Volume 85 - 2022 - Fasc.1 - Clinical images
Another gastrointestinal lesion amendable for ablation
A 79-year-old patient, with a history of redoendoscopic
ampullectomy (low grade dysplasia), was
referred to our hospital with cholestatic liver function
abnormalities and dilation of the common bile duct.
Diagnostic endoscopic ultrasound (EUS) was performed
(Figure 1, left), as well as upper gastrointestinal
endoscopy (Figure 1, right).
What is the final diagnosis and which treatment would
you propose?
An unexpected cause of proximal small intestinal obstruction
A 63-year-old caucasian male with history of tonsil cancer, under induction chemotherapy, reported food intolerance and vomiting with duration of one month. Symptoms had increased over the last days and were associated with a weight loss of 10 Kg during the past three months. The patient lived all of is life in an urban environment. General physical examination revealed cachexia and dehydration. Gastrointestinal symptoms persisted despite intravenous pantoprazole, prokinetic drugs and nasogastric tube insertion. On investigation, patient presented normocytic and normochromic anemia (9.2 g/dL), lymphocytosis (11.78 x109/L) with neutrophilia (70.7%) and eosinophilia (7.7%), hypoalbuminemia (2.8 g/dL) and elevated C-reactive protein (25.5 mg/dL).
Upper endoscopy revealed deformation of bulb and second part of the duodenum with mucosal edema, superficial ulceration and friability (Figure 1a). Biopsies were taken from the bulb and second portion of the duodenum. Computer tomography demonstrated gastric distention, duodenal wall thickening and lumen narrowing in the second and third portion of the duodenum (Figure 2). These findings were indicative of a functionally relevant duodenum stenosis. Histopathologic evaluation of biopsy specimens from the duodenum revealed moderate accumulation of eosinophilic granulocytes and
An unusual cause of massive rectal bleeding
A 76-year old female was referred to the gastro-enterology department because of massive rectal bleeding with hemoglobin decrease to 9 g/dL. She was in follow-up at the oncology department for a multiple myeloma and treated with Lenalidomide-Dexamethason since 2018. She had a past medical history of rectal bleedings due to angiodysplastic lesions of the right colon, treated with argon plasma coagulation (APC). The last left colonoscopy in 2019, performed for chronic diarrhea, was macroscopically normal and histopathologic examination ruled out a microscopic colitis.
During colonoscopy significant edema of the caecal-colon ascendens and recto-sigmoidal mucosa was seen, with important submucosal hematomas and some bleeding mucosal tears. The remaining colon mucosa was slightly reddish.
Polypoid colon mucosa in a leukemia patient
A woman, followed for chronic myeloid leukaemia, presented for a routine examination. Her medical history was marked by recurrent Helicobacter pylori gastritis and polymyalgica rheumatica. She was under dasatinib and hormone replacement therapy. At clinical examination, she complained about digestive disorders with altered bowel habits. Biology, including leucocyte count, remained normal. A colonoscopy was performed. Endoscopic examination revealed a colonic mucosa covered by multiple tiny nodular lesions (<5mm) from the hepatic angle to the sigmoid and with an abnormal pattern of vascularisation (Fig. 1). Staged biopsies were taken.
Microscopic examination revealed discrete achi-tectural distortions. The stroma contained a mixed inflammatory infiltrate composed of neutrophils, eosinophils and lymphocytes. Immunohistochemistry for CD3, CD5, CD20 and CD79 did not bring arguments for a lymphoma. There were no malignant or dysplastic cells.
