Bilateral pulmonary nodules and mediastinal lymphadenopathy in a patient with Sjogren's syndrome.

Bronchus-associated lymphoid tissue is a normal component of the lung's immune system and may be analogous to gut-associated lymphoid tissue, a form of mucosa-associated lymphoid tissue. Bronchial-associated lymphoid tissue lymphoma is a distinct subgroup of low-grade B-cell extranodal non-Hodgkin lymphoma, classified as marginal-zone lymphoma. It is a rare disorder and appears with a distinct clinical and radiological presentation. We report a case of a patient with a history of Sjogren's syndrome who presented with bilateral pulmonary nodules and mediastinal lymphadenopathy, and who was diagnosed as having bronchus-associated lymphoid tissue lymphoma.

Gastric antral vascular ectasia: case report and review of the literature.

Gastric antral vascular ectasia is the source of up to 4% of nonvariceal upper gastrointestinal bleeding. It can present with occult bleeding requiring transfusions or with acute gastrointestinal bleeding. It is associated with significant morbidity and mortality and has been associated with such underlying chronic diseases as scleroderma, diabetes mellitus, and hypertension. Approximately 30% of cases are associated with cirrhosis. We report two cases of gastric antral vascular ectasia with two strikingly different endoscopic appearances. We further describe the clinical, endoscopic, histologic, and therapeutic aspects of this entity.

Multilocular thymic cyst with epithelioid granulomata of unknown etiology: a radiologic and histopathologic correlation.

Thymic cysts (congenital or acquired) are believed to account for 3% to 5% of all mediastinal masses. Multilocular thymic cysts are an acquired reactive inflammatory process arising within the thymus gland and are less common than the congenital unilocular type. Multilocular cysts have been reported in association with a variety of neoplastic, autoimmune, and infectious conditions. We report a case of a 23-year-old white man who presented with a 2-week history of progressive right-sided shoulder and chest pain. He was found to have an anterior mediastinal mass involving the thymus. This case of multilocular thymic cyst is particularly unique due to the presence of abundant epithelioid granulomata within the cyst, a finding that has not previously been emphasized as a histologic feature of these lesions, and one that expands the histopathologic differential diagnosis, warranting exclusion of infectious and autoimmune etiologies.

Digital ischemia as a paraneoplastic consequence of squamous cell lung carcinoma.

We report the case of a 40-year-old man who presented with digital ischemia and squamous cell lung carcinoma. Based on review of the literature, to our knowledge this case represents the youngest patient with lung carcinoma associated with digital ischemia and the only one with this type of tumor. The patient's digital ischemia symptoms improved rapidly with systemic chemotherapy; however, he did eventually lose the distal portion of 1 finger to dry gangrene and mummification.

Prostate carcinoma metastatic to the stomach: report of two cases and review of the literature.

We report two cases of prostate carcinoma metastatic to the stomach. In the first case, the patient had indolent disease before presenting with gastric metastasis. The patient responded to treatment with resolution of gastrointestinal bleeding and other symptoms. In the second case, the patient developed aggressive prostate carcinoma while on immunosuppressive therapy following kidney transplant. His tumor became widely systemic, and he ultimately died of his disease. Although rare, the possibility of prostate carcinoma metastatic to the stomach should be considered when a patient with a history of prostatic adenocarcinoma presents with gastrointestinal symptoms.

Hepatic Calcified Tumor-like Mass Complicating Umbilical Vein Catheterization in a Neonate.

Presented is a case of a hepatic calcified mass complicating umbilical vein catheterization in a neonate and diagnosed by wedge biopsy. Wedge biopsy of the hepatic mass, situated in proximity to the falciform ligament, revealed expansion of portal tracts by fibrosis and calcification. Some aggregates of calcified material appeared in ectatic vascular spaces. The biopsy findings accounted for the radiographic appearance of the mass and the constellation of features were deemed indicative of calcification secondary to umbilical vein catheterization. Umbilical vein catheterization in neonates may be complicated by a calcified mass that requires histologic evaluation for distinction from other space-occupying lesions. Such a calcified pseudotumor may develop after an umbilical catheter has been in place for only 5 days.

Dumping syndrome, a cause of acquired glycogenic hepatopathy.

A 2-year-old boy, having undergone fundoplication for gastroesophageal reflux disease and fed by gastrostomy, presented with recurrent emesis, syncope with hypoglycemia, and persistently elevated serum liver transaminase levels. Liver biopsy revealed hepatocellular glycogenosis by light and electron microscopy. Further evaluation showed no evidence of diabetes mellitus, glycogen storage disease, or corticosteroid use. Since the hyperglycemic-hyperinsulinemic state of dumping syndrome would provide a mechanism for hepatocellular glycogenosis, the biopsy findings prompted consideration of dumping syndrome. Metabolic evaluation confirmed the diagnosis of dumping syndrome, and appropriate dietary management led to sustained resolution of symptomatology and hypertransaminasemia. Dumping syndrome is proposed to be a cause of hepatocellular glycogenosis, the latter representing a form of acquired glycogenic hepatopathy.

Barrett's esophagus: incidence and prevalence estimates in a rural Mid-Western population.

BACKGROUND AND AIMS: Barrett's esophagus (BE) predisposes to adenocarcinoma of the esophagus and survival in esophageal adenocarcinoma is low. We studied patients diagnosed with BE in the Marshfield Epidemiologic Study Area (MESA). Our objectives were to estimate the prevalence of diagnosed BE, estimate the annual incidence of initial diagnosis of BE, and characterize the demographics of patients diagnosed with BE. METHODS: We retrospectively reviewed medical records of patients diagnosed with BE until December 31, 2002. The esophagogastroduodenoscopy (EGD) reports were reviewed to establish the presence of columnar epithelium. All slides were retrieved and reviewed by a gastrointestinal pathologist to establish the presence of intestinal metaplasia and dysplasia. Chart abstraction was conducted using a standardized form. RESULTS: BE was histologically confirmed in 216 patients. All were white, 165 (76%) were male, and 81% had a hiatal hernia. Median age at diagnosis was 65.5 yr (range 17-94). Long-segment BE (LSBE) was present in 112 (51.9%) patients. The prevalence of histologically confirmed BE in MESA was 261.8 (95% CI 222.5-301.1) per 100,000 people. The incidence of an initial diagnosis of BE between 1996 and 2002 was 32.7 per 100,000 person-years (95% CI 27.1-38.2) and did not change significantly over the study period despite an increase in EGD rates. At the initial diagnosis, 41.7% of the patients were on proton pump inhibitors. Dysplasia was present in 24.5% of patients. CONCLUSION: The incidence of initial diagnosis of BE in a stable white population did not change significantly over a 7-yr period, despite an increase in EGD rates.