Changing trend in the spectrum of upper gastrointestinal bleeding in children-A multicentre experience.

In children, upper gastrointestinal bleeding (UGIB) is an uncommon, but potentially serious, condition with diverse etiologies. A prospective study had been undertaken to find out any changing trend in the etiology and outcome of pediatric UGIB in Eastern India. This retrospective analysis of case records of children, presenting in outpatient or emergency with hematemesis and/or melena from 2 tertiary GI centers of Kolkata, was undertaken to find out the etiologies of bleed and the outcome of management. A total of 180 children were evaluated including 30 (16.7%) infants. The predominant cause of GGIB was gastroduodenal ulcer and erosions (60%) followed by variceal bleeding (19.4%). Vascular lesions were detected in 4 (2%). Hyperplastic antral polyp was an unusual etiology in 3 (1.7%) infants. Various endotherapies were needed in 28% of cases. No mortality was noted. Melena, hemoglobin below 8 gm%, the need for volume replacement, and packed red blood cells transfusion on admission were associated with significant endoscopic lesions, which needed endotherapies. This study, comprising the largest cohort among Indian published series, found an etiology of pediatric upper GI bleed, different from the one, previously depicted. This may be a reflection either of regional variations or a changing trend over time.

Unifocal Gastric Langerhans Cell Histiocytosis in a Child-A Unique Case to Remember.

Langerhans cell histiocytosis (LCH) is the most common of the histiocytic disorders and occurs when the body accumulates too many CD1a/CD 207 positive Langerhans cells, a subset of the histiocytes in certain parts of the body where they can form tumors or damage organs. LCH is not a very common diagnosis in the pediatric age group. More than two-thirds of cases have the single-system disease with bones or skin as the commonly involved sites. Here, we present a 4-year-old child who had acute abdominal pain as chief complaint and etiological workup eventually led to a diagnosis of gastric LCH without affection of any other organ system. To the best of our knowledge, this is the first report of a unifocal gastric LCH in a child.

Intratumoral granulomatous reaction in recurrent pituitary adenoma: A unique presentation.

Pituitary adenoma is one of the most common intracranial neoplasms, usually presenting with endocrinopathies or visual field defects. Granulomatous hypophysitis, one of the subtypes of primary hypophysitis, is a rare neurological entity presenting as a sellar lesion with mass effect symptoms and endocrinological dysfunction. Majority of cases of primary hypophysitis are misdiagnosed as pituitary adenomas preoperatively, and histopathology is required for a definitive diagnosis. Granulomatous hypophysitis can be primary/idiopathic or secondary to a variety of causes such as infection, foreign body reactions, and systemic inflammatory conditions. The presence of tumoral microgranulomas in pituitary adenoma is exceedingly rare, having been documented only twice previously. We present a unique case of recurrent pituitary macroadenoma in a 59-year-old woman with histopathological features of idiopathic intratumoral noncaseating granulomatous inflammation. The presence of a granulomatous response in the absence of a systemic infectious or inflammatory disorder is suggestive of a local tumoral response to an as-yet unidentified antigen.

Bilateral ovarian metastases as the presenting manifestation of lung carcinoid in a 50-year-old woman: Case study and review of literature.

Neuroendocrine tumors (NETs) are neoplasms arising from dispersed neuroendocrine cells, localized to the gastrointestinal tract (GIT), lungs, adrenal medulla, and other sites. The term "carcinoid tumor" is usually limited to NETs of the lung and GIT. Ovarian carcinoids are uncommon, accounting for 0.1% of ovarian malignancies and 5% of all NETs. Primary ovarian tumors arise in pure form or as a component of teratomas, while ovarian NET metastases are predominantly from gastrointestinal primaries. To the best of our knowledge, there are only two previous reports of bronchopulmonary carcinoids (PCs) metastasizing to the ovaries. We describe a case of PC in a 50-year-old woman, with bilateral ovarian tumors as the presenting manifestation of the disease, and discuss the clinical and pathobiologic significance of this presentation.

Isolated ileal ganglioneuromatosis in an 11-year-old boy: Case report and review of literature.

Ganglioneuromatous proliferation in the gastrointestinal tract is a rare occurrence and is usually associated with specific syndrome complexes such as multiple endocrine neoplasia Type 2B or von Recklinghausen's disease. We report here a case of diffuse intestinal ganglioneuromatosis, presenting as intestinal obstruction and chronic constipation in an 11-year-old boy. Sporadic cases of intestinal ganglioneuromatosis in the absence of any systemic manifestations are a very rare cause of enteric motility disorders in childhood, and we discuss the pathological and clinical significance of this finding. Histopathological identification of this uncommon cause of a common pediatric problem is important since the condition is amenable to surgical treatment.

IgG Lambda Myeloma Presenting as Plasmacytic Ascites: Case Report and Review of Literature.

Multiple myeloma is a neoplastic disease of plasma cells accounting for 13 % of haematological malignancies and 2 % of all malignancies worldwide. Ascites may develop very rarely during the course of disease in multiple myeloma. We report the case of a 78 years old male with IgG lambda multiple myeloma who initially presented with plasmacytic ascites. An exhaustive review of world literature reveals 65 cases of ascites to have been reported in myeloma over a span of 62 years (1952 till date), usually developing in the course of treatment. This is the 7th case of plasmacytic ascites to have been diagnosed at initial presentation. We review the clinical features, diagnosis, prognostic significance and treatment of such cases.

Gastric, pancreatic, and ureteric duplication.

We report a case of an 8-month-old, asymptomatic child who was incidentally detected to have two cystic structures in the abdomen. Surgical exploration revealed a gastric and pancreatic duplication cyst along with a blind-ending duplication of the right ureter. Excision of the duplications was relatively straightforward, and the child made an uneventful recovery. This constellation of duplications has not been reported before.