Hepatic follicular lymphoma in an old patient with Crohn's disease: a rare case and review of the literature.

OBJECTIVE: Crohn's Disease (CD) has been associated with non-Hodgkin lymphoma. Follicular Lymphoma (FL) limited to the liver is extremely rare, accounting for 1% to 4.4% of all Primary Hepatic Lymphoma (PHL). CASE PRESENTATION: In 2018, an 85-years old male patient with post-operative recurrence of ileal CD referred rare episodes of fever and mild diffuse abdominal pain. Since cholecystectomy in 2001, clinical history was characterized by recurrent episodes of cholangitis and common bile duct stones. In 2018, ultrasonography and MRI showed a solid focal hepatic lesion (FHL)(4.5 cm x 2.5 cm) in the IV hepatic segment. The radiographic aspect of the lesion was unusual. Initially, focal nodular hyperplasia was suspected. Clinical history of cholangitis and radiological findings subsequently suggested a diagnosis of Hepatic Abscess (HA). A progressive enlargement of the FHL (7.3 cm x 5.8 cm) despite antibiotic treatments, led to perform a liver biopsy. Histological and immunophenotypical analysis of the FHL (7.5 cm x 5.4 cm) enabled a final diagnosis of FL. The "in situ" hybridization for Epstein-Barr virus (EBER) was negative. No additional lesions related to FL were initially detected, thus suggesting a very rare case of PHL in an old patient with CD never treated with thiopurines. CONCLUSIONS: This case report highlights the need to consider a rare diagnosis of FL of the liver in patients showing a challenging focal hepatic lesion of unknown origin.

[Clinico-electromyographic correlations in spasmophilia in the adult]. / Correlazioni clinico EMG nella spasmofilia dell'adulto.

In a group of spasmophilic subjects, symptoms imputable to the syndrome were compared with EMG signs of ischemic neuromuscular hyperexcitability, to evaluate their significance by logistic statistical analysis. Subjects with a duration of postischemic EMG spontaneous activity greater than the mean of normal values + 2.5 DS were considered positive for a spasmophilic syndrome. The following symptoms were selected as positive by the analysis: palpitations, nail and hairs abnormalities, headache, lipothymia; thermoregulation disorders and tremors were negatively related to the syndrome, while sleep disorders and asthenia emerged as positive in the logistic analysis but not significantly so.