BACKGROUND Duodenal Brunner's gland hyperplasia(BGH)is a therapeutic target when complications such as bleeding or gastrointestinal obstruction occur or when malignancy cannot be ruled out.Herein,we present a case...BACKGROUND Duodenal Brunner's gland hyperplasia(BGH)is a therapeutic target when complications such as bleeding or gastrointestinal obstruction occur or when malignancy cannot be ruled out.Herein,we present a case of large BGH treated with endoscopic mucosal resection(EMR).CASE SUMMARY An 83-year-old woman presented at our hospital with dizziness.Blood tests revealed severe anemia,esophagogastroduodenoscopy showed a 6.5 cm lesion protruding from the anterior wall of the duodenal bulb,and biopsy revealed the presence of glandular epithelium.Endoscopic ultrasonography(EUS)demonstr-ated relatively high echogenicity with a cystic component.The muscularis propria was slightly elevated at the base of the lesion.EMR was performed without complications.The formalin-fixed lesion size was 6 cm×3.5 cm×3 cm,showing nodular proliferation of non-dysplastic Brunner's glands compartmentalized by fibrous septa,confirming the diagnosis of BGH.Reports of EMR or hot snare polypectomy are rare for duodenal BGH>6 cm.In this case,the choice of EMR was made by obtaining information on the base of the lesion as well as on the internal characteristics through EUS.CONCLUSION Large duodenal lesions with good endoscopic maneuverability and no evident muscular layer involvement on EUS may be resectable via EMR.展开更多
BACKGROUND Intravascular lymphoma(IVL)is a rare subtype of lymphoma involving the growth of lymphoma cells within the vessel lumina without lymphadenopathy.Because of various modes of presentation and its rarity,IVL i...BACKGROUND Intravascular lymphoma(IVL)is a rare subtype of lymphoma involving the growth of lymphoma cells within the vessel lumina without lymphadenopathy.Because of various modes of presentation and its rarity,IVL is often diagnosed postmortem.Herein,we report a case of intravascular B-cell lymphoma with hypopituitarism,an extremely rare complication,that was successfully treated with chemotherapy.CASE SUMMARY An 80-year-old Japanese woman presented with a 7-mo history of a tingling sensation in the lower limbs.She also presented with various other symptoms such as pancytopenia,high fever daily,and unconsciousness with hypoglycemia.Although the doctor who previously treated her diagnosed hypoglycemia as being due to hypopituitarism,the cause of the other symptoms remained uncertain despite a 7-mo evaluation period.We performed bone marrow aspiration to evaluate pancytopenia and found that she had hemophagocytic lymphohistiocytosis(HLH).On the basis of a random skin biopsy for assessing the cause of HLH,she was diagnosed with intravascular B-cell lymphoma.HLH and hypopituitarism were considered secondary to IVL.All her clinical findings matched the presentations of IVL.She was immediately treated with chemotherapy and achieved complete response.She was relapse free two years after treatment.CONCLUSION IVL should be included in the differential diagnosis of hypopituitarism,which although life-threatening,is treatable through prompt diagnosis and appropriate chemotherapy.展开更多
文摘BACKGROUND Duodenal Brunner's gland hyperplasia(BGH)is a therapeutic target when complications such as bleeding or gastrointestinal obstruction occur or when malignancy cannot be ruled out.Herein,we present a case of large BGH treated with endoscopic mucosal resection(EMR).CASE SUMMARY An 83-year-old woman presented at our hospital with dizziness.Blood tests revealed severe anemia,esophagogastroduodenoscopy showed a 6.5 cm lesion protruding from the anterior wall of the duodenal bulb,and biopsy revealed the presence of glandular epithelium.Endoscopic ultrasonography(EUS)demonstr-ated relatively high echogenicity with a cystic component.The muscularis propria was slightly elevated at the base of the lesion.EMR was performed without complications.The formalin-fixed lesion size was 6 cm×3.5 cm×3 cm,showing nodular proliferation of non-dysplastic Brunner's glands compartmentalized by fibrous septa,confirming the diagnosis of BGH.Reports of EMR or hot snare polypectomy are rare for duodenal BGH>6 cm.In this case,the choice of EMR was made by obtaining information on the base of the lesion as well as on the internal characteristics through EUS.CONCLUSION Large duodenal lesions with good endoscopic maneuverability and no evident muscular layer involvement on EUS may be resectable via EMR.
文摘BACKGROUND Intravascular lymphoma(IVL)is a rare subtype of lymphoma involving the growth of lymphoma cells within the vessel lumina without lymphadenopathy.Because of various modes of presentation and its rarity,IVL is often diagnosed postmortem.Herein,we report a case of intravascular B-cell lymphoma with hypopituitarism,an extremely rare complication,that was successfully treated with chemotherapy.CASE SUMMARY An 80-year-old Japanese woman presented with a 7-mo history of a tingling sensation in the lower limbs.She also presented with various other symptoms such as pancytopenia,high fever daily,and unconsciousness with hypoglycemia.Although the doctor who previously treated her diagnosed hypoglycemia as being due to hypopituitarism,the cause of the other symptoms remained uncertain despite a 7-mo evaluation period.We performed bone marrow aspiration to evaluate pancytopenia and found that she had hemophagocytic lymphohistiocytosis(HLH).On the basis of a random skin biopsy for assessing the cause of HLH,she was diagnosed with intravascular B-cell lymphoma.HLH and hypopituitarism were considered secondary to IVL.All her clinical findings matched the presentations of IVL.She was immediately treated with chemotherapy and achieved complete response.She was relapse free two years after treatment.CONCLUSION IVL should be included in the differential diagnosis of hypopituitarism,which although life-threatening,is treatable through prompt diagnosis and appropriate chemotherapy.
