rare presentation of primary heptic lymphoma: a case report

Primary hepatic lymphoma [PHL] was a rare malignancy usually presenting with abdominal pain, malaise, Hepatomegaly, B-symptoms, fatigue, nausea, vomiting and jaundice. It mostly involves liver without any palpable lymphadenopathy and leukemia in peripheral blood smear. On July 22, 2014, a 64 year old man presented with abdominal pain localizing in Right upper quadrant and fullness from 2 years ago without any weight loss or constitutional symptoms. His physical examination revealed no mass or lymphadenopathy and lab data showed rise in Alkaline phosphatase [ALP] and Gamma-glutamyl transferase [gamma-GT]. Abdominal computed tomography [CT] scan with contrast showed a calcified lesion in the left lobe of liver and ill-defined hypodense area in medial segment of the left lobe of liver adjacent to gallbladder associated with mild central intra hepatic bile ducts dilation showing more enhancement in delay phase suggested peripheral cholangiocarcinoma. Finally surgical core needle biopsy of the liver confirmed malignant lymphoma of B cell type and patient was referred to oncologist for chemotherapy. His chemotherapy regimen consisted of rituximab 600 milligram [mg], endoxan 1250 mg, adriamycin 80 mg, vincristine 2 mg, prednisolone 100 mg [durgin five days] for 6 courses. After 5 months chemotherapy, on December 22, 2014 a follow up CT scan with IV and oral contrast was done. There was no evidence of previous mass lesion in the liver. In the follow up on May 9, 2015, he had no specific symptoms and all of his lab data were in normal range

case of concurrent multiple sclerosis and celiac disease

Multiple sclerosis [MS] is an autoimmune inflammatory process that affects the central nervous system [CNS]. Celiac disease [CD] is a systemic autoimmune disorder of gluten intolerance. Based on the presumed association of MS with multiple autoimmune processes, the coincidence of MS with gluten sensitivity has been investigated with controversial results. Here, we report a known case of MS with mild gastrointestinal symptoms and spontaneous abortions. Thorough paraclinical evaluations revealed iron deficiency anemia and high titers of tissue transglutaminase antibody [tTG]. A small bowel biopsy demonstrated changes compatible with CD, MARSH type 3c. Based on the serologic results and biopsy findings, a diagnosis of CD was established and the patient was instructed to consume a gluten-free diet. Gastrointestinal symptoms abated and her serum levels of tTG normalized, along with improvement in the patient's iron profile during follow ups. The combined presence of MS and CD is a rare situation for which previous studies have failed to clarify the existence of any correlation between MS and CD. Thus, further investigation of CD in MS patients with gastroenterological complaints is recommended.

Inflammatory myofibroblastic tumor of the small bowel: a case report

Inflammatory Myofibroblastic Tumor [IMT] is a rare neoplastic lesion with tendency toward local aggressive behavior and recurrence. The tumor most commonly occurs in the pulmonary system of children and young adult, although it may rarely develop in older patients and other organs. Symptoms are non-specific and depend on the location of the tumor. The gastrointestinal tract is rarely the primary site of origin for this lesion. We report an unusual presentation of this rare lesion in a 58 year old woman with intussusception and partial intestinal obstruction