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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 -
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 -
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 -
International Journal of Surgery Case... Dec 2021Appendiceal neuroendocrine tumors (ANETs) are incidentally found in 0.2-0.7% of appendectomies for suspected appendicitis.
INTRODUCTION AND IMPORTANCE
Appendiceal neuroendocrine tumors (ANETs) are incidentally found in 0.2-0.7% of appendectomies for suspected appendicitis.
CASE PRESENTATION
A 29-year-old female presented with pain in the right lower quadrant of her abdomen for the past 48 h. On emergency appendectomy for suspected acute appendicitis, a perforated appendix was found. Histopathological examination showed grade 1 (low) ANET.
CLINICAL DISCUSSION
Appendiceal neuroendocrine neoplasms (ANENs) are commonly found at the tip of the appendix and are treated with appendectomy alone. For few ANENs located at the base, or small tumors (≤2 cm) infiltrating the submucosa, the muscularis, the subserosa layer or the mesoappendix, right hemicolectomy is recommended. However, no guidelines have been established concerning patients with appendiceal perforation in case of ANENs.
CONCLUSION
Although rare, ANETs should be considered in the differential diagnosis of acute appendicitis. Since, ANETs are rarely diagnosed preoperatively, subsequent patient evaluation after appendectomy is crucial for management of the patient.
PubMed: 34839114
DOI: 10.1016/j.ijscr.2021.106625 -
BMC Gastroenterology Jan 2020Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has high accuracy and a low complication rate; therefore, it has been widely used as a useful tool for... (Review)
Review
Needle tract seeding recurrence of pancreatic cancer in the gastric wall with paragastric lymph node metastasis after endoscopic ultrasound-guided fine needle aspiration followed by pancreatectomy: a case report and literature review.
BACKGROUND
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has high accuracy and a low complication rate; therefore, it has been widely used as a useful tool for diagnosis of and to determine treatment strategies for pancreatic tumors. Recently, reports of the recurrence of needle tract seeding after EUS-FNA are emerging.
CASE PRESENTATION
An 83-year-old woman was referred to our hospital to undergo further examination of her pancreatic tumor. Multidetector computed tomography (MDCT) revealed a 25-mm-diameter mass in the pancreatic body. She underwent EUS-FNA (transgastric, 22-G needle, 2 passes) and was subsequently diagnosed with adenocarcinoma. Distal pancreatosplenectomy followed by adjuvant chemotherapy with S-1 for 6 months was performed. The level of carbohydrate antigen 19-9 gradually increased 22 months after surgery, and MDCT, which was performed 3 months later, revealed a 23-mm low-density mass in the stomach and paragastric lymph node swelling. Gastroendoscopy revealed a submucosal tumor, and endoscopic ultrasound revealed a hypoechoic mass in the submucosa of the gastric wall. Partial gastrectomy with lymph node resection was performed. The pathological findings showed adenocarcinoma extending from the subserosa to the submucosa and lymph node metastasis, consistent with a tumor recurrence from the resected pancreatic tumor. She received adjuvant chemotherapy with S-1; recurrence was not observed for 5 months, at the time of this writing.
CONCLUSION
It is important to pay careful attention to the development of needle tract seeding in patients with pancreatic cancer diagnosed by EUS-FNA. This is the first case of needle tract seeding with lymph node metastasis, highlighting the need for caution and providing novel insight in the postoperative follow-up of patients with pancreatic body/tail cancer.
Topics: Aged, 80 and over; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Neoplasm Recurrence, Local; Neoplasm Seeding; Pancreatectomy; Pancreatic Neoplasms; Postoperative Complications; Stomach; Stomach Neoplasms
PubMed: 31941458
DOI: 10.1186/s12876-020-1159-x -
Journal of Medical Case Reports Dec 2021Pneumatosis cystoides intestinalis is a rare and usually benign condition in which multiple thin-walled cysts develop in the submucosa or subserosa of the...
BACKGROUND
Pneumatosis cystoides intestinalis is a rare and usually benign condition in which multiple thin-walled cysts develop in the submucosa or subserosa of the gastrointestinal tract. While usually asymptomatic, severe cases can result in pneumoperitoneum, which can be managed surgically or medically depending on circumstances. We present a case of a patient with pneumatosis cystoides intestinalis, which presented as pneumoperitoneum following trauma. To our knowledge, there are no other published cases in which a trauma patient with pneumoperitoneum was found to have radiologic evidence of pneumatosis cystoides intestinalis.
CASE PRESENTATION
We present the case of a 37-year-old Hispanic male admitted to the hospital after being involved in a motorcycle accident. Computed tomography imaging of the abdomen and pelvis with oral and intravenous contrast demonstrated trace pneumoperitoneum, possibly originating from the splenic flexure of the colon without evidence of extravasation of oral contrast. Laparoscopy with conversion to exploratory laparotomy revealed bowel abnormalities at the distal transverse colon and splenic flexure, which were identified as pneumatosis cystoides intestinalis by pathology. There was no evidence of bowel perforation. A panel of abdominal radiologists attended the computed tomography interpretation to note that incidental atraumatic or traumatic rupture of the cysts could have caused the pneumoperitoneum. The patient had an uncomplicated postoperative course and was transferred to another facility per insurance request.
CONCLUSIONS
When presenting in the context of trauma, pneumatosis cystoides intestinalis can lead to difficult management decisions. To our knowledge, there are no existing evidence-based guidelines for the scenario of concurrent pneumatosis cystoides intestinalis, blunt abdominal trauma, and pneumoperitoneum in a patient with a benign abdominal exam. This patient's pneumoperitoneum was likely caused by rupture of preexisting cysts rather than frank bowel perforation. Patients who are asymptomatic, lack signs of clinically worrisome disease, and have a low pretest probability will likely not benefit from surgery and can be medically managed. Thorough discussion between surgeons and radiologists can be helpful when evaluating the clinical significance of a patient's pneumatosis cystoides intestinalis and aid in the decision to perform surgery.
Topics: Abdomen; Adult; Cysts; Humans; Intestinal Perforation; Male; Pneumatosis Cystoides Intestinalis; Pneumoperitoneum
PubMed: 34915922
DOI: 10.1186/s13256-021-03183-9 -
Animals : An Open Access Journal From... Dec 2022Colic remains the number one cause of mortality in horses, and large colon displacement including colonic volvulus is one of the leading causes for equine...
Colic remains the number one cause of mortality in horses, and large colon displacement including colonic volvulus is one of the leading causes for equine hospitalization and surgery. Currently, there is not an adequate model to study the pathophysiology of this condition. The objective of this proof-of-concept study was to determine if subserosal implantation of bioinert microchips in the large intestine would be detectable by a RFID (radio-frequency identification) receiver when the implanted microchips were adjacent to the body wall, thus identifying the location of the colon within the abdomen. A horse with no history of gastrointestinal disease underwent a ventral midline celiotomy to implant twelve bioinert microchips into the subserosa at predetermined locations within the large colon and cecum. A RFID scanner was used to monitor the location of the colon via transcutaneous identification 1-3 times daily for a one-month period. Following humane euthanasia, a postmortem examination of the horse was performed to assess microchip implantation sites for migration and histologic assessment. Eleven out of the 12 implanted microchips were successfully identified transcutaneously at occurrences as high as 100%. Odds ratios were calculated for the likelihood of identifying each chip in a location different from its most common location. Microchips implanted into the subserosa of the equine large colon can be used as a means of identifying the approximate location of the equine large colon via transcutaneous identification with an RFID scanner.
PubMed: 36496942
DOI: 10.3390/ani12233421 -
Cureus Mar 2024Multiple primary tumors are rare but their incidence is increasing nowadays with advancements in diagnostic methods and the extended survival of individuals previously...
Multiple primary tumors are rare but their incidence is increasing nowadays with advancements in diagnostic methods and the extended survival of individuals previously treated for malignancies. However, synchronous occurrence of gastric cancer (GC) and colonic cancer (CC) is a rare entity. A 41-year-old male came with complaints of epigastric pain associated with anorexia, rapid weight loss, and occasional constipation. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis reported mucosal thickening in the antrum, likely GC with circumferential wall thickening of the transverse colon with pericolic fat stranding suggestive of CC. Upper gastrointestinal endoscopy and colonoscopy were also done and a biopsy was taken from representative sites, which confirmed malignancy. He completed three cycles of chemotherapy preoperatively and underwent subtotal gastrectomy, D2 lymphadenectomy, gastrojejunostomy, jejunojejunostomy, and transverse colectomy simultaneously. Histopathological examination confirmed moderately differentiated gastric adenocarcinoma penetrating into the subserosa and well-differentiated colonic adenocarcinoma invading the muscularis propria. Immunohistochemical analysis of mismatch repair (MMR) proteins was done to determine the association with hereditary nonpolyposis colorectal cancer syndrome (HNPCC) or Lynch syndrome. The patient underwent postoperative chemotherapy along with immunotherapy. To conclude, synchronous occurrence of primary GC and primary CC with similar MMR protein expression in immunohistochemistry is an uncommon entity.
PubMed: 38646233
DOI: 10.7759/cureus.56607 -
The Turkish Journal of Pediatrics 2023Pneumatosis cystoides intestinalis (PI) is a rare but important condition in which widespread air sacs are found in the submucosa, and subserosa of the bowel wall....
Pneumatosis cystoides intestinalis mimicking free intraabdominal air following chemotherapy for relapsed acute myeloblastic leukemia in a transplanted neutropenic child: a case report.
BACKGROUND
Pneumatosis cystoides intestinalis (PI) is a rare but important condition in which widespread air sacs are found in the submucosa, and subserosa of the bowel wall. Although it has several etiologies, children receiving chemotherapy are at risk for PI. Preferred imaging tools for the diagnosis are abdominal direct radiography and computed tomography. In patients with PI, rupture of intramural air sacs is the source of benign pneumoperitoneum, causing free air without true intestinal perforation. Intestinal perforation or obstruction are indications for surgical intervention.
CASE
Here, we present a 4-year-old patient diagnosed with acute myeloblastic leukemia (AML), who underwent allogeneic hematopoietic stem cell transplantation (HSCT) from a matched sibling donor (MSD) and developed PI after HSCT. The patient was consulted to the pediatric surgery department, and her oral feeding was stopped. Broad spectrum antibiotics (teicoplanin, metronidazol and vancomycin) were initiated. Her fever increased during the 24-hour monitoring, there was no stool passage, CRP ( > 25 mg/dL, normal value < 1 mg/dL) and abdominal distension increased and there was prolonged neutropenia and radiologic investigations could not rule out intestinal perforation, so the patient underwent exploratory laparotomy. No intestinal perforation was found. There was no sign in the intestinal wall and numerous gas-filled cysts of various sizes.
CONCLUSIONS
PI is an uncommon complication, and direct radiography/computed tomography scans are very helpful in making the diagnosis in suspicious cases. PI, should be kept in mind, especially in transplanted or relapsed leukemia patients receiving intensive chemotherapy.
Topics: Animals; Female; Humans; Child; Child, Preschool; Pneumatosis Cystoides Intestinalis; Leukemia, Myeloid, Acute; Hematopoietic Stem Cell Transplantation; Tissue Donors; Anti-Bacterial Agents
PubMed: 37661686
DOI: 10.24953/turkjped.2023.116