Volume 84 - 2021 - Fasc.3 - Case reports
Misleading clinical presentation of carcinoid syndrome
Rare cases of carcinoid syndromes can develop from either
gastrointestinal neuroendocrine tumors (NETs) without liver
metastasis or large retroperitoneal involvement. We report
a case of a patient with isolated flushing highly suggestive of
carcinoid syndrome caused by an ileal NET with adjacent lymph
node metastases but with no liver metastases. The final diagnose
was delayed for this patient due to a combination of misleading
clinical presentation and negative usual screening tests (urinary
5-HIAA and serum chromogranine A). Given its high sensitivity
and specificity, ⁶⁸Ga-DOTATATE PET confirmed the diagnosis of
neuroendocrine tumor. Therefore, this case reminds clinicians that
carcinoid syndrome may manifest as flushing only and highlights
that imaging is a major aspect of the evaluation and diagnosis of
patients with suspected gastrointestinal NETs.
Regression of multiple hepatocellular adenomas after cessation of oral contraceptive pills: a case report and review of the current literature
Hepatocellular adenoma (HCA) is an uncommon benign liver
neoplasm usually solitary and identified incidentally on imaging.
We report a case of a 50-year old female who was diagnosed with
multiple hepatic adenomas of the inflammatory subtype. After
discontinuation of oral contraception a decrease of both the
number and size of the liver lesions was seen on magnetic resonance
imaging (MRI) without the need of further intervention. The major
challenge in the clinical management of patients with multiple
HCAs resides in the risk assessment for future complications. In the
case of multiple HCAs subtype seemed to be more relevant than the
actual number of lesions. Because little is known about the natural
evolution in patients with multiple HCAs, we performed a review
of the current literature with focus on the different subtypes and
their clinical relevance.
Unusual intra-rectal “laterally spreading tumour” in immunosuppressed patient with ulcerative colitis
Condyloma acuminatum (CA) is a manifestation of Human
Papillomavirus (HPV) infection which usually occurs in genital and
perianal regions. We report a 46-year-old man with an ulcerative
proctitis diagnosed four years earlier, asymptomatic for a long time
under azathioprine but without any follow-up for three years. A
colonoscopy was performed prior to potential immunosuppressive
treatment discontinuation and showed a circumferential “laterally
spreading tumour” in the rectum. Surprisingly biopsies revealed
a CA with a very focally high-grade intra-epithelial lesion.
Azathioprine was stopped and a transanal surgical resection was
performed. At guided anamnesis, patient confirmed to be a former
active “men who have sex with men”. No recurrence of proctitis
occurred despite azathioprine discontinuation. A retrospective
review of the histological sections suggests that it was, in fact,
an intestinal spirochetosis misdiagnosed as inflammatory bowel
disease. Involvement of the rectal mucosa by HPV is a rare
condition and this may have been promoted by inappropriate
immunosuppressive treatment.
Erythema multiforme in the esophagus
Erythema multiforme is an immune-mediated
mucocutaneous disorder. Mucosal involvement
usually affects the oral region, the genitals or the eyes.
We report a case of esophagitis caused by erythema
multiforme in a patient diagnosed with lung cancer.
Esophageal manifestation in erythema multiforme
is rarely seen. Besides esophagitis it can lead to
esophageal strictures. Erythema multiforme is mostly
triggered by infection or drugs but the association
with malignancy has been described.
