ABSTRACT
Primary esophageal lymphoma is extremely rare, with fewer than 30 cases reported in the literature. Presentation is nonspecific with multiple radiological and endoscopic appearances, posing its diagnosis a challenge. We report a case of a primary esophageal lymphoma diagnosed by endoscopic ultrasound-fine needle aspiration in a 68-year-old woman referred to our hospital for evaluation of a submucosal tumor spreading all over the esophageal wall. We describe its clinical and imaging features and stand out the importance of having a specific preoperatory diagnosis in order to avoid a major surgery.
Subject(s)
Autoimmune Diseases , Bile Duct Neoplasms , Cholangiocarcinoma , Cholangitis, Sclerosing , Autoimmune Diseases/diagnosis , Bile Duct Neoplasms/diagnosis , Bile Ducts, Intrahepatic , Cholangiocarcinoma/diagnosis , Cholangitis, Sclerosing/diagnostic imaging , Diagnosis, Differential , Humans , Immunoglobulin GABSTRACT
The pancreatoduodenal groove is a small area where pathologic processes involving the distal bile duct, duodenum, pancreatic head, ampulla of Vater, and retroperitoneum converge. Despite great advances in imaging techniques, a definitive preoperative diagnosis is challenging because of the complex anatomy of this area. Therefore, surgical intervention is frequently required because of the inability to completely exclude malignancy. We report 3 cases of patients with different groove pathologies but similar clinical and imaging presentation, and show the essential role of endoscopic ultrasound (EUS) in making a specific preoperative diagnosis, excluding malignancy in the first case, changing diagnosis in the second case, and confirming malignancy in the third case. EUS was a fundamental tool in this cohort of patients, not only because of its ability to provide superior visualization of a difficult anatomical region, but because of the ability to guide precise, realtime procedures, such as fine-needle aspiration.
ABSTRACT
Complications of celiac disease could present with intestinal perforation and rarely, gastrointestinal bleeding, which are usually secondary to nongranulomatous ulcerative jejunoileitis or T-cell lymphoma. We describe the case of a 66-year-old male patient with an 8-year history of celiac disease (CD) who presented with recurrent abdominal pain and gastrointestinal bleeding. Several tests were performed to find out possible complications associated to CD. Due to an overt gastrointestinal bleeding, an arteriography was performed and signs of polyarteritis nodosa were found. Vascular disease was aggressive, and despite multiple medical and surgical treatments the patient died. As arteriography is not usually performed for the study of the complications of CD, it is possible that the association between CD and PAN has been underdiagnosed.
