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Case Reports in Pathology 2021Solitary fibrous tumors are rare tumors of mesenchymal origin. Although most often observed in the lung pleura, they have been reported in varied extrapleural sites. A...
Solitary fibrous tumors are rare tumors of mesenchymal origin. Although most often observed in the lung pleura, they have been reported in varied extrapleural sites. A 70-year-old male with complicated Crohn's disease presented with 3 days of nausea, emesis, constipation, and abdominal pain. Computed Tomography (CT) demonstrated mucosal thickening of the middescending colon, consistent with fibrosing stricture. Surgical excision revealed an unusual, 5 cm mass originating in the subserosa. Histopathology of the lesion was notable for a proliferation of cells with spindle and stellate-shaped nuclei and no appreciable mitotic figures, which extended into the muscularis and submucosa. Immunohistochemistry was STAT6 nuclear positive and cytoplasmic CD34 positive, diagnostic for solitary fibrous tumor (SFT). In this case, the SFT infiltrating into the muscularis propria and subserosa caused the stricture and bowel obstruction. This illustrates that while fibrosing strictures are usually the etiology of bowel obstruction in the setting of Crohn's disease, other rare possible causes should be considered.
PubMed: 34707913
DOI: 10.1155/2021/3278392 -
Surgical Case Reports Jan 2021Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare ischemic bowel disease with venous occlusion resulting from the proliferation of smooth...
BACKGROUND
Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare ischemic bowel disease with venous occlusion resulting from the proliferation of smooth muscles in the venous intima. In most patients, the disease affects rectosigmoid colon and causes persistent abdominal pain and hematochezia, which is similar to inflammatory bowel disease (IBD). In addition, it is difficult to make a precise diagnosis of IMHMV without surgery.
CASE PRESENTATION
An 81-year-old woman was admitted to our hospital with mild abdominal pain, nausea and vomiting. Repeated adhesive ileus was suspected due to the previous open and laparoscopic surgeries. Surgery was planned to treat small bowel obstruction. Intraoperatively no adhesive lesions were observed. However, a mass lesion was seen at the terminal ileum, which was suspected to have caused her bowel obstruction. Partial resection of the small intestine was performed. Macroscopic and histopathological examinations of the excised specimen showed circumferential ulceration with scarring, a thickened venous wall with active inflammation, and fibrotic changes that consequently produced stenosis and obstruction of the venous lumen in the subserosa. Additionally, Elastica van Gieson staining demonstrated thickening of the venous intima. The final diagnosis was IMHMV. At two years and 8 months after the operation, the patient was well without any additional medication.
CONCLUSION
IMHMV of the small intestine is rare. We described a case of IMHMV that was associated with ileus.
PubMed: 33438070
DOI: 10.1186/s40792-020-01100-8 -
Cureus Apr 2023The origin of endometriosis has multiple theories, with controversy over which may demonstrate the prominent pathophysiology. The most common extra-pelvic organ system...
The origin of endometriosis has multiple theories, with controversy over which may demonstrate the prominent pathophysiology. The most common extra-pelvic organ system affected by endometriosis is the gastrointestinal tract. Gastrointestinal endometriosis (GE) accounts for 3 to 37% of all endometriosis cases, and appendiceal endometriosis is present in around 3% of GE cases, therefore constituting less than 1% of all endometriosis cases. In this report, we present a 24-year-old female with a past medical history significant for endometriosis status post two excisional laparoscopies who presented with eight months' duration of right lower quadrant pain, constant and stabbing, with rebound tenderness. Appendectomy and histopathology demonstrated focal endometriosis, diffuse serosal fibrovascular adhesions involving the appendiceal serosa/subserosa, as well as a dilated lumen filled with hemorrhagic content. When the appendix is not considered in endometriosis pathology, patients are at increased risk for unresolved pain and further laparoscopic procedures. Prophylactic appendectomy appears to be a worthwhile consideration in patients with chronic pelvic pain, given the high frequency of appendiceal pathology.
PubMed: 37214070
DOI: 10.7759/cureus.37825 -
BMC Pulmonary Medicine Mar 2023Recently, deaths due to mucormycosis in immunocompromised hosts have increased; however, the clinical and pathological features of mucormycosis are not fully understood,...
BACKGROUND
Recently, deaths due to mucormycosis in immunocompromised hosts have increased; however, the clinical and pathological features of mucormycosis are not fully understood, especially in view of the associated high mortality and rare incidence in immunocompetent patients.
CASE PRESENTATION
We have described a rare autopsy case of a 67-year-old Japanese man with chronic obstructive pulmonary disease who contracted mucormycosis. He had not been on any immunosuppressants, and his immune functions were intact. Since 3 days prior to admission to our hospital, he had experienced progressive dyspnea, productive cough, and fever. Chest computed tomography revealed pleural effusion in the left lower hemithorax and consolidation in the right lung field. Although he was administered with tazobactam-piperacillin hydrate (13.5 g/day), renal dysfunction occurred on the ninth disease day. Therefore, it was switched to cefepime (2 g/day). However, his general condition and lung-field abnormality worsened gradually. Cytological analysis of the sputum sample at admission mainly revealed sporangiophores and unicellular sporangioles, while repeated sputum culture yielded Cunninghamella species. Therefore, he was diagnosed with pulmonary mucormycosis. Liposomal amphotericin B (5 mg/kg/day) was initiated on the 28 disease day. However, chest radiography and electrocardiography detected cardiomegaly and atrial fibrillation, respectively, and he died on the 37 disease day. A postmortem examination revealed clusters of fungal hyphae within the arteries of the right pulmonary cavity wall, the subpericardial artery, intramyocardial capillary blood vessels, and the esophageal subserosa vein. Direct sequencing revealed that all fungal culture samples were positive for Cunninghamella bertholletiae.
CONCLUSIONS
Cunninghamella bertholletiae could rapidly progress from colonizing the bronchi to infecting the surrounding organs via vascular invasion even in immunocompetent patients.
Topics: Male; Humans; Aged; Mucormycosis; Autopsy; Lung Diseases, Fungal
PubMed: 36932380
DOI: 10.1186/s12890-023-02382-y -
International Journal of Health Sciences 2021Intestinal cystic pneumatosis is a pathological entity of strange presentation, characterized by the presence of extraluminal gas located at the level of the submucosa...
Intestinal cystic pneumatosis is a pathological entity of strange presentation, characterized by the presence of extraluminal gas located at the level of the submucosa and/or subserosa of the intestinal walls, forming cystic lesions that generally vary from 0.5 to 2.0 cm presenting an incidence around 0.03% in the general population. We present the case of a patient who presented to the emergency department for sudden abdominal pain, diffuse signs of peritoneal irritation, and a history of previous laparotomy for perforated gastric ulcer as the only relevant history. An X-ray was performed showing pneumoperitoneum, with subsequent histopathological diagnosis of cystic intestinal pneumatosis.
PubMed: 34912187
DOI: No ID Found -
The American Journal of Case Reports Nov 2021BACKGROUND The term "sclerosing mesenteritis" includes a spectrum of rare idiopathic diseases involving the small and/or large bowel. It appears as a diffuse, localized,...
BACKGROUND The term "sclerosing mesenteritis" includes a spectrum of rare idiopathic diseases involving the small and/or large bowel. It appears as a diffuse, localized, or multinodular thickening of the mesentery, with a variable degree of chronic non-specific inflammation, fat necrosis, and fibrosis. CASE REPORT Here, we report a case of 83-year-old woman with symptoms of intestinal occlusion, vomiting, and abdominal pain. Radiographic examinations showed air fluid levels in right and left quadrants and in the mesogastric site, while computed tomography (CT) documented a strangulated inguinal hernia with ileal obstruction. Based on clinical examination and radiologic findings, the patient underwent surgery for inguinal hernia reduction. The examination of viscera revealed 2 tracts of ileum with ischemic signs and covered by fibrin; thus, the 2 intestinal loops were resected. Histological examination revealed chronic non-specific inflammation of the whole intestinal wall, including the subserosa in the resected tract of proximal ileum, while the distal ileal loop (not herniated tract) showed a subserosal fibrous nodule of 2 cm in greatest diameter, composed of a proliferation of spindle cells haphazardly arranged in a collagenized stroma. The diagnosis of sclerosing mesenteritis was rendered. CONCLUSIONS The present case shows the possibility of an incidental diagnosis during another intervention such as hernia surgery. Pathologists should be aware of this disease to avoid confusion with aggressive tumors such as intra-abdominal desmoid-type fibromatosis and gastrointestinal stromal tumor.
Topics: Aged, 80 and over; Female; Humans; Intestinal Obstruction; Intestine, Small; Mesentery; Neoplasms; Panniculitis, Peritoneal
PubMed: 34836933
DOI: 10.12659/AJCR.933189 -
The American Journal of Case Reports Mar 2021BACKGROUND Endometriosis is an ectopic proliferation of endometrial glands and interstitium outside the uterus. It usually affects the organs surrounding the uterus, and... (Review)
Review
Small Bowel Obstruction Caused by Ileal Endometriosis with Appendiceal and Lymph Node Involvement Treated with Single-Incision Laparoscopic Surgery: A Case Report and Review of the Literature.
BACKGROUND Endometriosis is an ectopic proliferation of endometrial glands and interstitium outside the uterus. It usually affects the organs surrounding the uterus, and less often, involvement of extrapelvic organs, such as the intestines and urinary tract, is observed. CASE REPORT A 40-year-old woman had been experiencing intermittent right lower abdominal pain for years, which worsened months earlier. The patient was admitted for the worst pain ever accompanying nausea and vomiting. Contrast-enhanced computed tomography revealed a heterogeneously enhanced lesion that measured approximately 50×25×35 mm, and a caliber change of the ileum at the same site with dilated small bowel proximal to the caliber change were observed. Colonoscopy revealed that the ileocecal valve and the lumen of the terminal ileum protruded inward, suggesting an extramural compression by the lesion. Since the patient showed no improvement following conservative therapy, bowel resection through a single-incision laparoscopic surgery was successfully performed. Histopathological exploration showed patchy infiltration of endometrium-like tissues in the muscularis propria and subserosa layers of the ileum and appendix. Moreover, nearby lymph nodes resected for their firmness showed similar findings. CONCLUSIONS We report a case of recurrent intestinal obstruction due to ileal and appendiceal endometriosis with lymph node involvement, which was successfully treated by single-incision laparoscopic surgery. Careful follow-up is important because the prognosis for the intestinal endometriosis with lymph node involvement is still unclear.
Topics: Adult; Appendix; Endometriosis; Female; Humans; Ileum; Intestinal Obstruction; Laparoscopy; Lymph Nodes
PubMed: 33755660
DOI: 10.12659/AJCR.930141 -
Diseases of the Colon and Rectum Jul 2022Idiopathic myointimal hyperplasia of the mesenteric veins is a segmental ischemia associated with noninflammatory hyperplasia of the intimal smooth muscle of the... (Observational Study)
Observational Study
BACKGROUND
Idiopathic myointimal hyperplasia of the mesenteric veins is a segmental ischemia associated with noninflammatory hyperplasia of the intimal smooth muscle of the mesenteric veins. Owing to its rarity, timely diagnosis is often difficult.
OBJECTIVE
The goal of this study was to improve clinical practice in terms of the diagnosis of idiopathic myointimal hyperplasia of the mesenteric veins.
DESIGN
This was a retrospective observational study.
SETTINGS
This study was conducted in a single institution with case collection from clinical archives.
PATIENTS
Data from 12 cases of idiopathic myointimal hyperplasia of the mesenteric veins were retrieved from 2006-2020. Most patients were elderly men, with a male-to-female ratio of 10:1.
MAIN OUTCOME MEASURES
Clinical, endoscopic, radiologic, and pathologic characteristics of idiopathic myointimal hyperplasia of the mesenteric veins served as outcome measures.
RESULTS
Radiologically, marked segmental mural thickening and poor enhancement involved the sigmoid colon and rectum in most cases, with extension to the descending colon in some cases. Typical cases showed obliteration of the inferior mesenteric veins and collateral vessels. Colonoscopic findings were reminiscent of ischemia or ulcerative colitis, but sharp demarcation from the uninvolved segment was the most distinguishing feature. Surgically resected specimens showed marked segmental mural thickening, edema, and mucosal discoloration grossly. Microscopically, thick-walled, tortuous veins were observed mainly in the submucosa and subserosa, and the submucosa was markedly thickened in all cases. The subserosal large veins showed myointimal hyperplasia, and pericolic fat necrosis was invariably observed. The most useful histologic finding in biopsy material was tortuous, arteriolized mucosal capillaries with occasional fibrinoid necrosis.
LIMITATIONS
This study was limited by its small number of cases and selection bias; there was also no prospective external validation.
CONCLUSIONS
Radiologic and pathologic features of idiopathic myointimal hyperplasia of the mesenteric veins are distinct from those of ulcerative colitis or nonspecific ischemic colitis. Careful interpretation of endoscopic and radiologic images and generous biopsies with interpretation by experienced pathologists might lead to an early diagnosis and prevent unnecessary medical treatment. See Video Abstract at http://links.lww.com/DCR/B806.
LA HIPERPLASIA MIOINTIMAL IDIOPTICA DE LAS VENAS MESENTRICAS ES UNA PECULIAR ISQUEMIA VENOSA QUE PUEDE DIAGNOSTICARSE ANTES DE LA CIRUGA
ANTECEDENTES:La hiperplasia miointimal idiopática de las venas mesentéricas es una isquemia segmentaria asociada con hiperplasia no inflamatoria del músculo liso de la íntima de las venas mesentéricas. Debido a su rareza, el diagnóstico oportuno suele ser difícil.OBJETIVO:Mejorar la práctica clínica con respecto al diagnóstico de hiperplasia miointimal idiopática de venas mesentéricas.DISEÑO:Estudio observacional retrospectivo.AJUSTES:Institución única, colección de casos de archivos clínicos.PACIENTES:Se recuperaron datos de 12 casos de hiperplasia miointimal idiopática de las venas mesentéricas durante el período 2006-2020. La mayoría de los pacientes eran hombres de edad avanzada, con una proporción de hombres a mujeres de 10:1.PRINCIPALES MEDIDAS DE RESULTADO:Características clínicas, endoscópicas, radiológicas y patológicas de la hiperplasia miointimal idiopática de las venas mesentéricas.RESULTADOS:Radiológicamente, se vio marcado engrosamiento mural afectando de manera segmentaria y escaso realce que comprometieron al colon sigmoides y al recto en la mayoría de los casos, con extensión al colon descendente en algunos casos. Los casos típicos mostraron obliteración de las venas mesentéricas inferiores y vasos colaterales. Los hallazgos colonoscópicos recordaban a la isquemia o la colitis ulcerosa, pero la demarcación nítida del segmento no afectado fue la característica más distintiva. Las piezas quirúrgicas mostraron un marcado engrosamiento mural de manera segmentaria, edema y decoloración de la mucosa de forma macroscópica. Microscópicamente, se observaron venas tortuosas de paredes engrosadas principalmente en la submucosa y subserosa y la submucosa se encontraba marcadamente engrosada en todos los casos. Las grandes venas subserosas mostraban hiperplasia de la mioíntima e invariablemente se observaba necrosis grasa pericólica. El hallazgo histológico más útil en el material de biopsia fueron los tortuosos capilares arteriolizados de la mucosa con necrosis fibrinoide ocasional.LIMITACIONES:Pequeño número de casos; sesgo de selección; sin validación externa prospectiva.CONCLUSIONES:Las características radiológicas y patológicas de la hiperplasia miointimal idiopática de las venas mesentéricas son distintas a las de la colitis ulcerosa o la colitis isquémica no específica. La interpretación cuidadosa de las imágenes endoscópicas y radiológicas y múltiples biopsias de manera generosa con la interpretación de patólogos experimentados pueden conducir a un diagnóstico temprano y prevenir tratamientos médicos innecesarios. Consulte Video Resumen en http://links.lww.com/DCR/B806. (Traducción-Dr Osvaldo Gauto).
Topics: Aged; Colitis, Ulcerative; Female; Humans; Hyperplasia; Ischemia; Male; Mesenteric Veins; Necrosis; Retrospective Studies
PubMed: 34803145
DOI: 10.1097/DCR.0000000000002072 -
Gan To Kagaku Ryoho. Cancer &... Nov 2019A 60s woman was found to have wall thickening of the gastric body and gallbladder in the follow-up CT scan after surgery for cervical carcinoma. An endoscopic... (Review)
Review
A 60s woman was found to have wall thickening of the gastric body and gallbladder in the follow-up CT scan after surgery for cervical carcinoma. An endoscopic examination revealed a type 3 tumor, located in the lesser curvature of the middle stomach. Abdominal CT showed lymphadenopathy at the lesser curvature. An enhanced thickened wall was also noted in the fundus of the gallbladder. FDG-PET/CT showed negative uptake in the gallbladder lesion. Distal gastrectomy and cholecystectomy were performed under the preoperative diagnosis of gastric cancer and adenomyomatosis. Histopathologically, the gastric lesion was a poorly differentiated adenocarcinoma, SE, ly1c, v1b. Moreover, the gallbladder lesion was a poorly differentiated adenocarcinoma proliferating mainly in the muscularis propria and subserosa, which had similar histological features as those in the adenocarcinoma part of gastric cancer. From these findings, the patient was diagnosed with gallbladder metastasis from gastric cancer. Gastric cancer rarely metastasizes to the gallbladder, and only 16 cases have been reported in Japan. We present the clinicopathological features with a review of the literature.
Topics: Female; Gallbladder Neoplasms; Gastrectomy; Humans; Japan; Neoplasms, Multiple Primary; Positron Emission Tomography Computed Tomography; Stomach Neoplasms
PubMed: 31748489
DOI: No ID Found -
Surgical Laparoscopy, Endoscopy &... Aug 2019A 59-year-old asymptomatic man underwent ultrasonography, which revealed gallstones and thickened gallbladder wall. Abdominal computed tomography (CT) showed a slightly... (Review)
Review
A 59-year-old asymptomatic man underwent ultrasonography, which revealed gallstones and thickened gallbladder wall. Abdominal computed tomography (CT) showed a slightly swollen bilocular gallbladder and a soft tissue mass in the fundus site. Segmental adenomyomatosis (ADM) was suspected because numerous fundic cystic lesions were seen on magnetic resonance imaging. Endoscopic ultrasonography revealed numerous Rokitansky-Aschoff sinuses (RAS) and a papillary soft tissue shadow surrounded with irregular and remarkably thickened fundic gallbladder wall. Fluoro-2-deoxy-D-glucose-positron emission tomography/CT demonstrated slightly increased fluoro-2-deoxy-D-glucose uptake in the corresponding lesion. Surgery was performed under a diagnosis of gallbladder carcinoma (GBC) with concomitant ADM, and histopathology revealed a 30-mm papillotubular adenocarcinoma extending from the gallbladder body to fundus with invasion into the subserosa. Numerous RAS were present throughout the gallbladder showing various degrees of dysplasia. Ki67 and p53-labeling index (LI) was significantly higher in the dysplastic epithelium compared with normal fundic epithelium. p53-LI was also markedly increased (72.1%) in tissue in front of tumor invasion. Interestingly, these hyperproliferation indicators were extremely high (Ki67-LI: 28.8%; p53-LI: 91.9%) in RAS with low-grade dysplasia even in the gallbladder neck. Although, generally, tumors do not develop in the gallbladder neck with segmental ADM, our results suggest that a gallbladder with ADM has potential for carcinogenesis regardless of location, with segmental ADM. On the basis of histopathology, our patient was diagnosed with GBC arising from RAS with multicentric and multistep growth. A relationship between GBC and ADM, especially segmental ADM, has been suggested but remains controversial. Our experience is very suggestive of carcinogenesis developing from ADM.
Topics: Adenocarcinoma; Adenomyosis; Biopsy, Needle; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy; Cholecystolithiasis; Diagnosis, Differential; Gallbladder Neoplasms; Humans; Hyperplasia; Immunohistochemistry; Magnetic Resonance Imaging; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Ultrasonography, Doppler
PubMed: 30570538
DOI: 10.1097/SLE.0000000000000617