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Volume 75 - 2012 - Fasc.2 - Case reports

Intestinal nodular lymphoid hyperplasia and extraintestinal lymphoma - A rare association

Nodular lymphoid hyperplasia of the gastrointestinal tract is characterized by the presence of innumerable small discrete nod- ules involving a variable segment of the gastrointestinal tract. The association between nodular lymphoid hyperplasia and other benign and malignant diseases has been clearly described, with an increased risk of gastrointestinal tumours, namely gastrointestinal lymphoma. However, the association with extraintestinal lym- phoma seems extremely rare. The authors present a clinical case of a patient with nodular lymphoid hyperplasia of the small and large intestine that subsequently developed an extraintestinal lymphoma (diffuse large B-cell lymphoma). (Acta gastroenterol. belg., 2012, 75, 260-262).


Focal parietal necrosis of the sigmoid due to atypical neuroleptics : a case report

We present the case of a 26-year-old man with schizoid person- ality disorder who suffered from a very focal and transparietal necrosis of the sigmoid after an overdose of atypical neuroleptics. This is a singular, rather unknown and potentially lethal side effect of these drugs. The physiopathology of this complication is multifactorial. (Acta gastroenterol. belg., 2012, 75, 263-265).


Dysphagia lusoria caused by a right-sided aorta

We report a case of an 80-year-old female with dysphagia lusoria caused by oesophageal compression by a right-sided atheromatous aorta. The relationship between aortic root vascular anomalies and dysphagia has been clearly established in literature and can be diagnosed by a barium swallowing study, followed by CT or MRI. Aortic anomalies and variations in aortic branches are caused by embryonic malformations and are mostly described in association with congenital heart lesions. In this pauci-symptomatic patient, the preferred treatment is a conservative management. (Acta gastroenterol. belg., 2012, 75, 266-269).


Lanreotide treatment of metastatic hepatocellular carcinoma resulting in partial regression and more than 3 years of progression-free survival

We describe the case of a 54 years old woman, with hepatitis B, in whom the diagnosis of a 6 cm hepatocellular carcinoma (HCC) in the left liver was made in 2001. Alpha-foeto-protein (AFP) was 63 ng/mL (Nl < 10 ng/mL). After work-up including liver and tumor biopsy confirming HCC and only fibrosis in the non- tumoral liver, left hepatectomy was performed. Final pathology showed a well differentiated HCC with tumoral portal vein throm- bosis. Unfortunately, lung and mediastinal adenopathies were detected by CT scan 17 months later. Mediastinal nodes were punc- tured by endosonographic ultrasound, confirming HCC. The patient started treatment with Lanreotide 30 mg twice a month (Somatuline PR®, Ipsen). Three months later, CT showed decrease in size of the mediastinal nodes and complete disappearance of the lung nodes. This objective response lasted for 42 months. The treat- ment was without any significant side effect. Retrospectively, immunohistochemistry was performed to detect somatostatine receptors (sstr) 2. Both the primary tumor and the node showed intense membranous and cytoplasmic staining for sstr2. In 2006, AFP rose and CT showed the appearance of a new mediastinal node. At that time, octreoscan® was performed and showed uptake in the new node, although insufficient for metabolic radiotherapy. This case suggests that, although a number of randomized con- trolled trials did not show a benefit of somatostatin analogues in the treatment of advanced HCC, a subset of patients could benefit from treatment provided their tumor expresses sstr2, on which the existing drugs are efficient. (Acta gastroenterol. belg., 2012, 75, 270- 273).