ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Clinical pathological cases in gastroenterology: Small intestine and colon

Clinical pathological cases in gastroenterology: Small intestine and colon
Literature review current through: Jan 2024.
This topic last updated: Jun 05, 2023.

INTRODUCTION — The following cases are meant to illustrate clinical, pathological, and endoscopic findings in patients with a variety of small intestinal and colonic conditions. Detailed discussions on the specific disorders are presented in corresponding topic reviews.

LEIOMYOMA — A 51-year-old woman with no significant past medical history underwent a screening colonoscopy. A sessile 6 mm nonbleeding submucosal nodule with smooth contour was visualized in the rectum (picture 1). Biopsy was successfully performed using cold forceps (picture 2A-B). The colonoscopy was otherwise normal to the cecum. (See "Local treatment for gastrointestinal stromal tumors, leiomyomas, and leiomyosarcomas of the gastrointestinal tract", section on 'Colon and rectum'.)

NEUROFIBROMA — A 44-year-old woman with a family history of colon cancer underwent screening colonoscopy. A single submucosal 5 mm nodule of benign appearance was found in the proximal sigmoid colon (picture 3). Cold forceps biopsies were obtained (picture 4A-C). The colonoscopy was otherwise normal to the cecum. (See "Peripheral nerve tumors" and "Peripheral nerve tumors", section on 'Neurofibroma' and "Neurofibromatosis type 1 (NF1): Pathogenesis, clinical features, and diagnosis", section on 'Peripheral neurofibromas'.)

GASTROINTESTINAL NEUROENDOCRINE (CARCINOID) TUMOR — A 50-year-old man underwent a screening colonoscopy and was noted to have a 10 mm submucosal nodule of benign appearance in the rectum (picture 5). The nodule was resected using hot snare technique and was retrieved (picture 6A-B). The colonoscopy was otherwise normal to the cecum. (See "Clinical characteristics of well-differentiated neuroendocrine (carcinoid) tumors arising in the gastrointestinal and genitourinary tracts" and "Diagnosis of carcinoid syndrome and tumor localization" and "Staging, treatment, and post-treatment surveillance of non-metastatic, well-differentiated gastrointestinal tract neuroendocrine (carcinoid) tumors".)

JUVENILE POLYPOSIS — A 37-year-old woman underwent an upper endoscopy and colonoscopy for the evaluation of iron deficiency anemia and guaiac positive stool. The patient denied any medication use and had no significant past medical or family history. An upper endoscopy was normal. The colonoscopy showed multiple pedunculated polyps throughout the colon ranging in size from 5 to 15 mm that were resected (picture 7 and picture 8). (See "Juvenile polyposis syndrome".)

MELANOSIS COLI — A 50-year-old woman with past medical history significant for bulimia and laxative abuse presented for screening colonoscopy (picture 9). Dark colored mucosa was seen in the entire colon, sparing the ileocecal valve. Biopsies were obtained (picture 10).

CYTOMEGALOVIRUS (CMV) COLITIS — A 76-year-old woman with history of chronic obstructive pulmonary disease (COPD) presented for the evaluation of abdominal pain, diarrhea, and weight loss over the past month. Colonoscopy revealed multiple 3 to 5 mm ulcers with surrounding erythema and intervening areas of normal appearing colon (picture 11). Multiple biopsies were obtained (picture 12A-C). (See "Epidemiology, clinical manifestations, and treatment of cytomegalovirus infection in immunocompetent adults", section on 'Gastrointestinal manifestations'.)

COLLAGENOUS COLITIS — A 68-year-old woman underwent a colonoscopy for evaluation of persistent watery diarrhea for the last six months. Previous work-up including stool analysis, stool cultures, complete blood count and differential, erythrocyte sedimentation rate, thyroid function tests, serum electrolytes, total protein, and albumin were normal. The colonoscopy was normal to the cecum and multiple random biopsies were obtained throughout the colon (picture 13A-B). (See "Microscopic (lymphocytic and collagenous) colitis: Clinical manifestations, diagnosis, and management", section on 'Diagnostic approach'.)

ISCHEMIC COLITIS — A 74-year-old woman presented to the emergency department with sudden onset of severe left upper quadrant abdominal pain, nausea, vomiting, and two episodes of hematochezia. Abdominal computed tomography scan revealed thickening of the transverse and descending colon. The following day, a flexible sigmoidoscopy was performed and revealed long shallow ulceration in the splenic flexure and descending colon, which was biopsied (picture 14 and picture 15). (See "Colonic ischemia", section on 'Clinical features' and "Colonic ischemia", section on 'Diagnosis'.)

CLOSTRIDIOIDES DIFFICILE COLITIS — A 74-year-old woman with recent history of antibiotic use for the treatment of a urinary tract infection presented to the emergency department for the evaluation of one week of diarrhea, which had increased in frequency from three soft bowel movements per day to 15 watery bowel movements per day with nocturnal episodes. On physical examination, she appeared dehydrated and was admitted to the hospital for further evaluation. Flexible sigmoidoscopy revealed diffuse pseudomembranes throughout the examined area of the colon with scant areas of visible colonic mucosa (picture 16). Biopsies of the colon were obtained (picture 17 and picture 18).

GIARDIASIS — A 53-year-old female presented for evaluation of a one-month history of diarrhea. She reported three to five episodes of soft, pale, foul smelling stools with frequent abdominal cramps and bloating. Stool analysis for ova and parasites and stool cultures have been negative. An upper endoscopy with biopsies was performed and biopsies of the small bowel were obtained (picture 19).

CELIAC DISEASE — A 50-year-old female presented for the evaluation of a one-year history of abdominal pain and diarrhea. The patient had a recent diagnosis of dermatitis herpetiformis. An upper endoscopy was performed and revealed scalloped and flattened duodenal folds; multiple biopsies were obtained from the duodenum (picture 20 and picture 21A-B). (See "Diagnosis of celiac disease in adults", section on 'Endoscopy with small bowel biopsy'.)

HETEROTOPIC GASTRIC MUCOSA — An 83-year-old male patient underwent surveillance upper endoscopy after an episode of upper gastrointestinal bleeding from a large gastric ulcer. An incidental finding of a duodenal bulb, benign appearing, sessile polyp of approximately 10 by 15 mm was found and biopsied (picture 22 and picture 23).

DUODENAL CARCINOID — A 72-year-old man with no significant past medical history underwent an upper endoscopy for the evaluation of occult blood in the stool (picture 24). A small polyp measuring 8 mm was found in the second portion of the duodenum. Snare polypectomy was performed with complete removal of the lesion (picture 25). (See "Epidemiology, clinical features, and types of small bowel neoplasms", section on 'Neuroendocrine tumors'.)

DUODENAL POLYPS — A 32-year-old man with a history of familial adenomatous polyposis and total colectomy at age 18 underwent an upper endoscopy (picture 26). He was diagnosed with multiple small duodenal adenomas one year prior. On repeat upper endoscopy, one year later, he is noted to have multiple small polyps throughout the duodenum. Biopsies of the duodenal polyps were obtained (picture 27). (See "Clinical manifestations and diagnosis of familial adenomatous polyposis", section on 'Extracolonic manifestations'.)

Topic 86480 Version 12.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟