Colonic basidiobolomycosis with liver involvement masquerading as gastrointestinal lymphoma: a case report and literature review

Abstract Basidiobolomycosis is an unusual fungal skin infection that rarely involves the gastrointestinal tract. This study reported a 5-year-old boy with gastrointestinal basidiobolomycosis that had been misdiagnosed as gastrointestinal lymphoma. He was treated by surgical resection and a combination of posaconazole and amphotericin B deoxycholate with an acceptable response and no recurrence.

Paracoccidioidomicosis colónica en un hospital de Lima - Perú: reporte de 4 casos / Colon Paracoccidioidomycosis in a hospital from Lima - Peru: report of 4 cases

La paracoccidioidomicosis es la micosis más prevalente de Sudamérica. En nuestro medio la afectación mucocutánea y linfática suele ser la de mayor prevalencia, siendo el compromiso intestinal pocas veces reportado. Se reportan 4 casos de afectación colónica con manifestación de dolor abdominal, diarrea crónica y disminución de peso en los cuales el diagnóstico se realizó a través de la anatomía patológica con la tinción de Gomori. La edad promedio fue de 29 años. La colonoscopía reveló presencia de múltiples úlceras en colon y en íleon distal. Como comorbilidad se encontró VIH en un paciente

Paracoccidioidomycosis is the most prevalent mycosis in South America. Mucocutaneous and lymph node involvement is the most frequent affectation of this disease in our country, with the intestinal commitment rarely reported. We report 4 cases of colonic manifestation with abdominal pain, chronic diarrhea, and weight loss. The diagnosis was made with biopsy and Gomori stain. The average age was 29 years old. The colonoscopy showed many ulcers in the ileum distal and colon. We found VIH as comorbidity in one patient

Doenças inflamatórias intestinais no Hospital Universitário da Universidade Federal de Sergipe: manifestações extraintestinais / Intestinal inflammatory diseases in the Hospital Universitario of Universidade Federal de Sergipe: extraintestinal manifestations

A doença inflamatória intestinal idiopática (DII) representa um grupo de condições inflamatórias crônicas, resultantes de ativação persistente e inadequada do sistema imune mucoso. Além dos sintomas intestinais característicos, as DII podem se manifestar através de uma série de manifestações extraintestinais (MEI). Objetivos: Avaliar a incidência das MEI das doenças inflamatórias intestinais no Hospital Universitário da Universidade Federal de Sergipe; diagnosticar as MEI das DII; instituir o tratamento adequado dos pacientes portadores dessas manifestações. Métodos: Foi aplicado um protocolo para diagnóstico das MEI; quando necessário os pacientes foram encaminhados para as respectivas especialidades. Resultados: Foram catalogados 49 pacientes portadores de DII; destes, 41 (83,6 por cento) apresentaram MEI. As MEI reumatológicas foram as mais frequentes, acometendo 35 pacientes. O restante das MEI foram assim distribuídas: um caso de MEI dermatológica; um caso de MEI urológica; um caso MEI pneumológica; quatro casos de MEI oftalmológicas; oito casos de MEI hepáticas. Conclusões: As MEI têm alta incidência (I=83,6 por cento) entre os pacientes portadores de DII; as MEI tiveram incidência semelhante entre os pacientes portadores de retocolite ulceratica idiopática e de Crohn; o início das MEI foi mais comum após o diagnóstico da DII; a classe de MEI mais prevalente foi a reumatológica (P=71,4 por cento).

Idiopathic inflammatory bowel disease (IBD) represents a group of chronic inflammatory conditions, resulting from persistent and inappropriate activation of mucosal immune system. Besides the typical intestinal symptoms, the IBD can manifest itself through a series of extraintestinal manifestations (EIM). Objectives: To evaluate the incidence of EIM in the Hospital Universitario of Universidade Federal de Sergipe; to diagnose EIM of IBD; to institute the appropriate treatment of patients with these manifestations. Methods: We applied a protocol for diagnosis of EIM; when necessary, patients were referred to their specialities. Results: We categorized 49 patients with IBD, whose 41 (83.6 percent) had EIM. The rheumatologics EIM were the most frequent, affecting 35 patients. The others EIM were distributed as follows: one case of dermatological EIM; one case of urologic EIM, one case of pulmonology EIM, four cases of ophthalmic EIM; eight cases of hepatic EIM. Conclusions: The EIM have a high incidence (I=83.6 percent) among patients with IBD; the EIM had similar incidence among patients with ulcerative colitis and Crohn's disease. The beginning of EIM was more common after the diagnosis of IBD; the rheumatologic EIM was most prevalent (P=71.4 percent).

Estudo comparativo entre MBI (FICE®) e a magnificação com índigo-carmin no diagnóstico diferencial de lesões neoplásicas e não-neoplásicas de cólon e reto / Comparative study between MBI (FICE®) and magnification chromoendoscopy with indigo carmine in the differential diagnosis of neoplastic and non-neoplastic lesions of the colorectum

CONTEXTO: O uso da cromoscopia virtual com sistema de imagem multibanda poderia auxiliar no diagnóstico in vivo de neoplasias colônicas. Objetivo - Avaliar a exatidão da magnificação associada à cromoendoscopia eletrônica ou com índigo-carmin na distinção entre lesões neoplásicas e não-neoplásicas do cólon e reto. MÉTODOS: Foram avaliadas prospectivamente 157 lesões colorretais em 75 pacientes. Empregou-se o sistema FICE® para a análise dos padrões de capilares, com a malha capilar negativa sendo considerada padrão de lesões não-neoplásicas, e a malha capilar positiva, o padrão das neoplasias. Após esta avaliação, ainda usando o sistema FICE®, o padrão de criptas foi definido conforme a classificação de Kudo. Por fim, instilou-se índigo-carmin à 0,8 por cento e outro estudo das criptas foi realizado. RESULTADOS: Entre as 157 lesões colorretais, classificou-se 116 como malha capilar positiva, sendo 115 confirmadas histologicamente como neoplasias. Já entre as 41 lesões com malha capilar negativa, 32 eram não-neoplásicas. A sensibilidade foi de 92,7 por cento, a especificidade de 97 por cento e a precisão de 93,6 por cento. Os padrões de criptas tipo I e II representaram as lesões não-neoplásicas e os tipos III-V, as neoplásicas. Com a utilização da cromoscopia eletrônica, observou-se sensibilidade de 94,4 por cento, especificidade de 97 por cento e precisão de 94,9 por cento. Já com o uso da magnificação associada ao índigo-carmin, a sensibilidade foi de 97,6 por cento, a especificidade de 93,9 por cento e a precisão de 96,8 por cento. CONCLUSÕES: Tanto a cromoendoscopia eletrônica, quanto o uso do índigo-carmin, associados à magnificação de imagens, apresentaram precisão elevada quanto ao diagnóstico histopatológico e não houve diferença estatística entre ambos os métodos.

CONTEXT: Multiband imaging (MBI)/Fuji Intelligent Color Enhancement (FICE®) is a spectral image processing technology that helps in vivo diagnosis of colorectal neoplasias. OBJECTIVE: To compare the diagnostic accuracy of the magnification with either the electronic chromoendoscopy or indigo carmine dye in the differential diagnosis of neoplastic and non-neoplastic colorectal lesions. Methods - Seventy five patients with 157 colorectal lesions were prospectively evaluated. The capillary pattern, as well as the pit pattern according to the Kudo classification, of colorectal lesions were evaluated by means of the FICE® system. Absence and presence of meshed capillary networks were labeled as non-neoplastic and neoplastic lesions, respectively. Afterwards, indigo carmine 0.8 percent was instilled and a new evaluation of the pit pattern was carried out. RESULTS: One hundred and sixteen of the 157 lesions were classified as positive meshed capillary network, 115 of them were confirmed histologically as neoplasia. Other 32 lesions out of 41 with negative meshed capillary network were non-neoplastic. Sensitivity, specificity and accuracy were, respectively, 92.7 percent, 97 percent and 93.6 percent. Pit patterns I and II were confirmed as non-neoplastic lesions, and patterns III to V were confirmed as neoplasies. Sensitivity, specificity and accuracy for the electronic chromoendoscopy were, respectively, 94.4 percent, 97 percent and 94.9 percent. Meanwhile, the figures for the magnification with indigo carmine were, respectively, 97.6 percent, 93.9 percent and 96.8 percent. CONCLUSIONS: Both methods, either the MBI/FICE® system or the use of indigo carmine dye with magnification, achieved a high accuracy for the differential diagnosis between neoplastic and non-neoplastic colorectal lesions.

Endometriose intestinal: uma doença benigna? / Bowel endometriosis: a benign disease?

A despeito do caráter benigno da endometriose, estima-se que 1 por cento dos casos esteja relacionado com câncer, especialmente quando ambas as condições ocorrem nos ovários. Lesões extra-ovarianas encontradas no septo retovaginal, cólon, bexiga, vagina e peritônio da região pélvica também já foram associadas com neoplasias malignas. Várias características do tecido endometrial ectópico o aproximam do fenótipo neoplásico, e a própria endometriose possui comportamento tipicamente neoplásico com capacidade de invasão do estroma adjacente e associação com lesões à distância. Esta revisão atualiza conhecimentos diagnósticos, clínicos e terapêuticos dos implantes intestinais de tecido endometriótico, bem como sua relação com processos neoplásicos para melhor compreensão de seu caráter benigno ou de seu eventual potencial para malignidade.

Endometriosis is generally assumed to be a benign disease, but it is estimated that 1 percent of cases are associated with cancer, especially when both conditions are present in the ovary. Extra-ovarian lesions in the rectovaginal septum, colon, bladder, vagina and peritoneum were already associated with malign neoplasia. Several characteristics of endometrial tissue are very similar to the neoplasia phenotype. Endometriosis itself typically behaves as a neoplasia process, spreading over adjacent stroma and being associated with distant lesions. This is an update on the diagnostic, clinical, and therapeutic knowledge of, management of bowel implants of endometrial tissue, as well as the relation with neoplastic processes to better understand its benign nature or eventual potential for malignancy.

Alteraciones histológicas asociadas a la preparación mecánica en cirugía colorrectal electiva / Bowel wall alterations associated with mechanical bowel cleansing before elective colonic surgery

Introducción: La preparación mecánica anterograda de colon en cirugía electiva es una práctica común utilizada en distintas operaciones sobre el segmento distal del tubo digestivo. La limpieza intestinal ha demostrado provocar alteraciones fisiológicas significativas y algunos autores han relacionado su uso con una mayor incidencia de complicaciones sépticas, aunque sin demostrar un sustrato anatómico o histológico que avale estas afirmaciones. Objetivo: Demostrar la aparición de alteraciones histológicas asociadas al uso de preparación mecánica anterograda en cirugía colorrectal electiva. Material y método: Durante un periodo de 10 meses se incluyeron en este estudio todos los pacientes sometidos a cirugía electiva de colon. Se excluyeron los pacientes que recibieron radioterapia pre operatoria y quienes recibieron preparación mecánica la semana previa a la cirugía. Los pacientes fueron randomizados en dos grupos: con y sin preparación de colon. Un patólogo evaluó las alteraciones histológicas en mucosa sana en forma ciega. Los datos fueron analizados con el programa Stata 8.0. Resultados: Participaron 34 pacientes en este estudio, de los que se excluyeron 2 por no haber sido resecados, ambos en el grupo que recibió preparación mecánica. El estudio de siete parámetros no demostró alteración significativa en los pacientes que recibieron preparación mecánica anterograda (p > 0,05). Conclusión: En esta serie prospectiva y aleatoria no se encontraron alteraciones histológicas atribuibles al uso de la preparación mecánica anterograda.

Background: Anterograde mechanical bowel cleansing is a common practice in colorectal surgery. However it can produce physiological disturbances and can be associated to a higher frequency of septic complications. Aim: To evaluate the appearance of histological alterations in the colon wall, associated to anterograde bowel cleansing. Material and methods: All patients subjected to elective colon surgery were randomized to a group with and other group without anterograde mechanical bowel cleansing before surgery. Patients subjected to preoperative radiotherapy and those that were subjected to bowel cleansing the week previous to surgery, were excluded. A sample was obtained from normal colon mucosa, far from the lesion that motivated surgery, for pathological study. The pathologist was unaware of the group assignation of patients. Results: Thirty four patients were studied. Eighteen (nine women) were randomized to receive mechanical bowel cleansing, 14 (eight women) did not receive cleansing and two were excluded from the study. No significant pathological bowel wall alterations were detected in the group subjected to mechanical cleansing. Conclusions: No pathological alterations of the bowel wall, attributed to anterograde bowel cleansing, were detected in this group of patients.

A Case of Pneumatosis Cystoides Intestinalis: Diagnosed by CT Colonoscopy / 대한소화기학회지

Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas filled cysts in the intestinal wall. The diagnosis of PCI is usually made by colonoscopy, histology, or radiologic findings. We report a case of PCI in a 35-year-old man. The patient initially complained of watery diarrhea and abdominal bloating for 2 weeks. Simple abdominal X-ray demonstrated numerous, small, round, air densities on the right upper abdomen along the ascending and proximal transverse colon. Colonoscopy revealed numerous, 5-20 mm sized, sessile polypoid, balloon-like distended, protruding subepithelial masses covered with normal colonic mucosa from cecum to proximal transverse colon. We performed a CT colonoscopy and confirmed PCI with multiple air-filled cystic masses along the colonic wall from cecum to proximal transverse colon. The patient was treated with antibiotics and oxygen inhalation for 2 weeks. Follow-up CT colonoscopy revealed marked regression in the number and size of the air-filled cystic masses. Herein, we report the first case of the PCI in Korea diagnosed by CT colonoscopy. Follow-up evaluation with CT colonoscopy was performed after the treatment of the PCI. CT colonoscopy is a useful non-invasive diagnostic tool for the diagnosis of pneumatosis cystoides intestinalis.

Cirugía electiva colo-rectal sin preparación mecánica: la ruptura de un paradigma en cirugía: Hospital General del Oeste "Dr. José Gregorio Hernández", Hospital Central de Las Fuerzas Armadas "Dr. Carlos Arvelo" Caracas-Venezuela / Elective colo-rectal surgery without mechanical bowell preparation: a paradigm surgery break up: Hospital General del Oeste Dr. José Gregorio Hernández and Hospital Central de Las Fuerzas Armadas Dr. Carlos Arvelo Caracas-Venezuela

Determinar si la cirugía electiva colo-rectal puede realizarse de forma segura sin preparación mecánica preoperatoria del colon. Evaluación en forma prospectiva de 43 pacientes sometidos a cirugía electiva colo-rectal en dos hospitales del área metropolitana de Caracas: Hospital General del Oeste Dr. José Gregorio Hernández y Hospital Central de las Fuerzas Armadas Dr. Carlos Arvelo. Los pacientes fueron divididos en 2 grupos. Grupo A: constituido por aquellos pacientes a los que se les realiza preparación intestinal mecánica anterógrada y retrograda, más antibioticoterapia profiláctica previa a la cirugía electiva, método utilizado de rutina en nuestros centros. Grupo B conformado por los pacientes a los que se les omitirá la preparación mecánica, recibiendo igualmente la antibioticoterapia profiláctica. Se les efectuó seguimiento postoperatorio hasta 30 días después del acto quirúrgico con el fin de establecer la tasa de complicaciones infeccisas en ambos grupos. Las características demográficas y el tipo de procedimiento quirúrgico no presentaron diferencias estadísticamente significativas. El riesgo de complicación en el grupo preparado fue de 2,33 veces mayor (IC-95 por ciento: 0.83-6,63) que en el grupo no preparado. Esta relación no fue estadísticamente significativa (p=0.179). El rol de la preparación mecánica de colon en la cirugía electiva es cuestionable y no se aprecia que brinde beneficios con respecto a los no preparados.

A Giant Colonic Hamartoma and Multiple Colonic Hamartomatous Polyps in a Middle-Aged Man

Colonic hamartomas are rare polypoid lesions. We report an unusual case of multiple colonic hamartomatous polyps, including a giant hamartoma, unrelated to hereditary or familial polyposis syndromes, in a 48-year-old man. The diameter of the largest polyp was 9.5 cm, and endoscopy revealed that the lesion caused colonic obstruction. The clinical, endoscopic and histological aspects of this case are discussed.

A Case of Primary Adenosquamous Carcinoma of the Liver with Formation of Colonic Fistula / 대한소화기학회지

Primary adenosquamous carcinoma of the liver is generally considered as an extremely rare subtype of cholangiocarcinoma. It has been reported mostly in a form of case studies. As far as we know, there was only one case report on tumor related with biliary fistula. Recently, we experienced a case of primary adenosquamous carcinoma of liver with a formation of tumor-colonic fistula. A 54-year-old man was transferred to our hospital due to liver mass detected by abdominal ultrasonogram. Dynamic computed tomogram of liver showed a large irregular hypodense mass without rim enhancement in right lobe of liver and also suggested a fistula formation between the tumor and hepatic flexure of right colon. Colonoscopic examination showed a large colonic wall defect in hepatic flexure and a friable, nodular mucosa around the defected colonic wall. Extended right lobectomy and right hemicolectomy were done. Microscopically, the tumor was composed of squamous cell carcinoma mainly with foci of the adenocarcinoma component.

Utilidad de la cromoendoscopia como método auxiliar de la colonoscopia / Usefulness of chromoendoscopy as an ancillary technique for colonoscopy

La cromoendoscopia es el empleo de tinciones para facilitar la identificación de lesiones o su correcta evaluación, diagnóstico, y tratamiento. La tinción más empleada en la colonoscopía es el índigo carmín, que es un método de contraste. El azul de metileno y el violeta de genciana, que se absorben por la mucosa, se utilizan junto a endoscopios de magnificación. Los endoscopios de magnificación permiten visión convencional, y magnificación hasta más de 150 veces, y se emplean para predecir el diagnóstico histológico mediante la observación de las aperturas de las criptas colónicas según la clasificación de Kudo. Los objetivos de la cromoendoscopia colónica son: 1) permitir la detección de pólipos no identificados con endoscopia convencional; 2) clarificar el margen de los pólipos planos para permitir su resección completa; 3) proporcionar el diagnóstico diferencial de los pólipos neoplásicos y no neoplásicos, y 4) facilitar la detección de lesiones neoplásicas en la enfermedad inflamatoria intestinal de larga evolución. La cromoendoscopia se considera imprescindible para el estudio y tratamiento de las neoplasias precoces de tipo plano. Los resultados de diversos estudios indican que la aplicación de índigo carmín en la mucosa colónica aumenta la detección de lesiones pequeñas y/o planas. La cromoendoscopia con equipos de magnificación muestra una elevada exactitud diagnóstica en el diagnóstico diferencial de los pólipos colónicos, y también permite evaluar la existencia de lesión residual tras la realización de mucosectomía. Estudios recientes sobre cromoendoscopia pancolónica en la vigilancia de la colitis ulcerosa de larga evolución, sugieren que esta técnica debe incorporarse ya a la práctica clínica.

Malignant colonic stricture with cecal perforation - A case report and a review of literature

A 79-year-old Saudi female with cecal perforation as a result of colonic malignant stricture is presented. This was treated by emergency subtotal colectomy and ileo-colic anastomosis with satisfactory result. This case reinforces the fact that patients above the age of forty with gastrointestinal symptoms require full work-up to rule out malignancy. Also it shows that abdominal ultrasound alone is of limited diagnostic value in detecting colonic stricture. Thirdly, large bowel obstruction, especially, when total should be treated urgently to avoid cecal perforation

Hirschsprung's disease: revisited.

The diagnosis and therapy of Hirschsprung's disease has changed in recent times and a firm diagnosis of the entity can be made pre-operatively by immunohisto-chemistry. There has been a recent trend of switching over from the conventional staged surgical procedures to primary pull-through procedures. In this article the newer concepts referring to its aetiology, pathogenesis, and the current technical advancements like stapler anastomosis, laparoscopic assisted pull-through and single one stage operation without colostomy are discussed along with a brief mention of current concepts in intestinal neuronal dysplasia, enterocolitis and total colonic aganglionosis.

Churg-Strauss syndrome with perforating ulcers of the colon

We report a case of a 72-year-old woman with Churg-Strauss syndrome, who presented with intestinal perforation. She has had bronchial asthma with peripheral blood eosinophilia for 30 years. Gross findings of a resected colon showed multiple ulcers with perforation. Histologic findings demonstrated transmural inflammation infiltrated with large numbers of eosionophils, neutrophils and lymphoplasma cells, and characteristic extravascular granuloma in the subserosa. There were multifocally-distributed transmural vasculitis showing all stages of activity in medium and small-sized arteries and veins located in the submucosa, and proper muscle and subserosal layers of the colon, some of which revealed granulomatous inflammation. Histologic finding of liver showed chronic viral hepatitis B with mild inflammatory activity and macronodular cirrhosis. Immunohistochemical findings, acid fuschin orange G staining and electromicroscope found no evidence of hepatitis B virus infection contributing to the pathogenesis of this lesion.

Affecçöes colorretais em portadores da síndrome da imunodeficiência adquirida e suas manifestaçöes endoscópicas / Colorectal diseases in AIDS patients and its endoscopic findings

Com a finalidade de se estabelecer as principais afecçoes colorretais observadas em pacientes portadores da síndrome da imunodeficiência adquirida com sintomas intestinais e verificar as alteraçoes endoscópicas relacionadas, foi analisada uma série de 236 colonoscopias realizadas em 186 pacientes. A colonoscopia foi sempre acompanhada de biopsias, mesmo quando nao havia alteraçoes endoscópicas. O diagnóstico mais freqüente foi colite pelo citomegalovírus identificado em 64 exames (27,1 por cento) e se apresentou caracteristicamente com padrao inflamatório ulcerativo. O segundo achado em freqüência foi o Cryptosporidium sp. observado em 31 exames (13,1 por cento), relacionando-se o processo inflamatório sem ulceraçoes. Outros patógenos observados com menor freqüência foram: Mycobacterium sp., Histoplasma capsulatum, Herpes simplex, Isospora sp. Giardia sp., Candida sp. e Campilobacter sp.. As afecçoes neoplásicas foram diagnosticadas em 10 exames (4,2 por cento) e representadas principalmente pelo sarcoma de Kaposi. Os autores concluem que: 1. as afecçoes colorretais mais freqüentes em portadores da AIDS (CMV e Cryptosporidium sp.) apresentam, na maioria das vezes, aspecto colonoscópico característico que podem sugerir diagnóstico; 2. a realizaçao de biopsias é fundamental: a) para confirmaçao diagnóstico; b) para realizaçao do diagnóstico quando da ausência de alteraçoes endoscópicas; c) para identificar a eventual concomitância de patógenos.

Padronizaçäo tecnica e histologica de colite experimental com acido trinitrobenzenosulfonico (TNBS) / Technical and histological standardization of experimental colitis with trinitrobenzene sulfonic acid

A tentativa de reproduzir doença inflamatoria experimental no colon gerou varios modelos de colite. Desde os trabalhos pioneiros de Morris e col., soluçöes de acido 2,4,6-trinitrobenzesulfonico (TNBS) vem sendo utilizadas em diferentes doses. Os objetivos deste trabalho foram padronizar a induçäo de colite, avaliar os efeitos clinicos (peso, ingestäo diaria, diarreia) e intestinais (alteracçös morfologicas do intestino inflamado) da utilizaçäo de soluçöes com TNBS e atestar a reprodutibilidade do processo inflamatorio. Utilizaram-se ratos Wistar submetidos a introduçäo por via retal de 2,5 ml de soluçöes contendo diferentes concentraçöes de TNBS a 5 por cento diluido em etanol...