1/4. Enterotherapy associated T-cell lymphoma: a case report and literature review.T-cell lymphoma of the intestine is a form of extranodal, non-Hodgkins lymphoma. Enteropathy associated T-cell lymphoma (EATCL) is a unique form of T-cell lymphoma involving the gastrointestinal tract. This disorder is rare and there is no consensus on guidelines for diagnosis or treatment. CASE: This 47 year old patient presented to the hospital with increasing abdominal girth and swelling of the lower extremities over the four days prior to admission. He complained of dyspnea on exertion, anorexia, nausea and vomiting, 40 pound weight loss over half a year, accompanied by intermittent diarrhea. On physical examination, the patient was found to have anasarca, an abdominal fluid wave with shifting dullness, mild abdominal tenderness, marked pitting edema of the extremities, and necrotic toes. A small bowel follow through revealed an abnormality in the mid-jejunum and a colonoscopy revealed two erythematous lesions near the cecum. Subsequent esophagoduodenoscopy and enteroscopy identified multiple white patchy lesions in the proximal jejunum. Biopsies were consistent with a T-cell lymphoma. The patient underwent a partial small bowel resection. Biopsies of the jejunum had ulceration and necrosis with a lymphomatous infiltrate. The lymphocytes were found to be a monoclonal CD2 positive T-cell population. A bone marrow biopsy was unremarkable. Enteropathy associated T-cell lymphoma is a rare, and this may be the first reported case of EATCL presenting as anasarca. DISCUSSION: The etiology and pathophysiology of intestinal lymphomas, particularly enteropathy associated T-cell lymphoma, is reviewed. CONCLUSION: EATCL is a rare and unique form of lymphoma without an exact treatment regimen which carries a high mortality rate.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/4. Intestinal metastasis causing intussusception in a patient treated for osteosarcoma with history of multiple metastases: a case report.Intestinal intussusception caused by metastatic tumors is a very rare condition. Preoperative diagnosis is not easy because of the condition's rarity and because of mild abdominal physical presentation. We report on a patient with osteosarcoma who suffered from abdominal pain and emesis during the period of autologous peripheral blood stem cell transplantation. He had undergone tumor excision and radiotherapy several times prior to autologous peripheral blood stem cell transplantation because of multiple metastases. Intestinal metastasis was suspected initially by computed tomographic scan and sonogram and was proved by surgical resection and pathological findings. Clinicians caring for pediatric patients with osteosarcoma with a history of multiple metastases should consider the possibility of intestinal metastases when equivocal abdominal symptoms develop after intensive chemotherapy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/4. Medullary carcinoma of the thyroid in the multiple mucosal neuromas syndrome.The clinical features of the multiple mucosal neuromas (MMN) syndrome permit the recognition of these patients and their potential development of the associated medullary thyroid carcinoma (MTC). The distinctive physical appearance caused by the mucosal neuromas, the Marfanoid habitus and, occasionally, the positive family history aid in establishing the diagnosis. Neurogangliomas are frequently present in the gastrointestinal tract of these patients who may have megacolon, constipation and diarrhea. The third instance of the MMN syndrome is reported in the newborn as intestinal obstruction. It is suggested that the syndrome be considered in the differential diagnosis of Hirschsprung's disease and bowel obstruction in the neonate. serum calcitonin measurements following stimulation by calcium or pentagastrin infusion reliably detect incipient MTC and may be used to select those MMN patients requiring thyroid surgery. Recognition of patients with the MMN syndrome and subsequent calcitonin screening and early surgical intervention will significantly reduce the chance of their developing terminal MTC. All MMN patients with mucosal neuromas or intestinal neurogangliomas should have such evaluations at least yearly. Relatives who are at risk for inheriting this dominant disease should be similarly evaluated, regardless of their normal appearance.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/4. Enteric intussusception due to metastatic intestinal tumors.Enteroenteric intussusception caused by metastatic tumors is a very rare condition. Because of its rarity and rather mild abdominal physical presentation, preoperative diagnosis is not easily made. Two cases of enteric intussusception due to metastatic intestinal tumors, with the main symptom of melena, are reported. intussusception was caused by metastatic liposarcoma in one patient and metastatic melanoma in the other. Both patients had long histories of malignant disease, for 15 and 8 years, respectively. They had undergone repeated surgical treatment for metastatic lesions. The diagnosis of enteric intussusception was initially made by computed tomographic scans and small bowel series and was confirmed by laparotomy and pathologic findings. We suggest that tumor metastasis to the small intestine with intussusception should be considered in patients with recurrent tumors and tarry stools.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |