Submucosal tumor-like lesion originating from colon tuberculosis: a case report and review of the literature.

A 76-year-old male had a solitary submucosal tumor-like lesion in the sigmoid colon originating from tuberculosis. The lesion, up to 1 cm in diameter, was found incidentally during a routine colonoscopy, which revealed a protuberant submucosal growth with a shallow depression of the overlying mucosa in the center of the tumor. Histologically, the endoscopic biopsy revealed caseating granulomas and infiltration of Langhans giant cells and epithelioid cells, consistent with tuberculosis, were also observed. Five reports of similar lesions from colon tuberculosis were found in a literature review, including the present case. In all cases, the submucosal tumor-like lesions which originated from tuberculosis were small and in an active stage of tuberculosis. Five cases of submucosal tumor-like lesions from gastric tuberculosis were also reported, with characteristics very similar to those of the lesions from colon tuberculosis. Therefore, we propose that lesions originating from tuberculosis should be included in the differential diagnosis of submucosal tumor-like lesions in the colon and stomach.

Characteristics of small bowel tumors detected by double balloon endoscopy.

BACKGROUND: A few reports suggest that the emergence of double balloon endoscopy (DBE) has likely changed the clinical picture of small bowel tumors (SBTs). AIM: To further clarify the characteristics of SBTs detected by DBE. METHODS: A retrospective chart review was conducted in 227 patients who had undergone DBE. RESULTS: The SBT group contained more symptomatic patients than the non-SBT group (90% vs. 49%, P<0.0005) with a significantly higher rate of gastrointestinal symptoms at presentation (72% vs. 33%, P<0.005). Twenty patients (8.8%) were eventually diagnosed with SBT, and their indications for DBE were obscure gastrointestinal bleeding (n=5), abdominal pain (n=5), abdominal fullness (n=5), vomiting (n=2), and diarrhea (n=1). Tumors were located in the jejunum in 14 patients (70%) and in the ileum in 6 (30%). A final histological diagnosis was assigned to all 20 patients: primary adenocarcinoma (n=8, 40%), malignant lymphoma (n=5, 25%), metastatic cancer (n=4, 20%), gastrointestinal stromal tumor (n=1, 5%), carcinoid tumor (n=1, 5%) and inflammatory fibroid polyp (n=1, 5%). Stenosis or ulceration were the most frequently observed endoscopic findings (n=13, 65%). All primary adenocarcinomas and three of four (75%) metastatic cancers showed stenosis or ulceration. Three of five (60%) malignant lymphomas showed multiple lymphomatous polyps. All patients but one underwent surgical resection or chemotherapy or both. CONCLUSION: DBE is a safe and useful procedure that enables a precise diagnosis of SBTs.