Fibrovascular polyp of the sigmoid colon

A case of a fibrovascular polyp of the sigmoid colon is reported. The patient tested positively for fecal occult blood on a mass survey for colorectal cancer, and underwent colonoscopic examination which revealed a pedunculated submucosal tumor in the sigmoid colon. The tumor, about 10 mm in diameter, had a short thin stalk and was removed endoscopically; the histological diagnosis was fibrovascular polyp. This extremely rare polyp is discussed, and particular attention is focused on the unusual endoscopic features and on the appropriate management.     

Fibrovascular polyp of the esophagus requiring esophagectomy

Fibrovascular polyps of the esophagus are rare, with only 110 cases reported in the world literature to date. Dysphagia is the most common symptom. The diagnosis is usually made by barium swallow or upper endoscopy, but almost a third of cases can be missed with these studies. Treatment is surgical. Only four cases in the literature underwent esophagectomy for removal. We present a female patient with a fibrovascular polyp of the esophagus who required a transhiatal esophagectomy to safely remove this mass.     

Pedunculated pharyngeal lipoma presenting as an esophageal polyp

We describe a case of pedunculated hypopharyngeal lipoma with radiographic and endoscopic correlation. This 66-year-old man presented with 3 years of intermittent dysphagia for solids and unrelated episodes of coughing. The literature regarding benign pedunculated polyps of the hypopharynx and proximal esophagus is reviewed. The clinical presentation, diagnostic workup, and recommended therapy for these unusual lesions are discussed.     

Aortoesophageal fistula： A case misdiagnosed as esophageal polyp

Aortoesophageal fistula (AEF) is a rare and fatal disorder.It is also a life-threatening cause of massive upper gastrointestinal hemorrhage. Thoracic aortic aneurysm is the most common cause of AEF. Management of a patient with this disorder requires rapid diagnosis and immediate intervention, which is considered the best way to save the patient's life. We report a case of AEF misdiagnosed as esophageal polyp.     

Diffuse esophageal leiomyomatosis with a pedunculated polyp

Although leiomyomas are the most common benign tumors of the esophagus, esophageal leiomyomatosis is a rare pathological entity, and pedunculated presentation is even rarer. A 61-year-old man was found, incidentally, to have an esophageal tumor on a survey of chest computed tomography (CT) examination for a pulmonary nodule. Endoscopy disclosed a pedunculated polyp covered by nearly normal esophageal mucosa, with surrounding annular extension of a submucosal elevation. Endoscopic ultrasonography (EUS) revealed a hypoechoic tumor, with a maximum diameter of 3cm originating from the thickened muscularis mucosa layer. The underlying muscularis propria layer was also prominently thickened. The polypoid lesion was then removed by endoscopic resection with wire-loop ligation, followed by snare electrocoagulation. The pathological diagnoses of the polyp and the surrounding submucosal lesions were both leiomyoma. Diffuse esophageal leiomyomatosis was suspected in this situation because of the characteristic pathological distribution. In this patient, the EUS findings corresponded well to the characteristic features of diffuse esophageal leiomyomatosis noted in previous reports, and this was of great help for the diagnosis, in addition to the endoscopic findings. This case report is presented with a particular focus on the problems associated with accurate diagnosis.     

Boerhaave revisited: spontaneous esophageal perforation as a diagnostic masquerader

Spontaneous perforation of the esophagus (Boerhaave syndrome) is an emergency that requires early diagnosis if death or serious prolonged illness is to be averted. The cases of three patients with spontaneous esophageal perforation simulating other primary diagnoses are described. The respective referral diagnoses were pericarditis, lung abscess, and pancreatitis. Each case was characterized by severe illness, and by delay in diagnosis despite multiple consultations. Two patients died. The literature is reviewed and the causes of delay in diagnosis are analyzed. More than 40 years after the first report of successful surgical repair, spontaneous esophageal perforation is insufficiently considered in diagnostic hypotheses, yet may be confirmed or excluded by simple methods. All clinicians need to be alert to this lethal disease, and to be aware of its frequent atypical presentations.     

Clopidogrel resistance: a diagnostic challenge

No clear and generally accepted definition of clopidogrel resistance has been achieved up to now. We believe that the new point-of-care assays of platelet function may help the clinicians to overcome to define clopidogrel resistance especially in patients undergoing percutaneous coronary intervention in whom the level of inhibition of platelets is clinically essential.     

Enteropathy-associated T-cell lymphoma: a diagnostic challenge

Diagnosis of refractory celiac disease (CD) is based on exclusion of other disorders, persistence of malabsorptive symptoms and villous atrophy, despite a strict gluten-free diet for at least 6-12 months. Detection of alterations in the intraepithelial lymphocyte population is crucial for diagnosis. A subgroup of patients with refractory CD may develop severe complications such as enteropathy-associated T cell lymphoma (EATL). We present the case of a patient with longstanding silent CD who developed EALT, highlighting the challenge posed by the diagnosis and treatment of this entity.