Mixed neuroendocrine non-neuroendocrine neoplasm (MiNEN) represents a rare diagnosis in the gastrointestinal tract. Only a few cases of MiNEN occurring in the small bowel had been previously reported. Here we report the first case of mixed high grade neuroendocrine carcinoma with villous adenoma arising in the duodenum. The patient is an 87-year-old female who presented for management of a 3.4 cm polypoid-like duodenal mass that was noted on a prior abdominal CT scan. PET scan showed intense uptake within the second portion of the duodenum consistent with a neoplasm. A biopsy previously performed showed tubulovillous adenoma. The patient had a remote history of breast cancer. Esophagogastroduodenoscopy was performed which showed fungating mass occupying 50% of the duodenal lumen and polypectomy was done. Grossly, the duodenal mass appeared as a pink-tan polypoid fragment of tissue. Microscopically, a villous adenoma is seen with focal area of high-grade dysplasia. Admixed with the villous adenoma, there are sheets of homogeneous small cells with high nuclear-cytoplasmic ratio, nuclear molding, high mitotic activity, and finely granular chromatin which stained positive for synaptophysin, CD56, CAM5.2, and CK8/18 while stained negative for chromogranin A, CK7, CK20, and CDX2. These findings support the diagnosis of high-grade neuroendocrine carcinoma arising in a background of villous adenoma. We report a first case of mixed high grade neuroendocrine carcinoma with villous adenoma arising from the duodenum. [N A J Med Sci. 2021;1(1):004-007. DOI: 10.7156/najms.2021.1401004]
Primary testicular diffuse large B-cell lymphoma is a well-recognized entity known for its indolent clinical course. Rapid dissemination and extensive dermal infiltration are not commonly encountered sequelae of this malignancy. Only one case report exists about its extensive dissemination and involvement of skin and bone. Here, we report a case of primary testicular diffuse large-B cell lymphoma treated with orchiectomy and adjuvant chemotherapy and recurred with widespread dermal involvement as non-blanching violet papule and nodular lesions clinically mimicking Kaposi sarcoma. Histopathological examination confirmed the lesion to be a recurrence of the original lymphoma with similar morphology and immunophenotype. Despite the adjuvant chemotherapy and radiotherapy, the disease progressed from stage-I to stage-IV within 16 months from the date of diagnosis, making it an unusually aggressive clinical course for primary testicular lymphoma. [N A J Med Sci. 2021;1(1):008-011. DOI: 10.7156/najms.2021.1401008] Key Words : primary testicular diffuse large B-cell lymphoma, Kaposiform lesion
Foreign bodies used during surgeries and endoscopy procedures may elicit inflammatory reactions and granuloma formation. The resultant lesion may mimic polyps or tumors, which require cautious interpretation. Here we reported that 69-year-old patient with history of treated rectal cancer underwent surveillance colonoscopy where a tubular adenoma was found in the cecum. A follow-up endoscopy found a flat polyp at the ileocecal valve. Right hemicolectomy was performed. On examining the specimen, two lesions were identified in the wall of the ileocecal valve area. Microscopically, there were foreign body giant cell granulomas filled with eosinophilic amorphous material which is consistent with an inflammatory reaction caused by submucosal lifting material injection used during colonoscopy for polypectomy. The granulomas mimicked recurrence of colorectal carcinoma. Therefore, surgeons and pathologists should be aware of the inflammatory reaction elicited by the new lifting agents that may resemble polyps or tumors. [N A J Med Sci. 2021;1(1):001-003. DOI: 10.7156/najms.2021.1401001]
The interpretation of colonic biopsies can be challenging if the histologic presentation is not characteristic. The association between microscopic colitis and inflammatory bowel disease is weak and unclear. Collagenous colitis has been most frequently reported in association with ulcerative colitis either before or many years after ulcerative colitis is established. There are few reports of Lymphocytic colitis in association with Crohn’s disease. To the best of our knowledge however Crohn’s disease presenting as lymphocytic pattern colitis with granulomas has rarely if ever been reported. We present a case of a 34 year old male who presented initially with perianal abscess and fistula-in-ano and subsequent colonoscopic biopsies demonstrated minimal active chronic colitis with granulomas that progressed to lymphocytic colitis pattern inflammation with granulomas within a period of 6-8 months of suboptimal compliance with therapy. [N A J Med Sci. 2020;1(1):009-013. DOI: 10.7156/najms.2020.1301009] Key Words : Microscopic colitis, Collagenous Colitis, Lymphocytic Colitis, Ulcerative Colitis, Crohn’s disease
Background and Aims : Management of common gastrointestinal diseases by non-gastroenterologists often includes diagnostic tests that do not positively impact patient care but increases cost of care. Our study aimed to determine the prevalence of common inpatient practices by non-gastroenterologist providers. Methods : A validated anonymous survey was designed using ‘Google Forms’ (google.com/forms) and responses were collected on a handheld tablet. The questions included basic demographics, level of training, training specialty and practices related to common gastrointestinal diseases. The practices included fecal occult blood testing (FOBT), recognition of melena, use of lipase in management of acute pancreatitis, placement of nasogastric tube in cirrhosis, duration of nil per oral (NPO) before procedures and international normalized ratio (INR) threshold for paracentesis. Descriptive analysis was performed. Results : We collected 150 responses from 4 different residency training hospitals in the United States. Of the respondents, 84% were resident trainees. Primary specialties of practice were internal medicine (82%), family medicine (11%), and others (7%). Inpatient FOBT was available in 95% of the facilities surveyed. With regards to melena, 77.5% correctly identified it as black tarry stool, but 17% also considered FOBT positive brown stool as melena. 21% correlated high lipase levels with more severe acute pancreatitis.19% considered history of cirrhosis a contraindication for placement of nasogastric tube. Only 35% performed abdominal paracentesis regardless of INR value. Discussion : Low value tests and procedures related to common gastrointestinal diseases are prevalent among non-gastroenterologists. Better communication between primary team and specialist and education is needed to optimize patient care.
