndrome appears to have a distinct phenotype, occurring in younger patients compared to sporadic GIST. Clinical discussion The clinical presentation can be highly variable, the association of gastrointestinal tumors associated with Von Recklinghausen's disease is up to 7%, postoperative treatment with imatinib is reserved for patients with a high risk of recurrence. Conclusion The treatment of primary GIST is complete surgical resection with free microscopic margins and an intact pseudocapsule.