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Volume 74 - 2011 - Fasc.3 - Letters

Immediate post-operative hypersensitivity reaction to Cetuximab in patients pre- operatively treated by the monoclonal antibody : what's wrong ?

Cetuximab, an anti-Epidermal Growth Factor Receptor (EGFR) monoclonal antibody, has been consid- ered for years as an effective drug in metastatic colorec- tal cancer (mCRC). Three patients, median age 65, were treated in our institution for rectal well-differentiated adenocarcinoma associated with synchronous liver-only metastatic disease. Pre-operative treatment consisted in 6 cycles of FOLFOX (Oxaliplatin 85 mg/m2 day 1, Elvorine 200 mg/m2 day 1, bolus 5-Fluorouracil 400 mg/m2 day 1 and continuous infusion 5-fluorouracil 2.4 g/m2 for 46 hours, administered every 2 weeks),


Advanced adenocarcinoma in a laterally spreading adenoma within a colonic diverticulum, followed-up for 4 years

Colonic neoplasia can arise from normal mucosa near or within a diverticulum. However, an adenocarcinoma arising within a diverticulum is a very rare phenomenon and to date only sporadic cases have been reported (1-8). Due to the lack of muscular layers within the diverticu- lum, the use of endoscopic polypectomy of a tumour within the diverticulum carries a risk of colonic perfora- tion. Additionally, it is usually difficult to determine whether the tumour component is benign or malignant ; hence, special precautions should be implemented in the diagnosis and treatment of such patients. A 71-year-old man was admitted to Nishijin Hospital because of mele- na on November 5, 2009.


Gallbladder involvement of diffuse large B-cell lymphoma mimicking gall- bladder carcinoma

We report a case of diffuse large B-cell lymphoma of the gallbladder mimicking gallbladder carcinoma. In this case, ERCP-guided brush cytology was useful for the differential diagnosis. A 54-year-old male was admitted to the hospital due to abdominal pain in September 2009. A physical examination revealed cervical lymphadenopathy. The laboratory data revealed increased serum levels of LDH (539 IU/l) and soluble interleukin-2 receptor (1230 U/ml). Abdominal ultrasonography (US) showed gallbladder wall thickening. Contrast computed tomog- raphy (CT) revealed irregular thickening of the gallblad- der wall. The gallbladder lesion showed low-intensity on T1-weighted magnetic resonance (MR) images and high intensity on diffusion-weighted (DW) images (Fig. 1).


A tight esophageal stricture secondary to a misplaced band and its management

Here we report a case of a tight esophageal stricture and our subsequent management, in particular high- lighting the use of very flexible guidewires and biliary balloons. A 74 year old woman initially presented to a private hospital with hematemesis. Esophagogastroduodeno- scopy (EGD) revealed esophageal varices which were subsequently banded with a multiband shooter. Further investigations confirmed that she had chronic hepatitis B cirrhosis with portal hypertension. Hemostasis was achieved and she was discharged. Four months later she presented again with complaints of progressive dyspha- gia. A barium swallow revealed a tight stricture at the level of the aortic knuckle with eventual filling of the stomach. She was then referred to our hospital, which is a tertiary center, for further management.


Ectopic pancreas mimicking submucosal gastric tumor

A 35-year-old man presented with intermittent epigas- tric pain for about 3 months. On physical examination, the patient was in good health ; bowel sounds were normal and there was no tenderness in the epigastric region; the liver and the spleen were not palpable. Laboratory findings were normal. An upper gastroin- testinal endoscopy revealed a submucosal lesion over- lying the mucosa of the posterior wall of the fundus. The submucosal lesion measured about 2 cm in diameter. The histopathological examination of the biopsy sample revealed chronic gastritis and mucosal hyperplasia. Biopsies collected endoscopically do not often provide the representative histological sample needed for further therapeutic decisions.