Assuntos
Granuloma de Células Plasmáticas , Neoplasias Gástricas , Humanos , Criança , Inflamação/patologia , Granuloma de Células Plasmáticas/diagnóstico , Granuloma de Células Plasmáticas/cirurgia , Granuloma de Células Plasmáticas/patologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgiaRESUMO
Follicular dendritic cell (FDC) sarcoma is an uncommon tumor of the liver with only 30 previous cases reported in the English literature. Histopathological examination is the gold standard for the diagnosis of FDC sarcoma although the diagnosis is often missed because of its rarity. It usually presents with spindle-cell morphology although epithelioid/biphasic morphology is also well-known. This morphological variation can also pose a diagnostic challenge. We discuss a case of unresectable hepatic FDC sarcoma in an adult male who was diagnosed in core biopsy. We highlight the relevant histomorphological differentials and diagnostic approaches to FDC sarcoma in this anecdote.
RESUMO
Strongyloides stercoralis is a common intestinal pathogen, which often causes disseminated infection in patients on long term immunosuppressive therapy. The features of this syndrome range from subtle abdominal discomfort to fatal infection. Many of the immunologically mediated dermatological conditions need prolonged treatment with Immunosuppressants. Hence there is increased risk of this infestation. In dermatology in-patients, strongyloides stercoralis hyperinfection can be confused with a number of conditions, such as steroid-induced gastritis, corticosteroid withdrawal, electrolyte imbalance, lepra reactions, and erythrodermic enteropathy. In a country like India, where barefoot walking is still prevalent, this condition has been reported less often. We report a series of five patients who were diagnosed with strongyloides hyperinfection syndrome during their admission in the dermatology department during the last year. This case series aims at creating awareness among the dermatologists, so that, this, potentially fatal but easily preventable and treatable condition, can be managed properly.
RESUMO
Pneumatic dilation (PD) is a cost-effective first-line treatment for achalasia. The most feared complication of PD is esophageal perforation (EP). As data on EP after PD for achalasia are not widely reported, we present the frequency, risk factors, and treatment-outcome of EP. Records of patients undergoing PD for achalasia (January 1995 to September 2015) were retrospectively reviewed. Of 433 patients (age 38 years, 13-88, 57% male), and 521 dilations, 12 were complicated by EP (2.7% of patients and 2.3% of PD). EP occurred in 7 (3.4%), 4 (1.7%), and 1 (4.1%) with use of balloon diameters 30, 35, and 40 mm, respectively. In most (11/12, 92%), EP occurred during the first PD. No risk factor for EP was identified (p = 0.65 for the first dilation vs. > 1 dilation, and 0.75 for balloon size of 30 mm vs. > 30 mm). Seven patients with contrast leak on esophagogram and/or computed tomography scan underwent surgery. One other with contrast leak was successfully treated with a fully covered self-expandable metal stent (FC-SEMS); the remaining four with small leak/pneumomediastinum were managed conservatively. The median duration of hospital stay following perforation was 13 days (7-26) and 8 days (6-10) in surgery and conservative groups, respectively. No mortality was observed in either group. The frequency of EP with PD was 2.3%. Though most EP (92%) occurred during the first dilation, neither the balloon size nor repeated dilations were identified as risk factors. Both surgical and conservative approaches had a favorable outcome in appropriate settings.
Assuntos
Dilatação/efeitos adversos , Acalasia Esofágica/terapia , Perfuração Esofágica/etiologia , Perfuração Esofágica/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dilatação/métodos , Perfuração Esofágica/epidemiologia , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemAssuntos
Neoplasias do Colo/diagnóstico , Neoplasias do Colo/patologia , Polipose Intestinal/patologia , Linfoma de Célula do Manto/diagnóstico , Linfoma de Célula do Manto/patologia , Colonoscopia , Histocitoquímica , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Radiografia Abdominal , Tomografia Computadorizada por Raios XAssuntos
Calcinose/terapia , Hematoma/etiologia , Litotripsia/efeitos adversos , Pancreatopatias/terapia , Pancreatite Crônica/terapia , Gastropatias/etiologia , Adulto , Endoscopia do Sistema Digestório , Feminino , Mucosa Gástrica/diagnóstico por imagem , Hematoma/diagnóstico , Hematoma/diagnóstico por imagem , Humanos , Gastropatias/diagnóstico , Gastropatias/diagnóstico por imagem , Tomografia Computadorizada por Raios XAssuntos
Calcinose/patologia , Mucosa Gástrica/patologia , Insuficiência Renal Crônica/diagnóstico , Gastropatias/patologia , Neoplasias Gástricas/diagnóstico , Calcinose/diagnóstico , Calcinose/etiologia , Diagnóstico Diferencial , Humanos , Masculino , Diálise Renal , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Gastropatias/diagnóstico , Gastropatias/etiologia , Adulto JovemAssuntos
Ancylostomatoidea/isolamento & purificação , Hemorragia Gastrointestinal/etiologia , Infecções por Uncinaria/diagnóstico , Infecções por Uncinaria/patologia , Intestino Delgado/parasitologia , Telangiectasia Hemorrágica Hereditária/diagnóstico , Telangiectasia Hemorrágica Hereditária/patologia , Animais , Endoscopia por Cápsula , Endoscopia do Sistema Digestório , Epistaxe/etiologia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/patologia , Infecções por Uncinaria/complicações , Infecções por Uncinaria/parasitologia , Humanos , Achados Incidentais , Intestino Delgado/patologia , Masculino , Recidiva , Telangiectasia Hemorrágica Hereditária/complicações , Adulto JovemAssuntos
Anemia/diagnóstico , Neoplasias Gastrointestinais/diagnóstico , Nevo Azul/diagnóstico , Anormalidades da Pele/diagnóstico , Neoplasias Cutâneas/diagnóstico , Pele/irrigação sanguínea , Malformações Vasculares/diagnóstico , Adolescente , Anemia/etiologia , Neoplasias Gastrointestinais/complicações , Humanos , Masculino , Melena , Nevo Azul/complicações , Anormalidades da Pele/etiologia , Neoplasias Cutâneas/complicações , Malformações Vasculares/etiologiaAssuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/tratamento farmacológico , Cisto Dermoide/diagnóstico , Cisto Dermoide/tratamento farmacológico , Lobo Frontal , Convulsões/diagnóstico , Convulsões/tratamento farmacológico , Antibacterianos/uso terapêutico , Anticonvulsivantes/uso terapêutico , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Descongestionantes Nasais/uso terapêutico , Período Pós-Parto , RupturaRESUMO
This case describes a 50-year-old man with multiple lytic bone lesions involving the skull, pelvis and ribs and associated features of anaemia, hypercalcaemia, azotaemia and subsequently found to be non-Hodgkin's lymphoma of anaplastic large T cell type (ALCL) on biopsy taken from a soft tissue mass in the anterior chest wall as an aetiology. We report this case with an aim to expand our knowledge of isolated osseous involvement in case of non-Hodgkin's lymphoma. This case was unique in the sense of an isolated osseous involvement in ALCL without any organomegaly and lymphadenopathy with a normal bone marrow biopsy finding. So in rare instances, T-cell lymphoma can present with a multiple lytic lesion, anaemia, hypercalcaemia. Although B-cell non-Hodgkin's lymphoma can present with the above manifestation, it is extremely rare for T-cell non-Hodgkin's lymphoma.
Assuntos
Neoplasias Ósseas/secundário , Linfoma Anaplásico de Células Grandes/patologia , Biópsia , Neoplasias Ósseas/diagnóstico por imagem , Diagnóstico Diferencial , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND AND OBJECTIVE: To study the incidence and pattern of gastro-oesophageal reflux disease (GORD) in patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) using dual-probe 24-h oesophageal pH recording. METHODS: This was a prospective study of 50 patients with mild-to-moderate stage COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. A detailed history of illness along with spirometry was done in all patients. In the study group, reflux symptoms were measured using a validated scoring system. All the patients underwent oesophageal manometry and dual-probe 24-h oesophageal pH recording. RESULTS: Symptoms of gastro-oesophageal reflux were present in 38 patients. Twenty-four-hour oesophageal pH monitoring revealed pathological reflux in 31 out of 38 symptomatic and 8 out of 12 asymptomatic patients. The overall rate of GORD was 78% in our study. Only distal GORD was observed in 11 (28.9%), and both distal and proximal GORD was observed in 20 (52.6%) out of the 38 symptomatic subjects. In the remaining 12 asymptomatic patients, eight had GORD. Distal GORD was present in six (50%) patients, and two (16.6%) had both distal and proximal GORD in this group. Isolated proximal GORD was not observed in any patient. CONCLUSIONS: There is an increased occurrence of GORD in patients with even mild-to-moderate COPD.
Assuntos
Refluxo Gastroesofágico/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Monitoramento do pH Esofágico , Esôfago/metabolismo , Esôfago/fisiopatologia , Feminino , Seguimentos , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Humanos , Incidência , Índia/epidemiologia , Masculino , Manometria , Pessoa de Meia-Idade , Pressão , Prognóstico , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Índice de Gravidade de Doença , EspirometriaRESUMO
Hypertrophic osteoarthropathy is characterised by digital clubbing and periosteal reaction of long bones. Most cases are associated with malignancy or other conditions such as congenital heart disease, liver cirrhosis, pulmonary fibrosis, biliary atresia and inflammatory bowel diseases. We report a middle-aged man found to have 15-year history of clubbing of the fingers and toes on his routine check-up for dyspepsia. Skiagram of hand joints showed periosteal apposition without any periosteal reaction of long bones. The search for a secondary cause of clubbing remained negative. The primary or idiopathic form is rare and has a good prognosis and has to be differentiated from secondary form. He was eradicated successfully with Pylori kit for his antral predominant Helicobacter-induced gastritis.
Assuntos
Deformidades Adquiridas da Mão/diagnóstico por imagem , Osteoartropatia Hipertrófica Primária/diagnóstico por imagem , Adulto , Dispepsia/complicações , Dispepsia/tratamento farmacológico , Dispepsia/microbiologia , Deformidades Adquiridas da Mão/complicações , Infecções por Helicobacter/complicações , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Humanos , Masculino , Osteoartropatia Hipertrófica Primária/complicações , RadiografiaRESUMO
Acute gastric volvulus associated with congenital diaphragmatic hernia is an unusual surgical emergency and its presentation in adulthood is extremely rare. Gastric volvulus is an uncommon condition which is difficult to diagnose and treat. This case describes a middle aged man presenting with post-traumatic acute abdomen and finally being diagnosed as a case of gastric volvulus due to congenital diaphragmatic hernia which was till now asymptomatic and undiagnosed. Clinical examination and chest x-ray was suggestive of hiatus hernia. Contrast-enhanced CT of thorax and abdomen revealed hiatus hernia and gastric volvulus. A provisional diagnosis of post-traumatic hiatus hernia with associated gastric volvulus was made and was operated on an emergency basis. Surprisingly, the intraoperative findings revealed significant adhesions near the diaphragm suggestive of congenital diaphragmatic hernia. Hence, a diagnosis of gastric volvulus due to congenital diaphragmatic hernia was made which remained asymptomatic and undiagnosed till adulthood. He responded well to operative management and remained asymptomatic afterwards.
Assuntos
Hérnia Hiatal/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas , Volvo Gástrico/etiologia , Diagnóstico Diferencial , Hérnia Diafragmática/complicações , Hérnia Diafragmática/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Volvo Gástrico/diagnóstico por imagem , Volvo Gástrico/cirurgiaRESUMO
Poorly differentiated neuroendocrine tumour in the periampullary region of the duodenum is a rare entity. This entity usually present in old men. Here we report a periampullary poorly differentiated neuroendocrine cancer (PDEC) of duodenum presenting in a young man with subacute history of jaundice, abdominal pain, pancreatitis and constitutional symptoms. MRI localised the tumour and endoscopy-guided biopsy of the lesion proved the diagnosis. Although palliative surgery and chemotherapy were planned, the patient opted to leave against medical advice.