1/60. Esophagitis dissecans superficialis associated with pemphigus vulgaris.The extension of bullous lesions in pemphigus to the esophagus is relatively uncommon, especially in patients who appear to be in clinical remission. Very rarely, pemphigus vulgaris may affect the entire esophagus, resulting in complete sloughing of the mucous membrane. A 20-year-old man with pemphigus vulgaris presented to the emergency room with acute onset of dysphagia, odynophagia, and hemoptysis. There were no cutaneous or oral findings of pemphigus on presentation, since he was being maintained on corticosteroids and azathioprine with excellent results. During initial evaluation in the emergency room, the patient was observed to vomit a cast of the mucosal lining of the esophagus. The morphologic description of such an esophageal cast is termed esophagitis dissecans superficialis. This is the third case of esophagitis dissecans superficialis in pemphigus vulgaris recorded in the medical literature.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
2/60. Gastroesophageal involvement in herpes simplex.herpes simplex in the gastric mucosa has not been previously described. The case presented here describes gastritis and esophagitis resulting from herpes simplex in a patient being treated with immunosuppressive agents. These changes were confirmed endoscopically and radiographically. biopsy specimens of the gastric and esophageal mucosa showed eosinophilic intranuclear inclusion bodies typical of herpes simplex. The pathogenesis and pathological appearance of herpetic gastritis and esophagitis are presented.- - - - - - - - - - ranking = 2keywords = mucosa (Clic here for more details about this article) |
3/60. Multiple esophageal rings: an association with eosinophilic esophagitis: case report and review of the literature.Esophagitis may present endoscopically with erythema, edema, loss of vascular pattern, friability, and ulceration of the esophageal mucosa. Left untreated, chronic esophagitis may result in stricture formation. The presence of multiple concentric rings involving the entire esophagus has been cited as a chronic form of esophagitis. We present a case of an 8-yr-old boy with multiple concentric esophageal rings and histological evidence of eosinophilic esophagitis, who failed medical antireflux treatment and responded to an elimination diet.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
4/60. Severe oesophagitis after allogeneic bone marrow transplantation for Fanconi's anemia.Allogeneic bone marrow transplantation (BMT) is an effective treatment for Fanconi's anemia (FA) but it requires a dose reduction of alkylating agents used for conditioning because of the increased sensitivity of FA cells to dna cross-linking agents. Oesophageal damage has not previously been described as a complication after allogeneic BMT for this indication. We report five cases of severe oesophagitis with stenosis in patients transplanted for FA. It occurred either early, or more surprisingly, several years after BMT and could have easily been misdiagnosed. It could be explained by hypersensitivity of the FA mucosal cells to cytotoxic agents despite the reduced doses of cyclophosphamide and irradiation or to non diagnosed congenital abnormalities of the oesophagogastric junction. However, the evolution of the oesophageal disease was favorable in all, and none of the patients developed secondary cancer. awareness of this complication will lead to earlier diagnosis and treatment of oesophageal stenosis and related malnutrition.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
5/60. herpes simplex virus esophagitis in the immunocompetent host: an overview.OBJECTIVE: The aim of this study was to delineate the characteristics of herpes simplex virus esophagitis (HSVE) in the immunocompetent host. methods: The study entailed a case report and a review of relevant literature through a medline search back to 1966. All cases with documented HSVE in patients without immunosuppression were selected and their characteristics defined. RESULTS: A total of 38 cases were identified. The age range was 1-76 yr and the male/female ratio 3.2/1. Antecedent exposure to HSV disease was described in eight cases (21.1%). A prodrome of systemic manifestations preceded the onset of esophageal symptoms in nine subjects (23.6%). Manifestations included acute odynophagia (76.3%), heartburn (50%), and fever (44.7%). Concurrent oropharyngeal lesions were uncommon (n = 8, 21.1%). Endoscopically, extensive involvement was common, showing friable mucosa (84.2%), numerous ulcers (86.8%), and whitish-exudates (39.5%). The distal esophagus was most commonly affected (63.8%). Microscopic examination showed characteristic viral cytopathology in 26 (68.4%) cases. Virus was recovered from esophageal-brushes or biopsies in 23 of 24 (95.8%) patients and immunocytochemistry was positive in seven of eight (87.5%) cases. Immune status was consistent with primary HSV infection in eight (21.1%) cases. The disease was self-limiting, although esophageal perforation and upper GI bleeding were reported in one case each. CONCLUSIONS: HSVE in the immunocompetent host is a rare but distinct entity, and is significantly more common in male subjects. It represents either primary infection or reactivation, and is characterized by acute onset, systemic manifestations, and extensive erosive-ulcerative involvement of the mid-distal esophagus. Histopathological examination alone may miss the diagnosis; adding tissue-viral culture optimizes the diagnostic sensitivity. It is usually self-limiting; whether antiviral therapy is beneficial remains unknown.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
6/60. Alkaline esophagitis evaluated by endoscopic ultrasound.Case Report: Two patients with corrosive esophagitis caused by alkaline household agents were examined with endoscopic ultrasound using a 20-MHz probe. In the first case, endoscopic ultrasound revealed circumferentially thickened mucosa and muscularis propria, and lack of differentiation between the mucosa and submucosa. However, esophageal stricture did not develop during 3 months of follow-up, suggesting that the deep lesion may have involved a narrow section of esophagus only. In the second case, a markedly thickened mucosa was seen, resulting in no sequelae. Endoscopic ultrasound offers a more accurate evaluation of the depth of the lesions in alkaline esophagitis compared to standard endoscopy or computed tomography. longitudinal studies are needed to identify lesions at greatest risk for progression to stricture.- - - - - - - - - - ranking = 4keywords = mucosa (Clic here for more details about this article) |
7/60. Acute necrotizing esophagitis: a case report.Acute necrotizing esophagitis is rare. The exact etiology is unknown in most cases. The esophagus appears black, necrotic and ulcerated on the upper endoscopy, thus the term "black esophagus" is used. Histologically, there is necrosis of the esophageal mucosa and submucosa. Here, we present a patient with cholangiocarcinoma who had upper gastrointestinal bleeding and was found to have acute necrotizing esophagitis on the upper endoscopy.- - - - - - - - - - ranking = 2keywords = mucosa (Clic here for more details about this article) |
8/60. Esophageal intramural pseudodiverticulosis (diffuse type).A rare case of esophageal intramural pseudodiverticulosis (EIPD) in a 65-year-old woman with intermittent dysphagia is reported. An upper gastrointestinal series revealed multiple pseudodiverticula, which had tiny flask-shaped outpouchings with a narrow neck extending outward from the upper to the lower thoracic esophageal wall. In particular, the occurrence of the pseudodiverticula was coincident with a narrowed segment of inflamed esophagus. The length of the esophagus involved was approximately 15 cm. Endoscopic findings included mild stricture and chronic inflammation of the mucosa. biopsy specimens showed active chronic esophagitis with bacterial and candida superinfection, but no evidence of neoplasm. Cellular local immune reactions, as a consequence of chronic inflammation, and possibly abnormal motor activity in the narrowed esophagus, may explain the etiological agent or may be possible secondary factors that caused the EIPD.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
9/60. Giant gastrointestinal stromal tumor, associated with esophageal hiatus hernia.An 85-year-old woman was admitted to our hospital because of vomiting. An upper gastrointestinal series what showed a large esophageal hiatus hernia, suggesting an association with extrinsic pressure in the middle portion of the stomach. An upper gastrointestinal endoscopic examination showed severe esophagitis and a prominent narrowing in the middle portion of the stomach, however, it showed normal gastric mucosa findings. CT and MRI revealed a large tumor extending from the region of the lower chest to the upper abdomen. From these findings, the tumor was diagnosed as gastrointestinal stromal tumor (GIST), which arose from the gastric wall and complicated with an esophageal hiatus hernia. We performed a laparotomy, however, the tumor showed severe invasion to the circumferential organs. Therefore, we abandoned the excision of the tumor. Histologically, the tumor was composed of spindle shaped cells with marked nuclear atypia and prominent mitosis. The tumor cells were strongly positive for CD34 and c-kit by immunohistochemical examination. From these findings, the tumor was definitely diagnosed as a malignant GIST. As palliative treatment, we implanted a self-expandable metallic stent in the narrow segment of the stomach. The patient could eat solid food and was discharged. In the treatment of esophageal hiatus hernia, the rare association of GIST should be considered.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
10/60. Heterotopic gastric mucosa in the upper esophagus: report of a case with a fistula.We report the case of a 36-year-old man with a patch of heterotopic gastric mucosa in the upper esophagus complicated by an esophageal fistula.- - - - - - - - - - ranking = 5keywords = mucosa (Clic here for more details about this article) |
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