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African Journal of Paediatric Surgery :... 2023Lipomas of the gastrointestinal tract (GIT) are generally rare. They are rare in children, and when they occur they are usually submucosa. Most of the submucosa lipomas... (Review)
Review
Lipomas of the gastrointestinal tract (GIT) are generally rare. They are rare in children, and when they occur they are usually submucosa. Most of the submucosa lipomas of GIT are present in the colon (65%-75%) and small intestine (25%). In children, intestinal lipoma is a documented cause of pathological lead point intussusception, especially when located in the submucosa. The present case report is of subserosa lipoma in the distal ileum. A 2-year-old boy presented with features of intestinal obstruction which was preceded by a painless abdominal mass. In the absence of computerised tomography scan, he was operated, and histopathology examination confirmed the mass as pedunculated fibrolipoma arising from the subserosa and causing extrinsic compression of the ileum.
Topics: Male; Humans; Child, Preschool; Intestinal Obstruction; Intussusception; Intestine, Small; Colon; Lipoma
PubMed: 37470563
DOI: 10.4103/ajps.ajps_171_21 -
Diagnostics (Basel, Switzerland) Apr 2023Pneumatosis cystoid intestinalis (PCI) is a rare condition, with a worldwide incidence of 0.3-1.2%. PCI is classified into primary (idiopathic) and secondary forms, with...
Pneumatosis cystoid intestinalis (PCI) is a rare condition, with a worldwide incidence of 0.3-1.2%. PCI is classified into primary (idiopathic) and secondary forms, with 15% and 85% of presentations, respectively. This pathology was associated with a wide variety of underlining etiologies to explain the abnormal accumulation of gas within the submucosa (69.9%), subserosa (25.5%), or both layers (4.6%). Many patients endure misdiagnosis, mistreatment, or even inadequate surgical exploration. In this case, a patient presented acute diverticulitis, after treatment, a control colonoscopy was performed that found multiple rounds and elevated lesions. To further study the subepithelial lesion (SEL), a colorectal endoscopic ultrasound (EUS) was performed with an overtube in the same procedure. For safe insertion of the curvilinear array EUS, an overtube with colonoscopy was positioned through the sigmoid as described by Cheng et al. The EUS evaluation evidenced air reverberation in the submucosal layer. The pathological analysis was consistent with PCI's diagnosis. The diagnosis of PCI is usually made by colonoscopy (51.9%), surgery (40.6%), and radiological findings (10.9%). Although the diagnosis can be made by radiological studies, a colorectal EUS and colonoscopy can be made in the same section without radiation and with high precision. As it is a rare disease, there are not enough studies to define the best approach, although colorectal EUS should be preferred for a reliable diagnosis.
PubMed: 37189527
DOI: 10.3390/diagnostics13081424 -
PloS One 2021Oncology applications of cell-free DNA analysis are often limited by the amount of circulating tumor DNA and the fraction of cell-free DNA derived from tumor cells in a... (Observational Study)
Observational Study
BACKGROUND
Oncology applications of cell-free DNA analysis are often limited by the amount of circulating tumor DNA and the fraction of cell-free DNA derived from tumor cells in a blood sample. This circulating tumor fraction varies widely between individuals and cancer types. Clinical factors that influence tumor fraction have not been completely elucidated.
METHODS AND FINDINGS
Circulating tumor fraction was determined for breast, lung, and colorectal cancer participant samples in the first substudy of the Circulating Cell-free Genome Atlas study (CCGA; NCT02889978; multi-cancer early detection test development) and was related to tumor and patient characteristics. Linear models were created to determine the influence of tumor size combined with mitotic or metabolic activity (as tumor mitotic volume or excessive lesion glycolysis, respectively), histologic type, histologic grade, and lymph node status on tumor fraction. For breast and lung cancer, tumor mitotic volume and excessive lesion glycolysis (primary lesion volume scaled by percentage positive for Ki-67 or PET standardized uptake value minus 1.0, respectively) were the only statistically significant covariates. For colorectal cancer, the surface area of tumors invading beyond the subserosa was the only significant covariate. The models were validated with cases from the second CCGA substudy and show that these clinical correlates of circulating tumor fraction can predict and explain the performance of a multi-cancer early detection test.
CONCLUSIONS
Prognostic clinical variables, including mitotic or metabolic activity and depth of invasion, were identified as correlates of circulating tumor DNA by linear models that relate clinical covariates to tumor fraction. The identified correlates indicate that faster growing tumors have higher tumor fractions. Early cancer detection from assays that analyze cell-free DNA is determined by circulating tumor fraction. Results support that early detection is particularly sensitive for faster growing, aggressive tumors with high mortality, many of which have no available screening today.
Topics: Breast Neoplasms; Circulating Tumor DNA; Colorectal Neoplasms; Female; Glycolysis; Humans; Lung Neoplasms; Mitosis; Models, Biological; Neoplasm Staging; Neoplasms; Reproducibility of Results
PubMed: 34432811
DOI: 10.1371/journal.pone.0256436 -
Journal of Medical Case Reports Oct 2023Behçet's disease (BD) is a chronic systemic disease characterized by vasculitis as the basic pathological change. BD is rare, and gastrointestinal involvement occurs in... (Review)
Review
BACKGROUND
Behçet's disease (BD) is a chronic systemic disease characterized by vasculitis as the basic pathological change. BD is rare, and gastrointestinal involvement occurs in 3% to 25% of affected patients. This article describes a rare case of intestinal BD along with a literature review of intestinal involvement in BD.
CASE PRESENTATION
A 50-year-old Han woman from China presented with a > 6-month history of distending pain in the right upper abdomen. Because of mechanical obstruction secondary to stricture formation from an ileocecal ulcer, she underwent radical right colon resection, and postoperative pathologic examination indicated an ileocecal ulcer. The patient was readmitted to the hospital 6 months postoperatively for recurrence of the same symptoms. Colonoscopy indicated obvious narrowing of the anastomosis with an oval-shaped deep ulcer that could not be passed by the endoscope. Pathologic examination showed acute and chronic inflammation of the anastomotic mucosa and granulation tissue. In addition, gastroscopy showed a 3.0- × 4.0-cm giant ulcer at the junction of the descending bulb along with a sinus tract. Moreover, total gastrointestinal computed tomography angiography showed significant thickening of the intestinal wall near the transverse colon, forming a sinus tract at the junction of the antrum and duodenum with a length of about 1.3 cm and width of about 0.2 cm. Further inquiry regarding the patient's medical history revealed that she had developed repeated oral ulcers 3 years previously and repeated eye inflammation 5 years previously. Specimens of the right half of the colon removed 6 months previously were sent to Run Run Shaw Hospital Affiliated to Zhejiang University for consultation. The pathologic examination revealed vasculitis in the submucosa and subserosa, and the patient was finally diagnosed with BD. She began treatment with adalimumab, and repeat gastroenteroscopy revealed that the intestinal ulcer had significantly improved.
CONCLUSIONS
An oval-shaped deep intestinal ulcer is a characteristic lesion in patients with BD and may involve the intestinal muscle layer. This case emphasizes that BD is a vasculitis affecting multiple organs and can present with a single, deep, clean-edged intestinal ulcer that penetrates the bowel wall to form a sinus tract. Therefore, careful examination and differential diagnosis should be carried out to prevent a poor prognosis. Adalimumab is effective for patients with intestinal BD.
Topics: Female; Humans; Middle Aged; Behcet Syndrome; Ulcer; Adalimumab; Intestinal Diseases; Inflammation; Vasculitis
PubMed: 37798676
DOI: 10.1186/s13256-023-04148-w -
Cancers Dec 2022The TNM classification system is one of the most important factors determining prognosis for cancer patients. In colorectal cancer, the T category reflects the depth of...
The TNM classification system is one of the most important factors determining prognosis for cancer patients. In colorectal cancer, the T category reflects the depth of tumor invasion. T3 is defined by a tumor that invades through the muscularis propria into pericolorectal tissues. The data of 1047 patients with complete mesocolic excision were analyzed. The depth of invasion beyond the outer border of the muscularis propria into the subserosa or into nonperitonealized pericolic tissue was measured and categorized in 655 pT3 patients: pT3a (≤1 mm), pT3b,c (>1−15 mm) and pT3d (>15 mm). The prognosis of these categories was compared. Five-year distant metastasis increased significantly from pT3a (5.7%) over pT3b,c (17.7%) to pT3d (37.2%; p = 0.001). There was no difference between pT2 (5.3%) and pT3a or between pT3d and pT4a (42.1%) or pT4b (33.7%). The 5-year disease-free survival decreased significantly from pT3a (77.4%) over pT3b,c (65.4%) to pT3d (50.1%; p = 0.015). No significant difference was found between pT2 (80.5%) and pT3a or between pT3d and pT4a (43.9%; p = 0.296) or pT4b (53.4%). The prognostic inhomogeneity in pT3 colon carcinoma has been demonstrated. A three-level subdivision of T3 for colon carcinoma in the TNM system into T3a (≤1 mm), T3b (>1−15 mm), and T3c (>15 mm) is recommended.
PubMed: 36551671
DOI: 10.3390/cancers14246186 -
Revista Espanola de Enfermedades... May 2024A 70-year-old male was admitted with severe haematochezia and lipothymia. His medical history was relevant for coronary artery disease and radiation proctopathy. During...
A 70-year-old male was admitted with severe haematochezia and lipothymia. His medical history was relevant for coronary artery disease and radiation proctopathy. During hospitalization, was hemodynamically stable with persistent haematochezia. Laboratory examination revealed continuous haemoglobin fall, despite erythrocyte reposition, with administration of 11 units since admission. Colonoscopy showed an 8mm fibrinous lesion with an adherent clot, at 40cm from the anal verge. During exploration, a heavy spurting haemorrhage developed, with haemostasis being achieved with 4 clips, followed by site tattoo. Considering the risk of severe bleeding relapse in a high-risk patient, the patient underwent emergent Hartmann type colectomy. Histopathology report revealed a vascular lesion with arterial and venous vessels, protruding through the submucosa, muscular and subserosa, with a focal mucosal erosion, without neoplastic disease, compatible with an arteriovenous malformation (AVM).
PubMed: 38767028
DOI: 10.17235/reed.2024.10419/2024 -
The Indian Journal of Surgery Jun 2018We experienced a rare case of gallbladder metastasis from renal cell carcinoma. A 68-year-old man was admitted for further evaluation of a gallbladder tumor, which had...
We experienced a rare case of gallbladder metastasis from renal cell carcinoma. A 68-year-old man was admitted for further evaluation of a gallbladder tumor, which had been identified on follow-up computed tomography after partial nephrectomy for renal cell carcinoma. Enhanced computed tomography and magnetic resonance imaging showed an enhancing polypoid mass in the gallbladder lumen. Endoscopic ultrasonography demonstrated a homogenous hypo-echoic polypoid lesion, and the outer hyper-echoic layer of the adjacent wall was intact. Blood flow signals in the wall side of the mass were observed on color Doppler endoscopic ultrasonography images. Laparoscopic cholecystectomy was performed and he was uneventfully discharged. Macroscopic examination of the specimen revealed a 12 × 7 × 5 mm pedunculated tumor attached by a thin pedicle to the fundus of the gallbladder. Histology confirmed a metastasis of the renal cell carcinoma that had infiltrated the shallow subserosa but had mainly grown into cavity of the gallbladder. These imaging findings are considered characteristic and may assist preoperative diagnosis in patients with a history of renal cell carcinoma.
PubMed: 29973761
DOI: 10.1007/s12262-017-1705-0 -
Frontiers in Surgery 2022Intestinal arteriovenous malformation is an abnormal connection between arteries and veins that bypasses the capillary system and may be a cause of significant lower...
BACKGROUND
Intestinal arteriovenous malformation is an abnormal connection between arteries and veins that bypasses the capillary system and may be a cause of significant lower gastrointestinal bleeding. On endoscopy, arteriovenous malformations are usually flat or elevated, bright red lesions. Overall, rectal localization of arteriovenous malformations is rare. The same may be said about polypoid shape arteriovenous malformations. Herein, we present a case of a large rectal polypoid arteriovenous malformations.
METHODS
Clinical, diagnostic, and treatment modalities of the patient were reviewed. Pre- and post-operative parameters were collected and analyzed. The clinical English literature is also reviewed and discussed.
RESULTS
A 60-year-old female patient was admitted to our emergency department for rectorrhagia and anemia. Rectoscopy revealed a polypoid lesion in the rectum and the biopsy showed fibrosis, necrosis areas, and hyperplastic glands. A total body contrast-enhanced computed tomography (CT) was performed revealing a parietal pseudonodular thickening with concentric growth and contrast enhancement, extending for about 53 mm. The mass wasn't removed endoscopically due to concentric growth, sessile implant, and submucosal nature. The patient underwent an uneventful laparoscopic anterior rectal resection. The postoperative hospitalization was free of complications. Histology showed the presence of a polypoid AVM composed of dilated arteries, veins, capillaries, and lymphatics, engaging the submucosa, muscularis, and subserosa layer.
CONCLUSION
After a review of the current English literature, we found only one case of rectal polypoid AVM. The scarcity of documented cases encumbers optimal diagnostic and treatment approaches.
PubMed: 35910477
DOI: 10.3389/fsurg.2022.924801 -
Clinical Journal of Gastroenterology Feb 2020Pneumatosis intestinalis is the presence of gas in the bowel wall and is divided into two categories: life-threatening pneumatosis intestinalis and benign pneumatosis... (Review)
Review
Pneumatosis intestinalis is the presence of gas in the bowel wall and is divided into two categories: life-threatening pneumatosis intestinalis and benign pneumatosis intestinalis. Pneumatosis cystoides intestinalis is a rare condition characterized by gas-filled cysts in submucosa and subserosa. The pathogenesis is unclear, although some causes have been theorized. The presenting clinical findings may be very heterogeneous. Intestinal pneumatosis may lead to various complications. Distinguishing between pneumatosis cystoides intestinalis and life-threatening pneumatosis intestinalis may be challenging, although computed tomography scan allows the detection of additional findings that may suggest an underlying, potentially worrisome cause of pneumatosis intestinalis. To correctly manage the patients affected with this disease is important to differentiate the two types of pneumatosis. The patients with pneumatosis cystoides intestinalis are usually treated conservatively; the surgical treatment is reserved for complications. We described a case of a patient with pneumatosis cystoides intestinalis and gastric perforation. The medical history of the patient revealed a breast cancer treated with mastectomy and chemotherapy; the patient did not report a history of gastrointestinal disease. The abdomen CT showed abscess formation at the level of the antro-pylorus, linear pneumatosis in the gastric wall, and free abdominal air. Multiple small air bubbles was observed in intestinal wall. The intestinal wall was not thickened with normal contrast mucosal enhancement. CT examination showed neither mesenteric stranding nor portal venous gas embolism. The findings of the surgery were gastric perforated peptic ulcer and benign pneumatosis intestinalis.
Topics: Abdominal Abscess; Aged; Female; Humans; Peptic Ulcer Perforation; Pneumatosis Cystoides Intestinalis; Stomach Ulcer; Tomography, X-Ray Computed
PubMed: 31161540
DOI: 10.1007/s12328-019-00999-3 -
BMC Gastroenterology Jun 2018Pneumatosis cystoides intestinalis (PCI) is characterized by gas-filled cysts in the intestinal submucosa and subserosa. There are few reports of PCI occurring in... (Review)
Review
BACKGROUND
Pneumatosis cystoides intestinalis (PCI) is characterized by gas-filled cysts in the intestinal submucosa and subserosa. There are few reports of PCI occurring in duodenum and rectum. Here we demonstrated four different endoscopic manifestations of PCI and three cases with intestinal stricture all were successfully managed by medical conservative treatment.
CASE PRESENTATION
There are 6 cases of PCI with varied causes encountered, in which the etiology, endoscopic features, treatment methods and prognosis of patients were studied. One case was idiopathic, while the other one case was caused by exposing to trichloroethylene (TCE), and the remaining four cases were secondary to diabetes, emphysema, therioma and diseases of immune system. Of the six patients, all complained of abdominal distention or diarrhea, three (50%) reported muco-bloody stools, two (33.3%) complained of abdominal pain. In four other patients, PCI occurred in the colon, especially the sigmoid colon, while in the other two patients, it occurred in duodenum and rectum. Endoscopic findings were divided into bubble-like pattern, grape or beaded circular forms, linear or cobblestone gas formation and irregular forms. After combination of medicine and endoscopic treatment, the symptoms of five patients were relieved, while one patient died of malignant tumors.
CONCLUSION
PCI endoscopic manifestations were varied, and radiology combined with endoscopy can avoid misdiagnosis. The primary bubble-like pattern can be cured by endoscopic resection, while removal of etiology combined with drug therapy can resolve majority of secondary cases, thereby avoiding the adverse risks of surgery.
Topics: Adult; Aged; Colon; Duodenum; Endoscopy, Gastrointestinal; Female; Humans; Intestinal Obstruction; Male; Middle Aged; Pneumatosis Cystoides Intestinalis; Radiography, Abdominal; Rectum; Tomography, X-Ray Computed
PubMed: 29954324
DOI: 10.1186/s12876-018-0794-y