A Rare Case of Juvenile Polyposis Syndrome Mimicking Ménétrier's Disease.

There is a wide differential diagnosis within polyposis syndromes. Our case represents an interesting and diagnostically challenging diagnosis involving a 41-year-old male who presented with an incidental gastric mass on imaging and a colonic mass seen on colonoscopy. Following multiple endoscopic evaluations, histological analysis, and genetic testing, the patient was ultimately diagnosed with juvenile polyposis syndrome (JPS)/hereditary hemorrhagic telangiectasia (HHT) despite the initial suspicion for Ménétrier's disease. His disease course was complicated by an acute upper extremity thrombus and diagnosis of colorectal carcinoma. This case highlights the importance of a thorough evaluation when polyposis syndromes are suspected. Prompt and accurate diagnosis can aid in the treatment, surveillance, and prevention of colorectal carcinoma.

Changes in Eustachian Tube Mucosa in Mice After Short-Term Tobacco and E-cigarette Smoke Exposure.

OBJECTIVES: To evaluate histologic changes in middle ear and eustachian tube (ET) mucosa of mice after exposure to tobacco or electronic cigarette (e-cigarette) smoke. To determine whether there were any mitigating effects of middle ear application of anti-IL-13 or the epidermal growth factor receptor antagonist AG1478 on noted changes within ET mucosa. STUDY DESIGN: Controlled animal study. METHODS: Fifty BALB/cJ mice were randomly assigned to one of five groups: A control group with no smoke exposure, two groups exposed to tobacco smoke, and two groups exposed to e-cigarette vapor. Within the exposed groups after 4 weeks of exposure, one ear was infiltrated with a saline hydrogel and the other ear with hydrogel of either Anti-IL-13 or AG1478. After four more weeks of exposure, the animals were euthanized and the ETs were evaluated for mucosal changes. RESULTS: Compared to control animals with no smoke exposure, there were significant decreases in the numbers of goblet cells within the ET mucosa of mice exposed to tobacco smoke and e-cigarette vapor. No significant differences in cilia, mucin, or squamous metaplasia were noted. Neither anti-IL-13 nor AG178 significantly altered goblet cell count in the ET mucosa of mice exposed to tobacco smoke; however, both agents significantly increased goblet cells within the ET mucosa of mice exposed to e-cigarette vapor. CONCLUSION: Short-term tobacco smoke and e-cigarette vapor significantly decrease goblet cell count in mouse ET mucosa. Middle ear application of both anti-IL-13 and AG1478 resulted in an increase in goblet cell count among mice exposed to e-cigarette vapor, but not to tobacco smoke. LEVEL OF EVIDENCE: NA Laryngoscope, 132:648-654, 2022.

Sudden death due to leukostasis in a subject with undiagnosed chronic lymphocytic leukemia.

Sudden death due to leukostasis and lymphocyte thrombi in patients with chronic hematologic malignancies is rare. Leukostasis is characterized by highly elevated leukemic cell count and decreased tissue perfusion symptoms, leading to severe complications and even death. Chronic lymphocytic leukemia (CLL) is a chronic lymphoproliferative disorder that shows a highly heterogeneous clinical course, ranging from indolent form to very aggressive disease. Due to its low metabolic and mitotic rate, there is a lower incidence of clinically significant leukostasis in patients with CLL. Two main theories have been proposed in the development of leukostasis: (1) increased blood viscosity due to large leukemic cell populations; (2) high metabolic activity and cytokine production by leukemic cells. Both mechanisms lead to local hypoxic damage.We present a case of a 70-year-old man who died suddenly in the absence of symptoms. Autopsy and histology examinations revealed findings consistent with CLL and diffuse leukostasis involving the major organs' vessels.In the presence of gross and/or microscopic findings suggesting a potential hematologic malignancy, undiagnosed or relapsing hematologic malignancies should be considered in the differential diagnosis of sudden deaths.

A rare case of adrenal collision tumor: Myelolipoma and schwannoma in the adrenal gland.

Adrenal collision tumors refer to coexistence of two adjacent, but histologically distinct, neoplasms involving the adrenal gland without histologic admixture at the interface. Myelolipoma is a rare but benign neoplasm. As its name implies, displays both mature adipose tissue and hematopoietic elements. These are usually unilateral and asymptomatic. Schwannomas, tumors derived from the peripheral nerve sheath, are also uncommon lesions in the adrenal gland. Here, we present a rare case of a 65-year-old male with clinical history of abdominal aortic aneurysm who was found to have a 13-cm "incidentaloma" by interventional radiologist during his aortic endograft control. Giving the size of the mass, team decided to excise it, and histopathological examination was performed. While most incidentally discovered adrenal tumors are benign, surgical excision is recommended in large lesions to exclude malignancy, avoid hemorrhage, and/or acute adrenal insufficiency. Given the rarity of such entity, its clinical course and prognosis remains unclear.

Peripheral artery leiomyosarcoma.

Vascular leiomyosarcomas are extremely rare tumors and represent only 0.001% of all malignancies. Venous leiomyosarcomas occur five times more often than arterial ones, with 50% of them originating in the inferior vena cava (IVC). Arterial leiomyosarcomas are most commonly encountered in the great vessels with less than 50% of them occurring in the peripheral circulation. A total of only seven cases of arterial leiomyosarcomas involving the femoral artery have been reported in literature to date. We report a case of an arterial leiomyosarcoma involving the profunda femoris artery, and provide a comprehensive review on peripheral arterial leiomyosarcomas-distribution, clinical presentation, radiological and histological diagnosis, staging, and treatment.