1/17. Idiopathic giant esophageal ulcers in a renal transplant patient responsive to steroid therapy.Idiopathic giant esophageal ulcers in immunocompromised patients have been described only in patients with acquired immunodeficiency syndrome. A solitary report of an idiopathic giant esophageal ulcer in an immunocompetent patient exists. We describe a case of idiopathic esophageal ulceration ultimately responsive to steroid therapy in a 31-year old immunosuppressed, human immunodeficiency virus-negative renal transplant patient. The case is described with particular reference to the evaluation, differential diagnosis, and therapeutic response to steroids. Similarities in presentation and treatment to giant esophageal ulcers in human immunodeficiency virus infection suggest an underlying immune defect as the likely cause. This is the first described case of giant esophageal ulceration responsive to steroids in an immunosuppressed human immunodeficiency virus-negative patient. This entity should be added to the differential diagnosis of esophageal ulceration in solid organ transplant recipients.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/17. Idiopathic giant esophageal ulcer in an hiv-positive child.We report a 3-year old hiv-positive female with a 2-cm deep ulcer in the mid-esophagus. A presumptive diagnosis of idiopathic giant ulcer was made after infectious pathogens had been excluded. The child was successfully treated with steroids. Although infectious causes of giant esophageal ulcers in hiv-positive children are common, the diagnosis of idiopathic giant ulcer must be considered in order to institute proper therapy.- - - - - - - - - - ranking = 0.875keywords = giant (Clic here for more details about this article) |
3/17. Giant fibrovascular polyp of the esophagus. A lesion causing upper airway obstruction and syncope.Giant fibrovascular polyp of the esophagus is a rare but dramatic entity. These large polyps arise in the proximal esophagus and can cause airway obstruction secondary to mechanical pressure on the larynx, or they can present as a mass that is regurgitated into the oral cavity. We present a 66-year-old man who complained of nausea and vomiting that were associated with a fibrovascular polyp protruding into the mouth. He had also experienced several episodes of syncope resulting from intermittent airway obstruction. He underwent an open resection of an 11.8-cm fibrovascular polyp and an endoscopic resection of a second fibrovascular polyp 2 days later. Histopathologically, both masses were composed of a mixture of mature adipose tissue lobules and fibrovascular tissue, lined by reactive squamous epithelium. Despite their large size, giant fibrovascular polyps should be recognized radiologically and pathologically as benign lesions. However, they can result in significant morbidity.- - - - - - - - - - ranking = 0.125keywords = giant (Clic here for more details about this article) |
4/17. Esophageal tuberculosis presenting with an appearance similar to that of carcinoma of the esophagus.A case of esophageal tuberculosis presenting with an appearance similar to that of esophageal cancer is reported. The patient was an 82-year-old man with progressive dysphagia. barium swallow and esophagoscopy revealed an elevated lesion with deep ulceration in the middle thoracic esophagus. Esophageal carcinoma, in particular, an undermining type of undifferentiated carcinoma, was suspected fluoroscopically and endoscopically. Histological examination of biopsy specimens revealed no malignancy, but there were epithelioid granulomas and a few Langhans' type multinucleated giant cells. Endoscopic ultrasonography clearly demonstrated an extramural lesion with calcification and direct infiltration of enlarged subcarinal lymph nodes into the esophageal wall. Ultrasonographic and histological findings indicated the possibility of esophageal tuberculosis. Although no bacteriological evidence was obtained, a therapeutic trial for tuberculosis, using antituberculous drugs, was started. After 2 weeks, the enlarged subcarinal lymph nodes were markedly reduced in size. The patient's symptoms improved gradually and had disappeared 8 weeks after he started treatment, when tubercle bacilli were isolated from sputum. A connection between the esophageal wall and its adjacent structures was clearly demonstrated by endoscopic ultrasonography. For patients with findings indicative of esophageal tuberculosis on endoscopic ultrasonography, a therapeutic trial for tuberculosis should be considered, even if polymerase chain reaction assay or culture is negative.- - - - - - - - - - ranking = 0.125keywords = giant (Clic here for more details about this article) |
5/17. Giant fibrovascular polyp of the esophagus.The role of endoscopic ultrasound (EUS) in the diagnosis and management of a giant fibrovascular polyp of the esophagus in a 46-year-old woman is described here. The fibrovascular polyp was detected at esophagogastroduodenoscopy, and EUS demonstrated that it originated from the submucosa. EUS-guided fine-needle aspiration was performed, and cytological examination of the specimen revealed benign fibro-fatty elements. The lesion was resected via a transcervical esophagotomy. The literature on fibrovascular polyps is reviewed.- - - - - - - - - - ranking = 0.125keywords = giant (Clic here for more details about this article) |
6/17. Primary esophageal tuberculosis.A case of primary esophageal tuberculosis in a young male is hereby reported who presented with epigastric pain and dysphagia. An esophageal ulcer was seen at 29 cm level, and tuberculosis was confirmed by the presence of caseating granulomas and Langhan's giant cells. He responded well to antituberculous treatment.- - - - - - - - - - ranking = 0.125keywords = giant (Clic here for more details about this article) |
7/17. histiocytic sarcoma with fatal duodenal ulcers.histiocytic sarcoma is an uncommon neoplasm of mature histiocytes with very poor outcome. We report an autopsy case of a true histiocytic sarcoma with characteristic symptoms of so-called "malignant histiocytosis of the intestine". The liver and spleen were enlarged, with remarkable tumor cell infiltration in the hepatic sinusoids and splenic sinuses. Tumor cells aggregated to form sporadic nodular lesions in the liver, which often showed coagulative necrosis. Infarcted lesions also occurred at the splenic subcapsular area. In addition, tumor cell infiltration was noted in the sinuses of bone marrow and lymph node. Tumor cells often demonstrated moderate pleomorphism with multinucleated giant cells. They were positive for CD68 and negative for T- and B-cell lineage markers, megakaryocytic markers, and CD30. Various examinations were done to rule out infection-associated hemophagocytic syndrome, and the absence of infectious diseases was revealed. Thus, the diagnosis of histiocytic sarcoma was made. Apart from these lesions, multiple ulcerations, some with fatal perforation, were found in the esophagus and duodenum. They showed only non-specific inflammatory changes without tumor cell involvement. The ulcers probably derived from ischemic condition through an embolic process caused by tumor cell infiltration elsewhere in the blood vessels at the periphery of the ulcers.- - - - - - - - - - ranking = 0.125keywords = giant (Clic here for more details about this article) |
8/17. Fistulous degeneration of a giant esophageal ulcer in a patient with acquired immune deficiency syndrome.Esophageal involvement in human immunodeficiency virus (hiv) disease can take many forms, including the recently described giant solitary ulcerations thought to be due to cytomegalovirus or, more recently, mycobacterium species. Current experience suggests that steroids may provide symptom relief and healing in selected patients. We report a case of fistulous change in one such ulcer, with documented endoscopic, radiologic, and pathologic findings. No organism was identified by culture or pathologic staining, leading to a postulated role for the persistent irritation of medications.- - - - - - - - - - ranking = 0.625keywords = giant (Clic here for more details about this article) |
9/17. Giant esophageal ulcer healed with steroid therapy in an AIDS patient.AIDS patients have been seen with a variety of ulcerating esophageal lesions, which may be refractory to both diagnostic approaches and empiric medical intervention. There are reports of these ulcers eroding vessels and severely limiting oral nutrition. After the report of success with prednisone therapy for oral and hypopharyngeal ulcers in AIDS patients, we attempted similar treatment of an AIDS patient with a refractory giant esophageal ulcer. The patient responded promptly to this therapy. To our knowledge this is the first report of successful prednisone therapy for giant esophageal ulcer in an AIDS patient.- - - - - - - - - - ranking = 0.25keywords = giant (Clic here for more details about this article) |
10/17. A case of spontaneous esophageal rupture treated with conservative therapy.A 51 year-old male was admitted because of abrupt hematemesis and loss of consciousness. Emergency endoscopy depicted a giant esophageal ulcer on the left side extending from the middle intrathoracic region to the lower intrathoracic region. Esophagography, performed on the second day of admission, revealed a huge cavity (10 cm x 7 cm) filled with contrast medium resulting from a rupture in the ulceration. His state of shock improved with conservative therapy and no severe mediastinitis was noted. The drainage from the cavity into the lumen of the esophagus was considered to be acceptable from esophagography and an endoscopic examination. Secondary to his stable condition and continuous drainage, this patient was treated conservatively throughout his clinical course. The patient was given intravenous hyperalimentation (IVH) until the 25th hospital day and was medicated with broad spectrum-antibiotics. On the 21st hospital day the size of the esophageal cavity was markedly decreased (7 cm x 2 cm). Only small irregular mucosa was noted on the esophagogram taken 6 weeks after admission. Six months after the onset, an X-ray examination revealed complete healing of the spontaneous esophageal rupture with no recurrence.- - - - - - - - - - ranking = 0.125keywords = giant (Clic here for more details about this article) |
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