Signet Ring Cell Lymphoma of the Small Bowel: A case report.
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ABSTRACT:
SUBMITTER: Basir N
PROVIDER: S-EPMC3517698 | biostudies-other | 2012 Nov
REPOSITORIES: biostudies-other
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Project description:Small bowel diaphragm disease is a rare condition usually associated with the prolonged use of non-steroidal anti-inflammatory drugs (NSAID) and that can be mistaken and treated as other pathologies. We describe a case of a 64-year-old man with a prolonged course of pain and subacute bowel obstructions, without any history of NSAID usage, found to have a multiple diaphragmatic stricture in the small bowel.
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Project description:BackgroundImmune checkpoint inhibitors (ICIs) have emerged as paradigm shifting treatment options for a number of cancers. Six antibodies targeting the immune checkpoint proteins programmed cell death 1 (PD-1), programmed cell death 1 ligand 1 (PD-L1) or cytotoxic T-lymphocyte associated protein 4 (CTLA4) have been approved. In some cases, response rates have been impressive, but not uniformly so and not consistently; similarly, toxicity to this class of therapeutic is often unpredictable and can be life threatening. Predicting treatment response and toxicity are two main obstacles to truly individualize treatment with ICIs. One of the most severe and life-threatening adverse events is colitis induced colonic perforation, estimated to occur in 1.0 to 1.5% of patients treated with ICIs. An important question to address is, under what circumstances is it appropriate to reinitiate ICI treatment post-bowel perforation?Case presentationThe patient is a 62-year-old woman, who presented with stage IV lung cancer. Immunohistochemical staining indicated that 80% of the patient's tumor cells expressed PD-L1. The patient was started on a three-week cycle of pembrolizumab. Subsequent reducing in tumor burden was observed within ten weeks. Initially, pembrolizumab was tolerated fairly well, with the exception of immunotherapy related hypothyroidism. However, the patient experienced a second, more serious immune-related adverse event (irAE), in the form of enteritis, which led to small bowel perforation and necessitated exploratory laparotomy. The concerning part of the small bowel was resected, and a primary anastomosis was created. Based on the pathological and surgical findings, the patient was diagnosed with pembrolizumab-associated small bowel perforation. The patient recovered well from surgery and, considering the patient's remarkable response to treatment, a collective decision was made to reinitiate pembrolizumab on post-operative day twenty-eight. The patient is continuing her immunotherapy with ongoing partial response and is able to continue her full-time job.ConclusionsThis case report highlights the challenges of identifying patients likely to respond to ICIs and those that are likely to experience irAEs and it discusses the impressive work that has been done to start to address these challenges. Lastly, the topic of reinitiating pembrolizumab treatment even after colonic perforation is discussed.
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Project description:•Small bowel obstruction has a broad list of diagnosis.•Thorough history and physical examination along with proper imaging is the key in determining the cause.•Endometriosis if diagnosed preoperatively may respond to hormonal therapy.•Laparoscopic exploration may be both diagnostic and therapeutic.•Small Bowel Endometriosis; A Case Report and Review of Literature.
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Project description:Introduction Small bowel obstruction is a common surgical emergency abdominal condition in clinical practice. Fecalith is one of the rare causative factors, especially phytobezoars. Case Report We report the case of a 66-year-old man admitted with “abdominal pain with vomiting for 1 day.” Enhanced CT of the abdomen suggested incomplete small bowel obstruction. The symptomatic treatment with fasting, fluid replacement, gastrointestinal decompression, and antibiotics was conducted after the patient was admitted to the hospital. After 2 days of treatment, the patient's abdominal pain was not significantly relieved, so a decision was made to perform laparoscopic examination surgery. During surgery, a columnar foreign body was found embedded in the lumen of the small intestine about 10 cm away from the ileocecal region. Combined with the patient's preoperative history of consuming a large number of persimmons, the primary diagnosis of small intestinal fecalith obstruction was considered. We performed an enterotomy to remove the foreign body, and the procedure was uneventful. On postoperative day 7, the patient was successfully discharged. Conclusion When we encounter a patient with intestinal obstruction without a history of surgery in our clinical work, we should take a careful history, especially about the consumption of foods that can cause phytoliths. When a patient has consumed a large amount of food that can cause phytobezoars before the abdominal pain, we should diagnostically consider it as phytobezoars intestinal obstruction, which helps to reduce the incidence of misdiagnosis and allows the patient to receive treatment timely and effectively.
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Project description:IntroductionSclerosing encapsulating peritonitis (SEP), or abdominal cocoon, is a remarkably rare entity. It consists of a fibrous layer or cocoon-like sac encasing, in most cases, the small bowel. The lack of specific symptoms makes preoperative diagnosis challenging.Case presentationA 50-year-old patient, with no history of abdominal surgery or medical diseases, was admitted for symptoms of small bowel obstruction. On examination, the patient was underweight with a BMI of 18 kg/m2. Vital signs were stable. His abdomen was mildly distended and soft. Abdominal CT scan showed signs in favor of a left paraduodenal hernia with incarcerated small bowel loops. Intraoperatively, the small bowels were encapsulated in a cocoon-like structure formed by thick fibrous tissue associated with multiple adhesions. Careful adhesiolysis with complete resection of the membrane was performed. The postoperative course was uneventful. One year later, the patient was symptom-free.DiscussionSEP is thought to be a persistent inflammatory disorder due to a cause that remains unidentified. It is divided into two categories based on its etiology: primary and secondary. The most common mode of SEP revelation is bowel obstruction. Because there is no clear consensus on SEP management, the therapeutic approach typically follows the management strategy of bowel obstruction.ConclusionSEP is an uncommon cause of bowel obstruction. Preoperative detection can be challenging in the absence of pathognomonic signs. Treatment is based on surgery, specifically entailing complete excision of the cocoon and adhesiolysis.
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Project description:IntroductionMost intraocular T-cell lymphomas arise from metastatic source. We are reporting a rare case of intraocular T-cell lymphoma masquerading as pseudo-hypopyon and vitritis. The eye involvement proved to represent a metastatic spread from a co-existing adrenal T-cell lymphoma, which was discovered after the initial ophthalmic presentation.Presentation of caseOur patient was a 71-year-old Saudi man, who was admitted for workup of anemia and weight loss. He also noticed a gradual, painless decline in his vision of both eyes, for which he was referred to the ophthalmology unit. Ocular examination revealed left eye 3 mm pinkish hypopyon. A diagnosis of T-cell lymphoma was made based on careful microscopic examination of the left aqueous fluid, immunohistochemical (IHC) and Flow cytometry analysis. Computerized tomography showed a large invasive left adrenal mass, which has proven to be a primary adrenal lymphoma with multiple metastasis including the intraocular involvement.DiscussionPrimary intraocular lymphoma is the most common lymphoma in the eye. Intraocular T-cell lymphoma is rare and is mostly metastatic. On the other hand, primary adrenal lymphoma (especially T-cell lymphoma) is also rare. There are only 5 cases of primary adrenal lymphoma, two of which, resulted in eye metastasis similar to our case. Primary adrenal lymphoma is known to be aggressive. Our patient eventually passed away.ConclusionThis report stresses the importance of referring patients with systemic lymphoma to an ophthalmologist to be evaluated for ocular involvement. Even though intraocular metastatic adrenal T cell lymphoma is rare, high clinical suspicion in patients who are presenting with pinkish hypopyon in the presence of other constitutional symptoms is essential.
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