Plasmacytomas are clonal proliferations of plasma cells which are cytologically and immunophenotypically identical as plasma cell myeloma, but manifest a localized osseous or extraosseous growth pattern. Solitary plasmacytoma of bone (P-bone) and solitary extramedullaryplasmacytoma (P-extramedullary) are rare diseases. Extramedullaries rarely occur in the GI tract, stomach, small bowel, colon, or rectum. The lower gastrointestinal EMP represents less than 5% of all cases, and location in the anal canal is exceedingly rare. We found only few cases of common presentation of inflammatory bowel disease and extramedullaryplasmacytoma.

INTRODUCTION:Successful endoscopic sclerotherapy is effective in securing hemostasis for bleeding lesions and remains the first line and only needed therapy for most of the patients (pts), but bleeding reoccurs in 10% to 30% pts, and 4% to 14% of the pts die after acute nonvariceal upper gastrointestinal bleeding (UGIB). The need for hospitalization and its duration for all the bleeding pts is still a controversial question.AIM:To create the simple scoring system able to determine low risk pts for rebleeding and mortality by establishing the relative importance of risk factors for rebleeding and mortality after successful endoscopic sclerotherapy of acute nonvariceal UGIB.PATIENTS AND METHODS:Prospective study included 3 15 pts who where admitted to hospital because of acute nonvariceal UGIB. All of them underwent gastroscopy with successful sclerotherapy within 12 hours after the admission. We investigated the episode of rebleeding and death during the initial hospitalization, and analyzed the following parameters: age, gender, drug intake, shock, bleeding stigmata, location of bleeding lesion and comorbidity.RESULTS:Rebleeding occurred in 53 pts (16.8%) and was determined by shock, bleeding stigmata and comorbidity. Eleven pts (3.5%) died and shock, rebleeding and comorbidity were all independent, statistically significant predictors of pts' mortality. The numerical scores for determination of pts with different risk levels for rebleeding and mortality have been developed using the significant predictors of rebleeding and death. The score values for rebleeding ranged from 3 to 9 and pts with values < or = 4 had low risk of rebleeding. We identified 59 pts (18.7% of all) with score for rebleeding < or = 4. Score values for mortality risk ranged from 3 to 8 and the values < 5 revealed negligible risk of death. In our group we found 290 pts (92.1% of all) with low mortality score values.CONCLUSION:Following the successful initial endoscopic sclerotherapy, these scores can help to identify pts with low risk of rebleeding and negligible risk of death, so they can be treated as outpatients.

Introduction: Helicobacter pylori induces gastric inflammation in host and such gastritis increases the risk of gastric and duodenal ulceration as well as adenocarcinoma. Because peptic ulcer disease is the major cause of morbidity, accurate diagnosis of H. pylori infection is very important. Unfortunately, there is no gold standard among diagnostic tests for Helicobacter infections. If gastroscopy is performed, histopathology and urease test are the most often used. Still, culturing of this bacterium is essential for drug susceptibility testing and analysis of virulence factors. Objective The aim of this study was to compare three diagnostic procedures - histopathology, urease test and culture, which are used to verify H. pylori infection. Method Three pairs of gastric mucosal biopsy specimens were collected from each of 28 dyspeptic patients undergoing endoscopy. Nineteen patients were not pretreated with antibiotics, while nine had received eradication therapy earlier. One pair of biopsy specimens was used for histopathologic examination, the second for urease test and the third was simultaneously cultured on nonselective and selective solid media. Isolate was identified as H. pylori on the basis of colony morphology, morphological properties and biochemical tests. Results In 14 out of 28 patients, H. pylori infection was confirmed on the basis of results of all diagnostic procedures. The concordance of these three methods was very good, because the results of histopathology, urease test and culture corresponded in 26 from 28 patients. Conclusion The conclusion of our study is that culture, as the method with high degree of concordance with other two procedures and the only that can give information on drug susceptibility of Helicobacter, is recommended for diagnosis of Helicobacter pylori infection along with histopathology and urease test.

BACKGROUND:Endoscopic ultrasonography(EUS) allows high-resolution demonstration of the entire gut wall. The aim of the study was to clarify the usefulness of the EUS in differential diagnosis of upper gastro-intestinal subepithelail lesions(SEL).METHODS:From September 1998- March 2005, EUS was performed in 1600 patients. Among them, in 206pts (13%), this examination was carried out due to previous upper endoscopy, which revealed the suspicion to SEL or extraluminal compression. We studied the location, the size, echo pattern and originating layer of SEL. The results were compared with CT, angiography and operation with histology when possible. All EUS examinations were performed using Olympus GIF-130 videoecho-endoscope with 7,5/12MHz switchable radial probe.RESULTS:EUS accuracy in separating intramural masses from extraluminal compression was 96%(44/46). Among 160 pts with true SEL, in 95(59.3%), EUS revealed the existence of a stromal tumor arising from muscularis propria (92) or muscularis mucosae (3). The size of the tumor varied from 5-75mm; depth: 8-40mm. 33 patients were operated on. In 14/16(87%), the EUS diagnosis of benign stromal tumor was confirmed on operation. In 18/19(95%), EUS correctly disclosed the malignant tumor. EUS accuracy in predicting malignancy was 91.5%(32/35). Findings suggestive for malignancy were: size 40mm; inhomogenicity with microcysts and irregular outer margin. In 12 pts, EUS revealed lypoma. Abberant pancreas was correctly diagnosed in all 22pts. In 16 persons, EUS disclosed submucosal cysts: 6 of them were operated on and EUS diagnosis was confirmed in all. In 10 patients EUS visualized varices. The finding was confirmed on angiography.CONCLUSION:The EUS appears to be very effective in differential diagnosis of SEL in upper gastro-intestinal tract. Tumour size greater than 40mm, inhomomogenous echo pattern and irregular outer margin are very suggestive for malignancy.

Gastrointestinal stromal tumor is a form of mesenchimal neoplasm that may be present in all parts of gastrointestinal system. We are reviewing diagnostic and therapeutic algorithms for patient with diagnosed gastrointestinal neoplasm of small intestine, experiencing repeated episodes of painful bleeding from gastrointestinal trackt.

BACKGROUND/AIMS:As well as causing chronic gastritis, Helicobacter pylori predisposes patients to peptic ulcer disease and gastric cancer, and induces gastric functional disorders. The aim of our study was to investigate the effects of H. pylori eradication therapy on the morphological and functional recovery of gastric antral and corpus D cells in patients with chronic gastritis during 6 months of follow-up.PATIENTS AND METHODS:Forty consecutive, dyspeptic patients referred for endoscopy (31 with H. pylori infection and nine controls; mean age 49 years; 17 men, 23 women) entered the study. All patients had histological signs of gastritis but no signs of peptic ulcer or gastric cancer. Antrum (n=8) and corpus (n=6) biopsy specimens were collected for routine histology, radioimmunoassay tissue somatostatin levels, immunohistochemistry and electron microscopy, prior to and 6 months after therapy. Basal plasma somatostatin levels were determined prior to eradication, plus 6 weeks and 6 months after therapy. Eradication therapy consisted of amoxicillin, metronidazole and omeprazole.RESULTS:Basal somatostatin plasma values in antral and corpus tissue were lower in infected patients than in the H. pylori-negative controls at the beginning of the study. A significant increase occurred after successful eradication therapy, together with an increase in the number of D cells in both regions. Changes in the D-cell ultrastructure in antral and corpus mucosa after eradication therapy suggest an increase in somatostatin synthesis and secretion.CONCLUSIONS:The structural and functional restoration of D cells following eradication therapy indicates possible recovery of the diseased mucosa.