Volume 75 - 2012 - Fasc.4 - Case reports
A misleading hepatic tumour : epithelioid angiomyolipoma
Hepatic angiomyolipoma (HAML) is a rare, benign mesenchy- mal neoplasm composed of varying amounts of smooth muscle cells, adipose tissue, and vessels. Its morphological diversity often poses diagnostic problems. In this paper, the authors report a peculiar case of epithelioid HAML mimicking histologically hepato- cellular carcinoma with focal areas resembling inflammatory pseudotumour. A 57 year-old male patient presented with abdomi- nal pain and discomfort. Non enhanced CT scan demonstrated a heterogeneous hypodense mass located in segment II and IV of the liver. Hepatocellular carcinoma was suspected and the patient underwent left lobectomy. Histologically, the tumour was mainly composed of epithelioid cells arranged in trabeculae and sheets (50% of the tumour surface) admixed with mature fat cells (20%) and thick-walled blood vessels. Lymphocytic aggregates and clusters of foamy histiocytes were focally found in the stroma (30%). Most of the epithelioid tumour cells were immunoreactive to homatropine methylbromide 45 (HMB-45) and smooth muscle actin. Morphological pattern and immunophenotype were consistent with epithelioid HAML. (Acta gastroenterol. belg., 2012, 75, 443- 445).
Cannabis-induced recurrent acute pancreatitis
Acute pancreatitis has a large number of causes. Major causes are alcohol and gallstones. Toxic causes, mainly represented by medication-induced pancreatitis account for less than 2% of the cases. Cannabis is an anecdotally reported cause of acute pancre- atitis. Six cases have previously been reported. Herein we report a new case of cannabis-induced recurrent acute pancreatitis. (Acta gastroenterol. belg., 2012, 75, 446-447).
A rare case of fever of unknown origin : Inflammatory myofibroblastic tumor of the liver. Case report and review of the literature
We present the case of a rare cause of fever of unknown origin (FUO). FUO is challenging for patients as well as for physicians as there are more than 200 differential diagnoses of FUO(1,2). Pointing out a diagnosis often requires numerous noninvasive and invasive procedures that sometimes even fail to explain the fever. Our patient was admitted twice to our hospital due to remitting fever rising up to 40°C without any subjective discomfort. At the first presentation no clinical focus could be identified. This includ- ed the examination of multiple blood and urine cultures, serology, autoimmune serology, transesophageal echocardiography, CT-scan of the lung and the abdomen, and bone scintigraphy. Elevated C- reactive protein (268 mg/l) decreased spontaneously and fever dis- appeared after 4 weeks. However, the patient was re-admitted 4 months later with identical symptoms. Multiple blood and urine cultures, serology, bone marrow examination, CT-scan of the lung and the abdomen, esophago-gastro-duodenoscopy and colonoscopy still showed no pathological findings. MRI-scan of the abdomen identified a liver tumor of 3.3 cm in diameter in segment 6 without typical signs of an adenoma, focal nodular hyperplasia or hepato- cellular carcinoma. Biopsy of the suspect liver lesion revealed an inflammatory myofibroblastic tumor (inflammatory pseudotu- mor). After surgical resection of the tumor elevated inflammation markers as C-reactive protein normalized and fever disappeared. One year after surgery no more episodes of fever re-occurred.
An inflammatory myofibroblastic tumor of the liver can be a rare cause of fever of unknown origin. MRI-scan can be an additional imaging tool to identify previously not recognized liver tumors. (Acta gastroenterol. belg., 2012, 75, 448-453).
Primary Sclerosing Cholangitis, Crohn's disease and HLA-B27 in Black South African Women
Crohn's disease is rare in South African black people and primary sclerosing cholangitis (PSC) is also rare in black patients with IBD, from South Africa. The presence of HLA-B27 is generally associated with seronegative spondylo-arthropathies and correlates with the occurrence of ankylosing spondylitis, recurrent mouth ulcers and uveitis, in patients with IBD. We describe two women with the combination of Crohn's disease, PSC and HLA- B27 from our cohort of the last 5 years of three black patients with Crohn's disease. Crohn's disease, PSC and HLA-B27 respectively, occur rarely in black South Africans and their concurrent presence in two black women suggests a pathogenetic link of HLA-B27 between Crohn's disease and PSC in this population. Female gender might be an additional determinant in this setting. (Acta gastroenterol. belg., 2012, 75, 454-457).
