A rare case of clear-cell carcinoid of appendix.

The carcinoids are the most frequent type of tumors arising from the appendix. In the majority of cases, these tumors are asymptomatic and usually are discovered after appendectomy. Definitive diagnosis relies on pathological examination of the resected appendix, size of the tumor being critical for the further management. Clear-cell change in neuroendocrine tumors (NETs) has rarely been described in the appendix. We choose to present a clear-cell carcinoid subtype of appendiceal NET to raise awareness on this potentially curable and rare condition that can be overlooked. We highlight the importance of the pathological exam and the morphological and immunohistochemical behavior of the tumor in confirming the diagnosis and aiding in the treatment decision making. Also, important entities should be considered in the process of differential diagnosis such as goblet-cell carcinoid or renal-cell÷ovarian carcinoma.

Hydatid Cyst of the Calf - a Rare Pathology that May Be Overlooked.

Hydatid disease is caused by an infestation with the tapeworm Echinococcus. Each parasite can produce thousands of eggs with oncospheres that can migrate to the liver or lungs and rarely to other sites, including muscles. The aim of this case study is to describe a rare case of a patient with an atipical hydatid cyst location and to raise awareness of this condition. We present the case of a 28-year-old female patient admitted in our clinic with a lump in her right calf who underwent surgical excision, hydatid cyst being suspected due to the aspect of the thin cyst wall membrane, confirmed by hystopathological examination. The post-operative course was uneventful and the patient was discharged five days later with medical treatment with albendazole. In conclusion, hydatid disease must be kept in mind as a differential diagnosis when facing a muscle cystic mass, even though it is very rare, and a good medical and surgical management may determine a permanent cure.

Severe Unresponsive Hypoglycemia Associated with Neuroendocrine Tumor of Unknown Primary Site - 18 Years after Rectal Cancer Surgery. Case Report.

INTRODUCTION: Neuroendocrine tumors are derived from cells that have the unique ability to synthesize, store and secrete a variety of metabolically active substances, peptides and amines, characteristic of the tissue of origin, which can cause distinct clinical syndromes. MATERIAL AND METHODS: We present the case of a 58-year-old patient diagnosed and surgically treated in January 1996 for stage III inferior rectal cancer, who was readmitted after 18 years presenting persistent diarrheic syndrome and asthenia. Investigations performed (abdominal CT) showed multiple liver metastases, initially suspected as being related to the rectal cancer. Biopsy of liver metastases and pathological and immunohistochemical analysis demonstrated the neuroendocrine origin (moderately differentiated neuroendocrine tumor). Seven months after the identification of liver metastases and after initiation of oncological therapy with Interferon and Somatostatin, the patient presented severe hypoglycemia (serum glucose 13-70 mg/dl) proved to be due to insulin-like factors (serum insulin level 64.9 ìU/ml) secreted by metastases. Due to the aggressive evolution of neuroendocrine tumor, with multiple episodes of severe hypoglycemia, resistant to treatment, the patient died approximately one month after the occurrence of hypoglycemic episodes. CONCLUSION: Despite comprehensive tests (abdominal CT scan, colonoscopy, bone scintigraphy and PET/CT), the primary site of the neuroendocrine tumors remained unknown.