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Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

SRY-box transcription factor 9 (SOX9) has been reported to be overexpressed in a wide variety of gastrointestinal malignancies. While its role has been studied in gastric cancer (GC), the results remain conflicting. This study aimed to evaluate the relationship between SOX9 immunohistochemistry results and the pathological and clinical characteristics of gastric adenocarcinoma, assessing its potential as a prognostic marker. Gastric tissue samples from 150 patients with gastric cancer were included in the study. Tissue sections were stained using an anti-SOX9 antibody, and relevant data were retrospectively collected from digital records. Immunostaining results were scored based on the proportion and intensity of stained nuclei throughout the tumor. A final immunostaining score was calculated by multiplying the SOX9 intensity score by the proportion score. Strong SOX9 nuclear staining was observed in 68 patients (45.3%), while moderate staining was seen in 60 patients (40%). SOX9 nuclear staining was absent in three patients (2%). A final SOX9 immunostaining score of ≥10, classified as high expression, was identified in 60 patients (40%). Patients with higher SOX9 expression or strong intensity scores exhibited significantly larger tumor sizes, higher rates of perineural and vascular invasion, more advanced T or lymph node staging, and greater likelihoods of lymphatic or distant metastases compared to those with lower SOX9 expression or intensity scores (all P < 0.05). These findings suggest that SOX9 staining intensity and expression are associated with increased tumor malignancy and disease progression. Therefore, SOX9 may serve as a prognostic pathological indicator in GC patients.

Acute abdomen is a serious condition frequently encountered in the emergency departments (ED). There are various etiologies causing acute abdomen, most common being acute appendicitis; however, there are rare causes of acute abdomen as well and one should keep them in mind while handling a patient with unusual clinical features. We herein present a 26-year-old male, with no past medical or surgical history, presenting with acute abdominal pain and distension to the ED. He was found to have a large vascular retroperitoneal mass on computed tomography which had invaded and perforated the duodenum thus causing the acute presentation. Repair of the duodenal perforation and sampling of the mass were performed in terms of surgical management. Pathology results revealed the mass originating from a burned out testis yolk sac tumor with embryonal carcinoma component. Although the original tumor had regressed at the testis, its metastasis at the retroperitoneal area had caused the clinical condition. This entity is described as the retroperitoneal metastasis of a burned-out testicular tumor. Few cases presenting with gastrointestinal bleeding secondary to invasion of the retroperitoneal metastasis have been reported. However, this is the first case in the literature presenting with duodenal perforation and acute abdomen. Sampling of the retroperitoneal tumor for histopathological diagnosis during the immediate surgical intervention facilitates the diagnostic management in these cases. Although scrotal examination combined with testis tumor marker assessments is essential for optimal patient management, the possibility of a burned-out testicular tumor with normal scrotal examination should always be kept in mind.