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Volume 73 - 2010 - Fasc.1 - Letters

Diffuse polyposis of small intestine

Primary lymphomas of the gastrointestinal tract account for about one third of extranodal lymphomas (1). Multiple lymphomatous polyposis (MLP) is a rare pres- entation of gastrointestinal lymphomas. It is character- ized by extensive involvement of the gut by lymphoma cells macroscopically appearing as multiple small poly- poid lesions. A 53-year-old man presented with a one-month his- tory of abdominal pain, weight loss and fever. His past medical history was unremarkable. He was extremely tired and cachectic. Laboratory findings were normal except for than low hemoglobin (7.1 g/dL), high erythro- cyte sedimentation rate (87 mm/h) and positive stool blood test. Upper gastrointestinal endoscopy revealed diffuse nodules and polyps (2-8 mm) in whole duo- denum. Colonoscopy showed similar lesions at the ileo-cecal valve and in the ileum (Fig. 1). Abdominal computed tomography revealed multiple abdominal lymphadenopathies and diffuse thickening of intestinal wall. Duodenum and ileum biopsies were compatible with diffuse large B cell lymphoma. They were positive for CD-20, Bcl-6, CD45 and negative for CD3, Bcl-2 and CD1O.Ki67 staining showed 90% reactivity. Although chemotherapy was planned, the patient died as a result of sepsis two days after diagnosis.


Perforated retroperitoneal retrofascial sigmoid diverticulitis as a cause of osteomyelitis and septic necrosis of the acetabulum and proximal femur

A 44 year old man was treated during four months for a purulent inflammation of the left inguinal lymph nodes. Abdominal CT delineated left psoas abscess with osteomyelitis of the proximal part of the left femur. Barium enema and intravenous pyelography were nor- mal. Left inguinal incision with opening of the retroperi- toneal space was performed and approximately 1 L of pus was evacuated. The patient also complained of pain in the left hip region with painful movements. Reincisions were made three times and finally pus was found in the hip joint with osteomyelitis of the femoral head of unknown cause. Garamycin and metronidazole were administered according to the antibiogram (Bacteroides spp., E. coli and S. rubidaea). In spite of therapy the condition worsened, with development of sepsis. Patient was sent to the Department of Surgery at the Clinical Hospital Center Zagreb.