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Volume 80 - 2017 - Fasc.4 - Letters

Imaging and histopathologic findings of desmoplastic small round cell tumor

Abdominal desmoplastic small round cell tumor (DSRCT) is an extremely rare malignancy (1). It typically affects young men with an aggressive clinical course (2). A 23-year-old male presented with constipation and poorly localized dull abdominal pain lasting for one month. He also suffered from poor appetite and unintentional weight loss. Abdominal examination revealed a palpable lower abdominal mass.


Olmesartan-associated enteropathy. A rare but easily treatable entity

A 76-year old woman, with a history of atrial fibrillation, hypertension and hypothyroidism, was referred to our clinic due to a 6-month history of severe diarrhea (7-8 watery stools per day and weight loss of about 30kg). She also complained of intense pruritus in the past 3 months. She reported an unsuccessful trial of empirical treatment for scabies and inadequate response to oral antihistamines. At presentation, a widespread maculopapular rash with scabs was noted. Previous evaluation included a colonoscopy and esopha- gogastroduodenoscopy (without biopsies), an abdominal CT and MRI and an endoscopic ultrasound without significant findings.


Pulmonary actinomycosis coexisting with intestinal tuberculosis as a complication of adalimumab treatment for Crohn's disease

Tumor necrosis factor alpha (TNF-a) blocking agents are highly effective in inducing and mantaining remission in Crohn's disease (CD) (1). However, due to the profound supression of T-cell mediated immunity, opportunistic infections still remain a major concern in this group of patients (2). We would like to draw attention to the unique case of a young patient with a imunomodulator therapy-resistant Crohn's disease treated with adalimumab who developed pulmonary actinomycosis and intestinal tuberculosis despite adequate screening for latent tuberculosis.


Endoscopic resolution of acute cholecystitis secondary to biliary fully covered metal stent

A 67-year-old man, with history of alcoholic chronic pancreatitis (CP), presented in the emergency department with intense pain in the right hypochondrium, and fever. Six months before, he underwent an endoscopic retrograde cholangiopancreatography (ERCP) with placement of a single plastic stent (8.5 Fr), for treatment of a common bile duct (CBD) stricture secondary to the CP. Four days before presentation, another ERCP was performed and the plastic stent was removed, and replaced for a fully covered self-expandable metal stents (FC-SEMS) [Evolution® Biliary, nitinol made, 60x10 mm (Cook Medical, Bloomington, Indiana, USA)], due to persistence of the CBD stricture, and the inability to place multiple plastic stents.


Ileal metastasis of a Colorectal Carcinoma in an asymptomatic patient confirmed by Single-Balloon Enteroscopy

Malignant neoplasms of the small bowel are unusual and often constitute a diagnostic and therapeutic challenge. Metastatic small bowel lesions, which are extremely uncommon, usually arise from lung, breast or gastric cancer; metastases originating from a primary colon cancer are particularly rare (1). Involvement of the small bowel usually occurs due to local invasion or peritoneal dissemination, rarely emerging from a direct hematogenous route (1). Small intestine metastases are usually revealed through bowel obstruction or bleeding, being rarely asymptomatic; hence, diagnosis almost always occurs during surgical procedures in an emergency setting (2). In asymptomatic patients, whose lesions are identified preoperatively, the diagnosis can be particularly defiant.


Gastrointestinal tract and Russell bodies - a case report of Russell body carditis and review of the literature

We report a case of rare Russell body (RB) carditis and present an analysis of the available literature on this topic. Our patient was a 77-year-old man referred for gastroscopy because of non-cardiac chest pain and mild dysphagia. Endoscopy revealed several areas of different and mildly prominent mucosa in the gastroesofageal junction (Fig. 1). Biopsy samples obtained from the gastroesofageal junction showed nondysplastic intestinal metaplasia with mild chronic inflammatory infiltrate of edematous lamina propria and abundant plasma cells containing intracytoplasmic eosinophilic globules highlighted by a periodic acid-Schiff (PAS) ; findings were identified by pathologist as RBs (Fig. 2). Patient's symptoms were controlled by PPI and prokinetics. Follow-up endoscopy with biopsies of different parts of upper GI tract was performed - without RBs presence except of the previously identified RB carditis.