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Multiple Lymphomatous Polyposis Associated With Mucosa-Associated Lymphoid Tissue Lymphoma of the Colon
Nishimoto, Naho MD1; Sakakibara, Yuko MD1; Nakazuru, Shoichi MD1; Mori, Kiyoshi MD, PhD2; Mita, Eiji MD, PhD1
doi : 10.14309/crj.0000000000000503
February 2021 - Volume 8 - Issue 2 - p e00503
Hemophagocytic Lymphohistiocytosis Associated With Hepatitis B and HIV Coinfection With Resultant Liver Failure
Blaney, Hanna MD, MPH1; Thotakura, Deepthi MD2; Sisco, Lauren MD3
doi : 10.14309/crj.0000000000000532
February 2021 - Volume 8 - Issue 2 - p e00532
Hemophagocytic lymphohistiocytosis is a syndrome of excessive immune activation frequently attributed to infection. We report a case of hemophagocytic lymphohistiocytosis secondary to hepatitis B in a patient with human immunodeficiency virus coinfection and subsequent liver failure.
Multifocal Nodular Fatty Infiltration of the Liver: A Rare Benign Disorder That Mimics Metastatic Liver Disease
Dreifuss, Nicolas H. MD1; Ramallo, Dario MD1,2; McCormack, Lucas MD, PhD, FEBS (HPB), FACS1
doi : 10.14309/crj.0000000000000537
February 2021 - Volume 8 - Issue 2 - p e00537
Fatty liver disease is a frequent diagnosis. Rarely, it adopts a multifocal nodular pattern mimicking multiple liver metastases. Multifocal nodular fatty infiltration of the liver entails a challenging problem that must be included as a differential diagnosis when dealing with healthy patients with an incidental finding of multiple liver lesions, even in the absence of obesity or metabolic syndrome. A complete clinical examination and high-quality imaging, including magnetic resonance imaging, might help to confirm diagnosis and to avoid unnecessary liver biopsies.
Do Not Skip the Retroflexion: A Case of Disseminated Anorectal Mucosal Melanoma
Chittajallu, Vibhu MD1; Simons-Linares, Carlos Roberto MD, MSc2; Oshilaja, Olaronke MD3; Chahal, Prabhleen MD, FACG, FASGE2
doi : 10.14309/crj.0000000000000513
February 2021 - Volume 8 - Issue 2 - p e00513
Less than 4% of melanomas are of mucosal origin, with primary anorectal mucosal melanomas comprising a small subset. Mucosal melanomas are often diagnosed at an advanced stage due to delay in patient presentation and obscured tumor origins leading to a more aggressive behavior and less favorable prognosis when compared with cutaneous melanomas. We present a case of metastatic anorectal mucosal melanoma with a negative colonoscopy 1 year earlier.
Collagenous Gastritis Masquerading as Eosinophilic Gastritis
Klein, Jeremy BA1,2; Wilkins, Benjamin J. MD, PhD3; Verma, Ritu MD4; Muir, Amanda B. MD2,5
doi : 10.14309/crj.0000000000000527
February 2021 - Volume 8 - Issue 2 - p e00527
A 11-year-old boy presented to the gastroenterology clinic after a 5-month history of fatigue, pallor, intermittent abdominal pain, and iron-deficiency anemia. Although the initial upper endoscopy was visually normally, the histological assessment was suggestive of eosinophilic gastritis. After multiple scopes and failed therapies, histologic analysis revealed a focus of thickened subepithelial collagen deposition suggestive of collagenous gastritis. A retrospective review of gastric biopsies using Gomori trichrome stain revealed previously unappreciated collagen deposition. This case report illustrates the benefit of performing trichrome stain on gastric biopsies in the setting of persistent or isolated gastric eosinophilia or iron deficiency anemia.
Acute Flare of Adult-Onset Autoimmune Enteropathy Associated With Cyclophosphamide
Liu, Jasmine MD1; Hindi, Ziad MD2; Aziz, Tariq MD, FRCPC3; Albashir, Siwar MD, FRCPC4
doi : 10.14309/crj.0000000000000541
February 2021 - Volume 8 - Issue 2 - p e00541
This is a case of adult-onset autoimmune enteropathy (AIE) in a 46-year-old man with multiple autoimmune conditions who presented with worsening disease process after receiving cyclophosphamide. We describe the investigations and management of this patient over a 6-year timeline. The diagnosis and management of AIE is challenging given the heterogeneity in clinicopathologic findings and a small number of adult case reports. We describe the current diagnostic criteria, review the literature on treatment options and outcomes, and discuss the evidence for cyclophosphamide in the treatment of AIE. Adult-onset AIE should be considered in the differential diagnosis of refractory diarrhea and weight loss.
Bone Marrow Suppression Associated With Celiac Disease in a 4-Year-Old Boy
Watson, Ashleigh MD1; Kolinski, Julie MD1; Suchi, Mariko MD, PhD2; Elkadri, Abdul MD1
doi : 10.14309/crj.0000000000000538
February 2021 - Volume 8 - Issue 2 - p e00538
Celiac disease is an immune-mediated process against gluten, resulting in inflammation and villous atrophy of the duodenum. Symptoms of malabsorption characterize the classic presentation; however, abdominal pain, constipation, and nutritional deficiencies can also be seen. We present a case of a 4-year-old boy who was found to have celiac disease after presenting with diarrhea, abdominal pain, weight loss, and new-onset pancytopenia. Symptoms resolved, and laboratory values normalized after the initiation of a gluten-free diet, indicating the bone marrow suppression was due to celiac disease, which needs to be considered when hematologic abnormalities are present, even in the absence of gastrointestinal symptoms.
The Pillow Sign: Is It Always Benign?
Alvencar, Sujay MD1; Holzwanger, Erik MD1; Dhingra, Rohit MD1; Karagozian, Raffi MD1; Olans, Lori MD1; Natov, Nikola S. MD1
doi : 10.14309/crj.0000000000000540
February 2021 - Volume 8 - Issue 2 - p e00540
Mucosa-associated lymphoid tissue (MALT) lymphoma is classically found in the stomach; however, in less common, cases can be found in extragastric locations. Colonic MALTomas are exceedingly rare and comprise a small group of extragastric cases. There is no standardized approach for optimal management of this disease. We report a case of a colonic MALT lymphoma found on colonoscopy that demonstrated the pillow sign and appearance of a benign lipoma. Despite antimicrobial and endoscopic therapy, the malignancy reoccurred in a patient with chronic hepatitis B, thereby precluding one of the mainstays of treatment, rituximab, until viral eradication.
Neuroendocrine Tumor of the Common Bile Duct Associated With von Hippel-Lindau Disease
Romero-Velez, Gustavo MD1; Pereira, Xavier MD1; Yang, Julie MD, FASGE2; Panarelli, Nicole C. MD3; McAuliffe, John C. MD, PhD, FACS1
doi : 10.14309/crj.0000000000000512
February 2021 - Volume 8 - Issue 2 - p e00512
We report a case of a common bile duct neuroendocrine tumor discovered in a patient with von Hippel-Lindau disease to emphasize the importance of recognizing this unusual diagnosis. This case illustrates the importance of endoscopic evaluation and the potential diagnostic pitfalls which may impact its appropriate management: the anatomic proximity of more common von Hippel-Lindau disease–related tumors, pathologic evaluation, and staging. Therefore, awareness of this rare diagnosis is important for appropriate treatment.
Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Diagnosis of Pancreatic Metastases Secondary to Ovarian Carcinoma
Chan, Sandy MD1; Wassef, Wahid MD, FACG2
doi : 10.14309/crj.0000000000000544
February 2021 - Volume 8 - Issue 2 - p e00544
Pancreatic metastases from ovarian carcinoma are rare. We present a case of a patient with pancreatic metastasis from primary ovarian carcinoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Our case illustrates a unique presentation of a patient with ovarian carcinoma presenting with symptoms secondary to common bile duct dilatation from a pancreatic head mass confirmed through a much less invasive approach. This diagnosis was essential in determining management and prognosis for the patient.
Insulinoma: A Recurrent Pancreatic Tumor Amendable to Computed Tomography–Guided Ethanol-Lipiodol Injection
Zaver, Himesh B. MD1; Alnahhal, Khaled I. MD2; Ghoz, Hassan MD3; Paz-Fumagalli, Ricardo MD4; Raimondo, Massimo MD3; Lukens, Frank J. MD3
doi : 10.14309/crj.0000000000000539
February 2021 - Volume 8 - Issue 2 - p e00539
Insulinomas are rare, with an annual incidence of 1–4 people per mission. Insulinomas are the most common functioning endocrine neoplams of the pancreas. Endoscopic ultrasound has both diagnostic and therapeutic yield in undifferentiated pancreatic tumors. We present a case of a recurrent insulinoma, refractory to surgical and medical management diagnosed with endoscopic ultrasound. Our case uniquely conveys a successful, alternative approach to addressing symptomatic insulinomas refractory to surgical or medical management through computed tomography–guided percutaneous ethanol-lipiodol injection.
