Myxoma immediately above the junction of the inferior vena cava and the right atrium: a rare cause of budd-chiari syndrome

The Budd-Chiari syndrome [BCS] is a rare disorder caused by the obstruction of the hepatic veins or the inferior vena cava [IVC] at the suprahepatic level. This syndrome is developed by either hepatic vein thrombosis or mechanical venous obstruction and leads to centrilobular hepatic congestion with the subsequent development of fibrosis and cirrhosis. Intracardiac tumors have been rarely reported as a cause of the BCS. These tumors usually originate from the atrial septum. Very rarely, they arise either from the junction of the IVC and the right atrium or from the Eustachian valve. There are a few case reports in the literature where atrial tumors have caused the BCS. In these cases, the tumors were malignant, and the patients died shortly after being diagnosed. We describe a 71-year-old female patient who presented with a 3-month history of abdominal pain and protrusion. On physical examination, blood pressure and pulse rate were normal. Jugular venous pressure was about 10 cm. Cardiac examination revealed a systolic murmur, grade IV/VI, in the left sternal border without radiation. Echocardiography showed a large mass [about 6×4 cm] in the right atrium with close contact to the origin of the IVC, obstructing it. Cardiac magnetic resonance imaging, with and without gadolinium, also confirmed the diagnosis. The patient underwent surgery, and the myxoma was removed. The tumor was a large solid mass, 5×4 cm in size, which originated immediately above the entrance of the IVC. The patient is in good condition 1 year afterward. We emphasize that atrial myxomas should be considered in the differential diagnosis of tumors that cause chronic BCS

Healing effect of pistacia atlantica fruit oil extract in acetic acid-induced colitis in rats

Considering the anti-oxidant properties of Pistacia atlantica and lack of data regarding its efficacy in the treatment of ulcerative colitis, this study aims at investigating the effect of the Pistacia atlantica fruit extract in treating experimentally induced colitis in a rat model. Seventy male Sprague-Dawley rats [weighing 220 +/- 20 g] were used. All rats fasted 24 hours before the experimental procedure. The rats were randomly divided into 7 groups, each containing 10 induced colitis with 2ml acetic acid [3%]. Group 1 [Asacol], group 2 [base gel] and group 7 [without treatment] were assigned as control groups. Group 3 [300 mg/ml] and group 4 [600 mg/ml] received Pistacia atlantica fruit orally. Group 5 [10% gel] and group 6 [20% gel] received Pistacia atlantica in the form of gel as enema. Macroscopic, histopathological examination and MDA measurement were carried out. All groups revealed significant macroscopic healing in comparison with group 7 [P<0.001]. Regarding microscopic findings in the treatment groups compared with group 7, the latter group differed significantly with groups 1,2, 4 and 6 [P<0.001]. There was a significant statistical difference in MDA scores of the seven treatment groups [F[5,54]=76.61, P<0.001]. Post-hoc comparisons indicated that the mean +/- SD score of Asacol treated group [1.57 +/- 0.045] was not significantly different from groups 4 [1.62 +/- 0.024] and 6 fl.58 +/- 0.028]. Our study showed that a high dose of Pistacia atlantica fruit oil extract, administered orally and rectally can improve colitis physiologically and pathologically in a rat model, and may be efficient for ulcerative colitis

Gastrointestinal tuberculosis in a renal transplant recipient presenting with intestinal perforation

Tuberculosis is more prevalent among renal transplant recipient than general population. Immunosuppressive drugs and corticosteroids are the most important causes of the disease. Although extra pulmonary tuberculosis constitute about 40% of the cases pulmonary tuberculosis is the most common clinical presentation. Isolated gastrointestinal tuberculosis is rare in these patients. This study presents a case of intestinal tuberculosis in a renal transplant recipient who died of intestinal perforation. Another interesting point of the case is development of tuberculosis after 18 years of transplantation. Previous studies showed the median interval of 18 months. The patient had received long-term immunosuppressive drugs as well as corticosteroid.

Primary pure squamous cell carcinoma of gallbladder presenting as acute cholecystitis

Squamous cell carcinoma of the gallbladder is rare and constitutes only 0.5-3% of all malignancies of this organ. Most of the reported cases have had a component of adenocarcinoma. We report a 70-year-old man who presented with acute onset right upper quadrant pain. He operated on based on a presumptive diagnosis of acute cholecystitis according to clinical and ultrasonographic findings. Histopathological examination of the infiltrating mass of the gallbladder revealed well differentiated keratinized squamous cell carcinoma invading full wall thickness. Thorough evaluations revealed no other primary site for the tumor. Pure primary squamous cell carcinoma of the gallbladder is rarely reported. Clinicians and pathologists must be aware of its vague clinical presentations