Mediastinal ganglioneuroblastoma-secreting vasoactive intestinal peptide causing secretory diarrhea

In this case report we describe a case of mediastinal ganglioneuroblastoma-secreting vasoactive intestinal peptide [VIP], causing secretory diarrhoea in an 18-month-old child. An 18-month-old girl presented with a 2-month history of diarrhoea, abdominal distension and weight loss. Investigations revealed secretory diarrhoea with hypokalaemia, hyponatraemia and hypochloraemia and metabolic acidosis. Her stool output was 2.5-3.1 day[-1] with increased stool sodium. VIP levels were strikingly high with normal glucagon and gastrin levels. X-ray of the chest revealed a well-defined mass in the right upper zone with tracheal shift, which was confirmed with computed tomography [CT] of the chest. The mass was resected and the patient became asymptomatic. This case shows that secretory diarrhoea caused by VIP and produced by ganglioneuroblastoma indicates a favourable prognosis, provided it is resectable

Elastofibroma dorsi: an under-diagnosed entity -clinical, imaging and pathological features

To report clinical, radiological and histopathological findings of elastofibroma dorsi.Thepurposeis to increase awareness among radiologists and clinicians of this under-diagnosed and interesting benign lesion. Retrospective review of 624 consecutive thoracic Computed Tomography [CT], 92 ultrasounds and 130 Magnetic Resonance Image [MRI] scans for detection of elastofibroma dorsi along with review of the clinical and histopathological findings. Three radiologists evaluated the imaging features using previously definedcriteria. A histopathologist reviewed the pathological findings. A tertiary level hospital and a specialized orthopedic center. Patients who were subjected to CT, Ultrasound and MRI scans of the thorax Interventions: CT, MRI, Ultrasound scans of the thorax and surgical excision. Detection of elastofibromasand their clinical, radiological and histopathologic findings. Only 50% of patients with elastofibrom a dorsicouldbe detected by all modalities though, on review, all lesions showed characteristic location, morphology, imaging as well as typical clinical and pathological features. Significant contrast enhancement of all lesions on MRI was an unusual finding in our study. An awareness of the radiological findingsand enhancement patterns on CT and MRI can help in the proper diagnosis of elastofibroma dorsi an entity often misdiagnosed in a high percentage of patients

Clinicopathological features in 102 cases of Hirschsprung disease

Hirschsprung disease [HD] is a predominantly childhood disorder of intestinal motility with a multifactorial and polygenic etiology. The objective of this study was to document the clinical and pathological features of HD in Kuwait, which has an estimated consanguinity rate of 54%.We analyzed all rectal and colonic biopsies [n=268] for suspected HD identified from the records in the Pathology Department of Al-Sabah Hospital for the period between 1994 and 2004. One hundred and two patients [87 males and 15 females] had historically confirmed HD. Fifty-eight [57%] were neonates [<1 month of age], while 21% were more than 4 months old. The diagnosis was based on open biopsy in 11 cases and rectal biopsies in 91 cases. Nine patients with open biopsies presented as intestinal obstruction, necrotizing enterocolitis, or perforation. The extent of the disease was unknown in 13 patients. There were 67 males and 3 females with short segment HD. Nine had long segment, two ultra-short segment and eight total colonic aganglionosis [TCA]. Five TCA cases involved the small intestine. A skip area was observed in two cases. Six patients had other anomalies. A positive family history for HD was established in three patients. Two of these were male siblings from a consanguineous marriage and had Waardenburg syndrome. This study has highlighted an exceptionally strong male predominance of short segment and a relatively high frequency [5.6%] of small intestinal involvement in HD in Kuwait. These data call for a more detailed epidemiological study with special emphasis on genetics

Inflammatory demyelinating pseudotumor

Inflammatory demyelinating pseudotumor [IDP] is a rare inflammatory lesion of unknown etiology, which presents as a space-occupying lesion but responds dramatically to steroid therapy. The objective of this report is to document 2 cases of IDP seen in Kuwait. Two female patients, aged 35 and 27 years presented with the clinical and radiological features of a space-occupying lesion. Radiological investigations showed partial ring-enhancing lesions with insignificant mass effect, which were multiple in patient one, and single in patient 2. Biopsies in each patient showed features of a demyelinating disorder. Both patients remarkably improved clinically on steroid therapy. The report highlights the need for an early and correct diagnosis of IDP for therapeutic purposes