["Giant" fibrovascular esophageal polyp]. / "Gigantischer" fibrovaskulärer Polyp des Ösophagus.

Fibrovascular polyps are rare mesenchymal tumors that arise mainly in the cricopharyngeal portion of the esophagus. They may protrude distally to become "giant" pedunculated lesions filling almost the entire esophageal lumen. Histologically they contain varying amounts of adipose, fibrous and vascular tissues and belong to spindle cell lipomas according to the classification of soft tissue tumors. Immediate resection of these benign lesions is warranted as they may be regurgitated and cause asphyxia. These lesions are usually treated by open surgery (left cervicotomy) or, less invasively, by peroral endoscopic surgery. Polyp removal by flexible endoscopy has been described but may be hazardous if its stalk is broad-based. In this report the case of a 73-year-old male with dysphagia is described in whom a "giant" fibrovascular polyp was diagnosed endoscopically and promptly removed surgically by the peroral route. At control endoscopy 14 months later, the asymptomatic patient was free of polyp recurrence.

[Lymphoma-induced antiphospholipid syndrome as a cause of splenic infarction]. / Lymphom-induziertes Antiphospholipidsyndrom als Ursache von Milzinfarkten.

HISTORY AND ADMISSION FINDINGS: A 71-year-old man presented with bilateral sialadenosis of the parotid gland, episodes of fever up to 39 °C, general malaise and weight loss of 5 kg within the last 6 weeks. At physical examination peripheral lymph nodes were not palpable. INVESTIGATIONS: Laboratory studies revealed a normal white blood cell count, anemia and thrombocytopenia. Serum C-reactive protein and lactate dehydrogenase were elevated on admission and rose further. Plasmatic coagulation was characterized by prolonged partial thromboplastin time and reduced prothrombin time. Abdominal computed tomography showed an enlarged spleen with irregular hypodense areas, indicating splenic infarctions. Enlarged lymph nodes were noted at the paraaortic region and in the splenic hilum. DIAGNOSIS: As the patient`s condition deteriorated from day to day a diagnosis had to be enforced. Splenectomy was thus performed which confirmed the CT findings of numerous infarcted areas. A marginal zone lymphoma was found within the splenic hilar lymph nodes. High titer serum antibodies against cardiolipin confirmed the diagnosis of secondary antiphospholipid syndrome (APS). TREATMENT AND COURSE: Oral anticoagulation with phenprocoumone was started; in addition, chemotherapy with rituximab, cyclophosphamide, vincristin and prednisolone (R-CHOP) was initiated. Despite clinical recovery serological markers of APS remained elevated. The lymphoma recurred only six months after chemotherapy had been completed, and the patient died two months later. CONCLUSION: Because of its potentially fatal consequences anticoagulation and treatment of the underlying disease are crucial in secondary APS.

[Segmental necrotizing colitis in a patient with E. coli O104:H4 infection]. / Segmentale nekrotisierende Kolitis bei einem Patienten mit EHEC-Infektion vom Typ O104:H4.

A 29-year-old man presented with abdominal cramps and bloody diarrhoea. Blood tests revealed elevated C-reactive protein (21.3 mg/dL; normal range 0.01 - 0. 82 mg/dL) and white blood cells (28200/µL, normal range 4000 - 10000/µL). Stool tests were negative for enteropathogenic bacteria and Clostridium difficile toxins A/B. Ultrasound and computed tomography showed massive swelling of the transverse colon and right colonic flexure. At endoscopy, circular necrosis of the mucosa was encountered in the proximal segments of the colon whereas distal parts of the organ showed patchy inflammation of minor severity. Extended stool testing identified Escherichia coli type O104:H4 as the causative microorganism. There was no evidence for haemolytic uraemic syndrome. Under conservative treatment the patient recovered clinically, serologically and endoscopically. At follow-up endoscopy, longitudinal ulcers and vital mucosa were present. In this case report the segmental pattern of mucosal necrosis in a patient with EHEC infection is noteworthy.

Two supernumerary marker chromosomes, originating from chromosomes 6 and 11, in a child with developmental delay and craniofacial dysmorphism.

The interpretation of the significance of marker chromosomes, which can be encountered at prenatal diagnosis, is extremely problematic. Various factors contribute to the difficulty of clarifying the phenotypic risks of supernumerary marker chromosomes, including differences in the size, structure, and origin of marker chromosomes, as well as the occurrence of multiple marker chromosomes of different origin in the same proband. Research on marker chromosomes is currently in a data-accumulation phase. We report the presence of two marker chromosomes, originating from chromosomes 6 and 11, in a child with developmental delay and craniofacial dysmorphism and discuss the related literature.