Volume 84 - 2021 - Fasc.4 - Case reports
Rectal plasmablastic lymphoma in Ebstein Barr virus positive and human immunodeficiency virus negative subject after external radiation therapy for prostatic cancer
Plasmablastic lymphoma (PBL) represents a rare and
aggressive subtype of diffuse large B cells lymphoma (DLBCL)
most associated with the human immunodeficiency virus (HIV).
Prognosis remains poor despite various treatment approaches.
We describe an evolution at six months of HIV negative PBL and
Ebstein Barr virus (EBV) positive PBL with chemotherapy. Role
of radiotherapy is still unclear.
An unusual recurrent ileocolonic injury
Potassium binders (Kayexalate® and Sorbisterit®) are commonly used to treat hyperkaliemia. They are made of sodium or calcium polystyrene sulfonate. Their use is associated with multiple adverse effects including ileocolonic (or more rarely upper digestive tract) injuries which can lead to necrosis or perforations. This side effect is mostly seen in patients with chronic kidney disease or constipation. It presents with abdominal pain, diarrhea or hematochezia. The diagnosis is made when the histo-logical analysis of samples from the erythematous or ulcerated digestive wall finds polystyrene sulfonate crystals embedded in the mucosa. This diagnosis can be suspected by taking a careful initial drug inventory, if the clinician is aware of this rare but serious adverse effect. The lack of specificity of clinical symptoms and endoscopic lesions makes this inventory even more essential. Treatment is mainly supportive and requires cessation of the drug, while surgery is inevitable in the most severe cases.
Role of enteroscopy in the diagnosis of whipple’s disease
Whipple’s disease is a rare chronic systemic infection caused
by Tropheryma whipplei. The widespread infection by this rod
is responsible for the protean clinical manifestations of the
disease, although its classical form is notable for the prevalence
of abdominal symptoms such as chronic diarrhea and abdominal
pain. Whitish-yellow patches, suggestive of lymphangiectasia, are
typically observed in the duodenum during upper endoscopy. The
diagnosis of this condition is supported by the identification in
duodenal biopsies of Periodic acid-Schiff staining within lamina
propria macrophages. Nevertheless, a significant portion of
patients do not have lesions within the range of conventional upper
endoscopy. Therefore, other endoscopic procedures such as video
capsule endoscopy and enteroscopy may be useful to detect more
distal lesions. The authors describe a case where the combined used
of both techniques allowed the unmasking of this disease.
Sarcoidosis-like disease with pulmonary infestation, meningoencephalitis and transverse myelitis after sigmoid cancer treatment
We present the case of a 40-year-old male with recent history of moderately differentiated invasive adenocarcinoma of the sigmoid in whom both respiratory and neurological disease developed simultaneously, mimicking diffuse metastatic disease. The broad differential diagnosis and pitfalls (both diagnostic and therapeutic) are described. Pulmonary sarcoidosis as well as neurosarcoidosis occur very rarely after solid cancers.
An unusual case of a gallbladder polyp
A 63-year old female patient with a medical history of hypereosinophilic syndrome with neurological and pulmonary involvement presented for a routine follow-up. The patient was asymptomatic but a routine scheduled ultrasound showed a gallbladder polyp of 19mm. One month later this polyp had grown to 36 mm. On magnetic resonance imaging of the liver there was a suspicion of gallbladder cancer and for this reason cholecystectomy was performed. Pathology however showed eosinophilic infiltration. Serum analysis showed an increase in her eosinophil count. The diagnosis of hypereosinophilic syndrome with eosinophilic infiltration of the gallbladder was made. The dose of corticosteroids was augmented and she recovered completely post-operatively with no residual flares of other organ damage during follow up.
