HISTOLOGICAL VARIANTS OF BLADDER TUMORS : DIAGNOSTIC, PROGNOSTIC AND THERAPEUTIC IMPLICATIONS – A CASE SERIES

Bladder cancer is one of the leading malignancies in the world associated with signi?cant morbidity and mortality. About 80% of a bladder cancer is urothelial variant, remaining 20% will have a divergent histological presentation. The pathophysiological study of these variants has recently increased because the therapeutic approach is not uniform for all variants. These variants have important diagnostic, prognostic and therapeutic implications. A molecular and genetic study of these variants will allow them to be better de?ned. Here we present four cases of Histological variants of bladder tumors with varying presentations in the department of urology, Madurai medical college, which is studied over the period of one year (2022-2023).

Characteristics of preliminary clinical diagnosis and treatment for gastritis cystica profunda accompanied with neoplastic lesions / 中华消化内镜杂志

Objective:To investigate the clinical features, characteristics under white-light endoscopy and endoscopic ultrasonography, and treatment strategies of gastritis cystica profunda (GCP) accompanied with or without neoplastic lesions.Methods:Clinical data of 35 patients, who were pathologically diagnosed as having GCP after endoscopic or surgical resection in Beijing Friendship Hospital, Capital Medical University from January 2015 to February 2021, were retrospectively collected, including 27 patients with neoplastic lesions. The demographic information, clinical manifestations, endoscopic features, treatment methods, and pathological results of GCP were summarized.Results:Thirty-five patients with GCP were 68.26±8.08 years old, and mostly male (80.00%, 28/35). The most common symptom was upper abdominal pain, accounting for 31.43% (11/35), and 25.71% (9/35) had no symptoms. Other symptoms included acid reflux, heartburn, abdominal distension, anemia, and choking sensation after eating. The most common site of GCP was cardia (51.43%, 18/35), and the main endoscopic manifestations of GCP were flat mucosal lesions (68.57%, 24/35), mainly 0-Ⅱa and 0-Ⅱa+Ⅱc type lesions, accounting for 66.67% (16/24). The second common endoscopic manifestation was polypoid eminence (20.00%, 7/35). Endoscopic ultrasonography was performed in 15 patients, with main manifestations of uniform hypoechoic with or without cystic echo (73.33%, 11/15). Among the GCP cases, 33 patients received endoscopic resection, and 2 received surgical treatment. The treatment processes were all successfully completed, and en-bloc resection was accomplished for all lesions receiving endoscopy, with the mean endoscopic operation time of 86.13 min. One patient suffered postoperative delayed bleeding after ESD which was stopped by endoscopic hemostasis. Final pathological results showed that the proportion of GCP complicated with neoplastic lesions was 77.14% (27/35), 68.57% (24/35) with early gastric cancer or precursor. Twenty-three cases achieved R0 resection. One case showed positive basal resection margin and vascular invasion, and recurrence happened in situ at the 5th month of follow-up, surgical resection was then performed. The endoscopic complete resection rate was 95.83% (23/24).Conclusion:GCP usually occurs in middle-aged and elderly male, often located in cardia, manifested mainly as flat mucosal lesions and polypoid changes. Endoscopic ultrasonography shows a high diagnostic value for GCP, and endoscopic treatment is safe and effective minimally invasive treatment for GCP.

Primary vesical actinomycosis with changes of cystitis cystica presenting as bladder mass

Actinomycosis is a rare chronic granulomatous suppurative infection caused by Gram-positive bacteria. The occurrence of primary vesical actinomycosis is extremely rare and only a few cases have been reported. Pre-operative diagnosis of vesical actinomycosis is challenging as the clinical and radiological features usually point towards bladder malignancy. Therefore, in most cases, definitive diagnosis is usually made after histopathological examination of the involved tissue. A 60-year-old male presented with complaints of hematuria, burning micturition, irritative, and obstructive urinary symptoms for 15 days. USG revealed a large soft-tissue mass having a polypoidal intraluminal and extraluminal component and involving the right posterolateral urinary bladder wall. CT scan showed a large irregular soft-tissue mass with multiple cystic lesions involving the right lateral wall of the urinary bladder. Transurethral resection of bladder mass biopsy was performed and the histopathological examination showed bacterial colonies of Actinomyces with changes of cystitis cystica. The patient was treated with amoxicillin and potassium clavulanate for 3 months. Actinomycosis should be kept as a rare differential diagnosis in cases presenting as bladder mass. The diagnosis is most commonly made by histopathology and may need a repeat biopsy to arrive at the correct diagnosis. The patient should be treated by penicillin group of antibiotics for 2–3 months and followed up for years to detect any recurrence

Técnica com retalho muscular duplo e fasciocutâneo na correção de úlceras isquiáticas por pressão / Technique with double muscle and fasciocutaneous flap in the correction of sciatic pressure ulcers

Úlceras por pressão são lesões ocasionadas na pele e tecidos subjacentes devido à força de pressão local, geralmente em pontos de proeminências ósseas. Cita-se aqui o caso de uma paciente acamada devido à lesão medular por mielomeningocele que evoluiu com úlcera em região isquiática à direita, tratada com técnica de retalhos muscular e fasciocutâneo de face posterior da coxa. Por ser lesão rotineiramente encontrada nesses pacientes portadores de limitações funcionais, é fundamental a realização de tratamentos adequados que visem a melhora clínica do paciente e minimizar índice de recidivas. Além disso, é de suma importância a implementação de novas técnicas cirúrgicas, haja vista a enorme variedade de lesões por pressão

Pressure ulcers are injuries to the skin and underlying tissues due to local pressure force, usually at points of bony prominence. We mention here the case of a bedridden patient due to a spinal cord injury caused by myelomeningocele that evolved with an ulcer in the right sciatic region, treated with the muscle flap and fasciocutaneous flap technique of the posterior thigh. As it is a lesion routinely found in these patients with functional limitations, it is essential to carry out appropriate treatments aimed at improving the patients clinical condition and minimizing the rate of recurrences. In addition, the implementation of new surgical techniques is of utmost importance, given the enormous variety of pressure injuries

Clinical profile of primary hyperparathyroidism in Northeast India: a single centre experience

Background: A retrospective study of the presentation of primary hyperparathyroidism was done at a tertiary care centre in northeast India and was compared with variable features in other parts in India and worldwide.Methods: The clinical presentation, biochemical parameters, radiological and histopathology findings of 27 subjects of primary hyperparathyroidism who presented to us over a period of 5 years were retrospectively analysed. Chi-square test, student t test and 'one way ANOVA' were used to compare different variables. Statistical significance was set at p<0.05.Results: The age distribution ranged from as young as 13 years to 72 years (39±16.7). The male:female ratio was 1:1.25. The duration of symptoms at presentation ranged from 2 to 72 months (21.7±20.3). The most common presentation was bone pain in 59.2% of cases, followed by proximal myopathy (48.1%), fatigue (44.4%), abdominal pain (44.4%), constipation (11.1%), hypertension (18.5%), palpable neck swelling (22.2%), limb deformity (22.2%) and fracture (14.8%). The mean serum calcium was 12.2±0.87mg/dl. Parathyroid adenoma was localized radiologically in all patients and single adenoma was the most common cause in 96.3%. Left inferior parathyroid adenoma was the most common site of involvement in 51.8%.Conclusions: Hyperparathyroidism at our centre in northeast India has a classic symptomatic presentation with severe bone and renal involvement and younger age at diagnosis, and equal gender distribution.

Diagnosis and treatment of 40 cases of gastritis cystica profunda / 中华消化内镜杂志

Objective To investigate the clinical,endoscopic and pathological features of gastritis cystica profunda (GCP).Methods A total of 40 patients with GCP confirmed by pathology who received endoscopic or surgical treatment at Renji Hospital,School of Medicine,Shanghai Jiaotong University from May 2013 to May 2018,were included in the retrospective analysis.The clinical data such as population composition,clinical manifestations,endoscopic findings and pathological results were summarized and analyzed.Results Among the 40 patients were predominantly males (75.0％,30/40),and the mean age of onset was 61.2 years.The most common sites were cardia (32.5％,13/40) and gastric antrum (30.0％,12/40).The clinical symptoms of the patients were atypical and it was difficult to diagnose GCP with routine endoscopy examination.The endoscopic findings were mostly type 0-Ⅱ (50.0％,20/40).GCP with neoplastic lesions accounted for 55％ (22/40).Unconditional logistic regression analysis showed that male (P =0.013,OR =31.093,95％ CI:2.079-464.976) and Helicobacter pylori infection (P =0.041,OR =10.225,95％ CI:1.096-95.411) were risk factors for GCP with neoplastic lesions.Conclusion GCP commonly occurs in middle-aged and elderly men,and varies in different manifestations under white light endoscopy.GCP is not a benign lesion,but can also coexist with neoplastic lesions,which are mostly differentiated intramucosal cancer.

Subchondral Bone Restoration of Supra-acetabular Brown Tumor Secondary to Parathyroid Carcinoma: A Case Report / 대한고관절학회지

The causes of osteolytic lesions found in radiological examinations are not quite certain. Therefore, to determine the appropriate treatment method, various approaches and analyzes are required to find the real cause. Hyperparathyroidism is one of the diseases which forms osteolytic bone lesions so-called brown tumor. A 55-year-old woman who had painful osteolytic bone lesions in both hip joint areas was diagnosed as parathyroid carcinoma after serial work-up. She underwent parathyroidectomy and follow-up imaging showed a decrease in brown tumor size and bone consolidation in the subchondral bone destruction area. Proper evaluation of osteolytic bone lesions helps to avoid unnecessary operative treatments and the first choice for the treatment of osteolytic bone lesions caused by parathyroid carcinoma is parathyroidectomy.

The clinical value of intracranial translucency (IT) in open spina bifida at 11-13 +6 weeks of gestation / 中国医师杂志

Objective To explore the clinical value of intracranial translucency (HT) in open spina bifida at 11-13 +6 weeks of gestation.Methods Abdominal ultrasound was performed in 200 cases of normal fetus and 6 cases of confirmed open spina bifida at 11-13 +6 weeks of gestation to compare the morphology of IT,diencephalon and midbrain.Results Fetal IT was readily recognized in all 200 normal cases,with diencephalons and midbrain showing number "8" shape.In 6 cases of open spina bifida,fetal IT cannot be identified,and the expected " 8" shape of diencephalon and midbrain was distorted.During 11-13 +6 weeks of pregnancy,the fetal brain is caused by intracranial negative pressure,resulting in morphological changes in the intracranial hyaline,diencephalon and mesencephalon.Conclusions Fetal brain characteristics including intracranial translucency and the shape of diencephalon and midbrain in 11-13 +6 weeks gestation are valuable ultrasound screening indicators for opens pina bifida.

Communicating Hydrocephalus in a case of long-term primary Hyperparathyroidism / Journal of the ASEAN Federation of Endocrine Societies

@#We present the rare case of a 47-year-old woman with protracted primary hyperparathyroidism complicated by communicating hydrocephalus and cerebellar tonsillar herniation secondary to calvarial thickening. The parathyroidglands remained elusive, despite the use of advanced preoperative imaging modalities and three neck explorations.The serum calcium was optimally controlled with cinacalcet and alfacalcidol. Awareness of this rare complication is essential for early diagnosis and prompt intervention to prevent fatal posterior brain herniation

Tumores pardos mimetizando enfermedad metastásica ósea como presentación inicial de un carcinoma paratiroideo: A propósito de un caso / Brown tumors mimetizing bone metastasic disease as an initial presentation of a parathyroid carcinoma: About a case

Objetivo: Describir caso inusual de paciente con tumor pardo, manifestación poco frecuente del hiperparatiroidismo, como presentación inicial de carcinoma de paratiroides. Caso Clínico: Paciente masculino de 25 años, inicia enfermedad actual en el 2011, caracterizada por dolor en encía inferior de hemiarcada izquierda, acompañada de tumoración en región maxilar inferior ipsilateral. Se evidencia progresión de dicha lesión y aparición de nueva tumoración en maxilar superior derecho, además de dolores óseos, limitación a la movilización y fracturas patológicas en húmeros. En abril de 2015 presenta disartria, dificultad en la alimentación por progresión de la tumoración en la cavidad oral, además de sangrado en el sitio de la lesión, por lo que es hospitalizado. Examen físico: lesión tumoral en maxilar superior e inferior que deforma la arcada dentaria, con sangrado activo que imposibilita la oclusión completa de boca, con asimetría facial. Extremidades: asimetría en ambos húmeros. Paraclínicos: PTH: 990 pg/mL, calcio: 13 mg/dL, fosfatasa alcalina: 300 UI/L. Se realiza paratiroidectomía y lobectomía tiroidea izquierda. Biopsia: carcinoma paratiroideo. A los meses se evidencia mejoría del dolor óseo y del tamaño de las lesiones. Conclusión: El carcinoma de paratiroides es una neoplasia rara, la prevalencia es menos de 1% de los casos de hiperparatiroidismo, y la incidencia es de 0.015 por 10000 casos. El tumor pardo es una forma infrecuente de manifestación de un hiperparatiroidismo, reflejando un desafío en el diagnóstico diferencial de una enfermedad metastásica ósea, y más aún cuando el carcinoma paratiroideo generalmente al momento del diagnóstico ya presenta metástasis a distancia.

Objective: To describe the unusual case of a patient with brown tumor, rare manifestation of hyperparathyroidism, as initial presentation of a parathyroid carcinoma. Case Report: Two years later evidence progression of the lesion, also appearance of new tumor in the right upper jaw, in addition to bone pain, limitation mobilization and pathological fractures in the humerus. In April 2015 the patient presents dysarthria and difficulty in feeding due to progression of the tumor in the oral cavity, in addition to bleeding at the site of injury, so it is hospitalized. Physical examination: tumor lesion in upper and lower jaw, which deforms the dental arch, with active bleeding that precludes complete occlusion of the mouth, with facial asymmetry. Limbs: asymmetry in both humerus. Paraclinical: PTH: 990 pg/mL, calcium: 13 mg/dL, alkaline phosphatase: 300 IU/L. Parathyroidectomy and left thyroid lobectomy was performed. Biopsy: parathyroid carcinoma. Months later, improvement in bone pain and lesion size was evident. Conclusions: Parathyroid carcinoma is a rare neoplasm, the prevalence is less than 1% of cases of hyperparathyroidism, and the incidence is 0.015 per 10,000 cases. The brown tumor is a rare form of manifestation of hyperparathyroidism, reflecting a challenge in the differential diagnosis of a metastatic bone disease, and even more when the parathyroid carcinoma usually at the time of diagnosis already presents distant metastases.

Pathologic Fracture of the Femur in Brown Tumor Induced in Parathyroid Carcinoma: A Case Report / 대한고관절학회지

Brown tumor refers to a change of skeletones that develops as a complication of hyperparathyroidism. As osteoclast is activated to stimulate reabsorption and fibrosis of bone, it causes a cystic change of the bone. Parathyroid carcinoma is being reported as a tumor that induces primary hyperparathyroidism. It causes excessive secretion of the parathyroid hormone and increases the blood parathyroid hormone and calcium. Bone deformation due to brown tumor is known to be naturally recovered through the treatment for hyperparathyroidism. However, there is no clearly defined treatment for lesions that can induce pathological fractures developing in lower extremities. We experienced a case where brown tumor developed in the proximal femur of a 57-year-old female patient due to parathyroid carcinoma. In this case, spontaneous fracture occurred without any trauma, and it was cured by performing intramedullary nailing fixation and parathyroidectomy. We report the treatment results along with a literature review.

Cistitis quística glandular presentada como cistopatía quística / Cystitis cystica glandularis presented as cystic cystopathy

Se presenta el caso de una mujer de 73 años, con historia de hematuria macroscópica de aparición reciente, con presencia de quistes en toda la extensión de la mucosa vesical, y con diagnóstico por biopsias de vejiga, de una cistitis glandular. Se habla de cistopatía quística cuando los quistes se encuentran difusamente en la vejiga, y frecuentemente coexiste con lipomatosis pélvica en pacientes obesas, como la que reportada aquí. Es considerada una lesión premaligna y por eso es importante un seguimiento cuidadoso con cistoscopias periódicas. La cistitis quística se presenta más frecuentemente en hombres y en personas de mayor edad. Macroscópicamente, se manifiesta con nódulos submucosos únicos o múltiples, y los hallazgos histológicos son la presencia de nidos uroteliales redondeados, con dilatación quística dentro de la lámina propia, y paralelos a la superficie urotelial.

The case of a 73-year-old woman with a history of recent appearance of gross hematuria and diffuse cystic bladder lesions, diagnosed through a bladder biopsy with cystitis cystica glandularis is here in reported. Cystic cystopathy is reviewed. It is caractherized by cysts found diffusely throughout the bladder and it frequently coexists with pelvic lipomatosis in obese patients, such as the one in the case reported. It is considered a premalignant lesion, therefore careful follow-up with periodic cystoscopy is indicated. Cystitis cystica is found more often among males and elders. Macroscopically, it occurs as single or multiple submucosal nodules and the histological findings are the presence of rounded urothelial nests with cystic dilation within the lamina propria and parallel to the urothelial surface.

Brain Characteristics of Open Spina Biifda on Ultrasound at 11-13+6 Weeks of Gestation / 中国医学影像学杂志

Purpose To explore the clinical value of ultrasound in charactering brain anomalies in open spina bifida at 11-13+6 weeks of gestation.Materials and Methods Abdominal and transvaginal ultrasound was performed in 125 cases of normal fetus and 4 cases of confirmed open spina bifida at 11-13+6 weeks of gestation to compare the morphology of intracranial translucency (IT), diencephalon and midbrain.Results Fetal IT was readily recognized in all 125 normal cases, with diencephalons and midbrain showing number 8 shape. In 4 cases of open spina bifida, fetal IT cannot be identified, and the expected 8 shape of diencephalon and midbrain was distorted.Conclusion Fetal brain characteristics including intracranial translucency and the shape of diencephalon and midbrain in 11-13+6 weeks gestation are valuable ultrasound screening indicators for open spina bifida.

Endoscopic diagnosis and treatment of gastritis cystica profunda with early gastric cancer / 中华消化内镜杂志

Objective To study the relationship between gastritis cystica profunda (GCP)and early gastric cancer (EGC),and to explore the diagnosis and treatment of GCP.Methods Clinical data of 17 patients,who were pathologically diagnosed as having GCP,including clinical symptoms,white light endo-scopic findings,magnifying endoscopic features,EUS outcomes and histopathological characteristics were an-alyzed.Results All 17 patients of GCP had no specific clinical symptoms or history of gastric surgery prior to the operation.Eight lesions were located at cardiac,4 at gastric body,4 at gastric antrum and 1 at gastric angle.As to the morphology,3 cases were type Ⅰ,3 type Ⅰ +Ⅱc,9 type Ⅱa +Ⅱc,1 type Ⅱc and 1 type Ⅱb +Ⅱc.The mean lesion size was 1.8 cm.Of 16 patients with preoperative EUS examination,11 patients were found to have cystic changes,with the diagnostic rate being 68.8%(11 /16).All 17 patients underwent ESD,14 (82.4%,14 /17)of which were found to have EGC.Postoperative pathology confirmed low grade intraepithelial neoplasia in 3 cases,high grade intraepithelial neoplasia in 7,intramucosal carcino-ma in 4,submucosal carcinoma in 3 patients.Conclusion EUS plays an important role in the diagnosis and treatment of GCP.And GCP is highly correlated with EGC,which should be managed in time.

Brown Tumor of the Cervical Spines: A Case Report with Literature Review

To report a rare case of axis brown tumor and to review literature of cervical spine brown tumor. Brown tumor is a rare bone lesion, incidence less than 5% in primary hyperparathyroidism. It is more common in secondary hyperparathyroidism with up to 13% of cases. Brown tumor reactive lesion forms as a result of disturbed bone remodeling due to long standing increase in parathyroid hormones. Cervical spine involvement is extremely rare, can be confused with serous spine lesions. To date, only four cases of cervical spine involvement have been reported. Three were due to secondary hyperparathyroidism. Only one was reported to involve the axis and was due to secondary hyperparathyroidism. This is the first reported case of axis brown tumor due to primary hyperparathyroidism. A case report of brown tumor is presented. A literature review was conducted by a Medline search of reported cases of brown tumor, key words: brown tumor, osteoclastoma and cervical lesions. The resulting papers were reviewed and cervical spine cases were listed then classified according to the level, cause, and management. Only four previous cases involved the cervical spine. Three were caused by secondary hyperparathyroidism and one was by primary hyperparathyroidism which involved the C6. Our case was the first case of C2 involvement of primary hyperparathyroidism and it was managed conservatively. Brown tumor, a rare spinal tumor that presents with high PTH and giant cells, requires a high level of suspicion.

Bone disease in primary hyperparathyroidism / Doença óssea no hiperparatiroidismo primário

Bone disease in severe primary hyperparathyroidism (PHPT) is described classically as osteitis fibrosa cystica (OFC). Bone pain, skeletal deformities and pathological fractures are features of OFC. Bone mineral density is usually extremely low in OFC, but it is reversible after surgical cure. The signs and symptoms of severe bone disease include bone pain, pathologic fractures, proximal muscle weakness with hyperreflexia. Bone involvement is typically characterized as salt-and-pepper appearance in the skull, bone erosions and bone resorption of the phalanges, brown tumors and cysts. In the radiography, diffuse demineralization is observed, along with pathological fractures, particularly in the long bones of the extremities. In severe, symptomatic PHPT, marked elevation of the serum calcium and PTH concentrations are seen and renal involvement is manifested by nephrolithiasis and nephrocalcinosis. A new technology, recently approved for clinical use in the United States and Europe, is likely to become more widely available because it is an adaptation of the lumbar spine DXA image. Trabecular bone score (TBS) is a gray-level textural analysis that provides an indirect index of trabecular microarchitecture. Newer technologies, such as high-resolution peripheral quantitative computed tomography (HR-pQCT), have provided further understanding of the microstructural skeletal features in PHPT.

A doença óssea no hiperparatiroidismo primário grave é representada pela osteíte fibrosa cística (OFC). Dor óssea, deformidades esqueléticas e fraturas patológicas são achados comuns na OFC. A densidade mineral óssea está, usualmente, extremamente diminuída na OFC, mas é reversível após a cura cirúrgica. Os sinais e sintomas da doença óssea grave incluem dor óssea, fraturas patológicas e fraqueza muscular proximal com hiper-reflexia. O comprometimento ósseo é tipicamente caracterizado pela aparência em “sal-e-pimenta” nos ossos do crânio, erosões ósseas e reabsorção das falanges, tumores marrons e cistos. Na radiografia, observam-se desmineralização difusa e fraturas patológicas especialmente nos ossos longos das extremidades. No hiperparatiroidismo primário (HPTP) sintomático grave, as concentrações séricas de cálcio e PTH estão usualmente bem elevadas e o comprometimento renal se caracteriza pela presença de urolitíase e nefrocalcinose. Uma nova tecnologia, recentemente aprovada para uso clínico nos Estados Unidos e na Europa, torna-se provável se difundir rapidamente, pois utiliza as imagens geradas pela densitometria DXA. O escore trabecular ósseo (TBS), obtido por meio da análise do nível da textura cinza das imagens dos corpos vertebrais, fornece informações indiretas sobre a microarquitetura trabecular. Novos métodos, como a tomografia de alta resolução quantitativa periférica computadorizada (HRpqCT), têm proporcionado conhecimentos adicionais sobre os achados da microarquitetura esquelética no HPTP.

A Case of Parathyroid Carcinoma Presenting as Brown Tumors / 대한이비인후과학회지

Carcinoma of the parathyroid gland has been reported as a rare disease occurring in 0.5 to 4% of patients with the primary hyperparathyroidism. Brown tumor is characterized as the terminal stage of remodeling processes during the primary or secondary hyperparathyroidism. Brown tumor induced by the primary hyperparathyroidism can commonly occur in the ribs, clavicle, and pelvic bone. We experienced a case of a 29-year old female patient, who had parathyroid carcinoma leading to primary hyperparathyroidism, followed by multiple Brown tumor. We present this case of parathyroid carcinoma with Brown tumors with a brief review of literature.

Osteitis Fibrosa Cystica Mistaken for Malignant Disease

A 65-year-old man with back pain had plain radiographs that showed multiple osteolytic bone lesions of the pelvis, femur and L-spine; an magnetic resonance imaging scan of the L-spine showed extensive bony resorption with a posterior epidural mass involving the L1 spinous process; these findings suggested multiple myeloma or bony metastasis. However, all serology testing was negative. The parathyroid hormone and serum calcium levels were found to be abnormally elevated. A fine needle aspiration biopsy suggested that the L-spine lesion was consistent with the diagnosis of osteitis fibrosa cystica. A pathological fracture of the spine compressed the spinal cord, and surgical intervention was required. The neck computed tomography and Tc-99m sestamibi scan showed a solitary parathyroid mass. A minimally invasive parathyroidectomy using intraoperative parathyroid hormone monitoring was performed and two enlarged parathyroid glands identified. This case illustrates the importance of the consideration of a rare brown tumor associated with primary hyperparathyroidism in patients with the bone lesions suggestive of a malignancy.

A Case of Gastric Inverted Hyperplastic Polyp Found with Gastritis Cystica Profunda and Early Gastric Cancer

A gastric inverted hyperplastic polyp is a rare type of gastric polyp and is characterized by downward growth of a variety of mucosal components into the submucosa. The polyp consists of columnar cells resembling foveolar epithelium and pyloric gland epithelium and can coexist with gastritis cystica profunda. Frequently, adenocarcinoma can coexist, but the relation is not clear. A 77-year-old male underwent endoscopic submucosal dissection due to early gastric cancer. A gastric inverted hyperplastic polyp was found in the removed specimen and gastric cystica profunda was also found. We report a case of gastric inverted hyperplastic polyp coexisting with gastric cystica profunda and gastric adenocarcinoma.

A Case of Enteritis Cystica Profunda in the Ampulla of Vater Mimicking Choledochocele

Enteritis cystica profunda is a very rare disease in which a mucin-filled cystic space is surrounded partially with nonneoplastic columnar epithelium in the submucosa of the small intestine. Most of the cases are accompanied by intestinal diseases, and the disease usually occurs in the jejunum and the ileum and there has been no report of a case that occurred in the ampulla of Vater. A 58-year-old healthy female patient without any particular symptom visited the hospital to get additional examination for a mass found on the ampulla of Vater by accident. In esophagogastroduodenoscopy, a cystic mass showing a positive pillow sign was found on the ampulla of Vater. Endoscopic retrogradecholangiopancreatography was conducted as choledochocele was suspected, but no abnormality was found in the biliary system. In endoscopic ultrasonography, multiseptated cystic structures were detected in the submucosal layer of the duodenum. The lesion was resected completely through endoscopic snare polypectomy and the case was histologically diagnosed as enteritis cystica profunda.