Misdiagnosis of hemangioma of left triangular ligament of the liver as gastric submucosal stromal tumor:Two case reports

BACKGROUND Extragastric lesions are typically not misdiagnosed as gastric submucosal tumor(SMT).However,we encountered two rare cases where extrinsic lesions were misdiagnosed as gastric SMTs.CASE SUMMARY We describe two cases of gastric SMT-like protrusions initially misdiagnosed as gastric SMTs by the abdominal contrast-enhanced computed tomography(CT)and endoscopic ultrasound(EUS).Based on the CT and EUS findings,the patients underwent gastroscopy;however,no tumor was identified after incising the gastric wall.Subsequent surgical exploration revealed no gastric lesions in both patients,but a mass was found in the left triangular ligament of the liver.The patients underwent laparoscopic tumor resection,and the postoperative diagnosis was hepatic hemangiomas.CONCLUSION During EUS procedures,scanning across different layers and at varying degrees of gastric cavity distension,coupled with meticulous image analysis,has the potential to mitigate the likelihood of such misdiagnoses.

Endoscopic ultrasound-guided lauromacrogol injection for treatment of colorectal cavernous hemangioma:Two case reports

BACKGROUND Colorectal cavernous hemangioma is a rare vascular malformation resulting in recurrent lower gastrointestinal hemorrhage,and can be misinterpreted as colitis.Surgical resection is currently the mainstay of treatment,with an emphasis on sphincter preservation.CASE SUMMARY We present details of two young patients with a history of persistent hematochezia diagnosed with colorectal cavernous hemangioma by endoscopic ultrasound(EUS).Cavernous hemangioma was relieved by several EUS-guided lauromacrogol injections and the patients achieved favorable clinical prognosis.CONCLUSION Multiple sequential EUS-guided injections of lauromacrogol is a safe,effective,cost-efficient,and minimally invasive alternative for colorectal cavernous hemangioma.

Is Helicobacter pylori infection associated with glycemic control in diabetics?

AIM:To investigate whether Helicobacter pylori(H.pylori) infection is associated with glycemic control and whether hyperglycemia is modified by eradication therapy.METHODS:The databases of Pub Med,Cochrane Library,Chinese Bio Medicine Web Base and Chinese Science and Technology Journals were searched from inception to June 2014.Studies examining the association between H.pylori infection and glycemic control and/or the effect of eradication treatment on glycemic control in diabetic humans were eligible for inclusion.Meta-analyses were conducted using the Review Manager software version 5.2.The outcome measures are presented as weighed mean differences(WMDs) with 95% confidence intervals(CIs).Statistical heterogeneity was assessed by the Cochran Q test and the I2 statistic.RESULTS:A total of 21 relevant publications were identified.A meta-analysis of 11 studies with 513 patients with diabetes mellitus(DM) showed significantly lower glycosylated hemoglobin(Hb A1c) levels in the H.pylori-negative than H.pylori-positive DM participants(WMD = 0.43,95%CI:0.07-0.79;P = 0.02).In children and adolescents with type 1 DM(T1DM),there was a positive association between H.pylori infection and Hb A1 c level(WMD = 0.35,95%CI:0.05-0.64;P = 0.02),but there was no difference in those with type 2 DM(T2DM,WMD = 0.51,95%CI:-0.63-1.65;P = 0.38).A meta-analysis of six studies with 325 T2 DM participants showed a significant difference in the fasting plasma glucose levels between H.pylori-positive and H.pylori-negative participants(WMD = 1.20,95%CI:0.17-2.23;P = 0.02).Eradication of H.pylori did not improve glycemic control in the T2 DM participants in a threemonth follow-up period(Hb A1 c decrease:WMD =-0.03,95%CI =-0.14-0.08;P = 0.57;fasting plasma glucose decrease:WMD =-0.06,95%CI:-0.36-0.23;P = 0.68).Glycemic control was significantly better in T1 DM participants who were not reinfected than in those who were reinfected(Hb A1c:WMD = 0.72,95%CI:0.32-1.13:P = 0.00).CONCLUSION:H.pylori infection is associated with poorer glycemic control in T1 DM patients,but eradication may not improve glycemic control in DM in a short-term follow-up period.

Screening for pancreatic cancer in familial high-risk individuals: A systematic review

AIM:To analyze the benefits and harms of pancreatic cancer screening in familial high-risk individuals(HRIs).METHODS:Studies were identified by searching PubMed,EBSCO,ClinicalTrials.gov and the Cochrane database from database inception to June 2014.We also obtained papers from the reference lists of pertinent studies and systematic reviews.Englishlanguage trials and observational studies were searched.The key words used as search terms were "screening" and "surveillance".Cost-effectiveness,diagnostic rate,survival rate,mortality and adverse events were the outcomes of interest.Age,sex,lifestyle and other confounding factors were also considered.However,anticipating only a few of these studies,we also included observational studies with or without control groups.We also included studies concerning the anxiety associated with pancreatic cancer risk and other psychological changes in familial HRIs.We extracted details on study design,objectives,population characteristics,inclusion criteria,year of enrollment,method of screening,adjusted and unadjusted mortality,cost-effectiveness and adverse events from the included studies.Studies were assessed using the Reporting of Observational studies in Epidemiology(STROBE) checklist.RESULTS:Sixteen studies on pancreatic cancer screening were included.Five studies included control groups,nine were observational studies without control groups,and the other two studies investigated the worry associated with pancreatic cancer risk.We found that pancreatic cancer screening resulted in a high curative resection rate(60%vs 25%,P = 0.011),longer median survival time(14.5 mo vs 4 mo,P < 0.001),and higher 3-year survival rate(20%vs 15.0%,P =0.624).We also found that familial HRIs had a higher diagnostic rate of pancreatic tumors than controls(34%vs 7.2%,P< 0.001).In patients who underwent regular physical examinations,more stage I pancreatic cancers were observed(19%vs 2.6%,P= 0.001).In addition,endoscopic ultrasonography,which was the main means of detection,diagnosed 64.3%of pancreatic cancers.In comparison,endoscopic retrograde cannulation of the pancreas,magnetic resonance imaging,and computed tomography diagnosed 28.6%,42.9%,and21.4%,respectively.For mass lesions,instant surgery was recommended because of the beneficial effects of post-operative chemotherapy.However,in patients with intraductal papillary mucinous neoplasms,we did not find a significant difference in outcome between surgery and follow-up without treatment.Moreover,pancreatic cancer screening in familial HRIs had a greater perceived risk of pancreatic cancer(P< 0.0001),higher levels of anxiety regarding pancreatic cancer(P< 0.0001),and increased economic burden.CONCLUSION:Pancreatic cancer screening in familial HRIs is associated with a higher detection rate and longer survival,although screening may influence psychological function and increase the economic burden.

Large heterotopic gastric mucosa and a concomitant diverticulum in the rectum:Clinical experience and endoscopic management

Heterotopic gastric mucosa(HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge.In the present study,a 14-year-old girl visited our hospital due to a 5-year history of repeated hematochezia.Colonoscopy showed a solitary superficial depressed lesion approximately 5 cm in size and a concomitant 1.5 cm deep diverticulum in the rectum.Histological examination of the endoscopic biopsy showed typical ectopic gastric mucosa in the depressed lesion and inside the diverticulum.Narrow band imaging further confirmed the histological results.Endoscopic ultrasound indicated that the lesion originated from the mucosal layer,and partially involved the submucosal layer.Endoscopic submucosal dissection was performed in this patient due to the large size and shape of the lesion.No bleeding,perforation or other adverse events were observed.The presence of HGM in the diverticular cavity greatly increased the surgical difficulty.A literature review was also carried out in our study.

Gastric metastasis presenting as submucosa tumors from renal cell carcinoma:A case report

BACKGROUND Gastric metastasis from renal cell carcinoma(RCC) is an extremely rare clinical entity.Due to an easily neglected RCC history,nonspecific symptoms and underrecognized endoscopic presentation may lead to a potential diagnostic pitfall in daily clinical practice.CASE SUMMARY We present a case of metastatic gastric tumors arising from RCC 5 years after radical nephrectomy.Simultaneous,multifocal metastases to the gallbladder,pancreas and soft tissue were observed.One year previously,a solitary submucosal discoid tumor with a central depression was detected in the gastric fundus in a 65-year-old man.Endoscopic ultrasonography(EUS) showed a 1.12 x 0.38 cm lesion originating from the deeper mucosal layers with partially discontinuous submucosa.One year later,the endoscopic findings of the lesion showed various changes.A large lesion of the protruding type(2.5 cm × 2 cm) was found in the fundus at the same location.EUS showed a heterogeneous mass that involved the mucosa and submucosal layer.In addition,two small similar submucosal lesions 0.4-0.6 cm in size were detected.These lesions had a central depression,surface mucosal congestion and thickened vessels.The two adjacent lesions in the fundus were resected by endoscopic submucosal dissection.Based on the postoperative pathological analysis,the patient was diagnosed with gastric metastasis from RCC.CONCLUSION Gastric metastasis from RCC should be considered in patients with a history of RCC irrespective of the time interval involved.