Pulmonary Symptoms as the First Manifestation of Crohn's Disease.

Crohn's disease is a granulomatous systemic illness with extra-intestinal manifestations. Of these extra-intestinal manifestations, lung involvement (0.4%) is the rare manifestation. Bronchopulmonary signs and symptoms are underrecognized, so suspicion should be high when granulomas are seen in lung biopsies. We report the case of a 27-year-old female who presented with bilateral pleuritic chest pain and shortness of breath. Chest X-ray showed left lung masses measuring up to 3.3 cm in the greatest dimension with right mid lung nodular opacity. Given the possibility of metastatic disease, positron emission tomography CT (PET-CT) scan was done, which showed activity in multiple liver lesions and multiple bilateral lung nodules. Both liver and lung biopsies were done, which showed multiple necrotizing and non-necrotizing granulomas. The patient was discharged home on antibiotics and antifungals. Few months later, she presented with loose stools and abdominal pain. CT scan of the abdomen and pelvis showed diffuse colonic wall thickening concerning for colitis. Colonoscopy showed ulcerated mucosa involving multiple parts of the colon. Biopsy of the colon showed mild to moderate acute colitis with submucosal non-necrotizing epithelioid granulomas, consistent with Crohn's disease.

Primary Squamous Cell Carcinoma of the Stomach: A Case Report and Review of the Literature.

Primary gastric squamous cell carcinoma (PGSCC) is an exceedingly rare disease, accounting for 0.04% - 0.07% of all gastric cancers. First reported in 1895 by Rörig et al, less than 100 cases of PGSCC worldwide have been reported in the literature. These reports show PGSCC is more common in males (5:1 male to female ratio), and exhibits a peak incidence in the sixth decade of life. It may involve any portion of the stomach with predilection for the proximal stomach, especially along the lesser curvature. Although no clear pathogenesis of this tumor has been reported, several plausible theories have been proposed. These include squamous differentiation of preexisting gastric adenocarcinoma, cancerization of ectopic squamous epithelium, malignant transformation of squamous metaplasia of glandular epithelium, association with Helicobacter pylori or Epstein-Barr virus infection, and evolution in the setting of marked chronic gastritis with intestinal metaplasia. This report presents and discusses the case of a 64-year-old female who developed PGSCC arising in the gastric fundus.

Glomus Tumor of the Esophagus: A Case Report and Review of the Literature.

We report an extremely rare case of primary glomus tumor of the esophagus, and review the corresponding literature. A 66-year-old female underwent a follow-up upper-gastrointestinal endoscopy due to dysphagia and previous history of esophageal lump. Endoscopic ultrasonography revealed a mass involving the deep mucosa and submucosa (Layers 2 and 3). Endoscopic biopsy revealed a mesenchymal tumor composed of nest of epithelioid cells with associated small blood vessels proliferation. Immunohistochemically, the tumor cells were positive for alpha smooth muscle actin and vimentin, but negative for c-kit and the vascular stroma was highlighted by positivity with CD34. Pathological examination confirmed that the tumor was a glomus tumor of the esophagus. The patient remains healthy without any recurrence to date.

"Russell Body Gastroenterocolitis" in a Posttransplant Patient: A Case Report and Review of Literature.

Russell bodies represent a cellular response to overstimulation of plasma cells, leading to the accumulation of abundant, nondegradable, condensed immunoglobulin in dilated rough endoplasmic reticulum cisternae. Russell body gastritis was first described 1998 by Tazawa and Tsutsumi. Since then only 39 cases involving the gastrointestinal tract have been reported in English literature, which include Russell body gastritis, duodenitis, and esophagitis. We report a case of a 44-year-old female with a history of diabetes mellitus, status post kidney and pancreas transplant who presented with multiple episodes of watery diarrhea associated with abdominal pain, nausea, and vomiting. Upper gastroendoscopic examination showed diffuse mild erythema in the gastric body and a clean-based duodenal ulcer. Lower gastroendoscopic examination was normal. Examination of multiple biopsies from duodenal, gastric, terminal ileum, and colonic mucosae revealed numerous plasma cells with abundant eosinophilic granular cytoplasm (Russell bodies) and eccentric nuclei, highlighted by PAS stain and CD 138 plasma cell marker. Helicobacter pylori stains were performed on gastric biopsies and were negative for organisms. To date, there are no cases described in English literature with multifocal Russell body infiltrates in gastrointestinal tract in a single patient including ileum and/or colon. This makes our case the first to be reported with these unique findings; thus, the spectrum of Russell body-associated chronic inflammation of the gastrointestinal tract would be more suitably referred to as "Russell body gastroenterocolitis."

Solitary Neurofibroma with Malignant Transformation: Case Report and Review Of Literature.

Solitary neurofibromas are rare tumors associated mainly with neurofibromatosis and widely described in the literature as benign. We report a case of a 55-year-old female with no history of neurofibromatosis who presented with a slow-growing, painless lump on her torso. Pathologic evaluation of the lesion after excisional biopsy revealed high mitotic activity and increased cellularity within the lesion as well as positive S-100 stain. She was diagnosed with solitary subcutaneous neurofibroma with features of malignant peripheral nerve sheath tumor transformation. To our knowledge, no other case of a solitary neurofibroma that transformed into a malignant tumor in this location was described in the literature.

Colonic schistosomiasis and associated cecal neuroma.

Schistosomiasis remains a major health threat in many resource-poor countries and is being seen with increasing frequency in developed countries among immigrants and tourists who have a history of freshwater exposure in endemic areas. We report a case ofa 56-year-old male with no significant past medical history, who presented for a routine screening colonoscopy, which revealed two polyps in the cecum, and multiple petechiae in the rectum. Histologic evaluation showed presence of Schistosoma mansoni eggs. One of the polyps, where eggs were also present, was diagnosed as neuroma/ Schwann cell hamartoma. This is the first reported casewhere colonic schistosomiasis is associatedwith cecal neuroma.

Polyps and polypoid lesions of the colon.

CONTEXT: A significant portion of colorectal biopsies are performed for evaluation of polyps or polypoid lesions. Accurately identifying these lesions will promote better patient care. OBJECTIVE: Review of the pathology of major colon polyps and polypoid lesions and highlight the most diagnostically useful features and their molecular biology. DATA SOURCE: Review of recent literature. CONCLUSIONS: Polypoid lesions of the colon can be thought of to be under 3 broad categories: syndromic, mesenchymal, and epithelial.

Hepatic intraductal oncocytic papillary carcinoma.

The authors report a case of hepatic intraductal oncocytic papillary carcinoma, a very rare subtype of hepatic papillary cholangiocarcinoma with only 8 cases reported so far in the English literature.