Introduction: Diffuse Large B Cell Lymphoma (DLBCL), as a set of heterogeneous aggressive lymphoma, most commonly originated in the germinal center B lymphocytes. Rare cases were from peripheral blood B cell (outside germinal center) or from the inert lymphoma development and transformation. And such tumor with originality outside germinal center was seldom seen in the literature. Even the tumor in combination with chronic gastritis has not been reported before.
Recent advances in the management of ulcerative colitis include new drug delivery systems that allow for once daily dosing and improved targeting of drugs to the colon. Newer formulations of mesalamine like MMX and granules have been shown to improve remission rates and patient adherence compared to older formulations. Other advances include the use of probiotics like VSL#3, low molecular weight heparins delivered to the colon via MMX tablets, and natural anti-inflammatories like curcumin, which has been shown to maintain remission in patients with quiescent ulcerative colitis. Endoscopic techniques like chromoendoscopy, narrow band imaging, and confocal laser endomicroscopy have also improved detection of
This document provides information on the diagnosis and management of abdominal tuberculosis. Key points include:
- Diagnosis can be made through histological evidence, operative findings, culture/animal inoculation, or demonstration of acid-fast bacilli.
- Imaging tools include plain X-ray, ultrasound, barium studies, CT, and colonoscopy. Ascitic fluid analysis and tests like ADA and PCR can also assist.
- Treatment involves a 6-month course of anti-tubercular drugs. Surgery is indicated for complications like obstruction, perforation, or abscesses.
- Surgical procedures depend on the location and extent of disease but may include resection, stricturoplasty, or drainage of abs
This document discusses the differences between Crohn's disease and tuberculosis of the intestine through clinical features, serology/immunology, radiology, endoscopy/colonoscopy, and histopathology. Some key differences include: Crohn's typically has a longer duration of illness (>12 months) and family history, while TB is more likely to present with fever and night sweats. Radiologically, TB often shows involvement of the ileocecal junction and ascites, while Crohn's can display skip lesions and transmural inflammation. Histopathologically, TB granulomas are typically larger and show caseation, while Crohn's granulomas are often smaller and single. Microbiological tests like PCR and
Non Hodgkin Lymphoma Of Caecum- A Case Reportiosrjce
This document reports a case study of a 38-year-old male who presented with abdominal pain and a mass and was diagnosed with non-Hodgkin lymphoma (NHL) of the cecum. Histopathological examination revealed diffuse large B-cell lymphoma involving the cecal wall and lymph nodes. Immunohistochemistry confirmed CD20/CD10/CD45 positivity and CD3/MPO/CD30/CD138 negativity, consistent with diffuse large B-cell lymphoma of follicular center origin. The diagnosis of colonic NHL is difficult but important to make, as chemotherapy offers excellent long-term survival outcomes.
esophageal carcinoma is one of the common gastrointestinal malignancy. Its usually present at advanced stage. Its management requires diagnosis as early as possible and staging followed by proper planning of treatment. Its treatment include endoscopic, surgical, adjuvant chemotherapy and palliative management.
Inflammatory bowel disease (IBD) refers to ulcerative colitis and Crohn's disease, which are chronic inflammatory conditions of the gastrointestinal tract. Ulcerative colitis causes inflammation of the colon, while Crohn's disease causes transmural inflammation that can involve any part of the gastrointestinal tract from mouth to anus. The causes of IBD are not fully understood but involve genetic susceptibility, environmental factors, and dysregulation of the immune system. Symptoms vary depending on the location and severity of inflammation. Treatment involves medications to induce and maintain remission such as aminosalicylates, corticosteroids, immunomodulators, antibiotics, biologics, and surgery for complications.
Laboratory investigations in inflammatory bowel disease deepakrsanghavi
Calprotectin is a marker for inflammation that can be measured in stool samples. Elevated levels of calprotectin indicate inflammation in the gastrointestinal tract. Calprotectin testing can help distinguish between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), as well as determine disease activity and monitor response to treatment for IBD. A calprotectin level below 50 μg/g indicates no inflammation, while a level over 200 μg/g suggests active organic disease requiring further evaluation. Calprotectin testing could reduce unnecessary colonoscopies by 67% in adults and 35% in children, but may delay diagnosis in 6% of cases due to false negatives.
Recent advances in the management of ulcerative colitis include new drug delivery systems that allow for once daily dosing and improved targeting of drugs to the colon. Newer formulations of mesalamine like MMX and granules have been shown to improve remission rates and patient adherence compared to older formulations. Other advances include the use of probiotics like VSL#3, low molecular weight heparins delivered to the colon via MMX tablets, and natural anti-inflammatories like curcumin, which has been shown to maintain remission in patients with quiescent ulcerative colitis. Endoscopic techniques like chromoendoscopy, narrow band imaging, and confocal laser endomicroscopy have also improved detection of
This document provides information on the diagnosis and management of abdominal tuberculosis. Key points include:
- Diagnosis can be made through histological evidence, operative findings, culture/animal inoculation, or demonstration of acid-fast bacilli.
- Imaging tools include plain X-ray, ultrasound, barium studies, CT, and colonoscopy. Ascitic fluid analysis and tests like ADA and PCR can also assist.
- Treatment involves a 6-month course of anti-tubercular drugs. Surgery is indicated for complications like obstruction, perforation, or abscesses.
- Surgical procedures depend on the location and extent of disease but may include resection, stricturoplasty, or drainage of abs
This document discusses the differences between Crohn's disease and tuberculosis of the intestine through clinical features, serology/immunology, radiology, endoscopy/colonoscopy, and histopathology. Some key differences include: Crohn's typically has a longer duration of illness (>12 months) and family history, while TB is more likely to present with fever and night sweats. Radiologically, TB often shows involvement of the ileocecal junction and ascites, while Crohn's can display skip lesions and transmural inflammation. Histopathologically, TB granulomas are typically larger and show caseation, while Crohn's granulomas are often smaller and single. Microbiological tests like PCR and
Non Hodgkin Lymphoma Of Caecum- A Case Reportiosrjce
This document reports a case study of a 38-year-old male who presented with abdominal pain and a mass and was diagnosed with non-Hodgkin lymphoma (NHL) of the cecum. Histopathological examination revealed diffuse large B-cell lymphoma involving the cecal wall and lymph nodes. Immunohistochemistry confirmed CD20/CD10/CD45 positivity and CD3/MPO/CD30/CD138 negativity, consistent with diffuse large B-cell lymphoma of follicular center origin. The diagnosis of colonic NHL is difficult but important to make, as chemotherapy offers excellent long-term survival outcomes.
esophageal carcinoma is one of the common gastrointestinal malignancy. Its usually present at advanced stage. Its management requires diagnosis as early as possible and staging followed by proper planning of treatment. Its treatment include endoscopic, surgical, adjuvant chemotherapy and palliative management.
Inflammatory bowel disease (IBD) refers to ulcerative colitis and Crohn's disease, which are chronic inflammatory conditions of the gastrointestinal tract. Ulcerative colitis causes inflammation of the colon, while Crohn's disease causes transmural inflammation that can involve any part of the gastrointestinal tract from mouth to anus. The causes of IBD are not fully understood but involve genetic susceptibility, environmental factors, and dysregulation of the immune system. Symptoms vary depending on the location and severity of inflammation. Treatment involves medications to induce and maintain remission such as aminosalicylates, corticosteroids, immunomodulators, antibiotics, biologics, and surgery for complications.
Laboratory investigations in inflammatory bowel disease deepakrsanghavi
Calprotectin is a marker for inflammation that can be measured in stool samples. Elevated levels of calprotectin indicate inflammation in the gastrointestinal tract. Calprotectin testing can help distinguish between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), as well as determine disease activity and monitor response to treatment for IBD. A calprotectin level below 50 μg/g indicates no inflammation, while a level over 200 μg/g suggests active organic disease requiring further evaluation. Calprotectin testing could reduce unnecessary colonoscopies by 67% in adults and 35% in children, but may delay diagnosis in 6% of cases due to false negatives.
This case report describes a 77-year-old male who presented with acute abdominal pain and was found to have perforated diverticulitis with abscess formation based on CT imaging. He underwent partial sigmoidectomy which showed diverticulitis but no tumor. However, fragments of mucinous adenocarcinoma were found in the abscess. Further surgery revealed a moderately-differentiated mucinous adenocarcinoma arising within a diverticulum. This case illustrates the difficulty in diagnosing adenocarcinoma arising in a diverticulum due to overlapping imaging findings with diverticulitis. A high index of suspicion is needed when findings are discrepant.
The document discusses inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease. IBD is characterized by chronic inflammation of the bowel that can affect any part of the gastrointestinal tract from mouth to anus. Common symptoms include abdominal pain, diarrhea, and weight loss. Treatment involves medications to reduce inflammation as well as surgery in severe cases to remove inflamed sections of bowel. Complications can include malnutrition, infection, bowel obstruction, and in rare cases colon cancer. The causes of IBD are not fully understood but involve an abnormal immune response in the gastrointestinal tract.
Primary non gestational extra gonadal choriocarcinoma of the lungAR Muhamad Na'im
This document discusses primary non-gestational extragonadal choriocarcinoma of the lung, a rare type of germ cell tumor. It begins by defining choriocarcinoma and distinguishing between gestational and non-gestational types. It then focuses on primary (non-gestational) choriocarcinoma of the lung, which accounts for less than 30 reported cases. The diagnostic criteria include exclusion of other primary sites and normalization of serum HCG levels after treatment. Histopathological examination shows malignant cells resembling trophoblast or syncytiotrophoblast cells. Prognosis is generally poor with average survival of 5 months.
The document discusses acute cholangitis, including its pathogenesis, clinical manifestations, diagnostic criteria, severity assessment, imaging, and management. Regarding diagnostic criteria, it summarizes that Charcot's triad has low sensitivity for diagnosing acute cholangitis compared to the Tokyo Guidelines 2007 and 2013 criteria. It also notes that the Tokyo Guidelines 2007 criteria for severity assessment were insufficient and have been revised in subsequent guidelines to better distinguish mild from moderate cases in the initial diagnosis.
This document provides information on Crohn's disease and ulcerative colitis. It discusses the definition, symptoms, diagnosis, and treatment of Crohn's disease, including that it is a chronic inflammatory bowel disease that can affect any part of the GI tract. It also summarizes ulcerative colitis as an inflammatory disease confined to the colon and rectum, noting its symptoms include bloody diarrhea and abdominal pain. The document provides details on evaluating and managing both conditions medically or surgically.
Crohn's disease and tuberculosis can be difficult to differentiate based on clinical features alone. Key factors that may help include disease duration, family history, presence of extraintestinal manifestations, and endoscopic and histological findings on biopsies. Radiological imaging findings can also provide clues but often overlap between the two conditions. A high index of suspicion is needed and further investigations including microbiological tests may be required in uncertain cases to arrive at the correct diagnosis and avoid unnecessary double treatment.
Inflammatory Bowel Disease (IBD) refers to two conditions: Crohn's disease and ulcerative colitis. Crohn's disease causes chronic inflammation of the gastrointestinal tract that can affect any location from mouth to anus in a discontinuous pattern. Ulcerative colitis causes non-granulomatous inflammation of the colon and rectum in a continuous pattern beginning in the rectum. The causes of IBD are not fully known but involve an immune reaction to environmental triggers in genetically predisposed individuals. Symptoms vary depending on the location and severity of inflammation. Management involves non-pharmacological approaches as well as medications to reduce inflammation like aminosalicates, corticosteroids, immunosuppress
Ulcerative colitis is a chronic inflammatory bowel disease that affects the large intestine. It has a complex interaction of genetic susceptibility, immunity, and environmental factors. The highest rates are seen in Northern Europe and North America. Clinically, it presents with diarrhea, rectal bleeding, abdominal pain, and can range from limited to the rectum to involving the entire colon. The pathology shows continuous superficial inflammation and regenerative changes. Treatment focuses on reducing inflammation and immunosuppression.
This document presents two case studies of patients with gastric cancer. The first case is a 60-year-old male who presented with epigastric pain and vomiting for two months. Various tests were performed and it was determined that he had a signet ring cell type adenocarcinoma of the stomach. He underwent a laparoscopic gastrectomy. The second case is a 72-year-old male who also presented with epigastric pain and chest heaviness. He was found to have adenocarcinoma of the stomach as well and underwent a laparoscopic gastrectomy. The document then provides further details on the anatomy, histopathology, classification, staging, signs and symptoms, and management of
The document discusses the difficulties in differentiating between Crohn's disease (CD) and intestinal tuberculosis (ITB) given their similar clinical, endoscopic, and histological features. Both are granulomatous diseases that can affect the intestine. While ITB is more common in India, rates of CD are increasing worldwide and also in developing countries. Making an accurate diagnosis is important as treatment approaches differ between the two conditions. Several clinical, endoscopic, radiological, and histological features are discussed that may suggest one condition over the other, but differences are often subtle. A high index of suspicion is needed to diagnose ITB in areas where it is endemic to ensure appropriate treatment.
This case presentation describes a 36-year-old woman with severe, steroid-refractory ulcerative colitis who developed immune thrombocytopenic purpura (ITP). She was initially treated with medications but did not improve. She underwent a laparoscopic colectomy with ileostomy due to continued bloody diarrhea and abdominal pain. Her platelet count decreased during the hospitalization but increased with treatment including intravenous immunoglobulin and steroids. Following discharge, her platelet count continued to improve on prednisone taper. She will return for an ileal pouch anal anastomosis surgery.
Abdominal tuberculosis is a common disease in Pakistan that is difficult to diagnose due to nonspecific symptoms. It most often affects the ileocaecal region of the small bowel and colon. Diagnosis requires considering a patient's clinical history, concomitant pulmonary tuberculosis, blood tests showing elevated ESR, and radiological findings of thickened bowel walls or lymph node enlargement. Diagnostic tools include endoscopy and biopsy to identify granulomas, as well as laparoscopy which has the highest diagnostic yield through visualization of the peritoneum and biopsy. Treatment involves a combination of anti-tuberculosis medications for 6-9 months. Surgery is reserved for complications like obstruction or perforation.
Join us for a lecture on inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. Roger S. Klein, MD, FACP, will highlight the latest in diagnostic technologies and treatment approaches for IBD. He also will discuss the importance of comprehensive care to help prevent IBD-associated health problems.
This document discusses abdominal tuberculosis, which can involve the gastrointestinal tract, peritoneum, and organs within the abdominal cavity. The ileoceal junction is most commonly affected. Clinical presentation varies greatly due to the complex pathological process. Diagnosis relies on a combination of investigations including imaging, laparoscopy, and biopsy. Treatment involves a combination of chemotherapy and sometimes surgery for complications like perforation or failure to resolve symptoms. Abdominal tuberculosis remains a diagnostic challenge due to its variable presentation and similarities to other diseases.
This case report describes a 68-year-old male patient with a giant 20 cm para-scrotal fibroepithelial polyp that had been present for 15 years. Physical examination revealed a solid scrotal tumor with erythematous and necrotic areas. Imaging studies showed a non-vascularized para-scrotal mass. The mass was surgically excised and pathology found it to be a benign fibroepithelial polyp with myxedema, acute vasculitis, and abscess areas. Fibroepithelial polyps are usually benign and asymptomatic, but can become infected, bleed, or cause obstruction depending on their location.
This case report describes the treatment of a 55-year-old male patient diagnosed with gastric diffuse large B-cell lymphoma (DLBCL) at the Portsudan Oncology Center in Sudan from August 2018 to July 2021. The patient received 8 cycles of CHOP chemotherapy, followed by 8 cycles of rituximab and 30GY radiotherapy to the gastric region and lymph nodes. The treatment resulted in regression of lesions. However, the patient later experienced a relapse and was treated with 8 cycles of ICE chemotherapy, with regression of lesions observed again. The report discusses DLBCL and the challenges of treating it at a small oncology center with limited resources and capabilities.
This case report describes a 61-year-old male patient who presented with chronic abdominal pain and was found to have xanthogranulomatous cholecystitis (XGC), a rare inflammatory disease of the gallbladder, along with gallstones. Imaging studies revealed thickening of the gallbladder wall and a mass, concerning for possible gallbladder carcinoma. The patient underwent cholecystectomy and was found to have XGC pathology, characterized by lipid-laden macrophages and chronic inflammatory cells infiltrating the gallbladder wall. XGC is a benign condition that can be confused for gallbladder cancer. The patient's surgery and recovery were uncomplicated.
Isolated Splenic Metastases from Rectal Carcinoma Five Years after Surgery: C...semualkaira
Primary splenic tumors and splenic metastases are uncommon, and
metastatic splenic tumors are even rarer [1]. According to reports,
the most common source of splenic metastases include melanoma,
tumors of the breast, lung, ovary, colon, stomach, and pancreas [2-
3]. Splenic metastases after rectal cancer surgery is very rare. This
paper reports a case of a patient with splenic metastases from rectal cancer 5 years after surgery. We discuss the route of metastasis
and treatment of this case.
Primary Follicular Lymphoma of the spleen: A Case report and literature reviewiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This case report describes a 77-year-old male who presented with acute abdominal pain and was found to have perforated diverticulitis with abscess formation based on CT imaging. He underwent partial sigmoidectomy which showed diverticulitis but no tumor. However, fragments of mucinous adenocarcinoma were found in the abscess. Further surgery revealed a moderately-differentiated mucinous adenocarcinoma arising within a diverticulum. This case illustrates the difficulty in diagnosing adenocarcinoma arising in a diverticulum due to overlapping imaging findings with diverticulitis. A high index of suspicion is needed when findings are discrepant.
The document discusses inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease. IBD is characterized by chronic inflammation of the bowel that can affect any part of the gastrointestinal tract from mouth to anus. Common symptoms include abdominal pain, diarrhea, and weight loss. Treatment involves medications to reduce inflammation as well as surgery in severe cases to remove inflamed sections of bowel. Complications can include malnutrition, infection, bowel obstruction, and in rare cases colon cancer. The causes of IBD are not fully understood but involve an abnormal immune response in the gastrointestinal tract.
Primary non gestational extra gonadal choriocarcinoma of the lungAR Muhamad Na'im
This document discusses primary non-gestational extragonadal choriocarcinoma of the lung, a rare type of germ cell tumor. It begins by defining choriocarcinoma and distinguishing between gestational and non-gestational types. It then focuses on primary (non-gestational) choriocarcinoma of the lung, which accounts for less than 30 reported cases. The diagnostic criteria include exclusion of other primary sites and normalization of serum HCG levels after treatment. Histopathological examination shows malignant cells resembling trophoblast or syncytiotrophoblast cells. Prognosis is generally poor with average survival of 5 months.
The document discusses acute cholangitis, including its pathogenesis, clinical manifestations, diagnostic criteria, severity assessment, imaging, and management. Regarding diagnostic criteria, it summarizes that Charcot's triad has low sensitivity for diagnosing acute cholangitis compared to the Tokyo Guidelines 2007 and 2013 criteria. It also notes that the Tokyo Guidelines 2007 criteria for severity assessment were insufficient and have been revised in subsequent guidelines to better distinguish mild from moderate cases in the initial diagnosis.
This document provides information on Crohn's disease and ulcerative colitis. It discusses the definition, symptoms, diagnosis, and treatment of Crohn's disease, including that it is a chronic inflammatory bowel disease that can affect any part of the GI tract. It also summarizes ulcerative colitis as an inflammatory disease confined to the colon and rectum, noting its symptoms include bloody diarrhea and abdominal pain. The document provides details on evaluating and managing both conditions medically or surgically.
Crohn's disease and tuberculosis can be difficult to differentiate based on clinical features alone. Key factors that may help include disease duration, family history, presence of extraintestinal manifestations, and endoscopic and histological findings on biopsies. Radiological imaging findings can also provide clues but often overlap between the two conditions. A high index of suspicion is needed and further investigations including microbiological tests may be required in uncertain cases to arrive at the correct diagnosis and avoid unnecessary double treatment.
Inflammatory Bowel Disease (IBD) refers to two conditions: Crohn's disease and ulcerative colitis. Crohn's disease causes chronic inflammation of the gastrointestinal tract that can affect any location from mouth to anus in a discontinuous pattern. Ulcerative colitis causes non-granulomatous inflammation of the colon and rectum in a continuous pattern beginning in the rectum. The causes of IBD are not fully known but involve an immune reaction to environmental triggers in genetically predisposed individuals. Symptoms vary depending on the location and severity of inflammation. Management involves non-pharmacological approaches as well as medications to reduce inflammation like aminosalicates, corticosteroids, immunosuppress
Ulcerative colitis is a chronic inflammatory bowel disease that affects the large intestine. It has a complex interaction of genetic susceptibility, immunity, and environmental factors. The highest rates are seen in Northern Europe and North America. Clinically, it presents with diarrhea, rectal bleeding, abdominal pain, and can range from limited to the rectum to involving the entire colon. The pathology shows continuous superficial inflammation and regenerative changes. Treatment focuses on reducing inflammation and immunosuppression.
This document presents two case studies of patients with gastric cancer. The first case is a 60-year-old male who presented with epigastric pain and vomiting for two months. Various tests were performed and it was determined that he had a signet ring cell type adenocarcinoma of the stomach. He underwent a laparoscopic gastrectomy. The second case is a 72-year-old male who also presented with epigastric pain and chest heaviness. He was found to have adenocarcinoma of the stomach as well and underwent a laparoscopic gastrectomy. The document then provides further details on the anatomy, histopathology, classification, staging, signs and symptoms, and management of
The document discusses the difficulties in differentiating between Crohn's disease (CD) and intestinal tuberculosis (ITB) given their similar clinical, endoscopic, and histological features. Both are granulomatous diseases that can affect the intestine. While ITB is more common in India, rates of CD are increasing worldwide and also in developing countries. Making an accurate diagnosis is important as treatment approaches differ between the two conditions. Several clinical, endoscopic, radiological, and histological features are discussed that may suggest one condition over the other, but differences are often subtle. A high index of suspicion is needed to diagnose ITB in areas where it is endemic to ensure appropriate treatment.
This case presentation describes a 36-year-old woman with severe, steroid-refractory ulcerative colitis who developed immune thrombocytopenic purpura (ITP). She was initially treated with medications but did not improve. She underwent a laparoscopic colectomy with ileostomy due to continued bloody diarrhea and abdominal pain. Her platelet count decreased during the hospitalization but increased with treatment including intravenous immunoglobulin and steroids. Following discharge, her platelet count continued to improve on prednisone taper. She will return for an ileal pouch anal anastomosis surgery.
Abdominal tuberculosis is a common disease in Pakistan that is difficult to diagnose due to nonspecific symptoms. It most often affects the ileocaecal region of the small bowel and colon. Diagnosis requires considering a patient's clinical history, concomitant pulmonary tuberculosis, blood tests showing elevated ESR, and radiological findings of thickened bowel walls or lymph node enlargement. Diagnostic tools include endoscopy and biopsy to identify granulomas, as well as laparoscopy which has the highest diagnostic yield through visualization of the peritoneum and biopsy. Treatment involves a combination of anti-tuberculosis medications for 6-9 months. Surgery is reserved for complications like obstruction or perforation.
Join us for a lecture on inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. Roger S. Klein, MD, FACP, will highlight the latest in diagnostic technologies and treatment approaches for IBD. He also will discuss the importance of comprehensive care to help prevent IBD-associated health problems.
This document discusses abdominal tuberculosis, which can involve the gastrointestinal tract, peritoneum, and organs within the abdominal cavity. The ileoceal junction is most commonly affected. Clinical presentation varies greatly due to the complex pathological process. Diagnosis relies on a combination of investigations including imaging, laparoscopy, and biopsy. Treatment involves a combination of chemotherapy and sometimes surgery for complications like perforation or failure to resolve symptoms. Abdominal tuberculosis remains a diagnostic challenge due to its variable presentation and similarities to other diseases.
This case report describes a 68-year-old male patient with a giant 20 cm para-scrotal fibroepithelial polyp that had been present for 15 years. Physical examination revealed a solid scrotal tumor with erythematous and necrotic areas. Imaging studies showed a non-vascularized para-scrotal mass. The mass was surgically excised and pathology found it to be a benign fibroepithelial polyp with myxedema, acute vasculitis, and abscess areas. Fibroepithelial polyps are usually benign and asymptomatic, but can become infected, bleed, or cause obstruction depending on their location.
This case report describes the treatment of a 55-year-old male patient diagnosed with gastric diffuse large B-cell lymphoma (DLBCL) at the Portsudan Oncology Center in Sudan from August 2018 to July 2021. The patient received 8 cycles of CHOP chemotherapy, followed by 8 cycles of rituximab and 30GY radiotherapy to the gastric region and lymph nodes. The treatment resulted in regression of lesions. However, the patient later experienced a relapse and was treated with 8 cycles of ICE chemotherapy, with regression of lesions observed again. The report discusses DLBCL and the challenges of treating it at a small oncology center with limited resources and capabilities.
This case report describes a 61-year-old male patient who presented with chronic abdominal pain and was found to have xanthogranulomatous cholecystitis (XGC), a rare inflammatory disease of the gallbladder, along with gallstones. Imaging studies revealed thickening of the gallbladder wall and a mass, concerning for possible gallbladder carcinoma. The patient underwent cholecystectomy and was found to have XGC pathology, characterized by lipid-laden macrophages and chronic inflammatory cells infiltrating the gallbladder wall. XGC is a benign condition that can be confused for gallbladder cancer. The patient's surgery and recovery were uncomplicated.
Isolated Splenic Metastases from Rectal Carcinoma Five Years after Surgery: C...semualkaira
Primary splenic tumors and splenic metastases are uncommon, and
metastatic splenic tumors are even rarer [1]. According to reports,
the most common source of splenic metastases include melanoma,
tumors of the breast, lung, ovary, colon, stomach, and pancreas [2-
3]. Splenic metastases after rectal cancer surgery is very rare. This
paper reports a case of a patient with splenic metastases from rectal cancer 5 years after surgery. We discuss the route of metastasis
and treatment of this case.
Primary Follicular Lymphoma of the spleen: A Case report and literature reviewiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
Case of a rare inflammatory hepatic hilar mass mimicking cholangiocarcinomaDebdeep Banerjee
This case report describes a rare case of an inflammatory hepatic hilar mass that mimicked cholangiocarcinoma in a 66-year-old man. Imaging and biopsy were initially suggestive of cholangiocarcinoma but surgical exploration revealed the mass to be caused by diffuse fibrotic and inflammatory reactions. A definitive diagnosis of benign inflammatory mass, rather than cholangiocarcinoma, was made based on histopathological examination showing only chronic inflammation. The patient recovered well with conservative management, highlighting the challenges of distinguishing between benign and malignant hilar masses preoperatively.
Chronic diarrhea as a result of colonic fistulas -two case reports with different origin. When it comes to chronic diarrhea symptom, the first thing
one thinks of is never a surgical cause, but an infectious disease. The aim of this paper is to show 2 different cases of chronic diarrhea, resulting from
benign surgical causes - colonic fistula. The first case is a result of cholecystocolic fistula, while the second is the result of gastrojejunocolic fistula.
Colonic fistulas originate from different causes: malignancy, NSAID, diverticulosis of the colon, cholecystitis, pancreatitis, lymphoma, or after radiation
therapy. They can also result from a trauma, which can be post-surgical.
Introduction:
Cholecystocolic fistula occurs as a result of the inflammation of the gallbladder. It arises from existing adhesions. The incidence rate
is not high, but the complication is not a rarity per se. It is less frequent complication than cholecystoduodenal fistula. The main symptoms are secretory
diarrhea, vitamin K malabsorption and weight loss, and thus suspicion of malignancy is usual. The treatment is surgical removal of the gallbladder,
fistula and part of the colon en bloc.
Case report:
A 73-year old male patient was admitted to the department after 5 months of medical treatment. Laboratory tests, coproculture,
colonoscopy, abdominal ultrasonography, and gastroduodenoscopy were performed - the diagnosis was not established. The diagnosis was made by
means of irrigography and short and narrow cholecystocolic fistula was confirmed. The possibility of malignant disease was not completely excluded.
The patient underwent surgery after parental nutrition-adhesions, gallbladder, and the prepared fistula were removed as well as the longitudinal part
of the transverse colon, which was simultaneously repaired. Ex-tempore diagnosis-the surgical specimen originated from inflammation, not from
malignancy. The post-operative course was uneventful. The first post-operative stool was normal. The patient gained some weight after a few months.
Conclusion:
Along with the contemporary diagnostics methods, contrast examination plays an important diagnostic role. When infection is
excluded as the cause of chronic diarrhea, cholecystocolic fistula should be considered. Malignant disease should be excluded before the surgery, or it
may be diagnosed during the surgery, which would determine the course of the treatment. The treatment of benign cholecystocolic fistula is surgical
en bloc procedure.
This document summarizes the findings of a tumor board discussion on a 45-year-old male patient with signet ring cell carcinoma of the stomach. A subtotal gastrectomy specimen showed a mucin secreting adenocarcinoma in the pyloric antrum extending to the submucosa and inner muscular layer. Lymph nodes and resection margins were free of tumor. Prognostic factors for gastric carcinoma are discussed, including age, tumor stage/size, location, margins, surgery type, lymph node involvement, DNA ploidy, protein expression, and more.
Mittal S, Hussain SA, Tiwari RVC, Poovathingal AB, Priya BP, Bhanot R, Tiwari H. Extensive pelvic and abdominal lymphadenopathy with hepatosplenomegaly treated with radiotherapy-A case report. J Family Med Prim Care. 2020 Feb;9(2):1215-1218. doi: 10.4103/jfmpc.jfmpc_1125_19. eCollection 2020 Feb. PubMed PMID: 32318498; PubMed Central PMCID: PMC7113973.
This document summarizes a case report of a 65-year-old female patient diagnosed with Grade II follicular lymphoma. She presented with abdominal pain, distension, and fever. Imaging showed extensive pelvic and abdominal lymphadenopathy and hepatosplenomegaly. A biopsy confirmed Grade II follicular lymphoma. She was treated with R-CHOP chemotherapy and radiotherapy to reduce the large tumor burden. She showed improvement with treatment and radiotherapy helped minimize morbidity given the extensive involvement. The case demonstrates the importance of early diagnosis and treatment of follicular lymphoma.
Similar to International Journal of Cancer & Cellular Biology Research (17)
A 5-year old boy, with an established diagnosis of a topic
dermatitis, previously treated by topical corticosteroids and emollient cream with a good improvement, developed widespread papules on his legs, hands and forearm that appeared 5 months ago.
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
Introduction: Laparoscopic surgery has been performed in Mexico since 1989, but no reports about training tendencies exist. We conducted a national survey in 2015, and here we report the results concerning training characteristics during the surgical residence of the respondents. Materials and Methods: A prospective study was conducted through a survey questioning demographic data, laparoscopic training during pre and post surgical residency and other of areas of laparoscopic practice. The sample was calculated and survey piloted before
application. Special interest in this report was placed on type and quality of training received. Data are reported in percentages.
Heterotopic Ossification (HO) is defined as pathological bone formation at locations where bone normally does not exist. The
presence of HO has been found to be a rare complication after stroke in several studies, whereas there are only sporadic references relating HO to Cerebral Palsy (CP) and few for CP and stroke. No effective treatment for HO has yet been found, whereas the cellular and molecular mechanisms have not been completely understood. Therefore, increased awareness among physicians is required, as a challenge for early diagnosis and treatment. A case of a male patient with CP, who developed HO on the paretichip joint following an ischemic stroke is presented.
Objectives: To assess the practice of food hygiene and safety, and its associated factors among street food vendors in urban areas of Shashemane, West Arsi Zone, Oromia Ethiopia, 2019.
Methods: Cross-sectional study design was applied from December 28, 2019 to January 27, 2020. Data was collected from 120 food handlers, which were selected by purposive sampling techniques. Information was gathered from interview and field observation by conducting food safety survey and using questionnaires via face to face interview. The collected data was entered using Epi Data 3.1 and finally, it was analyzed using SPSS VERSION 20.
A Division I football player experienced acute posterior leg pain while playing. An ultrasound examination revealed an unusual injury - a complete rupture of the plantaris tendon mid-substance. This type of isolated plantaris tendon injury has rarely been reported. Ultrasound was useful for diagnosis and guided rehabilitation by monitoring healing over time. The athlete was able to return to full competition within 3 weeks through a progressive rehabilitation program focused on restoring range of motion and strength. This case suggests isolated plantaris tendon injuries may allow for faster return to play than other potential causes of posterior leg pain.
Type 1 Diabetes (T1D), is a severe disease, representing 5-10% of all reported cases of diabetes worldwide. Fulminant Type 1 Diabetes Mellitus (FT1D) is a subtype of type 1 diabetes mellitus that is largely characterized by the abrupt onset of Diabetic Ketoacidosis (DKA) and severe hyperglycemia without insulin defi ciency. Viral infections have been hypothesized to play a major role in the pathogenesis of Fulminant Type 1 Diabetes Mellitus (FT1D) through the complete and rapid destruction of pancreatic beta cells. Coxsackie viral infection has been detected in islets of 50% of the pancreatic tissue recovered from recent-onset Type 1 Diabetes (T1D) patients. In this report we have highlighted a case where the patient developed a Group B Coxsackie virus infection culminating in the development of Fulminant Type 1 Diabetes Mellitus (FT1D).
Methods: Cercariae are released by infected water snails. To determine the occurrence of cercariae-emitting snails in SchleswigHolstein, 155 public bathing places were visited and searched for fresh water snails. Family and genus of the collected snails were determined and the snails were examined for the shedding of cercariae, using a standard method and a newly developed method.
Objective: To generate preliminary information about of enteroviruses and Enterovirus 71 (EV71) in patients with aseptic meningitis in Khartoum State, Sudan.
Method: Cerebrospinal fluid specimens were collected from 89 aseptic meningitis patients from different Khartoum Hospitals
(Mohammed Alamin Hamid Hospital, Soba Teaching Hospital, Omdurman Military Hospital, Alban Gadeed Teaching Hospital and Police Hospital) within February to May 2015. Among these 89 patients, 43 (48%) were males and 46 (52%) were females. The patient’s age ranged between 1 day and 30 years old. The collected specimens were assayed to detect enteroviruses and EV71 RNA using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) technique
Femoral hernias, comprise 2% to 4% of all hernias in the inguinal region, and occur most commonly in women. Th ey present typically with a mass below the level of the inguinal ligament. The sac may contain preperitoneal fat, omentum, small bowel, or other structures and have a high rate of incarceration and strangulation due to the small size of the hernia neck orifice, requiring emergency surgery. We present the case of a 54-year-old female patient with intestinal occlusion due to incarcerated femoral hernia, repaired by laparoscopic approach, that gave the patient the opportunity to attend her daughter’s wedding the same day.
Small Supernumerary Marker Chromosome (sSMC) is a rare genetic condition marked by the presence of an extra chromosome to the 46 human chromosomes. This case report describes a 4 year old child with SSMC on the 46th chromosome. The child presented with delayed speech and language development, seizures and mild developmental delay. Speech and Language evaluation was carried out and management options are discussed.
A catheter is a thin tube made from medical grade materials that serve a broad range of functions, but mainly catheters are medical devices that can be inserted in the body to treat disease or perform surgical procedures. Catheters have been inserted into body cavities, ducts, or vessels to allow for drainage, administration of therapeutic fluids or gases, operational access for surgery. Catheters help perform tasks in various systems such as cardiovascular, urological, gastrointestinal, neurovascular, and ophthalmic systems. A dataset of 12 patients with varying “weights” and “heights” was recorded along with the lengths of their catheter tubes. This data set was found from two revered statistical textbooks on linear regression and the Department of Scientific Computing at Florida State University. This data set was not able to be linked to any particular clinical or experimental research studies, but the data set can be used to help catheter manufacturers and medical professionals better decide on what particular catheter lengths to use for patients knowing only their height & weight. These research insights could be helpful to healthcare professionals that have patients with incomplete or no healthcare records
to decide what catheter length to use. The main investigative inquiry that needed to be answered was how does patient weight & height influence catheter length together and separately? We conducted linear regression and other statistical analysis procedures in R program & Microsoft Excel and discovered that this data exhibited a quality called multi collinearity. With multi collinearity, all predictors (2 or more
independent variables) are not significant in an all encompassing linear aggression, but the predictors might be significant in their own individual linear regressions. Individual linear regression analyses were conducted for both patient height & weight to see how much they both contribute to varying catheter length. Patient weight was found to be more impatful than patient height in relationship to catheter length, even though height and weight are a classical example of multi collinearity predictors.
Bovine mastitis has a negative impact through economic losses in the dairy sector across the globe. A cross sectional study was carried out from September 2015 to July 2016 to determine the prevalence of bovine mastitis, associated risk factors and isolation of major causative bacteria in lactating dairy cows in selected districts of central highland of Ethiopia. A total of 304 lactating cows selected randomly from five districts were screened by California Mastitis Test (CMT) for subclinical mastitis. Based on CMT result and clinical examination, over all prevalence of mastitis at cow level was 70.62% (214/304).
Two hundred fourteen milk samples collected from CMT positive cows were cultured for isolation of major causative bacteria. From 214 milk samples,187 were culture positive and the most prevalent isolates were Staphylococcus aureus 42.25% (79/187) followed by Streptococcus agalactiae 14.43%
(27/187). Other bacterial isolates were included Coagulase Negative Staphylococcus species 12.83% (24/187), Streptococcus dysgalactiae 5.88% (11/187), Escherichia coli 13.38% (25/187) and Entrococcus feacalis 11.23% (21/187) were also isolated. Moreover, age, parity number, visible teat abnormalities,husbandry practice, barn fl oor status and milking hygiene were considered as risk factors for the occurrence of bovine mastitis and they were found significantly associated with the occurrence of mastitis (p < 0.05). The findings of this study warrants the need for strategic approach including dairy extension that focus on enhancing dairy farmers’ awareness and practice of hygienic milking, regular screening for subclinical mastitis, dry cow therapy and culling of chronically infected cows.
A 36-year-old female developed right upper quadrant pain and nausea after taking the herbal supplement kratom for two weeks to manage back pain. Laboratory tests showed elevated liver enzymes. A liver biopsy ruled out other causes and determined she had drug-induced liver injury from kratom use. Her symptoms and liver enzymes gradually returned to normal over six weeks after stopping kratom. The case report discusses kratom's potential for hepatotoxicity and advises clinicians to consider its effects on patient health.
The assessment, diagnosis and treatment of critically ill patients is extremely challenging. Patients often deteriorate whilst being
reviewed and their rapidly changing pathophysiology barrages healthcare professionals with new data. Furthermore, comprehensive assessments must be postponed until the patient has been stabilised. So, important data and interventions are often missed in the heat of the moment. In emergency situations, suboptimal management decisions may cause signifi cant morbidity and mortality. Fortunately, standardisation and careful design of documentation (i.e. proformas and checklists) can enhance patient safety. So, I have developed a series of checklist proformas to guide the assessment of critically ill patients. These proformas also promote the systematic recording and presentation of information to facilitate the retrieval of the precise data required for the management for critically ill patients. The proformas have been modifi ed extensively over the last twenty years based on my personal experience and extensive consultation with colleagues in several world-renowned centres of excellence. The proformas were originally developed for use in the intensive therapy unit
or high dependency unit. However, they have been adapted for use by outreach teams reviewing patients admitted outside of critical care areas. The use of these tools can direct eff orts to provide appropriate organ support and provides a framework for diagnostic reasoning.
This review article discusses microvascular and macrovascular disease in systemic hypertension. It summarizes that:
1) Cardiac imaging plays a crucial role in risk stratifying hypertensive patients and identifying management strategies by properly diagnosing microvascular and coronary artery disease.
2) The nitric oxide synthase (eNOS) G298 gene allele may be a marker for microvascular angina in hypertensive patients, as studies have found it to be more prevalent in hypertensive patients with chest pain and reversible myocardial defects but normal coronary arteries.
3) Both structural changes like capillary rarefaction and functional changes like endothelial dysfunction can cause microvascular dysfunction and angina in hypertensive individuals in the absence of
This study characterized dengue infections in Pakistan by analyzing hematological and serological markers in 154 suspected dengue cases and 146 control patients with other febrile illnesses. NS1 antigen was detected in 55% of dengue cases, IgM antibodies in 30%, and both in 15%. Control groups primarily had malaria (71%) and enteric fever (20%). Hematological markers (platelet count, hematocrit, WBC) measured before and after treatment showed significant differences for platelet count and hematocrit but not WBC count between the groups. Analysis of clinical symptoms and serological/hematological markers helps diagnose dengue, assess prognosis, and inform prevention efforts to reduce morbidity, mortality and spread of the disease.
Researchers from Utrecht recently published yet another paper on the use of Magnetic Resonance Imaging (MRI)demonstrating an additional failed attempt to understand the importance of qualitative versus quantitative imaging, and anatomic versus physiologic imaging. Th e implications of this failure here cannot be overstated.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Background: This report describes a unique case of a patient that developed psychotic symptoms believed to be secondary
to a tentorial meningioma with associated hydrocephalus. These psychotic symptoms subsequently abated with placement of a
ventriculoperitoneal shunt. Case description: 60-year-old female was admitted to an inpatient psychiatric facility on a psychiatric involuntary commitment petition due to progressive paranoia, homicidal ideation and psychosis. The work up showed a calcified six cm tentorial meningioma with associated hydrocephalus. The patient initially rejected treatment but later became amenable to placement of Ventriculoperitoneal Shunt
(VPS).
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Introduction
Diffuse Large B Cell Lymphoma (DLBCL) is one of the most
common types of cancer with a tendency toward diffuse aggressive
behavior and recurrence [1-4]. It is estimated that there are over
200,000 new cases of B-Cell Non-Hodgkin’s Lymphoma (B-NHL) in
2015, accounting for a predicted4% of new cancer diagnoses and3%
of cancer deaths. For the therapy of this tumor, the first-line strategy
was immune-chemotherapy, typically rituximab with CHOP for
diffuse large B-cell lymphomas or with hyper-CVAD for Burkitt
lymphomas [5-8], but the longer prognosis was poor. It is a reactive
or inflammatory process in the lymphoid system mostly occurring in
elderly patients, however, latest research shows that some cases have
been reported with unusual extra-lymphoid center (originated from
peripheral blood) [3]. Poor prognosis of the tumor was monitored
because of an aggressive behavior with intra-abdominal and
retroperitoneal diseases [4,9]. There is limited number of lymphoma
cases found in the gastrointestinal tract [10]. However, such diffuse
large B cell lymphoma with chronic gastrointestinal inflammation
has been rarely reported before. Also, the depth and extent of surgery
in such cases has not yet been studied because of the rarity of these
cases. In this paper, the aim was to report a rare lymphoma occurred
in jejunum of an old male patient with chronic gastroenteritis in
order to provide helpful guidance for digestive physicians.
Case Presentation
A 51-year-old man, transferred to the emergency department in
our hospital on 2014-12-1, presented with drastic abdominal pain
in the peripheral umbilicus direction. Pathological course was as
follows: since January, 2014, there were no significant incentives, but
the pain, as the durative ache, appeared mainly under the xiphoid
region, and accentuated when dining, also radiated to the small of the
back. Intestinal peristalsis abated with loss of appetite. Accordingly
there were a series of non-specific clinical symptoms, for example,
reduced gastric acid, belching, nausea, vomiting, diarrhea, chills,
fever. In the course of the disease, no obvious changes was found
in the spirit, appetite, sleep of the patient, and in the urine amount,
weight strength, but the color of the excreta gradually deepened. The
sole evidence was with chronic gastritis in the previous history.
On admission, physical examination revealed light abdominal
tenderness and small rigidity around the peri-umbilical region.
It exhibited mild anemia face, general superficial lymph node
enlargement, sclera and skin jaundice. No obvious abnormality was
got in heart-lung auscultation. Other parameters were in normal
range, including no abdominal tenderness, no rebound tenderness,
no gastrointestinal type, no abdominal varicose veins, no Murphy
sign, etc. Previous laboratory tests from other hospital showed
normal leukocyte count and hemoglobin level. All other biochemical
values were within the normal range. Heart colored ultrasonography
revealed no abnormalities. MRI results in liver and spleen indicated
the cholecystitis and gall bladder small polyps.
After hospital, the blood routine showed that, erythrocyte
3.78×1012
/ L, hemoglobin 109g/ L, red blood cells deposited 33.8%,
blood sedimentation 28 mm/ h; coagulant function showed that, Fib
5.27 g/L, ALT 7 U/L, TP 49.41 g/ L, propagated 28.95 g/ L, blood
CRP is 31.54 mg/ L, other parameters from the blood including
renal function, blood amylase and AFP, CEA, CA199 were all in
normal range. But the stool occult blood was slightly positive. Special
inspection included that, one was gastroscopy, the results indicated
chronic atrophic antral gastritis with debauched and chronic
esophagitis; the colonoscopy showed no obvious abnormalities; the
gastrointestinal barium meal showed that, the patient had chronic
gastritis; small intestine microscope exhibited no obvious organic
disease in the small intestine (Figure 1).
With a presumptive diagnosis of chronic gastroenteritis,
cholecystitis,thereaftersuppressingacidsecretion,protectingstomach,
spasmolysis and other symptomatic treatment were performed to
the patient. In the first 3 days abdominal pain symptoms abated, but
unfortunately, in the following days the clinical symptoms aggravated
Abstract
Introduction: Diffuse Large B Cell Lymphoma (DLBCL), as a set of heterogeneous aggressive lymphoma, most commonly originated
in the germinal center B lymphocytes. Rare cases were from peripheral blood B cell (outside germinal center) or from the inert lymphoma
development and transformation. And such tumor with originality outside germinal center was seldom seen in the literature. Even the
tumor in combination with chronic gastritis has not been reported before.
Presentation of case: A 51-year-old man admitted to emergency department with acute abdominal pain around the umbilicus.
From the collective materials, the initial diagnosis was as chronic gastritis,cholecystitis and gall bladder small polyps. After hospital, the
optimal therapy did not relieve the symptoms. Intraoperatively, a mass with a diameter of almost 5 cm originated from the distal jejunum
segments neighboring the duodenum was seen. The patient was managed by segmental resection of the small intestine including the
mass. Histologically, the cancerous cells are 4-5 fold larger than the normal lymphocytes. They exhibited atypical, and these heterotypic
lymphocytes diffusely infiltrated in the whole layer of the digestive tract. The immunohistochemical studies showed that tumor cells
expressed B cell differentiation antigen, with positivity for CD20, CD3, CD5, CD30, Ki-67(> 80%), Bcl, MUM, and negativity for CD21,
CD10, Bcl-2. So, the final pathologic diagnosis was diffuse large B lymphoma of the jejunum.
Discussion: Microscopic examination of the small intestine is a necessary means of diagnosis of the disease. Concomitant resection
of tumoral lesions detected in the neighbor intestinal segments should be considered to diagnose and treat. For the diagnosis of this
kind of tumor, immunohistochemistry pattern including positivity for CD20, CD3, CD5, CD30 etc. plays a crucial role. Therefore, detailed
immunohistochemistry analysis should be constructed in suspicious cases.
Conclusion: Coexistence of diffuse large B lymphoma of the jejunum with chronic gastritis, cholecystitis and gall bladder small
polyps is a rare event. Complete surgical excision and postoperative chemotherapy could be regarded as the main modality of such
disease. Long-term follow up with serial imaging techniques is recommended.
3. SRL Cancer & Cellular Biology
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greatly. At this time, the stool occult blood emerged strong positive
and the blood routine showed HGB: 106 g/ L, so the consideration was
that, pancreatic lesions were still not excluded, then line abdominal
CT examination was conducted (Figure 2), the data still showed no
abnormalities in pancreas, just a few swollen mesenteric lymph nodes
were seen. Then a surgery was performed on this patient in order to
confirm the abnormalities. During intraoperative process, chronic
jejunum inflammation was detected. Some swollen and even melt
lymph nodes were seen. Therefore, the segmental resection of the
inflamed jejunum including the mass was conducted. The specimens
collected were sent to pathological office for further investigation.
Also, the wound recovered well at the seventh postoperative day
with no inflammation, bleeding and edema. On the 3th postoperative
month, he had no abdominal symptoms and neoplastic recurrence
from the follow up and laboratory examinations.
Histopathology
The specimen was collected from the jejunum with a length of 10
cm after fixation in 10% neutral buffered formalin. Histopathology
was concordant with chronic intestine inflammation as infiltration
of the mucosa by atypical leukocytes. A serial section of the inflamed
jejunum revealed a polypoid mass with a diameter of 5.5 cm. The
tumor was covered with normal mucosa and it was located from the
sub epithelial to subserosal planes, mostly intraluminal. Tissue serial
slices of the lesion showed diffuse lymphocytes appearance with no
well demarcated borders in all layers of the jejunum. Perforation,
necrosis, hemorrhage, calcification and ulceration were not identified
macroscopically. But histologically, the tumor cells scattered in the
mesenchyma surrounded degenerated or necrotic normal tissue. The
immunohistochemical studies showed that tumor cells were positive
for CD20, CD3, CD5, CD30, Ki-67(> 80%), Bcl, MUM. Additionally,
negative results were detected for antibodies to CD21, CD10, Bcl-2
(Figure 3). Ki-67 was positive in 15% of the cells. The final pathologic
diagnosis was diffuse large B lymphoma of the jejunum. Also, the
written consent was taken from the patient.
Discussion
B-Cell non-Hodgkin’s lymphoma is one of the most common
types of cancer in the world [2,4,11]. The tumor was of invasive
malignancy to the human health, and commonly occurred in the
elderly male patients, and the average age was more than 60. In
clinic, the manifestation of the tumor was that, the single or multiple
lymph nodes grew up quickly in the short time period, even outside
the nodes there was a rapid increase of the mass, progress rapidly,
and damage the function of liver and spleen. Although lymph node
is the most common site of the lesion, few occurrences have also
been reported in extra-germinal sites including the mediastinum,
gastrointestinal tract, skin, bone, brain, etc [9,10,12]. Some reporters
also showed the inert lymphoma was involved in this lesion [13].
These lymphoma cells could be activated and transformed, which
cause the cancerous cell diffusely invade the normal organ. Extra-
germinal site lesions usually present with non-specific signs and
symptoms including abdominal pain, gastric and intestinal mass
with occasional obstruction and shit character change in patients.
Such patients are often easy to exert misdiagnosis. The efficient test
modalities are in urgent need. The small intestine microscope is of
new imaging techniques developed in recent years. It can be used to
confirm the site of the tumor and the condition of this lesion. Besides
the equipment monitoring, concomitant resection of tumoral lesions
and histopathological examination are of the essence. It has also been
suggested that long-term follow up with serial imaging techniques
are required [14-18]. However, the choice of the imaging test and
the interval has not been determined yet. As a B lymphocyte surface
marker, the CD20, CD30, MUM etc [19], should be tested commonly.
Except the B cell clusters of differentiation, the Bcl-2/6, P53 and
Myc gene mutations should also be investigated because of about
Figure 1: The pathological site was captured by gastro scope (above) and small intestine microscope (below).
Figure 2: The picture indicated the pathological site highlighted in orange
color captured by computer tomography.
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20-30% DLBCL has t (14;18) and the Bcl gene translocation[20-23].
As a biomarker of tumor proliferative activity, Ki-67 value may be
helpful to determine the time interval for follow up [24]. Therefore,
an individualized follow up should be planned for each patient. The
intestine microscope and PET/CT tomography at the postoperative
3th month was evaluated as normalcy for the patient [16-18].
The clinical therapy for such tumor was far unsatisfactory.
Different therapies strategies were applied in different patients.
Stem cell transplantation, Mitral valve repair engineering, targeting
therapy and various chemical drugs were used to cure this type of
tumor. But little success was achieved [25]. Anti-CD20 monoclonal
antibody (rituximab) was still the first-line chemotherapy medication
[26-28]. Although a few patients were cured by the standard immune-
chemotherapy, while over 50% of patients showed resistance to
rituximab or tolerance against the chemotherapeutics, which caused
them to relapse and then died of the disease. Drug resistance is a
major challenge to the long-term efficacy of targeted cancer therapies.
Recently, people began to adopt tumor autophagy to kill this tumor.
Although autophagy process can degrade some unnecessary or
dysfunctional cellular components via the fusion of autophagosomes
and lysosomes, the role of autophagy in tumor therapy remained
complex. Emerging evidences showed that this modality remains
controversial: On one hand, when under severe conditions such as
nutrient deprivation, commander of growth inhibition, cells tended
to up-regulate autophagy for degenerating misfolded protein or
damaged organelle to provide fundamental nutrients and energy
for survival [29]. On the other hand, some anti-tumor drugs like
arsenic could induce overreacted autophagy, leading to autophagy-
dependent cell death in Acute Myelocytic Leukemia (AML) cells [30].
Recent years, some scientists tried to use the strategy of co-inhibition
of autophagy and Hh pathway, but the effect was not far satisfactory.
Thus, looking for better treatment and medications become the
challenge of more scholars [31-33]. From the data of statistics, this
tumor is sensitive to chemotherapy, the use of strengthening the
MDT, about 60-80% of the patients can completely respond; about
50% of the patients can clinically recover. Anti-CD20 monoclonal
antibody (Rituximab, mabthera) combining with chemotherapy can
significantly improve the prognosis of patients. And it is now still the
most successful biological treatment of clinical cases.
Conclusion
DiffuseLargeBCellLymphoma(DLBCL)isasetofheterogeneous
aggressive lymphoma, which occurred in germinal center or extra-
germinal sites of old adults. For the diagnosis of DLBCL, the intestine
microscope and immunohistochemistry pattern plays a crucial role.
Complete surgical excision in combination with chemotherapy might
be the main modality of the therapy of diffuse large B cell lymphoma
[9,11]. Long-term follow up with serial imaging techniques may
be recommended for possible aggressive behavior and recurrence.
Doctors firstly should pay attention to the clues of the symptoms, signs
and related inspection, look for a more reasonable explanation, avoid
missed diagnosis. Secondly, the advantage of intestine microscope
(capsule endoscope) should attract much attention because of more
comfort, longer distance and higher sensitivity. Thirdly, the usage
in combination of capsule endoscopy and enteroscopy in the initial
diagnosis of intestinal diseases could provide more helpful insights
for the digestive physicians.
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