Pseudoachalasia as the first manifestation of signet-ring cell duodenal carcinoma.

INTRODUCTION: Pseudoachalasia is a rare clinical condition, often caused by malignancy. Rarely, this entity can reveal the underlying neoplasia. To the best of our knowledge, we report the first case of pseudoachalasia revealing a metastatic signet-ring cell carcinoma of the non-ampullary duodenum. CASE REPORT: A previously healthy 67-year-old patient presented with a 3-month history of rapidly progressive intermittent dysphagia with 20kg weight loss. An upper endoscopy showed multiple duodenal ulcerations on congestive mucosa. Duodenal biopsies revealed tumor proliferation formed by independent cells with atypical nuclei. In immunohistochemistry, tumor cells expressed pan-cytokeratin. Esophageal manometry revealed an aspect in favor of achalasia type II. The CT scan showed ascites and pleural effusion. Their punctures confirmed the presence of neoplastic cells. The diagnosis of metastatic signet-ring cell duodenal carcinoma revealed by pseudoachalasia was retained. CONCLUSION: In the presence of rapidly progressive symptoms with significant weight loss, especially in the elderly patients, malignancyassociated pseudoachalasia should be suspected.

Unexpected isolated hepatic tuberculosis discovered during laparoscopic cholecystectomy: A case report.

Isolated hepatic tuberculosis is a rare form of extrapulmonary tuberculosis. We report an exceptional case of a 51-year-old female patient complaining from right upper abdominal quadrant pain, who underwent laparoscopic surgery for millimetric gallbladder polyps. Preoperative ultrasound hepatic morphology and biochemical hepatic tests revealed no abnormalities. There were no clinical patterns for an active tuberculosis. During surgery time, scattered sub-centimeter whitish nodular lesions were discovered on the upper surface of the liver. Although gallbladder pathological examination did not reveal any significant abnormalities, per surgery hepatic biopsy indicated the presence of a giant cell granuloma with caseous necrosis highly suggestive of hepatic tuberculosis. Treatment by anti-bacillary drugs according to local standard protocol was conducted with favorable outcomes. Therefore, diagnosis of hepatic tuberculosis may be considered in endemic countries in totally asymptomatic patients or complaining from unexplained and isolated abdominal pain, in absence of any morphologic or biochemical hepatic abnormalities.

Anemia-induced liver injury: A rare case revealing glucose-6-phosphate dehydrogenase deficiency.

Hypoxic hepatitis may occur due to hemodynamic mechanisms of hypoxia secondary to anemia without any context of reduced blood flow, respiratory failure, or shock state. Etiology of anemia should be investigated in order to avoid recurrence.

Pseudo-Meigs' Syndrome in Tunisian H Syndrome Female Patient: First Case Reported.

H syndrome is an extremely rare autosomal recessive affection caused by biallelic mutations in the SLC29A3 gene encoding the human equilibrative nucleoside transporter hENT3. The hallmark signs are cutaneous consisting of hyperpigmentation and hypertrichosis patches. Besides, associated systemic manifestations are highly various reflecting phenotypic pleiotropism. Herein, we report a first case of pseudo-Meigs' syndrome occurring in a young Tunisian H syndrome diagnosed patient with a novel homozygous frameshift mutation in exon 2 of the SLC29A3 gene: p.S15Pfs*86 inducing a premature stop codon. The patient developed ascites associated with left ovarian mass and she underwent surgery. After tumor resection, ascites disappeared rapidly. Histological examination showed serous cystadenoma of the ovary orienting the diagnosis towards pseudo-Meigs' syndrome.