Angiosarcoma of the Small Intestine: A Case Report and Literature Review

A case of primary intestinal angiosarcoma in a 59-yr-old man is reported. The patient had recurrent gastrointestinal bleeding with normal upper and lower gastrointestinal endoscopies, technetium-99m-labeled erythrocyte scan, and angiography. Barium small bowel series and abdominal computerized tomography showed an deal mass. Pathological examination was consistent with hemangiosarcoma with both solid and vasoformative patterns. Metastatic disease was also identified in the small bowel mesentery, liver, spleen, lungs, and brain. No identifiable underlying or epidemiologic factors have previously been reported to be associated with this rare type of tumor of the gastrointestinal tract. the pertinent literature on gastrointestinal angiosarcoma also is reviewed.     

Angiosarcoma of the Colon and Rectum: Report of a Case and Review of the Literature

Angiosarcoma is a malignancy that occurs rarely in the gastrointestinal tract. We present a case of a 77-year-old male who had rectal bleeding and obstructive bowel symptoms. A large near-obstructing mass was seen endoscopically, but biopsies were inconclusive. A CT scan showed a large sigmoid lesion, and the patient had surgical resection. A large hemorrhagic-appearing tumor was found at operation. Angiosarcoma of the sigmoid colon was diagnosed on histologic examination. After colonic resection, the patient rapidly developed numerous liver metastases and died six months later. A review of the literature reveals only 12 other reported cases of colorectal angiosarcoma; 62 percent of these patients died within one year of surgical resection. The role of adjuvant radiation and/or chemotherapy is unclear. In conclusion, colorectal angiosarcomas are rare tumors that behave very aggressively, and the outcome is generally poor.Reprints are not available.     

Case Report: Adult Nesidioblastosis A Case Report and Review of the Literature

George F. Laidlaw first described a pancreatic abnormality now known to be the most common cause of persistent hyperinsulinemic hypoglycemia in infants in 1938 (1, 2). The term he coined, nesidioblastosis, is derived from the Greek words for islets (nesidia) and germ (blastos) (3). It accurately describes the characteristic feature of nesidioblastosis, islet cells differentiating and budding from ductal epithelium. In adults, hyperinsulinemic hypoglycemia is rarely caused by nesidioblastosis and is usually caused by insulinoma or exogenous insulin treatment (4, 5). The first case series of adult nesidioblastosis was reported by Harness et al in 1981 (6). Since this case series of six patients, there have been only sporadic literature reports of adult nesidioblastosis, documenting fewer than 20 cases of adult nesidioblastosis over the past 15 years (3, 7-10). This paper presents an adult patient with hyperinsulinemic hypoglycemia due to nesidioblastosis and provides a guide to the diagnosis and treatment of this rare disorder in the adult population.     

Hepatic Amyloidosis Presenting as Severe Intrahepatic Cholestasis: A Case Report and Review of the Literature

Although hepatic involvement is common in all forms of amyloidosis, jaundice is infrequent and usually mild. We report a case of a 74-yr-old man with severe intrahepatic cholestasis and hepatic amyloid. The topography of amyloid deposition was unusual, in that deposits were confined predominantly to the portal tract. They appeared as a dense eosinophilic infiltrate that stained with congo red. A review of the English-language literature revealed only 18 prior patients with hepatic amyloid associated with severe intrahepatic cholestasis. The histology of only one of these patients showed a similar distribution of amyloid deposits.     

Hepatic Mucormycosis in a Patient of Acute Lymphoblastic Leukemia: A Case Report with Literature Review

Mucormycosis is an invasive opportunistic fungal infection associated with a high mortality rate, and normally occurs in immunocompromised patients. It can be encountered during neutropenia following chemotherapy in acute leukemia patients. The common sites involved are rhinocerebral, pulmonary, gastrointestinal and spleen. Hepatic involvement has been reported rarely. We hereby report a case of acute lymphoblastic leukemia who while on chemotherapy developed hepatic mucormycosis and was managed successfully despite its treatment being quite challenging, especially in the context of surgery in a neutropenic sick patient.     

Subcapsular Hepatic Hematoma After Endoscopic Retrograde Cholangiopancreatography: A Case Report and Review of Literature

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently performed procedures for the diagnosis and treatment of biliary-pancreatic diseases. ERCP-related complications total around 2.5% to 8%, with a mortality rate ranging from 0.5% to 1%. An exceptional ERCP complication is subcapsular hepatic hematoma, and few cases are reported worldwide.We present the case of a 52-year-old woman with a history of recurring upper abdominal pain and a clinical and ultrasonographic diagnosis of obstructive jaundice due to common bile duct stones. After 2 difficult endoscopic biliary procedures, common bile duct stones clearance was obtained. Post-ERCP course was symptomatic with upper abdominal pain and anemization with hemodynamic instability.CT scan demonstrated a 15 cm × 11 cm subcapsular hepatic hematoma filled with air and liquid on the surface of the right hepatic lobe. The patient was successfully treated with the embolization of a small branch of right hepatic artery angiographically identified as the cause of bleeding.Subcapsular hepatic hematoma after ERCP is a rare complication that must be taken into account in the differential diagnosis of symptomatic cases after ERCP. Its diagnosis is based on clinical and laboratory data and especially on imaging (ultrasound, CT, or MRI). Treatment is often conservative but, in some cases, embolization or percutaneous drainage or surgery may be necessary.     

Liver Transplantation in Antituberculosis Drugs-Induced Fulminant Hepatic Failure: A Case Report and Review of the Literature

The antituberculosis drugs isoniazid (INH), rifampicin (RMP), pyrazinamide (PZA), and ethambutol (EMB) usually expose patients to the risk of fulminant hepatic failure (FHF). This report presents a case of liver transplantation in antituberculosis drugs-induced FHF and reviews the relevant literature. A 39-year-old woman with pelvic and salpinx tuberculosis experienced complex pelvic exenteration. After the operation, she was administrated INH, RMP, PZA, and EMB to prevent tuberculosis. Two months later, examination revealed severe FHF and the antituberculosis therapy regimen was changed to ciprofloxacin and streptomycin. Subsequently, urgent orthotopic liver transplantation was performed. Posttransplantation, her serum transaminases improved gradually, but her total bilirubin level and direct bilirubin level continued to worsen, which may have been related to the rejection. However, irreversible damage from antituberulosis drugs was note excluded. Two liver biopsies and histological examinations were performed. One year after transplantation, she died as a consequence of ischemic cholangitis and pulmonary infection. A literature review revealed 9 other published cases of antituberculosis drugs-associated FHF with liver transplantation.This report suggests that, in most cases of antituberculosis drugs-induced FHF, discontinuation of toxic drugs and orthotopic liver transplantation are always sufficient treatment.     

Pituitary Lymphoma: A Case Report and Literature Review

We report the case of a B-cell type pituitary lymphoma in a 65 year-old male immunocompetent patient who presented with hypogonadotropic hypogonadism and central hypothyroidism and subsequently developed pulmonary lymphoma. Only three cases of pituitary lymphoma have been previously reported, one in a patient with acquired immunodeficiency syndrome, one case of T-cell lymphoma reported in the Japanese literature, and one case of B-cell lymphoma. The previously reported immunocompetent patients presented with signs and symptoms of optic chiasm compression as contrasted to our patients endocrinologic presentation. B-cell lymphoma of the pituitary gland is a exceedingly rare though distinct clinical entity.     

Case Report: Aortoesophageal Fistula Case Report and Review of the Literature

Dubrueil (1) described the first case ofaortoesophageal fistula in 1818. Chiari (2) in 1914described the syndrome of aortoesophageal fistula as atriad of: midthoracic pain or dysphagia followed by a herald hemorrhage and fatalhematemesis. Carter et al (3), in an autopsy review of24 cases of aortoesophageal fistula, found that 80% hada sentinal hemorrhage prior to fatal exsanguination. Wereport a case of an aortoesophageal fistula due to asaccular aneurysm of the descending aorta and review thecauses, clinical manifestations, diagnostic modalities,and treatment options of this uncommon but often fatal cause of upper gastrointestinalhemorrhage.     

Differential Diagnosis and Management of a Recurrent Hepatic Cyst: A Case Report and Review of Literature

Echinococcus granulosus, which causes cystic echinococcosis, is an uncommon condition in the United States. We report a case of a 78-year-old Caucasian female who presented to her primary care physician in 1999 with right upper quadrant pain. She had a history of frequent foreign travel. Abdominal imaging demonstrated a 12.5-cm hepatic cyst. The cyst was drained and the pathology report on the fluid indicated no bacterial, parasitic, or malignant etiology. Serology tests for Entamoeba and Echinococcus antibodies were negative. The patient underwent multiple hepatic cyst aspirations until 2008 for recurring symptoms. In 2008, abdominal imaging demonstrated solid internal components within the cyst. Repeat Echinococcus antibodies ordered were abnormally elevated. Cyst aspiration demonstrated Echinococcus protoscolex. We report this case to discuss the diagnosis and management of hydatid cyst and to emphasize that with increasing globalization, physicians must maintain a high index of clinical suspicion for parasitic etiologies in patients with hepatic cysts.     

Hemobilia in a Patient With Multiple Hepatic Artery Aneurysms: A Case Report and Review of the Literature

Hepatic artery aneurysm is a rare vascular lesion that accounts for nearly 10% of hemobilia cases. Its etiology is most often atherosclerosis, trauma, or infection. Autoaggressive disorders are rarely associated with hepatic artery aneurysm as is thyroid dysfunction. Presented here is a case of hemobilia secondary to a rupture of one of multiple aneurysms of both right and left hepatic arteries in a women with a history of rheumatoid arthritis, hypothyroidism, and hypertension. Surgical intervention has been the rule in the past. Selective transcatheter embolization has gained clinical application in recent years, especially in the treatment of intrahepatic aneurysms. Its efficacy and safety are demonstrated by this case.     

Emphysematous Pyelonephritis: A Case Report and Review of the Literature

Emphysematous pyelonephritis is a rare and life-threatening suppurative infection of renal parenchymal and perirenal tissues, characterized by spontaneous gas production. Although uncommon (76 cases in the literature), it occurs almost exclusively in diabetic patients (87 % of the cases). We describe a recent case of a diabetic woman with emphysematous pyelonephritis due to E. coli, successfully managed with unilateral nephrectomy. Symptoms, diagnostic approach and management are discussed and related to the previously reported series.     

Granulomatous Gastritis: A Case Report and Review of the Literature

A 69-yr-old white female presented to her physician with a 3-yr history of epigastric pain. Gastric biopsies revealed noncaseating granulomas in the mucosa and submucosa. No definite etiological factor could be detected. A diagnosis of idiopathic granulomatous gastritis was made. In the past, this condition has prompted surgery. Steroids have also been advocated. Our patient was managed successfully with symptomatic treatment, without the use of steroids or surgical intervention. She remains well 4 yr later.     

Syphilitic Hepatitis: A Case Report and Review of the Literature

Although recognized for more than 400 yr hepatic complications of syphilis are uncommon and frequently overlooked as explanations for acute liver dysfunction. We describe a case of acute hepatitis during the course of relapsing secondary syphilis, with additional confirmation of the diagnosis by lymph node biopsy demonstrating Treponema pallidum.     

Esophageal Actinomycosis: A Case Report and Review of the Literature

Abstract A 37-year-old African–American male with acquired immunodeficiency syndrome (AIDS) presented with recurrent chest pain. An upper gastrointestinal endoscopy had been performed two months previously and esophageal biopsy revealed extensive candidal infection with ulceration. He temporarily responded to fluconazole. Repeat biopsy revealed actinomyces and continued candidal infection. Review of the original biopsy also demonstrated actinomyces in addition to candida. After initial response to therapy with penicillin, he worsened on outpatient therapy and subsequently expired from progression of disease. Lack of compliance may have been contributary. To date, 8 patients with esophageal actinomycosis have been reported, five of whom had AIDS. Of the remaining three, none was otherwise immunocompromised. This is the first report of esophageal actinomycosis occurring as a superinfection of candidal ulceration. We also describe the findings and utility of thoracic CT in this condition and review the literature.     

Coronary Stent Infections: A Case Report and Literature Review

Although rare, coronary artery stent infections are associated with a high mortality rate. Since the introduction of coronary stents in 1987, only 16 cases of infection have been reported. We report a new case in a 66-year-old woman who had undergone a difficult percutaneous coronary intervention procedure, during which 3 overlapping stents were implanted in the mid portion of the right coronary artery. Twenty-two days after the procedure, the patient died. Autopsy revealed the cause of death to be pericardial tamponade due to rupture of the right ventricular myocardium. The stented portion of the right coronary artery was enveloped by an abscess, and purulent material completely occluded the stents. Cultures of the myocardium were positive for methicillin-resistant Staphylococcus aureus. We conducted a review of the literature on coronary artery stent infections. Data suggest that early-onset infections (<10 days after stent implantation) are potentially amenable to medical therapy alone, but late-onset infections (≥10 days after implantation) or major complications necessitate combined surgical and medical therapy. Medical therapy consists of broad-spectrum antibiotics. Surgical intervention includes stent removal if possible, and abscess drainage or perforation repair when indicated.Key words: Blood vessel prosthesis implantation/adverse effects, coronary stent infections, prosthesis-related infections/complications/diagnosis/therapy, stents/adverse effects, Staphylococcus aureusCoronary artery stents have been in use for more than 2 decades. Stent infections are rare, hard to treat, and potentially devastating. Our treatment of a patient with a coronary stent abscess prompted us to review the literature. From our experience and the evaluation of previously reported cases,^1–14 we propose an approach for diagnosing and treating these infections.