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Volume 81 - 2018 - Fasc.3 - Clinical images

An unusual cause of rectal polyposis

A 32-years old man admitted to the gastroenterology clinic with the complaint of rectal discharge. He had difficulties of defecation (straining and sense of incomplete evacuation) since childhood. He denied rectal digital manipulation. His past medical history, family history, physical examination and laboratory tests were all unremarkable. Total colonoscopy showed multiple rectal polyps (Fig. 1) and biopsies were taken from those polyps (Fig. 2). What is the diagnosis?


An uncommon splenic mass

A 37-year-old man presented with pain and progressively increasing fullness in the left upper quadrant for three months. He also complained of loss of appetite and significant weight loss for two months. There was no associated fever, nausea or vomiting. On examination, there was a large, firm, non-tender mass in the left upper quadrant. The laboratory data indicated mild anemia with hemoglobin at 10.6 g/dL (normal, 12-14 g/dL). His liver function tests, renal function tests and blood tumor markers were normal. His past history was significant for total left parotidectomy for a tumor 3 years back. Ultrasonography (US) showed a large heterogeneous splenic mass. A biphasic computed tomography revealed a large 18X12 cm heterogeneously enhancing mass involving the entire splenic parenchyma with large central necrotic areas (Fig. 1A, arrow). Liver (Fig. 1A, short arrow) and lung nodules (Fig. 1B, arrow) were also detected. What is your diagnosis?


What is the waterlily sign ?

The waterlily sign (Fig. 1) represents the freely floating endocyst of the Echinococcus granulosus, causing hydatid cysts (HC). The HC is severe, neglected, misdiagnosed, worldwide infectious disease, caused by a tapeworm, Echinoccocus granulosus, endemic of rural areas. Humans are incidental hosts. Fever and constitutional symptoms usually occur only if there is rupture or bacterial superinfection of the cyst. Ultrasound remains the diagnostic method of choice in the work-up of hepatic cystic lesions; it can differentiate cystic echinococcosis from the alveolar form, caused by Echinoccocus granulosus (Fig. 2) and Echinoccocus multilocularis, respectively. The current standard of treatment is based on the WHO Classification; Albendazol is the drug of choice; according to the clinical scenariO. Puncture, Aspiration, Injection, and Reaspiration (PAIR) and surgery are correctly indicated. The rate of cyst recurrence is 16.2% , 3.3% and 3.3% with open surgery, percutaneous intervention and laparoscopic surgery, respectively.