ABSTRACT
BACKGROUNDS AND AIMS: Hepar lobatum carcinomatosum (HLC) is an exceptional acquired hepatic distortion which consists in irregularly lobulated hepatic contours seen in patients with known liver metastases, usually from breast carcinoma. We aimed to describe and analyze five similar cases of HLC resulting from metastatic mammary carcinoma in the liver and associated with rapid hepatic failure. METHODS: Five cases of HLC were investigated. Medical (including blood liver tests), radiological and histological data (2 cases) were collected and retrospectively analyzed. All patients were followed up for metastatic invasive ductal carcinoma of the breast and had a common pattern of treatment with combination of targeted therapies (bevacizumab, AVASTIN) and chemotherapy (paclitaxel, TAXOL). RESULTS: All the patients showed rapid hepatic failure after a mean of 9 courses of bevacizumab/paclitaxel. In all cases, liver imaging revealed liver capsule retraction and an irregular lobular margin. An apparent tumor regression of all liver metastases was showed in two cases. Biopsies were consistent with sinusoidal obstruction syndrome (SOS) and, surprisingly, no tumoral cells were found. CONCLUSION: Although rare, such an unusual pattern of liver metastasis may mimick acute cirrhosis and cause rapid hepatic failure in patients, despite possible apparent tumor regression on imaging. The etiology of this pathology is unclear, and may involve multiple pathogenic factors. Direct or indirect vascular injury plays an important role in the development of HLC.
Subject(s)
Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/secondary , Liver Neoplasms/pathology , Liver Neoplasms/secondary , Aged , Female , Humans , Middle AgedABSTRACT
INTRODUCTION: Sarcoidosis and sarcoid reactions have been previously reported in association with cancer. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a minimally invasive test for investigating mediastinal lymph nodes PATIENTS AND METHODS: We conducted a retrospective review of 54 patients undergoing EUS-FNA in a cancer institute for suspected metastatic mediastinal lymph nodes showed by CT-imaging or positron emission tomography (PET). Patients with non-caseating granuloma identified by EUS-FNA were included RESULTS: EUS-FNA identified non-caseating granuloma in seven out of the 54 included patients. Most of them had positive PET. One patient had a prior history of sarcoidosis before the diagnosis of cancer. Another patient developed micrometastasis associated with sarcoid-like reaction. There was no adverse outcome associated with the EUS-FNA procedure CONCLUSIONS: Sarcoidosis must be included in the differential diagnosis of patients with a history of malignancy who develop mediastinal lymphadenopathy. EUS-FNA is a safe and minimally invasive test to obtain tissue diagnosis.
Subject(s)
Endoscopic Ultrasound-Guided Fine Needle Aspiration , Lymph Nodes/pathology , Mediastinal Diseases/pathology , Mediastinal Neoplasms/pathology , Sarcoidosis/pathology , Adult , Diagnosis, Differential , Female , Humans , Liver/pathology , Male , Middle Aged , Retrospective StudiesABSTRACT
Radiofrequency ablation (RF) is a relatively safe and reliable technique for the treatment of pulmonary metastases that has seen rapidly expanding use. Lesions situated near the diaphragm are difficult to treat by RF due to the risk of thermal injury to the diaphragm. Diaphragmatic perforation with progressive development of a diaphragmatic hernia is a rare but serious complication. Treatment is surgical. We present the first case reported in the literature of intestinal obstruction in a left diaphragmatic hernia that developed following RF treatment of a pulmonary metastasis.
Subject(s)
Adenocarcinoma/surgery , Catheter Ablation/adverse effects , Hernia, Diaphragmatic, Traumatic/diagnosis , Lung Neoplasms/surgery , Adenocarcinoma/secondary , Aged , Hernia, Diaphragmatic, Traumatic/etiology , Humans , Lung Neoplasms/secondary , Male , Rectal Neoplasms/pathologyABSTRACT
Esophageal adenocarcinoma and its precursor Barrett's esophagus are increasing in incidence in western populations. Gastroesophageal reflux and high body mass index (BMI) are known risk factors. Studies about Barrett's esophagus in obese patients have emphasised the role of central adiposity as a stronger risk factor than BMI in the development of specialized intestinal metaplasia and subsequently esophagus adenocarcinoma. The proinflammatory impact of adipocytokines of the abdominal fat associated with the metabolic syndrome is also relevant. Except cardiovascular diseases, type 2 diabetes and non alcoholic steatohepatitis, abdominal obesity and metabolic syndrome are responsible of an increase of prevalence of esophageal adenocarcinoma, but also other cancer sites. In this review, we study the up to date main epidemiologic and physiopathologic data concerning this association that could be important in future for a preventive action in obese patients, especially when metabolic syndrome is present.
Subject(s)
Gastroesophageal Reflux/complications , Obesity/complications , Adenocarcinoma/etiology , Esophageal Neoplasms/etiology , Esophagitis, Peptic/etiology , Gastroesophageal Reflux/epidemiology , Humans , Obesity/epidemiologyABSTRACT
The association of microscopic colitis with celiac disease is rare. A case of microscopic colitis associated with celiac disease and following administration of venlafaxine in a 67-year-old patient is described. The pathophysiologic hypotheses of such an association are discussed.
Subject(s)
Antidepressive Agents, Second-Generation/adverse effects , Celiac Disease/chemically induced , Celiac Disease/complications , Colitis, Microscopic/chemically induced , Colitis, Microscopic/complications , Cyclohexanols/adverse effects , Selective Serotonin Reuptake Inhibitors/adverse effects , Aged , Biopsy , Colitis, Microscopic/diagnosis , Colitis, Microscopic/pathology , Colon/pathology , Colonoscopy , Depressive Disorder/drug therapy , Humans , Male , Venlafaxine HydrochlorideABSTRACT
Sporadic colonic juvenile polyps are uncommon in adults. We report three cases for which clinical manifestations were presence of occult blood in the stool, rectal bleeding or chronic diarrhea. Two of these polyps occurred in the caecum which is an uncommon localisation. Endoscopic characteristics of these polyps were indistinguishable from adenomas. Endoscopic resection was complicated in one case by bleeding.
Subject(s)
Colonic Polyps/diagnosis , Adult , Aged , Colonic Polyps/surgery , Diarrhea/etiology , Endoscopy, Gastrointestinal , Female , Gastrointestinal Hemorrhage/etiology , Humans , Male , Occult Blood , RectumABSTRACT
OBJECTIVE: To report the mechanism of diarrhoea in patients with subacute colonic pseudo-obstruction, profuse secretory diarrhoea and hypokalemia. PATIENTS: Five consecutive patients who developed colonic pseudo-obstruction, profuse watery diarrhoea and severe hypokalemia. Investigations excluded mechanical intestinal obstruction. Usual cause of diarrhoea were ruled out. Abdominal distension and diarrhoea improved simultaneously in all cases after colonoscopic decompression or intravenous neostigmine. RESULTS: Faecal ionograms showed a low osmotic gap and high faecal potassium concentration explaining the hypokalemia: 100 to 180 mEq/kg (usually inferior than 50 mEq/l in case of secretory diarrhoea) and low faecal sodium concentrations. Potassium salts were the only factor identified as the driving osmotic force for the diarrhoea. CONCLUSION: Secretory diarrhoea is classically due to chloride active secretion with passive sodium secretion or to inhibition of sodium absorption. In five cases of Ogilvie's syndrome we evidenced an original mechanism of secretory diarrhoea due to active potassium secretion responsible of a profound hypokalemia. This novel type of diarrhoea may be a hallmark of colonic pseudo-obstruction due to colonic distension.
Subject(s)
Colonic Pseudo-Obstruction/complications , Colonic Pseudo-Obstruction/metabolism , Diarrhea/metabolism , Feces/chemistry , Hypokalemia/etiology , Potassium/analysis , Potassium/metabolism , Aged , Aged, 80 and over , Humans , MaleABSTRACT
We report a case of acute renal insufficiency in a 77 year-old patient who took flurbiprofen as antiplatelet therapy. This is an important observation because it illustrates the potential risk of acute renal insufficiency, when using flurbiprofen before invasive medical examination or surgery in patients receiving long-term treatment with angiotensin converting enzyme inhibitors or angiotensin II inhibitors. This risk is probably underestimated in usual clinical practice.
Subject(s)
Acute Kidney Injury/chemically induced , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Flurbiprofen/adverse effects , Aged , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Antihypertensive Agents/adverse effects , Diabetes Mellitus, Type 2/complications , Diabetic Retinopathy , Humans , Male , Platelet Aggregation Inhibitors/adverse effects , Ramipril/adverse effectsABSTRACT
INTRODUCTION: Hypercalcemia is a rare complication of non-Hodgkin lymphoma. Usually, hypercalcemia occurs late in the disease course, except for high-grade lymphoma. Most often hypercalcemia is related to excessive level of circulating PTH-rP or sometimes, 1,25(OH)2D3. Concomitant high plasmatic concentration of PTH-rP and 1,25(OH)2D3 is uncommon. EXEGESIS: We report the case of a 82-year-old man who presented with abdominal pain and weight loss, leading to the diagnosis of diffuse large-B-cell lymphoma (high-grade lymphoma) associated with symptomatic hypercalcemia (3.21mmol/l). PTH-rP and 1,25(OH)2D3 plasmatic levels were high. Calcium concentration was normalized with glucocorticoids and sequential chemotherapy. CONCLUSION: This case report confirms that hypercalcemia, as consequence of excessive plasmatic level of PTH-rP secreted by tumoral cells, can occur early in the course of high-grade lymphoma. Glucocorticoids and chemotherapy are the best treatment options.
Subject(s)
Hypercalcemia/etiology , Lymphoma, Non-Hodgkin/diagnosis , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Humans , Lymphoma, Non-Hodgkin/diagnostic imaging , Lymphoma, Non-Hodgkin/drug therapy , Male , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
We reported a 92-year-old woman with hyponatremia (117 mmol/l) occurring three days after the introduction of tramadol. Diagnosis of inappropriate antidiuretic hormone secretion was based on blood and urinary analysis and dosage of antidiuretic hormone. Natremia became normal after tramadol cessation and fluid restriction. Natremia must be measured when neurological abnormality occurs with tramadol treatment.
Subject(s)
Hyponatremia/chemically induced , Tramadol/adverse effects , Aged, 80 and over , Analgesics, Opioid/adverse effects , Female , Humans , Muscle, Skeletal , Pain/drug therapy , Vasopressins/metabolismABSTRACT
PURPOSE: Anemia in patients with alcoholic liver cirrhosis is a common issue. The diagnosis could be difficult because of the multiplicity of causes, usually associated, and specificities in the diagnostic approach. This subject has not been reviewed for almost two decades. We propose a review based upon analysis of the literature and our clinical experience. CURRENT KNOWLEDGE AND KEY POINTS: Because of the alcoholism and the biological consequences of the liver disease, laboratory findings, especially the mean corpuscular volume, should be interpreted with caution in the diagnostic approach. Despite these drawbacks, the diagnosis of anemia is detailed according to the usual plan: normocytic, macrocytic and microcytic anemias. Finally, we propose practical guidelines. FUTURE PROSPECTS AND PROJECTS: Further prospective studies should assess the real burden of nutritional deficiencies, easily treatable. The prognostic significance of hemolytic anemias in patients with alcoholic liver cirrhosis should be studied.
Subject(s)
Anemia/diagnosis , Liver Cirrhosis, Alcoholic/complications , Acute Disease , Anemia/epidemiology , Anemia/etiology , Anemia, Hemolytic/diagnosis , Diagnosis, Differential , Hemorrhage/complications , Humans , Liver Cirrhosis, Alcoholic/epidemiology , Practice Guidelines as TopicSubject(s)
Abdominal Pain/etiology , Cysts/diagnosis , Gastric Mucosa , Gastritis/diagnosis , Gastroscopy , Polyps/diagnosis , Stomach Diseases/diagnosis , Stomach Neoplasms/diagnosis , Aged , Cysts/pathology , Cysts/surgery , Female , Follow-Up Studies , Gastric Fundus/pathology , Gastric Fundus/surgery , Gastric Mucosa/pathology , Gastric Mucosa/surgery , Gastritis/pathology , Gastritis/surgery , Humans , Polyps/pathology , Polyps/surgery , Stomach Diseases/pathology , Stomach Diseases/surgery , Stomach Neoplasms/pathology , Stomach Neoplasms/surgeryABSTRACT
OBJECTIVE: Mesenteric panniculitis is a rare disorder characterized by nonspecific inflammation and/or necrosis and/or fibrosis in the adipose tissue of the bowel mesentery. Its signification, primary or associated with other diseases, is a subject of controversy. METHODS: A descriptive and retrospective study of patients with an abdominal CT examination showing features of mesenteric panniculitis and for whom biopsy with immunohistochemical examination was obtained in all cases. RESULTS: Seven patients were enrolled (4 men and 3 women) with a median age of 62,1 years. None of the patients without an identified etiology had a history of abdominal surgery. An associated disease was identified in 4 cases: breast cancer (1), non-Hodgkin's lymphoma based on peripheric lymph nodes biopsy (2) and cryoglobulinemic vascularitis based on renal biopsy (1). In the 3 remaining cases, isolated mesenteric panniculitis was the only abnormality despite thorough imaging and pathologic investigations. CONCLUSION: Except an obvious malignancy context or a history of abdominal surgery, a pathologic examination of the mesenteric panniculitis lesions is necessary, especially to eliminate another mesenteric disorder. Mesenteric panniculitis is often associated with lymphoma.
Subject(s)
Panniculitis, Peritoneal/etiology , Adult , Aged , Biopsy , Breast Neoplasms/complications , Cryoglobulinemia/complications , Female , Humans , Immunohistochemistry , Lipodystrophy/complications , Lymphoma, Non-Hodgkin/complications , Male , Middle Aged , Panniculitis, Peritoneal/pathology , Retrospective Studies , Vasculitis/complicationsABSTRACT
INTRODUCTION: Thromboembolic events are serious complications in patients with inflammatory bowel disease. EXEGESIS: An 18-year-old patient, with a one year history of ulcerative colitis, presented with cerebral venous thrombosis during the decreasing period of corticotherapy after an active phase of the disease. Under treatment, the neurological disorder rapidly improved. No inherited thrombophilia was found. CONCLUSION: The role of acquired and inherited risks factors is discussed.
Subject(s)
Colitis, Ulcerative/complications , Sinus Thrombosis, Intracranial/etiology , Adolescent , Anticoagulants/therapeutic use , Colitis, Ulcerative/drug therapy , Humans , Male , Sinus Thrombosis, Intracranial/drug therapy , Treatment OutcomeABSTRACT
AIM OF THE STUDY: To determine diagnostic modalities and both immediate and long-term treatment of superior mesenteric venous thrombosis. PATIENTS AND METHODS: Retrospective study from 1997 to 2004 in two institutions concerning patients with superior mesenteric vein thrombosis. RESULTS: Nine patients (all males, mean age=55 years), were included. Abdominal pain (100%), vomiting (44%), and bowel activity disorders (44%) were the most common symptoms. A personal or familial thrombosis history was present in 67% of patients. A genetic predisposing factor of thrombosis was present in 78% of patients. The diagnosis was established with CT-scan in 8 cases with a mean delay of 8 days. Treatment was exclusively medical in 33% of patients and included surgery in 67%. All operated patients underwent resection for bowel infarction and only one had immediate anastomosis. All enterostomies were subsequently closed. No patient died. CONCLUSION: Diagnosis of superior mesenteric vein thrombosis is frequently delayed and relies on CT-scan with intravenous contrast. Prognosis is globally favourable but depends on early application of anticoagulation therapy. In case of surgery, bowel-sparing resection is indicated and enterostomies are often needed. Genetic disorders predisposing to thrombosis are very frequent, that may indicate prolonged even definitive anticoagulation therapy.
Subject(s)
Mesenteric Vascular Occlusion/diagnosis , Mesenteric Veins/pathology , Venous Thrombosis/diagnosis , Abdominal Pain/diagnosis , Enterostomy , Fibrinolytic Agents/therapeutic use , Genetic Predisposition to Disease , Humans , Infarction/surgery , Intestinal Diseases/diagnosis , Intestine, Small/blood supply , Male , Mesenteric Vascular Occlusion/therapy , Middle Aged , Retrospective Studies , Thrombectomy , Thrombolytic Therapy , Time Factors , Tomography, X-Ray Computed , Venous Thrombosis/genetics , Venous Thrombosis/therapy , Vomiting/diagnosisSubject(s)
Brain/abnormalities , Cornea/abnormalities , Hepatolenticular Degeneration , Adult , Chelating Agents/therapeutic use , Enzyme Inhibitors/therapeutic use , Forecasting , Hepatolenticular Degeneration/diagnosis , Hepatolenticular Degeneration/genetics , Humans , Magnetic Resonance Imaging , Male , Molybdenum/therapeutic useABSTRACT
Frequently found in kidney, angiomyolipoma is a rare mesenchymal tumor when diagnosed in the liver and usually benign composed of proliferative blood vessels, fatty tissue and smooth muscle. We report the case of a 67-year-old woman who underwent a left hepatectomy for a 4th segment tumor unidentified after imaging and fine needle biopsy. Final anatomopathologic examination revealed an epithelioïd hepatic angiomyolipoma with signs of malignant behaviour as vascular and lymphatics embolus and invaded left portal vein thrombosis. During the subsequent 24-month follow-up, no recurrence was observed. A review of the literature found only two cases of malignant hepatic angiomyolipoma with fatal issue, however, their incidence must be underrated because of their scarcity and the difficulty of their diagnosis, which needs immunohistochemical confirmation with HMB 45 in particularly. Advances in imaging and anatomopathology in particular with the concept of PEComa (Perivascular-Epithelioïd Cell) as the unifying feature should lead to the recognition of the various variant patterns and cell types. The latter which are important for a correct diagnosis, in order to obtain reliable data about frequency, possible malignant behaviour and therefore consensus management for hepatic angiomyolipoma.