A rare cause of obscure gastrointestinal bleeding.

A 62-year-old woman was referred to Gastroenterology appointment due to severe iron deficiency anemia (5.9 g/dL), complaining of asthenia and requiring blood transfusion. The patient denied blood loss. Initial blood test showed a severe iron deficiency, with ferritin of 5ng/mL and transferrin saturation of 2.7%. Folic acid and vitamin B12 were normal. Upper gastroscopy and colonoscopy didn't show any lesions. Abdominopelvic CT and capsule endoscopy were, also, normal.

An uncommon colonic polyp.

A 50-year-old male was referred to a Gastroenterology appointment after a screening colonoscopy with a 25mm exophytic lesion, with a depressed central area, on the transverse colon. Histologic examination of the biopsy specimen showed low-grade dysplasia. The patient was submitted to a new colonoscopy and what was seen was a flat lesion with central depression, with no lift-sign (Figure 1a and 1b) and, therefore, endoscopic resection was not performed. New endoscopic biopsies were taken and showed no dysplasia.

Germ cell tumor with duodenal involvement: a rare case of gastrointestinal bleeding.

A 19-year-old male presented to the emergency department with a 7-day history of melena, anorexia and asthenia. Blood tests revealed a hemoglobin of 5.8 g/dL. Upper endoscopy showed a large ulcerated and stenosing lesion in the duodenum. The histologic examination of the biopsy specimen showed a neoplasia with epithelioid cells, accentuated atypia and pleomorphism, expressing MNF 116 cytokeratin, CD30, glypican 3 and alpha-fetoprotein on immunohistochemistry, suggesting of a germ cell tumor metastasis.