Extraskeletal myxoid chondrosarcoma metastatic to the pancreas: A case report

Extraskeletal myxoid chondrosarcoma (EMC) is a lowgrade sarcoma characterized by developing metastases and local recurrence in high rate. It is mainly deep seated in the proximal extremities. The most common metastatic sites are the lungs, soft tissues, lymph nodes, bones and the brain. To our knowledge, no case of clearly defined EMC has been reported to date developing a metastasis in the pancreas. We describe a case of a man suffering from EMC who developed a single pancreatic metastasis 20 years after the initial diagnosis. A 49-year-old man was submitted to surgical excision of an EMC, in left thigh, 20 years ago. Fourteen years after the initial diagnosis a local recurrence in left thigh occurred. Multiple lesions of metastatic origin, in both lungs, were excised via thoracotomies until the time being. In 2003, as a part of a periodically performed imaging control, an abdominal CT scan was performed revealing a solid lesion in the pancreas. Distal pancreatectomy was performed. The histopathology of the excised specimen proved to be the one of metastatic lesion of EMC. The above-mentioned case of EMC is, as far as we know, the first one described developing a certain pancreatic metastasis.

Sclerosing encapsulating peritonitis in a liver transplant patient: A case report

We report a patient with HBV-related hepatocellular carcinoma （HCC） and refractory ascites who had received a peritoneal-venous shunt （PVS） 1 year before liver transplantation, Urgent surgical intervention following bowel obstruction and failure of immunosuppression therapy. No intestinal obstruction was found during an initial PVS. However, intestinal obstruction developed 2 was found upon exploration. This is the first reported case of cocoon abdomen caused by PVS and exacerbated by liver transplantation.

Unusual manifestations of gastric inflammatory fibroid polyp in a child

AIM:Inflammatory fibroid polyp (IFP) is a rare benign lesion that may occur throughout the digestive tract.IFP is more commonly found in the antrum of the stomach in particular. It mostly affects adults at the average age of 60 years.These polyps are able to cause abdominal pain,gastrointestinal bleeding,intestinal obstruction or intussusception.In this paper we report a case of gastric TIP with unusual presenting features. METHODS:A child with gastric IFP was described and the literature was reviewed, RESULTS:A 4-year-old girl presented with fever for 2 months,arthralgia of knees and ankles,iron defidency anemia, and hypoalbuminemia.Her stool examination was positive for occult blood.The upper gastrointestinal study demonstrated a large Iobulated mass at the upper part of gastric body.Partial gastrectomy en blocwith this 5 cm×8 cm mass was subsequently performed.Pathological examination was consistent with IFP.Following the mass excision,her fever abruptly declined and disappeared together with anemia and arthralgia.She remained asymptomatic and the abdominal ultrasonography performed at the 24-month follow-up demonstrated no recurrence of the tumor. CONCLUSION:The etiopathogenesis of IFP still remains unclear,The presence of IFP throughout the gastrointestinal tract and its variable clinical appearances make it difficult to diagnose,The inflammatory symptoms found in this patient support the hypothesis of inflammatory benign lesions of IFP.

Solitary colonic neurofibroma in a patient with transient segmental colitis: Case report

Neurofibromas of the large bowel are very rare and usually are part of the colonic involvement in neurofibromatosis type 1 （Nf1, yon Recklinghausen＇s disease）. Solitary neurofibromas of the colon are extremely rare. We describe a case of an isolated neurofibroma that was found in the large bowel of a patient who suffered from segmental colitis and presented with bloody diarrhea. A review of the literature is also included, concerning the disclosure of isolated neurofibromas in the gut and other body parts and the type of gastrointestinal involvement in von Recklinghausen＇s disease.

Celecoxib-induced cholestatic liver failure requiring orthotopic liver transplantation

Selective cyclooxygenase-2 （COX-2） inhibitors are widely used due to their efficacy and good safety profile. However, recent case reports have described varying degrees of liver injudes associated with the use of COX-2 inhibitors. We report the case of a patient who developed acute cholestatic hepatitis progressing to hepatic failure requiring liver transplantation, following a 3-d course of celecoxib for treatment of generalized muscle aches and pains. The clinical presentation, the laboratory data, as well as the liver histopathology were supportive of the putative diagnosis of drug induced liver injury.

Adenosquamous carcinoma arising within a retrorectal tailgut cyst: Report of a case

Retrorectal, developmental tail gut cysts, include dermoid cysts, rectal duplication cysts and retrorectal cyst-hamartomas. Retrorectal cyst-hamartomas （RCH） are derived from remnants of the tail gut, the most caudal part of the embryonic hincl gut, which normally involutes by the 8^th wk of embryonic development （3-8 mm stage）. They have specific radiological and histopathological features that distinguish them from other similar formations （dermoid cysts, enteric duplication cysts and teratomas）. We report a patient with adenosquamous carcinoma arising within RCH, who underwent complete resection of the cyst through anterior laparotomy, and reached complete （recurrencefree for 14 mo, so far） functional recovery. The cyst was incidentally discovered during hysterectomy 12 years ago. Diagnostic, therapeutic arid histopathological aspects of this rare case are discussed. The mentioned pedod between diagnosis and surgical treatment suggests that RCH, given enough time, can develop malignant degeneration, and should be resected at the time of diagnosis.

Takotsubo Cardiomyopathy in a Female Patient After Laparoscopic Oophorocystectomy: a Case Report

TAKOTSUBO cardiomyopathy （TC）, also known as ＂left apical ballooning syndrome＂ and ＂broken heart syndrome＂, has been reported throughout the world occasionally. The major cause of thisdisease is psychological or physical stress, and it has various clinical presentations. In this article, we present a TC case caused by laparoscopic oophorocystectomy.

Massive recurrent synovial sarcoma of the neck:a case report

We report a rare case of massive recurrent synovial sarcoma of the neck in a 25-year-old woman.Physical exami- nation showed a 30×28 cm well-defined subcutaneous mass in the left cervical region,compressing the trachea to the right. Systemic examination revealed no metastasis to other organs.The diagnosis of sarcoma was established by percutaneous needle biopsy.Branches of the left subclavian artery and the left external carotid artery were found to supply the tumor,their embolization successfully shrank the tumor preoperatively allowing subsequent resection.Pathological analysis confirmed the diagnosis of synovial sarcoma.The patient was without recurrence 12 months after operation.

Primary malignant melanoma of the esophagus

Primary malignant melanoma of the esophagus （PMME） is an extremely rare and aggressive tumor, comprising less than 0.2% of all primary esophageal neoplasms. There are fewer than 270 reported cases in worldwide literature, most of which are scattered cases reported. This tumor has usually been reported as a pedunculated, polypoid tasion in the middle and lower third of the esophagus. Hematogenic and lymphogenic metastases are commonly reported for PMME cases. Although surgical resection has been considered as the best possible option, the prognosis has been nonetheless poor, even combined with adjuvant chemotherapy postoperatively, according to the literatures. Here we reported such a case on its clinical presentations and treatment.

Hepato-splenic lymphoma:a rare entity mimicking acute hepatitis:A case report

We reported a case of non-Hodgkin's lymphoma where liver involvement was the predominant clinical manifestation.A 27-year old man presented wiht markedly elevated serum aspartate aminotrasferase,alanine aminotransferase and lactate dehydrogenase,reduced prothrombin activity,thrombocytopenic purpura and hepato-splenomegaly without adenopathy.Viral,toxic, autoimmune and metabolic liver diseases were excluded. Bone marrow biopsy showed an intracapillary infiltration of T-lymphocytes with no evidence of lipid storage disease. Because of a progressive spleen enlargement,splenectomy was performed.Histological examination showed lymphomatous intrasinuses invasion of the spleen. Immunohistochemical investigation revealed the T phenotype of the neoplastic cells:CD45+,CD45RO+, CD3+,CD4-,CD8-,TIAl-.About 50 % of the lymphoid cells expressed CD56 antigen.The diagnosis of hepatosplenic T cell lymphoma was done.The patient was treated with chemotherapy,which induced a complete remission.Eighteen months later,he had a first relapse with increased aspartate aminotransferase,alanine aminotransferase,lactate dehydrogenase, thrombocytopenic purpura and blast in the peripheral blood. In spite of autologous bone marrow transplantation,he died twenty months after the diagnosis.Even in the absence of a mass lesion or lymphoadenopathy,hepatosplenic T- cell lymphoma should be considered in the differential diagnosis of a patient whose clinical course is atypical for acute hepatic dysfunction.

Dieulafoy's lesion:A case series study

AIM: Dieulafoy's lesion (DL) accounts for 1-5.8% of cases of acute upper gastrointestinal bleeding (GIB). Its mortality is high, approaching 20%, despite recent advances in endoscopic therapy. We aimed to report our experience in the treatment of DL.METHODS: A retrospective case study of all patients with DL between January 1993 and January 2003 was done. Characteristics, treatment methods, success rates and 30-d mortality of the patients were analyzed. RESULTS: Thirty-six patients were noted to have DL in the study period. Thirty-three records were available for assessment in which 35 DL were identified. The median age of the patients was 67 years with male to female ratio of 5.6:1. Significant comorbidities existed in 69% of the patients. Eighty-nine percent of the DL was found at first endoscopy, three DL at laparotomy. Significant coexistent endoscopic findings existed in 23%. Hemostasis was achieved in 88% by using adrenaline injection, or in combination with heater probe application at first endoscopy. Four cases had re-bleeding, all were successfully treated endoscopically. The 30-d mortality rate was 23%.CONCLUSION: Successful endoscopic hemostasis could be achieved in 100% of cases of DL. The overall mortality may still remain high, mainly due to the comorbidities and age of these patients.

Primary cardiac lymphoma:a case report and review of the literature

Primary cardiac lymphoma (PCL) is an extremely rare neoplasm and usually defined as a non-Hodgkin's lymphoma being exclusively located in the heart and/or the pericardium. It is particularly difficult to diagnose this rare disease due to its nonspecific clinical manifestations. The prognosis of this disease is poor. In this diffuse large B-cell lymphoma, the patient finally died of heart failure after 2 courses of chemotherapy with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone).

Asymptomatic early acute appendicitis initiated and diagnosed during colonoscopy: A case report

Colonoscopic diagnosis of asymptomatic early acute appendicitis is exceedingly rare. Although obstruction of common physiologic mechanism of acute appendicitis, all of the previously documented cases in the literature have only shown a patent appendiceal lumen with pus flowing into the cecum. We present the case of a patient undergoing colonoscopy for colorectal cancer evaluation with no abdominal symptoms. An obstructed, swollen appendix was seen. The process was probably initiated during the colonoscopy, documenting perhaps the earliest stage of acute appendicitis for the first time. Endoscopic, CT and microsCOpic documentation of the case is also presented.

Pulmonary embolization as primary manifestation of hepatocellular carcinoma with intracardiac penetration: A case report

Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previously. In our case report, a 63-year-old man presented with high fever and six episodes of recurrent pneumonias during the last half year. Echocardiography was performed, a solid mass was found in the right atrium. Transesophageal echocardiography proved a tumor mass in the inferior vena cava (IVC) extending into the right atrium, abdominal ultrasound revealed tumor mass in the IVC and a solid tumor in the liver. Combined liver and heart surgery was attempted in order to remove the tumor mass from both the liver and the right atrium. Acute cor pulmonale occurred during tumor removal from the right atrium and the patient expired. In addition to local factors the possibility of embolization should arise in the background of recurrent pneumonia. Occult carcinoma must be included in possible causes of recurrent pulmonary embolism. Searching for primary malignancy should include HCC as frequent cause of hypercoagulability. In case of HCC, echocardiography is suggested because of the possibility of expansion in IVC or right atrium and tumor-embolization.

Crohn's disease and recurrent appendicitis: A case report

The clinical diagnosis of classic Crohn's disease (CD)of the small bowel is based on a typical history, tender right lower quadrant fullness or mass, and characteristic radiographic findings of the terminal ileum. Appendicitis may as well present with chronic or recurrent symptoms and this presentation may be confused with CD. We herein describe the case of a young teenage girl with a presumptive diagnosis of CD, who was ultimately diagnosed as having chronic nongranulomatous appendicitis. The literature on the subject is reviewed.

Multiple immune disorders in unrecognized celiac disease:a case report

We reported a female patient with unrecognized celiac disease and multiple extra intestinal manifestations, mainly related to a deranged immune function, including macroamilasemia, macrolipasemia, IgA nephropathy,thyroiditis, and anti-b2-glicoprotein-1 antibodies, that disappeared or improved after the implementation of a gluten-free diet.

Familial gastric cancers with Li-Fraumeni Syndrome: A case repast

TO THE EDITORAlthough the incidence of gastric cancer has declined somewhat in recent years, it remains one of the most common cancers worldwide[1], and is the most common cancer in East Asian countries such as Korea and Japan[2].In terms of the genetics of gastric cancer, mutations in CDH1 (E-cadberin) have been associated with hereditary diffuse gastric cancer (HDGC). The first germline mutation in CDH1 was reported in a large Maori HDGC family[1],with subsequent corroborations in Western and Asian HDGC families[3-5], CDH1 mutations are believed to be associated with up to 50% of HDGC families[5], but have not been linked with sporadic or intestinal types of gastric cancer[5].

Central mucoepidermoid carcinoma of the jaws:report of two cases

Central mucoepidermoid carcinoma of the jaws (CMCJ) is an extremely rare neoplasm. The clinical manifestation of CMCJ is nonspecific, which includes swelling, pain, mobile teeth and bleeding, etc. To develop the diagnosis and treatment of CMCJ. this article presents 2 cases of CMCJ treated in our hospital. Their clinical data, treatment and prognosis were analyzed retrospectively.

Malignant Myofibroblastoma of the Bladder:a Case Report

In July 2006, a 32-year old female patient was found to have a 3 ×3 cm^2 neoplasm in the left lateral wall of her bladder. There was superficial necrosis and bleeding. Previously she had received a cystoscopy in another hospital because of painless gross hematuria and anemia. A partial resection of the bladder was conducted because attempts of medical hemostasis were unsatisfactory. Pathological examination indicated that the lesion was a spindle cell tumor of the bladder （Fig. 1）. Since the tumor cells had encroached into the smooth muscle, there was extensive cellular proliferation in the muscle layer and pathologic karyokinesis could be seen, suggestive of a malignant myofibroblastoma. The lateral and basilar cutting edges were oositive.

Lapatinib-induced hepatitis: A case report

Lapatinib is an inhibitor of the tyrosine kinases of human epidermal growth factor receptor type 2 (HER2) and epidermal growth factor receptor type 1, with clinical activity in HER2-positive metastatic breast cancer. We present here a 60 year-old patient with metastatic breast cancer who presented with jaundice and increased serum aminotransferase levels and who had been treated with lapatinib for the previous 14 days. Laboratory tests excluded other causes of acute liver injury. Liver biopsy revealed lesions compatible with drug-induced hepatotoxicity. Bilirubin and liver enzymes returned to normal within three months of lapatinib discontinuation. Lapatinib should be included among the causes of druginduced hepatitis.