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International Journal of Surgery Case... Apr 2024Intravascular papillary endothelial hyperplasia (IPEH), originally described by Pierre Masson in 1923, is a benign vascular lesion characterised by the reactive...
INTRODUCTION
Intravascular papillary endothelial hyperplasia (IPEH), originally described by Pierre Masson in 1923, is a benign vascular lesion characterised by the reactive proliferation of endothelial cells. This tumour typically manifests on the fingers, head, neck, or trunk. However, involvement of other organ systems, including abdominal organs, is possible although exceedingly rare.
CASE PRESENTATION
A 57-year-old male patient presented to the emergency department with a 24-h history of recurrent light-headedness. The patient was haemodynamically stable, and physical examination showed no abdominal pain. Digital rectal examination unveiled melena. Initial blood analysis indicated a haemoglobin level of 10.5 g/dL. Comprehensive workup with abdominal computed tomography, upper and lower endoscopy, and gastrointestinal lumen MRI failed to yield significant findings.
DISCUSSION
On the fourth day of hospitalisation, persistent melena and transfusion of four units of blood triggered a new upper endoscopy. This endoscopy extended to the jejunum, revealing a submucosal lesion measuring 20 mm, situated approximately 40 cm distal to the ligament of Treitz. Due to ongoing intraluminal bleeding with decreased haemoglobin levels, a segmental jejunal resection was performed. Pathological examination confirmed the diagnosis of a completely resected submucosal IPEH.
CONCLUSION
IPEH, also known as Masson's tumour, is an uncommon vascular lesion within the intestinal tract, occasionally resulting in persistent haemorrhage. The preferred treatment is total surgical resection, with a low likelihood of recurrence. Currently, postoperative surveillance is not recommended. To the best of our knowledge, no cases of recurrence have been documented for Masson's tumour localised in the gastrointestinal tract in the existing literature.
PubMed: 38471215
DOI: 10.1016/j.ijscr.2024.109501 -
Revista Espanola de Enfermedades... Mar 2024Brunner's gland hyperplasia or Brunneroma is a rare benign proliferative lesion of the small intestine. It is often incidentally discovered during endoscopy or imaging...
Brunner's gland hyperplasia or Brunneroma is a rare benign proliferative lesion of the small intestine. It is often incidentally discovered during endoscopy or imaging studies. The endoscopic presentation can be nodular, polypoid, or a diffuse glandular proliferation with thickening of the duodenal wall, which can be mistaken for malignant neoplasia. It rarely causes gastrointestinal bleeding. Is presented a case of a 25-year-old man who presented with melena and anemia secondary to Brunner's gland hyperplasia.
PubMed: 38469814
DOI: 10.17235/reed.2024.10347/2024 -
Cureus Feb 2024Advanced and metastatic gastrointestinal stromal tumors (GISTs) presenting with surgical emergencies are rare. Neoadjuvant imatinib being the treatment of choice for...
Advanced and metastatic gastrointestinal stromal tumors (GISTs) presenting with surgical emergencies are rare. Neoadjuvant imatinib being the treatment of choice for non-metastatic advanced disease with a proven role in downstaging the disease may not be feasible in patients presenting with bleeding and obstruction. We present a case series with retrospective analysis of a prospectively maintained database of patients with advanced and metastatic GISTs presenting with surgical emergencies. Clinical characteristics, imaging and endoscopic findings, surgical procedures, histological findings, and outcomes in these patients were studied. Four patients were included in this case series, with three males and one female (age range: 24-60 years). Two patients presented with melena; one with hemodynamic instability despite multiple blood transfusions underwent urgent exploratory laparotomy for bleeding gastric GIST, while the other underwent surgical exploration after careful evaluation given the recurrent, metastatic disease with a stable metabolic response on six months of imatinib. One patient with metastatic jejunal GIST who presented with an umbilical nodule and intestinal obstruction was given a trial of non-operative management for 72 hours, but due to non-resolution of obstruction, segmental jejunal en bloc resection with the dome of the urinary bladder with reconstruction and metastasectomy was needed. The patient with advanced gastric GIST who presented with gastric outlet obstruction was resuscitated, and an attempt of endoscopic naso-jejunal tube placement was tried, which failed, and exploration was needed. The mean length of hospital stay was 7.5 days. Histopathological examination confirmed GIST in all four patients with microscopic negative resection margins. All patients were started on imatinib with dose escalation to 800 mg in the patient with recurrent and metastatic disease; however, the patient with bleeding gastric GIST experienced severe adverse effects of imatinib and discontinued the drug shortly. All four patients are disease-free on follow-ups of 15 months, 48 months for the patient with advanced non-metastatic disease, and six and 24 months for the patients with metastatic disease. In the era of tyrosine kinase inhibitor (TKI) therapy for advanced and metastatic disease, upfront surgery is usually reserved for surgical emergencies only. Surgical resection, the cornerstone for the treatment of resectable GIST, may also be clinically relevant in metastatic settings, although it requires a careful and individualized approach.
PubMed: 38465042
DOI: 10.7759/cureus.53851 -
Cancer Diagnosis & Prognosis 2024Given that gastric small cell neuroendocrine carcinoma (SCNEC) is notably more aggressive than conventional adenocarcinoma, and a platinum-based regimen aligned with the...
BACKGROUND/AIM
Given that gastric small cell neuroendocrine carcinoma (SCNEC) is notably more aggressive than conventional adenocarcinoma, and a platinum-based regimen aligned with the treatment for pulmonary SCNEC is advocated when chemotherapy is needed, ensuring an accurate pathological diagnosis is paramount.
CASE REPORT
A 63-year-old man, examined for melena, underwent gastroscopy which revealed a total circumferential Borrmann type 3 lesion extending from the pylorus to the antrum of the stomach. He underwent a distal gastrectomy with D2 lymphadenectomy. The microscopic examination revealed SCNEC with a minor adenocarcinoma component. Immunohistochemically, the SCNEC was diffusely positive for synaptophysin, CD56, and INSM1, very focally positive for chromogranin A, and negative for leukocyte common antigen, CD3, and CD20. A significant observation in this case was the complete negativity for epithelial markers including keratin (CK7, CK8, CK20, CAM5.2, and AE1/AE3) and epithelial membrane antigen.
CONCLUSION
Diffuse positivity for neuroendocrine markers, negativity for other lineage markers, and a transition from the adenocarcinoma component, if present, serve as significant diagnostic clues for gastric SCNEC with loss of epithelial markers expression. SCNEC should not be excluded solely based on the negative result for epithelial markers.
PubMed: 38434925
DOI: 10.21873/cdp.10306 -
Zhongguo Yi Xue Ke Xue Yuan Xue Bao.... Feb 2024Type Ⅳ hiatal hernia with a high risk usually presents sudden or suddenly worsening epigastric pain,vomiting,and dysphagia.It is not conducive to early diagnosis and...
Type Ⅳ hiatal hernia with a high risk usually presents sudden or suddenly worsening epigastric pain,vomiting,and dysphagia.It is not conducive to early diagnosis and treatment when symptoms are atypical.Type Ⅳ hiatal hernia with severe anemia is rare.This article reports an atypical case of type Ⅳ hiatal hernia with melena and severe anemia as the main manifestations,aiming to improve clinicians' identification of the atypical clinical presentations of type Ⅳ hiatal hernia.
Topics: Humans; Hernia, Hiatal; Anemia
PubMed: 38433644
DOI: 10.3881/j.issn.1000-503X.15600 -
Cureus Jan 2024Renal cell carcinoma (RCC) most commonly metastasizes to the lung, lymph nodes, bone, and liver. RCC metastasizing to the small bowel is exceedingly rare (0.7%), and the...
Renal cell carcinoma (RCC) most commonly metastasizes to the lung, lymph nodes, bone, and liver. RCC metastasizing to the small bowel is exceedingly rare (0.7%), and the ileum is the least likely site. We discuss the case of a 63-year-old male patient who presented with melena and a 10-kg unintentional weight loss in the preceding month 10 years after undergoing curative nephrectomy for RCC; he was found to have an ileal mass on CT imaging. He subsequently underwent a diagnostic gastroscopy and laparoscopy, later converted to a laparotomy, with bowel resection and anastomosis. The immunohistochemistry was consistent with RCC. This case report highlights the need for awareness about this rare but potential site of metastasis, which may present with gastrointestinal bleeding.
PubMed: 38420097
DOI: 10.7759/cureus.53141 -
JPMA. the Journal of the Pakistan... Feb 2024To determine different aetiologies and outcomes of upper gastrointestinal bleeding in hospitalised patients.
OBJECTIVE
To determine different aetiologies and outcomes of upper gastrointestinal bleeding in hospitalised patients.
METHODS
The retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised data from December 2019 to April 2021 related to adult patients of either gender with nongastrointestinal illnesses who developed bleeding at least 24 hours after admission. Data was reviewed for clinical characteristics, cause of bleeding and clinical outcome. Data was analysed using SPSS 23.
RESULTS
Among 47,337 hospitalised patients, upper gastrointestinal bleeding was identified in 147(0.3%); 98 (66.7%) males and 49 (33.3%) females. The overall mean age was 62.73±14.81 years (range 20-95 years). Of the total, 125(85%) presented with overt bleeding and 22(15%) with a drop in haemoglobin level. There were 34(23%) patients on aspirin, 36(24%) on dual anti-platelets, 41(28%) on therapeutic anticoagulation, and 81(55%) on prophylactic anticoagulation. There were 7(5%) patients having a history of non-steroidal anti-inflammatory drugs (NSAIDs), and 12(8%) were on steroids. In terms of associated medical conditions, pneumonia, stroke, and acute coronary syndrome were commonly seen with frequency of 29.9%, 8.1% and 7.4% respectively. Overall, 36(24.4%) patients underwent endoscopy, 8(5.4%) had therapeutic measures to control bleeding, 14(9.5%) had bleeding for >48 hours, 89(60.5%) were stepped up to special care. Mortality was seen in 36(24.5%) cases.
CONCLUSIONS
Hospital acquired gastrointestinal bleeding was found to be uncommon, and there were several risk factors for such bleeding events.
Topics: Adult; Male; Female; Humans; Young Adult; Middle Aged; Aged; Aged, 80 and over; Retrospective Studies; Tertiary Care Centers; Gastrointestinal Hemorrhage; Risk Factors; Endoscopy, Gastrointestinal; Anticoagulants; Anti-Inflammatory Agents, Non-Steroidal
PubMed: 38419217
DOI: 10.47391/JPMA.7141 -
BioRxiv : the Preprint Server For... Feb 2024The definitive demonstration of protein localization on primary cilia has been a challenge for cilia biologists. Primary cilia are solitary thread-like projections that...
The definitive demonstration of protein localization on primary cilia has been a challenge for cilia biologists. Primary cilia are solitary thread-like projections that contain specialized protein composition, but as the ciliary structure overlays the cell membrane and other cell parts, the identity of ciliary proteins are difficult to ascertain by conventional imaging approaches like immunofluorescence microscopy. Surface scanning electron microscopy combined with immuno-labeling (immuno-SEM) bypasses some of these indeterminacies by unambiguously showing protein expression in the context of the 3D ultrastructure of the cilium. Here we apply immuno-SEM to specifically identify proteins on the primary cilia of mouse and human pancreatic islets, including post-translationally modified tubulin, intraflagellar transport (IFT) 88, the small GTPase Arl13b, as well as subunits of axonemal dynein. Key parameters in sample preparation, immuno-labeling, and imaging acquisition are discussed to facilitate similar studies by others in the cilia research community.
PubMed: 38405740
DOI: 10.1101/2024.02.16.580695 -
Journal of Korean Medical Science Feb 2024
Topics: Male; Humans; Aged; Melena; Gastrointestinal Hemorrhage; Diagnosis, Differential
PubMed: 38374631
DOI: 10.3346/jkms.2024.39.e66