ABSTRACT
Neuroendocrine tumors (NETs) have varied pathophysiological characteristics, location, clinical presentation, management & outcome. Unfortunately, most NETs are non-functional and therefore, either remain asymptomatic until incidentally detected or present very late with pressure symptoms, adding up to the associated morbidity and mortality. Here we presented a case of a 43-year gentleman, who presented to gastroenterology OPD with chief complaints of heartburn and pain in the upper abdomen for one year. He had an equivocal clinical examination and laboratory parameters. Upper GI endoscopy and computed tomography revealed multiple nodular growths in the D1 segment and pylorus of the stomach. He was successfully managed by wide local excision of D1 and distal stomach (pylorus) followed by Polya gastrojejunostomy reconstruction. Histopathology confirmed well-differentiated NETs, low Ki67, and positive for chromogranin and synaptophysin. This case draws attention to the early age of presentation of multifocal NETs with vague symptoms and equivocal clinical examination. Coexisting gastric NETs with duodenal NETs in itself is very rare, never the less non-functional status and pre-operative diagnostic dilemma. Here, we have also drawn attention to the pros and cons of various diagnostic tools and how their utility can sometimes limit the approach of clinicians, apart from a high index of suspicion.
ABSTRACT
While cervical swellings usually are located in anterior midline like thyroglossal cyst, thyroid swellings, or in antero-lateral aspect of neck like cold abscess, branchial cyst, lymphangioma, cervical lymphadenopathy etc. Nape of the neck swelling is even less common with differentials including lipoma, sebaceous cyst, lymphangioma, etc. Hydatid cyst (HC) is often missed as a differential resulting in intraoperative surprises. This case report might change the mind of the readers to keep HC in back of their minds while approaching a case of swelling of the neck. Here we report a case of 15 years’ female who presented with swelling of nape of neck which on evaluation was inclining towards lipoma/epidermal cyst. With an intention for surgical exploration and excision, the patient was taken for operation, where we discovered it to be HC and the same was later confirmed by histopathology as well. Because of its rare presentation the primary diagnosis of HC is often missed out in spite of having sensitive cytology and imaging modalities. Hence, by reporting this case we intend to emphasize six facts a clinician, a radiologist and also a pathologist must consider while keeping primary HC at an unusual site as a differential diagnosis.
ABSTRACT
OBJECTIVE: A clinicopathological study of patients presenting with necrotizing enteritis, similar to the Pig-Bel disease of Papua New Guinea. METHODS: A clinicopathological study of 95 patients presenting in last ten years with acute abdominal pain with diarrhea and/or bleeding per rectum and vomiting and found to have lesions similar to Pig-Bel disease. RESULTS: 89% of the patients were young adult vegetarians from lower socio-economic strata. 94% of cases presented between May and August every year showing a marked seasonal variation. Jejunum was the most common site (95%) involved. Gross examination showed blackish brown 'skip' lesions with gangrene and perforations. Histology showed marked necrosis and congestion of all the layers with mucosal ulcerations. CONCLUSION: A disease simulating Pig-Bel disease occurs in India. It is more common in young adult vegetarians and may have a different etiology from that proposed in endemic regions.