Mechanical ileus of the small bowel due to an inflamed Meckel's diverticulum with an enterolith - a case report with literature review.

BACKGROUND: Meckel's diverticula result from incomplete obliteration and regression of the omphaloenteric duct and are the most common congenital intestinal malformations. Many Meckel's diverticula remain asymptomatic and are discovered as incidental findings. They present a diagnostic challenge. METHODS: We report the case of a 35-year-old man who presented with an acute abdomen and ileus. Computed tomography of the abdomen showed a mechanical small bowel ileus. There was a calibre jump in the terminal ileum with a round endoluminal definable hyperdense structure of almost 2 cm in diameter. RESULTS: An exploratory laparoscopy was performed revealing an inflamed Meckel's diverticulum with impacted enterolith as the cause of the intestinal obstruction. CONCLUSION: In symptomatic Meckel's diverticula, haemorrhage and obstruction are the most common complications. The development of ileus due to a Meckel's diverticulum with an enterolith is considered extremely rare but should be taken into account.

Sclerosing angiomatoid nodular transformation of the spleen mimicking metastasis of melanoma: a case report and review of the literature.

BACKGROUND: Sclerosing angiomatoid nodular transformation is a benign disorder of splenic tissue and is often mistaken as a potentially malignant entity in the diagnostic process. To the best of our knowledge, this is the first report of sclerosing angiomatoid nodular transformation mimicking metastasis of melanoma in the literature. CASE PRESENTATION: A 43-year-old white man presented with a newly found splenic mass 4 years ago to our Department of Gastroenterology. He was diagnosed as having a superficial spreading malignant melanoma localized at his left instep 7 years ago and was successfully treated with radical local resection. Several diagnostic procedures were conducted. Ultrasound showed a hypoechoic lesion in the inferior pole of his spleen with a diameter of 2 cm, blurred boundaries, and inhomogeneous interior pattern. Contrast-enhanced ultrasound was inconclusive and showed only discrete contrast enhancement of the lesion with accentuated nodule-like enrichment of the boundaries in the arterial phase. Computed tomography and magnetic resonance imaging scans showed two splenic lesions which were highly suspicious of metastasis. Magnetic resonance imaging of his head was inconspicuous. Bone scintigraphy showed no abnormal results. Fine-needle aspiration indicated metastasis of the above-mentioned malignant melanoma. We conducted a laparoscopic splenectomy. His intraoperative and postoperative course were uneventful. In contrast to the result of the fine-needle aspiration, the presence of metastasis of melanoma could not be confirmed. Histological analysis revealed nodule-like arrangement of fibroblasts with low cell density and a predominance of dilated capillaries, indicating sclerosing angiomatoid nodular transformation of the spleen. CONCLUSIONS: There are no preoperative diagnostic imaging procedures which can definitely differentiate sclerosing angiomatoid nodular transformation from malignancies in cases of morphological and immunophenotypic variations of the specimen. Morphological and immunophenotypic variations of the specimen represent a diagnostic challenge and can mimic malignoma. As reported in our case, the specimen obtained by ultrasound-guided fine-needle aspiration led to the diagnosis of metastasis of melanoma. Splenectomy is often conducted due to a splenic mass suspicious of malignoma as described in our case or with unknown valency in different diagnostic imaging procedures.

Localized retroperitoneal Castleman's disease: a case report and review of the literature.

INTRODUCTION: Castleman's disease, also known as angiofollicular lymph node hyperplasia, is a rare disease with two known expansion types, unicentric and multicentric, which play a major role in determining therapy. We focus here on the unicentric type, which can be treated and cured by surgery. To date, approximately 1000 cases of Castleman's disease have been reported in the literature. CASE PRESENTATION: A 50-year-old Caucasian woman presented to our Department of Hematology and Internal Oncology with increasing fatigue as her sole symptom. Diagnostic investigations including laboratory studies, ultrasound, computed tomography and magnetic resonance imaging were performed. These revealed an interaortocaval, retroperitoneal tumor mass in her upper abdomen as the only manifestation of the disease. No enlarged lymph nodes were detected. We conducted a laparotomy with radical extirpation of the tumor mass (10×9×5.7cm). Complete tumor resection with clear margins was achieved. A pathological analysis of the resected sample showed atypical lymphoid tissue of small to medium cells with some clearly visible nucleoli, enlarged sinusoidal vessels, pleomorphic calcifications and focally preserved germinal-center-like structures. Histological and immunohistochemical analysis confirmed the diagnosis of Castleman's disease: staining for CD3, CD5, CD10, CD20, CD23, CD79 and Ki-67 was strongly positive in the germinal-center-like structures. Histological findings clearly showed the disease to be the hyaline vascular subtype. Staining for cyclin D1 and CD30 was negative. Expression of CD15 was positive in the enlarged sinusoidal vessels. A supplementary clonality analysis was without pathological findings. Tests for human immunodeficiency virus and human herpes virus 8 were negative and results from a bone marrow biopsy were normal. Our patient recovered well from surgery and was discharged from our hospital. To date, no recurrence of the disease has been detected. CONCLUSION: Castleman's disease is a rare disorder that remains a diagnostic challenge. Radical surgical resection is considered to be the gold standard for treating the unicentric variant of this disease.

Overdiagnosis of a typical carcinoid tumor as an adenocarcinoma of the lung: a case report and review of the literature.

BACKGROUND: Overdiagnosis of bronchopulmonary carcinoid tumors together with overtreatment can cause serious postoperative consequences for the patient. We report of a patient with a typical bronchopulmonary carcinoid tumor, which was initially misdiagnosed and treated as an adenocarcinoma of the lung. GnrH receptors and the associated Raf-1/MEK/ERK-1/2-pathway are potential targets for analogs in cancer treatment. We suspected a correlation between the lack of tumor growth, application of leuprolide and the Raf-1/MEK/ERK-1/2-pathway. Therefore, we examined GnrH receptor status in the examined specimen. CASE PRESENTATION: In 2010 a 77 year-old male patient was shown to have a tumor mass of about 1.7 cm diameter in the inferior lobe of the left lung. Since 2005, this tumor had hitherto been known and showed no progression in size. The patient suffered from prostate cancer 4 years ago and was treated with TUR-P, radiation therapy and the application of leuprolide. We conducted an explorative thoracotomy with atypical segment resection. The first histological diagnosis was a metastasis of prostate cancer with lymphangiosis carcinomatosa. After several immunohistochemical stainings, the diagnosis was changed to adenocarcinoma of the lung. We conducted a re-thoracotomy with lobectomy and systematic lymphadenectomy 12 days later. The tumor stage was pT1 N0 MX G2 L1 V0 R0. Further immunohistochemical studies were performed. We received the results 15 days after the last operation. The diagnosis was ultimately changed to typical carcinoid tumor without any signs of lymphatic vessel invasion. The patient recovered well from surgery, but still suffers from dyspnea and lack of physical performance. Lung function testing revealed no evidence of impairment. CONCLUSION: The use of several immunohistochemical markers, careful evaluation of hematoxylin-eosin sections and the Ki-67 labelling index are important tools in discriminating between carcinoids and other bronchopulmonary carcinomas. Although we could not detect GnrH-receptors in the examined specimen, there may be individual differences in expression. GnrH receptor profiles in typical and atypical carcinoids should be scrutinized. This could lead to new therapeutical options, since the GnrH receptor has already been described on atypical carcinoids. Clinically tested drugs such as leuprolide could come to use.

Differential effects of TGF-beta on connective tissue growth factor (CTGF/CCN2) expression in hepatic stellate cells and hepatocytes.

BACKGROUND/AIMS: Connective tissue growth factor (CTGF/CCN2) has been implicated in the pathogenesis of hepatic fibrosis and suggested as a downstream mediator of the fibrogenic master cytokine TGF-beta. METHODS: We investigated the effect of TGF-beta1 on CTGF/CCN2 expression in cultured rat hepatic stellate cells and hepatocytes by means of Western and Northern blotting, immunocytochemistry, reporter gene analysis, and metabolic labelling. RESULTS: We found that the expression of CTGF/CCN2 in hepatic stellate cells is (i) only marginally (if at all) stimulated by TGF-beta and by a constitutively active type I TGF-beta receptor, (ii) independent from Smad2/3 phosphorylation, (iii) not reduced by TGF-beta1 antagonists or ALK5-receptor inhibitors and (iv) not upregulated during transdifferentiation to myofibroblasts in culture. However, expression and secretion of CTGF/CCN2 in cultured hepatocytes increased spontaneously during culture and was strongly stimulated by TGF-beta1. In bile-duct ligated and CCl(4)-treated rat livers, a strong CTGF/CCN2 expression in hepatocytes was noticed. Endothelin-1 stimulated CTGF/CCN2 expression in stellate cells but not in hepatocytes. Pathway specific signalling inhibitors point to the involvement of non-Smad signalling cascades but their contribution to CTGF/CCN2 regulation is different in both cell types. CONCLUSIONS: The results do not reveal a relevant interrelation between TGF-beta function and CTGF/CCN2 expression in hepatic stellate cells, which is in contrast to hepatocytes.