Misdiagnosis of an elevated lesion in the esophagus: A case report.

BACKGROUND: Esophageal carcinosarcoma (ECS) is a rare biphasic tumor and a type of esophageal malignancy, which presents as protruding or elevated lesions. ECS patients are often not hospitalized until they have severe dysphagia. ECS is easily misdiagnosed as a benign tumor due to its atypical characteristics under endoscopy. With the popularization of endoscopic treatment, these patients are often referred to endoscopic treatment, such as endoscopic submucosal dissection (ESD). However, there is a lack of consensus on the endoscopic features and therapies for ECS. Here, we report a case of ECS and discuss the value of endoscopic diagnosis and therapeutic strategies. CASE SUMMARY: A 63-year-old man was admitted to the hospital with dysphagia. During the endoscopic examination, an elevated lesion was found with an erosive and hyperemic surface covered with white pseudomembranous inflammation. Endoscopic ultrasonography (EUS), biopsies, and enhanced thoracic computed tomography were performed, suggesting that it was a benign lesion and located within the submucosal layer. This lesion was diagnosed as a fibrovascular polyp with a Paris classification of 0-Ip. The patient was then referred to ESD treatment. However, the post-ESD pathological and immunohistochemical study showed that this lesion was ECS with a vertical positive margin (T1b stage), indicating that we made a misdiagnosis and achieved a noncurative resection. Due to the potential tumor residue, additional open surgery was performed at the patient's request. In the postoperative pathological study, no tumor remnants or metastases were discovered. The patient was followed for 1 year and had no recurrence. CONCLUSION: ECS can be misdiagnosed at the initial endoscopy. EUS can help to identify the tumor stage. Patients with T1b stage ECS cannot be routinely referred to ESD treatment due to the high risk of metastasis and recurrence rate.

Endoscopic and Pathological Characteristics of Cronkhite- Canada Syndrome: A Retrospective Analysis of 76 Cases.

BACKGROUND: Cronkhite-Canada syndrome (CCS) is a disease of unknown etiology characterized by the presence of multiple gastrointestinal polyps, chronic diarrhea, loss of appetite, alopecia, onychodystrophy, and cutaneous hyperpigmentation. CCS is a rare disease with an incidence rate of 1 per million. Clinicians are not aware of this disease, and the discovery of gastrointestinal polyps is often a starting point for the diagnosis of this disease. By analyzing the endoscopic and pathological characteristics of CCS, this study aims to deepen our understanding of gastrointestinal polyposis and facilitate early diagnosis of CCS. METHODS: We screened databases, including the Chinese Biomedical Literature Database (CBM Web), the China Academic Journals Fulltext Database (CJFD), and PubMed for CCS cases reported from January 2010 to January 2020, and conducted a retrospective analysis of endoscopic and pathological characteristics of these cases. RESULTS: The endoscopic data of the 76 retrieved cases revealed that CCS is gastrointestinal polyposis with the intensive and confluent distribution. The greater the number of polyps and the higher their distribution, the brighter their color. A pathological assessment revealed that both gastric polyps and intestinal polyps are mainly juvenile hamartomatous polyps and have a high malignant transformation rate. Interstitial edema, eosinophil infiltration, and cystic dilation of glands are common features of CCS polyps, distinguishing them from other gastrointestinal polyposis syndromes. CONCLUSION: CCS is a polyp disease different from other gastrointestinal polyposis. Analysis of its endoscopic and pathological characteristics can contribute to the understanding and early diagnosis of the disease.

Effect of chitosan on blood profile, inflammatory cytokines by activating TLR4/NF-κB signaling pathway in intestine of heat stressed mice.

Heat stress can significantly affect the immune function of the animal body. Heat stress stimulates oxidative stress in intestinal tissue and suppresses the immune responses of mice. The protecting effects of chitosan on heat stress induced colitis have not been reported. Therefore, the aim of this study was to investigate the protective effects of chitosan on immune function in heat stressed mice. Mice were exposed to heat stress (40 °C per day for 4 h) for 14 consecutive days. The mice (C57BL/6J), were randomly divided into three groups including: control group, heat stress, Chitosan group (LD: group 300 mg/kg/day, MD: 600 mg/kg/day, HD: 1000 mg/kg/day). The results showed that tissue histology was improved in chitosan groups than heat stress group. The current study showed that the mice with oral administration of chitosan groups had improved body performance as compared with the heat stress group. The results also showed that in chitosan treated groups the production of HSP70, TLR4, p65, TNF-α, and IL-10 was suppressed on day 1, 7, and 14 as compared to the heat stress group. In addition Claudin-2, and Occludin mRNA levels were upregulated in mice receiving chitosan on day 1, 7, and 14 of heat stress. Furthermore, the IL-6, IL-10, and TNF-α plasma levels were down-regulated on day 1, 7, and 14 of heat stress in mice receiving the oral administration of chitosan. In conclusion, the results showed that chitosan has an anti-inflammatory ability to tolerate hot environmental conditions.

Delayed bowel obstruction after seat belt injury: a case report.

BACKGROUND: Delayed bowel obstruction due to seat belt injury is extremely rare. The delayed onset of nonspecific symptoms makes a timely diagnosis difficult. A deep understanding of the characteristics of this condition is helpful for early diagnosis and treatment. CASE PRESENTATION: A 39-year-old male was transferred to our hospital from another hospital complaints of progressive abdominal distension and severe weakness. In the previous hospital, he was diagnosed with "adult megacolon" and was recommended for surgical treatment. In our hospital, he was diagnosed with delayed bowel obstruction due to seat belt injury and underwent surgical intervention. Following laparoscopic adhesiolysis and resection of the narrow small intestine, his symptoms improved rapidly, and he was discharged. CONCLUSION: Delayed bowel obstruction due to seat belt injury may present clinical symptoms any time after the injury. Imaging examination, ileus tube and small colonoscopy may provide us with valuable cues for the diagnosis and treatment of delayed bowel obstruction, and laparoscopy may be an alternative approach in surgical intervention.

Endoscopic resection of giant gastrointestinal stromal tumor at the esophagogastric junction: a case report.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) at the esophagogastric junction are rare and its treatment is complicated and challenging. Endoscopic resection has advantages with less complications compared to open and laparoscopic surgery. CASE PRESENTATION: We report a 33-year-old male patient who was admitted to our department complaining of abdominal fullness for 20 days. A huge submucosal tumor at the esophagogastric junction was found by upper gastrointestinal endoscopy. We successfully resected the lesion through endoscopic submucosal excavation without complications, which was pathologically confirmed to be a GIST. The patient was discharged 5 days after operation and has been doing well, and there was no recurrence 8 months after the operation. CONCLUSION: ESE is possibly an effective and minimally invasive method of giant esophagogastric junction stromal tumor.

[Helminth Infections in Goats in Nimu County of Tibet].

Postmortem examinations were made in 99 goats in Nimu County of Tibe, and parasites were collected and identified based on morphology. The collected parasites were categorized, and infection status was analyzed. The helminth infection rate was 100% among the goats, and all showed a pattern of mixed infection. The identified parasites belonged to 21 species, 15 genera, and 9 families. The Trichuris genus（36.4%） was the most prevailing among nematodes in the gastrointestinal tract; Paramphistomum cervi（60.6%） and Paramphistomum gotoi（60.6%） were predominant among trematodes detected; Cysticercus tenuicollis（52.5%） was the predominant cestode detected; and Orientobilharzia turkestanicum was the major parasite detected in the portal vein (69.7%).