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Volume 70 - 2007 - Fasc.2 - Case reports

Chronic oesophagitis dissecans : a case report

Chronic oesophagitis dissecans is an often unrecognised cause of chronic dysphagia. It usually occurs in otherwise healthy patients and was first described asmonmameutachorpnedaocduhaesaomcnupacrocrncoaorzercraoternshaorcpuyfocrmlnotadcapntefosnstofwsitn:sodnchlsauflhoucmeagndi,u,cyflc,atxalbntcnolhi-son4tlogiofuencl2oi3gnr)eonit.nhigfosco)sin)cehamsosf(dtpn1ouWtmsficehnpidogrkesu)iegex(ahl(eyudagironfaigwoycta(eyhitalieicwtltetloltcloloitglcasntnuieis e report the case of a patient with chronic dysphagia due to chronic oesophagitis dissecans. (Acta gastroenterol. belg., 2006, 69, 223-225).


Acute motor sensory polyneuropathy (AMSAN) complicating active ulcerative colitis with a patchy distribution

We report a case of acute motor and sensory neuropathy during a flare of ulcerative colitis. A 28-year-old male presented with a flare of distal ulcerative colitis despite treatment with mesalamine enemas and suppositories simultaneously with rapidly deteriorat- ing weakness and needle sensation in both legs. Neurological assessment showed axonal sensorimotor polyneuropathy affecting mainly the lower limbs and to a lesser extent the upper limbs. Colonoscopy revealed moderately to severe active ulcerative colitis with a patchy distribution involving the rectum and the right colon. Vitamin and folic acid levels were normal. Virological, immunological and other laboratory tests were negative except for positive anti-ganglioside antibodies (anti-GM1). Ulcerative colitis and polyneuropathy improved when patient was treated with immunosuppressive therapy (corticosteroids, immunoglobulin and azathioprine). Peripheral polyneuropathy is a rare extrain- testinal manifestation of ulcerative colitis and it is probably asso- ciated with an autoimmune pathogenetic mechanism. (Acta gastro- enterol. belg., 2006, 69, 226-230).


A case of early gastric cancer with bone metastases: are bone marrow micrometastases significant ?

Gastric adenocarcinoma is currently the 14th cause of death worldwide. Early gastric cancer, defined as cancer not penetrating deeper than the submucosa, is considered to carry an excellent prognosis with 5-year survival rates reaching more than 90%. Cases of bone metastases due to intramucosal gastric cancer are very rarely described. A case of a 70-year old male presenting with confirmed bone metastases 7 years after a curative resection for a mucosal gastric carcinoma is discussed. The patient was investi- gated with bone marrow biopsy and bone scan and showed no other signs of disease. The clinicopathologic features included poor differentiation, signet ring cells presence, no lymph node involvement and a negative second laparotomy two years after the initial surgery. Studies concerning the presence of residual disease in the form of bone marrow micrometastases are briefly reviewed emphasizing that intramucosal gastric cancer still carries the pos- sibility for metastasis, many years after a curative resection, man- dating long term alertness from the attending physician. (Acta gastroenterol. belg., 2006, 69, 231-234).


Clear Cell Adenocarcinoma of colorectum : A case report and review of the literature

Primary clear cell adenocarcinoma of the colorectum is a rare neoplasm, which differs from ordinary carcinomas of the colorec- tum in morphological features, but shares some traits of clear cell carcinoma of other organs. The tumor is usually composed of polygonal or oval cells with abundant granular and clear cyto- plasm. The nuclei are often in hyperchromatic shapes with vesicu- lar nucleoli. We report the first case of clear cell adenocarcinoma of the col- orectum in China and review the related published cases. The tumor was located in descending colon of a 37-year-old man, and was rich in glycogen but poor in mucin. By immunoperoxidase and histochemical staining, we clarified the clinicopathological characteristics, diagnosis and differential diagnoses, and pursued its potential pathogenesis. In our case, necrosis, high mitotic activ- ity and lymph node metastasis may suggest a highly malignant tumor and an advanced pathological stage. Nevertheless, the patient has survived for one year with the help of operation and postoperative adjuvant chemotherapy. Regardless of the stage and differentiation, surgical therapy and proper adjuvant chemother- apy are effective means to treat the clear cell adenocarcinoma of the colorectum. (Acta gastroenterol. belg., 2006, 69, 235-238).


Thoracoabdominal wall tumour seeding after percutaneous radiofrequency ablation for recurrent colorectal liver metastatic lesion : a case report with a brief literature review

Radiofrequency is a safe and effective minimally invasive pro- cedure in the treatment of liver and other organs neoplastic lesions. Percutaneous access of neoplastic liver tissue is the most common access and electrodes are placed with imaging guidance into the tumour to be ablated. Complications during and after radiofrequency ablation (RFA) are of major or minor severity. Tumour dissemination related to the percutaneous access seems to be very unusual. Herein, we present a rare case of thoracoabdominal tumour wall dissemination after RFA of a recurrent hepatic colorectal metastasis previously removed by surgery. A 64-year-old man with a recurrent hepatic metastatic lesion was treated with internally cooled radiofrequency (RF) for ablation of a 3x3cm in size tumour mass. Two sessions of RFA in one-month period were performed. Computed tomography (CT) of the upper abdomen and carcinoembryonic (CEA) antigen were used for estimation of the disease progression in the patient's fol- low-up. Ten months after RFA the patient presented abdominal pain and a mass appeared on the right thoracoabdominal area with simultaneous lung metastases. In conclusion, a large size, bulky and superficial mass on the liver parenchyma adjacent to the thoracoabdominal wall as well as multiple RFA sessions, seem to represent risk factors for tumour dissemination through the needle electrode used during the RFA procedure in hepatic metas- tases of colorectal cancer. (Acta gastroenterol. belg., 2006, 69, 239- 242).


Hypocalcaemic seizures : sign of intestinal disease ?

We describe a baby admitted with convulsions, fever, low pro- tein level and coagulation abnormalities where congenital intesti- nal lymphangiectasia was confirmed by endoscopy and histology. Treatment with a low fat diet, supplemented with medium chain triglycerides (MCT), resulted in a disappearance of the symptoms and normal growth. When confronted with seizure-like attacks, electrolyte disturbances and hypo-albuminemia one should con- sider the possibility of protein losing enteropathy. (Acta gastro- enterol. belg., 2006, 69, 243-244).