1/19. Bowel perforation during chemotherapy for non-hodgkin's lymphoma.Bowel perforation in patients with primary malignant lymphoma usually occurs at the site of tumor. A 78 year-old man underwent chemotherapy for malignant lymphoma. He presented with abdominal pain. An emergency operation was performed under a diagnosis of panperitonitis. At laparotomy, an anal-side perforation approximately 20 cm from the Treiz ligament was observed. drainage and partial resection of the jejunum was performed. Histopathologic examination demonstrated that there was no characteristic finding of malignant lymphoma around the perforation site in the case. Perforation of the small intestine is one of the most critical complications during the chemotherapy for malignant lymphoma. In cases of chemotherapy for malignant lymphoma, especially systemic administration, we should keep in mind the possibility of perforation of the small intestine. Fortunately, emergency surgery saved the patient presented in this report. Early diagnosis and treatment are important to improve prognosis of bowel perforation in patients with primary malignant lymphoma.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/19. Primary intestinal posttransplant T-cell lymphoma.There have been only five reported cases of primary posttransplant T-cell lymphoma. We report the first case associated with the use of sirolimus (Rapamycin, Wyeth-Ayerst, philadelphia, PA). The patient, receiving prednisone, cyclosporine, and sirolimus treatment, developed ascites, diarrhea, and weight loss 7 months after his second renal transplant. Tissue obtained at laparotomy established the diagnosis of primary T-cell lymphoma. Latent membrane protein-1 for Epstein-Barr virus was negative, but in-site hybridization test for Epstein-Barr-encoded rna was positive. Despite aggressive chemotherapy, the patient died 8 months posttransplant. This is the sixth reported case of primary intestinal posttransplant T-cell lymphoma, but it is the first case associated with the use of sirolimus. The incidence of posttransplant lymphoproliferative disease in patients receiving sirolimus should be studied.- - - - - - - - - - ranking = 0.019882765964501keywords = membrane (Clic here for more details about this article) |
3/19. A case of primary small intestinal cancer diagnosed by laparoscopy.The patient was a 61-year-old female who developed ileus. Physical findings showed abdominal distension but peritoneal irritation signs were not observed. After the conservative treatment by the ileus tube, encircling stenosis was observed in the jejunum at about 50 cm on the anal side from the Treitz ligament on contrast radiography of the small intestine through the ileus tube. Tumor markers were normal except for mild elevation of IL2-R (609 U/ml). After confirming sufficient bowel decompression and the absence of other lesions, surgery was performed based on a preoperative diagnosis of small intestinal tumor including adhesive ileus, GIST, or malignant lymphoma. First, under the laparoscopic observation, the lesion was resected and definitive diagnosis was established as primary moderately to poorly differentiated adenocarcinoma of the small intestine by rapid intraoperative pathological diagnosis. Then, extensive jejunal resection involving sufficient lymph node dissection was performed as open surgery. Radical surgery was successfully performed.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
4/19. Multiple metastases to the small bowel from large cell bronchial carcinomas.AIM: Metastases from lung cancer to gastrointestinal tract are not rare at postmortem studies but the development of clinically significant symptoms from the gastrointestinal metastases is very unusual. methods: Formalin-fixed, paraffin-embedded tissues were cut into 5 microm thick sections and routinely stained with hematoxylin and eosin. Some slides were also stained with Alcian-PAS. antibodies used were primary antibodies to pancytokeratin, cytokeratin 7, cytokeratin 20, epithelial membrane antigen, vimentin, smooth muscle actin and CD-117. RESULTS: We observed three patients who presented with multiple metastases from large cell bronchial carcinoma to small intestine. Two of them had abdominal symptoms (sudden onset of abdominal pain, constipation and vomiting) and in one case the tumor was incidentally found during autopsy. Microscopically, all tumors showed a same histological pattern and consisted almost exclusively of strands and sheets of poorly cohesive, polymorphic giant cells with scanty, delicate stromas. Few smaller polygonal anaplastic cells dispersed between polymorphic giant cells, were also observed. immunohistochemistry showed positive staining of the tumor cells with cytokeratin and vimentin. Microscopically and immunohistochemically all metastases had a similar pattern to primary anaplastic carcinoma of the small intestine. CONCLUSION: In patients with small intestine tumors showing anaplastic features, especially with multiple tumors, metastases from large cell bronchial carcinoma should be first excluded, because it seems that they are more common than expected.- - - - - - - - - - ranking = 0.019882765964501keywords = membrane (Clic here for more details about this article) |
5/19. Laparoscopic-assisted small bowel resection of a leiomyoma causing recurrent obscure gastrointestinal bleeding.A 62-year-old man experienced recurrent painless episodes of melenas and undiagnosed chronic anemia for 4 years. Despite extensive radiologic and endoscopic work-up, the origin of the bleeding could not be identified. At his last admission, visceral angiography revealed an area of hypervascularity at the initial portion of the jejunum, containing irregular, corkscrew vessels coming from the first jejunal branch of the superior mesenteric artery. Under general endotracheal anesthesia, a 10-mm trocar for the 30 degree laparoscope was inserted subumbilically using the open Hasson technique. Two 5-mm trocars were also used suprapubically and at the left iliac fossa. A 2.5 cm diameter, smooth, hypervascular tumor was easily visualized on the jejunal wall 10 cm from the ligament of Treitz. The small bowel segment was laparoscopically mobilized and brought through the subumbilical trocar site, which was extended 1 cm. A limited small bowel resection and a stapled anastomosis were easily performed extracorporeally. Histopathologic examination diagnosed a benign gastrointestinal tumor (gastrointestinal stromal tumor, leiomyoma). The patient was discharged on postoperative day 2. Laparoscopic identification and mobilization allows a loop of small bowel to be exteriorized through a small incision; the anastomosis can be safely performed extracorporeally. The advantages of rapid postoperative recovery and reduced pain are evident.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
6/19. Recurrent gastrointestinal bleeding due to leiomyosarcoma of the small intestine. Case report.Three cases of small-intestinal leiomyosarcoma are presented. The neoplasms were located within 50 cm from the ligament of Treitz and the only symptoms was severe recurrent gastrointestinal bleeding. All the tumours were demonstrated at mesenteric angiography and were removed by simple resection of the tumour-bearing segment.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
7/19. Pathological features of multiple endocrine neoplasia type IIb in childhood.The features of two patients with multiple endocrine neoplasia type IIb are described. Patient 1, a 9-year-old boy with marfanoid features, presented with chronic constipation and failure to thrive since infancy. Patient 2, a 12-year-old boy with marfanoid features, presented with a five-year history of persistent cervical lymphadenopathy. In patient 1, the myenteric and submucosal nerve plexuses at all levels of the small and large intestines were comprised of diffusely disorganized, hyperplastic, mature ganglion cells and nonmyelinated nerve fibers. Nerve plexus dissection with morphometric analysis showed marked thickening of the myenteric plexus with a quantitative increase in neural tissue. Patient 2 had a submucosal neuroma of the tongue. Both patients had occult medullary thyroid carcinoma, and patient 2 had cervical lymph node metastases. Both neoplasms showed positive staining for cytokeratin, carcinoembryonic antigen, calcitonin, bombesin, chromogranin, serotonin, and Leu 7. Electron microscopy showed membrane-bound, intermediate-sized, dense-core neurosecretory granules in tumor cells. In patient 2, calcitonin-positive amyloid was present with localization of calcitonin by immunoelectron microscopy to cytoplasmic secretory granules and to extracellular amyloid fibrils. These cases illustrate the potential for missed or delayed diagnosis in multiple endocrine neoplasia syndromes.- - - - - - - - - - ranking = 0.019882765964501keywords = membrane (Clic here for more details about this article) |
8/19. Pleomorphic carcinoma of the small bowel. The limitations of immunohistochemical specificity.We report 3 cases of poorly differentiated tumors of the small bowel with histological, immunohistochemical, and ultrastructural studies. The patients were male, aged 45, 57, and 63. In all 3 cases, histological features of spindle cell, epithelioid cell and giant cell areas favoured a diagnosis of carcinoma, although a malignant stromal tumor could not be firmly excluded. immunohistochemistry demonstrated in the 3 cases a strong expression of both "epithelial" (cytokeratin) and "stromal" (vimentin) markers; one tumor expressed the epithelial membrane antigen, and another one desmin. Electron microscopy showed no specific features in one case. The case positive for desmin demonstrated intracytoplasmic lumina, allowing the diagnosis of carcinoma. In spite of a non-specific immunohistochemical pattern, we finally considered these 3 tumors as of epithelial origin, corresponding to the rare and recently described pleomorphic carcinoma of the small bowel. This report emphasizes the difficult diagnosis of some poorly differentiated tumors, particularly in the gastro-intestinal tract. Such problems had until recently been resolved by ultrastructural and mostly by immunohistochemical studies. However, an increasing number of reports, together with our 3 cases, show unexpected reactivity of tumors with theoretically specific immunoreactions, such as those directed against intermediate filaments. Coexpression of intermediate filaments could be due to cross reactivity of molecules bearing common epitopes, or to the presence of different filaments in the same cell type; recent immunoblotting studies favour this latter hypothesis.- - - - - - - - - - ranking = 0.019882765964501keywords = membrane (Clic here for more details about this article) |
9/19. Immunophenotype analysis of malignant histiocytosis of the intestine.Five cases of malignant histiocytosis of the intestine and one case of true histiocytic lymphoma were studied using immunohistological techniques. In paraffin sections tumour cells in all cases were shown to contain alpha-1-antitrypsin and to express the leucocyte common antigen. Four of the five cases of malignant histiocytosis of the intestine and the case of histiocytic lymphoma expressed the epithelial membrane antigen. Cryostat sections in four cases of malignant histiocytosis of the intestine showed that most tumour cells reacted with anti-T cell monoclonal antibodies. Only a minority expressed a typical monocyte macrophage phenotype.- - - - - - - - - - ranking = 0.019882765964501keywords = membrane (Clic here for more details about this article) |
10/19. Recurrent gastrointestinal bleeding due to smooth muscle tumours of the small intestine.The cause of recurrent gastrointestinal hemorrhage can be very difficult to identify. When the source of bleeding is beyond the ligament of Treitz the bleeding is often from a smooth muscle tumour of the small intestine. A review of the records of the Royal victoria Hospital, Montreal, for the past 25 years discovered 14 instances of such tumours, in more than half of which the presenting symptom was recurrent gastrointestinal hemorrhage of obscure origin. barium contrast roentgenography, endoscopy and radionuclide scanning have not been found helpful in diagnosis. Selective angiography followed by laparotomy is the best mode of management with respect to both investigation and treatment. The data obtained from our series of cases are compared with those of other series reported in the literature.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
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