Epithelioid hemangioma of liver-The first reported case.

Epithelioid hemangioma, otherwise known as angiolymphoid hyperplasia with eosinophilia, is a rare benign vasoproliferative disease with an unknown etiology. We report the case of a 42-year-old man with routine bloods test showing mildly elevated serum bilirubin level. CT scan revealed a lesion in the left liver lobe not typical of FNH. PET/CT scan and a dynamic liver MRI were consistent with a malignant mass. Surgical resection was performed. Histopathology of the 45 mm mass reported well-defined, slightly lobular proliferations of capillary-sized vessels around several central muscular vessels. Although the endothelial cells revealed a "hobnail" appearance, none of them showed pleomorphism or mitotic activity. Endothelial cells showed reactivity for the endothelial markers (CD34, CD31) and smooth muscle was detected in the blood vessel walls via immunohistochemistry. Despite its benign nature, epithelioid hemangioma of the liver can lead to a diagnostic and therapeutic dilemma due to the malignant looking features on imaging modalities.

Is duodeno-jejunal bypass liner superior to pylorus preserving bariatric surgery in terms of complications and efficacy?

PURPOSE: Based on recent scientific evidence, bariatric surgery is more effective in the management of morbid obesity and related comorbidities than conservative therapy. Pylorus preserving surgical procedures (PPBS) such as laparoscopic single-anastomosis duodeno-jejunal or duodeno-ileal bypass with sleeve gastrectomy are modified duodenal switch (DS) surgical techniques. The duodeno-jejunal bypass liner (DJBL) is a novel surgical method in the inventory of metabolism focused manual interventions that excludes duodeno-jejunal mucosa from digestion, mimicking DS procedures without the risk of surgical intervention. The aim of this article is to summarize and compare differences between safety-related features and weight loss outcomes of DJBL and PPBS. METHODS: A literature search was conducted in the PubMed database. Records of DJBL-related adverse events (AEs), occurrence of PPBS-related complications and reintervention rates were collected. Mean weight, mean body mass index (BMI), percent of excess of weight loss (EWL%), percent of total weight loss (TWL%) and BMI value alterations were recorded for weight loss outcomes. RESULTS: A total of 11 publications on DJBL and 6 publications on PPBS were included, involving 800 and 1462 patients, respectively. The baseline characteristics of the patients were matched. Comparison of DJBL-related AEs and PPBS-related severe complications showed an almost equal risk (risk difference (RD): -0.03 and confidence interval (CI): -0.27 to 0.21), despite higher rates among patients having received endoscopic treatment. Overall AE and complication rates classified by Clavien-Dindo showed that PPBS was superior to DJBL due to an excess risk level of 25% (RD: 0.25, CI: 0.01-0.49). Reintervention rates were more favourable in the PPBS group, without significant differences in risk (RD: -0.03, CI: -0.27 to 0.20). However, PPBS seemed more efficient regarding weight loss outcomes at 1-year follow-up according to raw data, while meta-analysis did not reveal any significant difference (odds ratio (OR): 1.08, CI: 0.74-1.59 for BMI changes). CONCLUSION: Only limited conclusions can be made based on our findings. PPBS was superior to DJBL with regard to safety outcomes (GRADE IIB), which failed to support the authors' hypothesis. Surgical procedures showed lower complication rates than the incidence of DJBL-related AEs, although it should be emphasized that the low number of PPBS-related mild to moderate complications reported could be the result of incomplete data recording from the analysed publications. Weight loss outcomes favoured bariatric surgery (GRADE IIB). As the DJBL is implanted into the upper gastrointestinal tract for 6 to 12 months, it seems a promising additional method in the inventory of metabolic interventions.

Mesenteric actinomycosis / Mesenterialis actinomycosis.

Összefoglaló. Egy 46 éves nobeteg esetét ismertetjük, akinél láz és görcsös hasi fájdalom miatt kezdodött kivizsgálás. A hasi ultrahangvizsgálat során a colon transversum területén megvastagodott falú konglomerátum volt látható. A kolonoszkópia során organikus eltérés nem igazolódott. A hasi komputertomográfiás vizsgálat retroperitonealis térfoglalást írt le, ezért onkológiai bizottság javaslata alapján mutét mellett döntöttünk. Egy hónappal a panaszok jelentkezése után megtörtént a mutét, melynek során úgy tunt, hogy egy megközelítoleg 5 × 8 centiméteres, a vékonybélbol kiinduló, a colon ascendenst és a sigmabelet is érinto, daganatnak imponáló terimét találtunk. Jobb oldali hemicolectomiát végeztünk, és reszekáltuk a sigmabélfal részletét. A szövettani vizsgálat malignitást nem igazolt, hanem a bélfallal összefüggést nem mutató, mesenterialis actinomycosist írt le. A hasi, mesenterialis actinomycosis ritka kórkép, mégis fontos, hogy gondoljunk rá mint differenciáldiagnosztikai lehetoségre, így a beteg a leheto leghamarabb megkaphatja a megfelelo kezelést. Esettanulmányunk bemutatásával a kórkép ismeretének fontosságára szeretnénk felhívni a figyelmet. Orv Hetil. 2021; 162(3): 116-119. Summary. We present the case of a 46-year-old female, who presented with fever and abdominal pain. Abdominal ultrasound revealed a thickened-walled conglomerate near the transvers colon. Colonoscopy did not show any organic abnormality. Abdominal computed tomography described a retroperitoneal mass, so we decided on surgery based on the multidisciplinary team decision. One month after the onset of symptoms, laparotomy was performed, and it seemed that we found an approximately 5 × 8 centimetre tumour attached to the small intestine involving the ascending and sigmoid colon. We performed right hemicolectomy and sigmoid colon wall resection. Histology result showed mesenteric actinomycosis with no connection to the intestinal wall, no malignancy was revealed. Although the abdominal, mesenteric actinomycosis is a rare disease, it is important to think of it as a differential diagnostic option, so the patient can get proper treatment and cured sooner. Our aim with presenting this case report is to highlight the significance of this disease. Orv Hetil. 2021; 162(3): 116-119.