1/15. Duodenal carcinoid tumor: report of a case diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy with immunocytochemical correlation.Fine-needle aspiration biopsy is a reliable and accurate method for the endoscopic diagnosis of gastrointestinal malignancies and it is particularly well suited for evaluation of submucosal lesions. We report the cytopathologic findings of a case of malignant carcinoid tumor of a 44-year-old male who presented with melena and a nonhealing duodenal ulcer. Endoscopic ultrasound examination revealed a submucosal lesion in the pyloric region. Fine-needle aspiration revealed abundant cellularity with tumor cells arranged in sheets and loose groups and dispersed single cells in a clean background. Papillary fragments, capillaries cuffed by tumor cells, and rosette formation were also noted. The cells were moderate in size, round to oval, with a small subpopulation of spindle-shaped cells. The nuclei were uniform, round to oval, with smooth nuclear borders. The chromatin pattern was finely granular with a salt-and-pepper appearance. The cytoplasm of the cells was small to moderate in amount, pale, and showed fine granularity. The differential diagnosis included a neuroendocrine neoplasm vs. an epithelioid gastrointestinal stromal tumor. The tumor cells were focally positive for chromogranin and negative for CD34, supporting the diagnosis of a neuroendocrine neoplasm. The differential diagnosis of primary gastrointestinal carcinoid tumors from gastrointestinal stromal tumors can be very difficult in cytologic material. In cases when diagnostic material is scant, or only present on one smear, the use of smear division and cell transfer in order to perform immunocytochemical stains may be of considerable value to confirm the neuroendocrine nature of the neoplasms.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/15. Reactive nodular fibrous pseudotumor of the gastrointestinal tract and mesentery: a clinicopathologic study of five cases.Although the majority of mesenchymal lesions of the gastrointestinal tract are neoplastic in nature, nonneoplastic reactive processes may involve the gastrointestinal tract and mesentery, causing diagnostic confusion with more aggressive neoplasms, such as fibromatosis or gastrointestinal stromal tumors. In this study, we report a series of fibroinflammatory lesions of the gastrointestinal tract that we think represent a relatively cohesive group of tumors and describe the clinical and pathologic features of this entity, which we have termed "reactive nodular fibrous pseudotumor." The tumors affected five patients (four male and one female patient) who ranged in age from 48 to 71 years (mean 56 years). Two patients presented with acute abdominal pain without a significant past medical history, two had incidental lesions discovered during evaluation for other medical conditions, and one was found to have an abdominal mass. Three patients had a history of abdominal surgery. The tumors were multiple in three patients and solitary in two patients. In four cases, at least one of the tumors involved the small intestine or colon, and the lesion was confined to the peripancreatic soft tissue in one case. The tumors were firm, tan-white, ranged in size from 4.3 to 6.5 cm in greatest dimension, and were grossly well circumscribed. All of the lesions were of low to moderate cellularity and composed of stellate or spindled fibroblasts arranged haphazardly or in intersecting fascicles. Three cases had microscopically infiltrative borders. The stroma was rich in collagen, which was wire-like, keloidal, or hyalinized. Intralesional mononuclear cells were sparse but were more numerous peripherally and frequently arranged in lymphoid aggregates. Immunohistochemical stains demonstrated that all of the tumors stained for vimentin, 80% stained for CD117 or muscle specific actin, 60% stained for smooth muscle actin or desmin, and none of the tumors stained for CD34, S-100 protein, or anaplastic lymphoma kinase-1. Follow-up information was available in all cases: four patients had no residual disease following surgical resection (mean follow-up 16.3 months) and one patient who had an incomplete surgical resection had stable disease at 26 months. In summary, we report a series of distinct intraabdominal fibroinflammatory pseudotumors that we have collectively termed "reactive nodular fibrous pseudotumors." These lesions are uncommon and may infiltrate the bowel wall, thereby mimicking primary bowel neoplasms or intraabdominal fibromatosis. Recognition of these nonneoplastic lesions is important, as they pursue a benign clinical course, but may be confused with other mesenchymal neoplasms that require more aggressive treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/15. Peripheral T-cell lymphoma of AILD (angioimmunoblastic lymphadenopathy with dysproteinemia) type involving gastrointestinal tract. A morphologic, phenotypic and genotypic study.A case of angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) which showed widespread involvement of the gastrointestinal tract is reported. A lymph node biopsy specimen showed the characteristic histological features of AILD. During the progression of the illness, lymphomatous lesions developed in the gastrointestinal tract, complicated by cytomegalovirus infection. A double immunoenzymatic study using a combination of Ki-67 antibody and antibodies against surface antigens demonstrated that CD3 , CD4 , and/or T-cell receptor (TCR) beta cells were predominant (67-68%) among the population of proliferating Ki-67% cells, rather than CD8 or CD22 cells. Clonal rearrangement of the TCR beta chain gene was also detected. These findings provide further evidence for the neoplastic nature of lesions of this type, and the diagnosis of peripheral T-cell lymphoma.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/15. Multiple granular cell tumors of the gastrointestinal tract with subsequent development of esophageal squamous carcinoma.A 52-year-old woman initially presented to our medical center with synchronous, submucosal tumors of the esophagus, stomach, and transverse colon. The gastric and colonic tumors were resected, and both displayed infiltrating sheets of polygonal cells with coarsely granular cytoplasm and small vesicular nuclei. The neoplastic cells of both tumors were immunoreactive for S-100 protein. Ultrastructural studies revealed the lysosomal nature of the cytoplasmic granules. Although the esophageal mass was not resected, it was felt that this represented another focus of granular cell tumor of the gastrointestinal tract. Two years later, she presented with disseminated squamous carcinoma of the esophagus. At autopsy, a submucosal granular cell tumor was found adjacent to the squamous carcinoma of the esophagus. To our knowledge, this is the first reported case of synchronous granular cell tumors that involved multiple segments of the gastrointestinal tract, one of which was later associated with a squamous carcinoma of the esophagus.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/15. diagnostic imaging of the small bowel in a case of occult gastrointestinal bleeding.A case of a male patient with occult gastrointestinal bleeding and negative gastroscopy and colonoscopy is presented and discussed. Oral small bowel barium follow-through was performed upon the patient request. It documented a jejunal neoformation. The analysis of radiologic findings directed towards a probably extramucosal origin. Subsequent CT evaluation confirmed a neoformation inseparable from a jejunal loop with inhomogeneous contrast enhancement, therefore of suspected malignant nature. The histological examination on the surgical specimen documented the presence of a stromal tumor of indeterminate malignancy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/15. Multifocal lymphangioendotheliomatosis with thrombocytopenia: a rare cause of gastrointestinal bleeding in the newborn period.Severe gastrointestinal bleeding in the newborn period is a serious but uncommon phenomenon that has a broad differential diagnosis. In the following case report we describe a rare phenomenon in which a newborn presents with severe hematemesis, hematochezia, and thrombocytopenia that are resistant to repeated platelet and packed red blood cell transfusions. Previous cases have been reported, but none of the patients described presented within the first 8 days of life. The early age of presentation and refractory nature of this disease entity to multiple therapies make it a diagnostic and therapeutic dilemma for all physicians involved in the care of newborns.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/15. Reactive lymphoid hyperplasia of the liver in a patient with multiple carcinomas: a case report and brief review.A rare case of reactive lymphoid hyperplasia (RLH) of the liver in a 75-year-old woman admitted to hospital for surgical treatment of gastric, caecal and colon carcinomas is described here. Two nodular lesions in the left and right lobes of the liver were clinically diagnosed as metastatic tumours by computed tomography of the abdomen. A demarcating grey-white mass of size 1.4 cm was observed in a partially resected liver specimen. On examining the lesion microscopically, it was found to be composed of hyperplastic lymphoid follicles, lymphocytes, plasma cells, other inflammatory cells and interlaced hyalinised fibrous tissues. In the portal tracts around the lesion, chronic inflammatory cell infiltrates were seen, but no interface hepatitis or lymphoid follicle was observed. No evidence of monoclonality was observed by immunohistochemistry for B and T cell markers, in situ hybridisation for kappa and lambda light chains, and polymerase chain reaction analysis of immunoglobulin heavy chains or T cell receptor beta and gamma gene rearrangements. Bcl-2 immunoreactivity was not observed in the germinal centre. Epstein-Barr virus (EBV) antigen (latent membrane protein-1) and EBV-encoded small RNAs were not detected. A proliferation neither of myofibroblasts nor of cells positive for follicular dendritic cell markers was observed. RLH, formerly known as pseudolymphoma, has been reported of the liver in only 14 cases and is considered to be a differential diagnosis of small nodular lesions of the liver. That RLH has an inflammatory reactive nature, not a neoplastic disposition, and that EBV does not participate in the pathogenesis of RLH is supported by this case.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/15. Biclonal gammopathy--report of a case with primary gastrointestinal lymphoma.A 61-year-old female patient had had abdominal pain for two months; primary gastrointestinal lymphoma of diffuse, large cell type histology was diagnosed. bone marrow study was negative. Bimodal gamma globulin was found on serum protein electrophoresis. immunoelectrophoresis and immunofixation confirmed the nature of biclonal gammopathy with a fast-migrating IgM-kappa band and a slow-migrating IgG-kappa band. Biclonal gammopathy is unusual, and only rarely have cases been reported. The immunologic and molecular implications of biclonal gammopathy are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/15. The role of immunohistochemistry, electron microscopy, and ultrastructural cytochemistry in the diagnosis of mixed carcinoma-neuroendocrine neoplasms.We studied four mixed carcinoma-neuroendocrine neoplasms from gastrointestinal tract and pancreas by routine light microscopy (LM), immunohistochemistry (IH), electron microscopy (EM), and ultrastructural cytochemistry (UC). By LM, the individual tumors showed fairly pure neuroendocrine (carcinoid) or epithelial (papillary) patterns, mixed neuroendocrine-carcinoma features and poorly-differentiated tumor in sheets and nests which did not lend itself to morphologic characterization. IH demonstrated mixed expression, within different areas of the same neoplasm, of epithelial antigens (keratins and carcinoembryonic antigen [CEA]) and neuroendocrine markers (neuron-specific enolase [NSE], bombesin and neurohormonal peptides). By EM, each tumor showed ultrastructural features of epithelial and neuroendocrine differentiation which varied substantially in terms of number of cells involved and their distribution; two of the neoplasms showed biphasic differentiation within single cells. The nature of the neurosecretory granules was verified with the uranaffin reaction (UR). This study illustrates the value of combining LM, IH, EM and UC for the identification of mixed carcinoma-neuroendocrine lesions.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/15. 99mTc-DTPA uptake in malignant and inflammatory bowel disease: experience from gastrointestinal bleeding studies.During the evaluation of 99Tcm-DTPA for localization of acute gastrointestinal bleeding in 81 studies (78 patients), it was observed that there was an increased 99Tcm-DTPA at sites of inflammatory and malignant lesions of the GI tract in 18 studies. Active bleeding was detected only in 10 and no bleeding was detected in the remaining eight studies. In all the increased DTPA uptake helped to localize the site of bleeding. Image subtraction of early from delayed images according to a predefined acquisition and processing protocol helped to differentiate bleeding from non bleeding lesions. We conclude that increased 99Tcm-DTPA uptake in malignant and inflammatory lesions of the bowel is an additional advantage for its use in localizing the site of acute GI bleeding. technetium-99m diethylenetriamine pentaacetic acid (99Tcm-DTPA) has been widely used for imaging the brain and kidneys since it was introduced by Hauser in 1970. Kadir and Strauss in 1979 reported that 99Tcm-DTPA localizes in segments of bowel with inflammation due to ulcerative colitis, regional enteritis and other forms of enterocolitis. Recently we reported the advantages of 99Tcm-DTPA in localizing the site of acute gastrointestinal bleeding. inflammatory bowel diseases are among the causes of gastrointestinal bleeding. One of the problems in localizing the site of the bleeding by radionuclide procedures is the intermittent nature of the bleeding. We have reviewed all gastrointestinal bleeding studies in our department using 99Tcm-DTPA from January 1984 till September 1985 in order to find out whether increased uptake of 99Tcm-DTPA was helpful in localizing the bleeding lesion due to malignancy and/or inflammation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
| | Next -> |