Contact Bleeding Research Articles

Penyuluhan Kesehatan tentang Kanker Serviks pada Wanita Usia Subur (WUS) di Desa Kertawinangun Kecamatan Kedawung Kabupaten Cirebon

Cervical cancer is a primary malignant tumor originating from squamous epithelial cells or cells originating from the vagina and urethra, usually occurring in the cervix or cervix which is located between the uterus and the sexual canal (vagina). According to WHO 2018, cervical cancer is the fourth leading cause of death in women throughout the world, estimated at 570,000, while new cases in 2018 or 6.6% of all cancers in women. Human papilloma virus or commonly called (HPV) is known to cause cervical cancer which can be transmitted through sexual intercourse, infection with several types of viruses, and personal hygiene. Symptoms of cervical cancer can be recognized by the presence of fluid from the birth canal, namely abnormal vaginal discharge, contact bleeding (bleeding during intercourse), and feeling pain during coitus / sexual intercourse as well as bleeding even after entering menopause. Early symptoms of pre-cancerous conditions are generally characterized by the discovery of abnormal cells. These abnormal cells develop into cervical cancer and then the following symptoms of cervical cancer appear; the appearance of pain and bleeding during sexual intercourse (contact bleeding), abnormal vaginal bleeding, such as bleeding outside the menstrual cycle, bleeding between regular menstrual periods, menstrual periods that are longer and more abundant than usual, bleeding after menopause, vaginal discharge excessive and abnormal, if the cancer has spread to the pelvis, the patient will suffer from complaints of pelvic pain, difficulty urinating, and enlarged kidneys. Cervical cancer can be prevented 100% by HPV vaccination, using condoms, avoiding tobacco consumption, and early detection and treatment of precancerous lesions.

The Incidence of Cervical Intraepithelial Neoplasia or Cervical Cancer in Women Referred With Postcoital Bleeding.

The incidence of cervical cancer among patients with postcoital bleeding (PCB) was the primary objective of this study. Furthermore, the proportion of cervical intraepithelial neoplasia requiring treatment and the correlation between PCB and the presence of high-risk human papillomavirus (HPV) was determined. Lastly, the study aimed to identify risk factors among the referred women. A retrospective cohort study was conducted at a university hospital in Denmark between January 1, 2017 and December 31, 2019. Women referred with PCB were identified with the ICD diagnosis codes "DN930 Postcoital and contact bleeding" and "DN930B Contact bleeding." Demographic and paraclinical data were extracted from the journals and the supportive systems: Patoweb and the Danish Microbiology Database. A total of 789 women were included in this study, with only 0.25% ( n = 2) diagnosed with cervical cancer and 2.5% ( n = 20) diagnosed with cervical intraepithelial neoplasia II-III and adenocarcinoma in situ. Human papillomavirus testing was only conducted in a minority of cases, and a low incidence of high-risk human papilloma virus was detected in the 22 cases, n = 5. A very low incidence of cervical cancer and high-grade cervical intraepithelial neoplasia reported among women referred with PCB. Prognostic factors as body mass index, smoking, and HPV vaccination status may predict the risk of cervical cancer. Selection criteria like primary testing for hrHPV and cytology as cotests before referral to colposcopy may reduce the number of unnecessary colposcopies.

Colposcopy-A Valuable Diagnostic Tool for Pregnant Women With Unexplained Vaginal Bleeding.

We aimed to examine the diagnostic value of colposcopy in a large cohort of pregnant women with unexplained vaginal bleeding during the second or third trimester. This retrospective study included women who underwent colposcopy due to vaginal bleeding in the second and third trimesters during 2012-2022 at a tertiary care hospital. Demographics, obstetric data, bleeding characteristics, colposcopy results, cervical cytology testing, a sonogram directed at the placenta, and birth details were collected. In total, 364 women were included. The mean maternal age was 29.7 years and the mean gestational age at examination was 30.7 weeks. Vaginal bleeding was mild in 80.8%, moderate in 14.6%, and severe in 4.7%. Only 3.3% had been vaccinated against human papilloma virus and 25.5% underwent a Pap smear study before pregnancy. Colposcopy diagnosed the bleeding source in 83 women (22.8%). The colposcopic examination revealed vaginal bleeding due to contact bleeding from ectropion in 46 (12.6%), a decidual/cervical polyp in 37 (10.2%), acetowhite epithelium in 12 (3.3%), herpes genetalis in 2 (0.5%), and bleeding from vaginal varices in 2 (0.5%). Of those who were recommended a follow-up examination after the postpartum period, only 49.1% completed such.Among women with compared to without postcoital bleeding ( N = 72), the risk of abnormal colposcopic findings was higher (24 [33.3%] vs 54 [19.7%], p = .017) and the rate of abnormal Pap smear was higher (7 [13.2%] vs 7 [3.2%], p = .008). Colposcopy can be a valuable diagnostic tool for women with unexplained vaginal bleeding in the second or third trimester.

Craniofacial fibrous dysplasia mimicking sinunasal mucocele: Case report

Background: Fibrous Dysplasia is a congenital, non-inherited, benign intra-medullary bone lesion in which the normal bone marrow is replaced by abnormal fibro-osseous tissue. It can manifest in axial and extra -axial skeleton and tissues. The wide range of clinical manifestations from skeletal changes to soft tissues swellings and skin discoloration makes it a disease of note in the clinical settings. Some of its complications include malignant transformation, gastrointestinal reflux to cardiac involvement with arrhythmias and even sudden death. Until recently with advent of modern imaging modalities, it was a disease of diagnostic debacle as it was often misdiagnosed .This is a case report of a 17 year old male who was misdiagnosed as sinunasal mucocele until histology proved it to be fibrous dysplasia. Objective: The objective of the report is to draw attention to the diagnostic challenge posed at CT imaging. Methods: This case report was carried out at University College Hospital Ibadan. Results: Showed right sided facial swelling measuring about 15x10cm. The mass was firm to hard in consistency, non-tender and not attached to the overlying skin. There was no loss of sensation in the skin over it. The right eye was displaced superiorly and laterally. A nasal aspect of the mass was seen to occupy the whole of the ipsilateral nasal cavity which it occluded deviating the nasal septum to the left and narrowing the left nasal cavity. It was fleshy and showed contact bleeding. The attending ENT Surgeons made a working diagnosis of right sinunasal tumour with possible malignant transformation. The radiographs of the sinuses showed expansile sclerotic lesion involving the nasal bones, the right maxillary bone, right ethmoidal and maxillary sinuses. The inferior aspect of the right frontal sinus was also affected. A cranial computed tomography (CT) scan (Fig 2-4) showed a multi-loculated hypodense mass with mildly enhancing septations (HU16) within the right frontal, ethmoidal, sphenoidal and maxillary sinuses. There was associated expansion of the affected sinuses with thinning of their cortices. No evidence of aggressive bony destruction was seen. The radiologists made a diagnosis of benign sinunasal tumour most likely mucocele. After right maxillectomy, histology proved the lesion to be fibrous dysplasia. This report goes further to support the need for application of more imaging modalities especially the modern and higher slices CT scanner, higher Tesla(2T )MRI , PET and fusion CT/PET scanners in arriving at radiological diagnosis that will be more compatible with the pathological condition of the patients as against what was in place at the time of this case report .Radiologists are also encouraged to have a high index of suspicion for the disease and to explore the possibilities of the differentials in order not to miss the diagnosis of FD

Cervical neuroendocrine carcinoma in the third trimester: a rare case report and literature review

BackgroundThe incidence of cervical neuroendocrine carcinoma (CNECC) during pregnancy is extremely rare. Insufficient awareness of gynecological tumor screening, as well as atypical and insidious initial clinical symptoms, may result in diagnostic delays and misdiagnosis. There is no standardized treatment for cervical cancer in pregnancy. Herein, we present a case of cervical neuroendocrine carcinoma diagnosed in the third trimester of pregnancy.Case presentationA 26-year-old female at 30 1/7 weeks of gestation presented with lower back and sacroiliac joint pain, abdominal distension, and lower limb dyskinesia. A pelvic examination revealed a large fungating gray mass that encompassed the entire cervix, with cervical contact bleeding testing positive. Imaging studies showed a significant cervical mass, diffuse liver changes, and metastasis to multiple sites. Biopsy results revealed poorly differentiated cervical carcinoma exhibiting high-grade neuroendocrine features, consistent with a diagnosis of large cell neuroendocrine carcinoma. The patient was diagnosed with stage IVB CNECC with HPV18 (+), and due to the gestational age of the fetus and her deteriorating condition, she underwent cesarean section delivery after receiving fetal lung maturation therapy. Following surgery, eight cycles of neoadjuvant chemotherapy were applied. Unfortunately, she succumbed to multiple tumor metastases six months post-treatment. Despite this tragic outcome, the infant was discharged in a healthy condition.ConclusionsCNECC during pregnancy, particularly the large-cell type, is an ultra-rare condition with poor prognosis. This case highlights the importance of individualized treatment approach and the need for better screening, early detection, and treatment. Given the rarity of the disease, further research is warranted to determine the prognostic factors and develop effective treatment strategies for this ultra-rare and aggressive malignancy.

Clinical Analysis of Patients with Cervical Cancer After Adequate Radiotherapy and Surgery

Objective: To explore the effect of giving adequate radiotherapy before surgery on the recovery of patients with cervical cancer. Methods: An experimental study was carried out in Aviation General Hospital (hereafter referred as our hospital) from March 2022 to March 2023. Fifty patients with cervical cancer were retrospectively analyzed. The patients underwent surgery 15–20 days after adequate external radiotherapy, and the clinical effect was analyzed. Results: The symptoms of the patients were relieved, among which contact bleeding and irregular vaginal bleeding completely resolved in 27 patients and 19 patients, respectively; although intermittent vaginal bleeding persisted in 3 patients, the symptom improved compared with before treatment; for 1 patient, the treatment was ineffective, as there was no significant improvement in symptoms. For patients with stage IB2 cancer, the tumor reduction rate after treatment was about 50%–70%, but the reduction in 2 patients was insignificant. Conclusion: Cervical cancer is a serious condition. Adequate radiotherapy before surgery has a significant effect. It reduces the difficulty of surgery and creates an opportunity for patients to undergo surgery, thus improving the treatment effect. Therefore, it is worthy of clinical promotion.

Mistakes and complications in the diagnosis and treatment of children with organic foreign body aspiration

The reason for the publication of this article was the increase in the number of children with long-standing organic foreign bodies in the respiratory tract, the late diagnosis of which causes severe complications. The article presents the three most significant cases from the general series, when the diagnosis and treatment tactics at the stages of treatment were associated with errors both at the prehospital stage and in the hospital. In the first clinical case, as it turned out, the child had aspired multiple foreign bodies. The first bronchoscopy revealed one solid foreign body. Due to severe fibrinous-purulent endobronchitis and contact bleeding, the bronchoscopy procedure was aborted. However, after 10 days, the child independently coughed up the second seed, which was a surprise to us. Control bronchoscopy after 3 weeks revealed no foreign bodies. In the second clinical observation, a child developed bronchiectasis due to a long stay of a foreign body in the respiratory tract. The third case demonstrates the diagnosis and treatment tactics in a child with a foreign body against the background of a coronavirus infection. In the first and third cases, the results of treatment were satisfactory. In the second case, a long stay of peanuts in the respiratory tract led to bronchiectasis in the lower lobe of the left lung, which required its removal. In the follow-up, there are no complaints, the child grows and develops according to age. The study analyzes the mistakes made at the stages of diagnosis and treatment of children with foreign bodies in the respiratory tract.Conclusion. Young children with long-term and atypically current respiratory diseases, dubious and even normal radiological picture with the absence of comprehensive information on the anamnesis of diseases should alert the doctor to the possibility of aspiration of a foreign body in the respiratory tract and serve as the basis for performing bronchoscopy.

Pattern and predictors of cervical epithelial cell abnormalities among unscreened and under-screened women in Lagos, Nigeria: a cross-sectional study.

Women who had never undergone cervical screening (CS) or who have infrequent CS are at increased risk of having cervical epithelial cell abnormalities (CECA) that may lead to cervical cancer (CCa). Our study determined the pattern and factors that predict the occurrence of CECA among unscreened and under-screened women in Lagos, Nigeria. This was an analytical cross-sectional study among 256 consenting sexually active women between 21 and 65 years who attended a community CS programme in Surulere, Lagos, Nigeria, in June 2019. Information on socio-demographic, reproductive, sexual, behavioural and clinical characteristics were collected and a Pap smear test was done. Women with abnormal cervical cytology were followed up and given appropriate treatment. Data analysis was done using Statistical Package for Social Sciences version 23. Descriptive statistics were computed using frequencies and association was tested using odd ratio. The participants' mean age was 42.7 ± 10.3 years, majority were married (79.9%) and were human immune deficiency syndrome (HIV) negative (63.1%). The prevalence of CECA was 9.8%. Atypical squamous cell of undetermined significance and atypical squamous cell cannot exclude high-grade squamous intraepithelial lesion were the most common CECA with prevalence rates of 7.4% and 2.0%, respectively. Having a partner with multiple sexual partners (adjusted odd ratio (AOR) = 19.23), being HIV positive (AOR = 25.61), giving birth for the first time before the age of 26 years (AOR = 5.55) and presence of a combination of either abnormal vaginal discharge, contact bleeding or an unhealthy cervix on clinical examination (AOR = 13.65) independently predicted the occurrence of CECA. There is a need to prioritise CS for women with these risk factors to prevent CCa and reduce the burden of the disease in our environment.

Sinonasal Lymphoma: A Rare Pathology Presenting with Common Post-Influenza Symptoms

Sinonasal malignancies are uncommon and only account for 3% of head and neck cancers. Despite diffuse large B-cell lymphomas (DLBCL) being the most common type of non-Hodgkins lymphoma occurring at various extranodal sites, its occurrence as a sinonasal tumor is exceedingly rare. Early detection and treatment of sinonasal lymphoma, have favourable outcomes with improvements in the 2-year and 5-year survival rates. We are reporting a case of primary sinonasal DLBCL in a 63-year-old lady who initially presented with nasal obstruction and epistaxis, both common symptoms in patients who have had a recent Influenza A infection. However, due to the unilaterality and progressive nature of her nasal obstruction, she warranted a specialist otorhinolaryngology assessment. Naso endoscopy revealed a unilateral nasal mass extending from the right middle meatus to the nasal floor and was friable with contact bleeding. These clinical findings are similarly seen in most of the various types of sinonasal malignancies, and diagnosis can be challenging. Pathologists rely upon immunohistochemical staining profiles to differentiate this highly heterogeneous group of malignancies. Histopathological examination confirmed the diagnosis of sinonasal lymphoma. The treatment of this rare pathological entity is discussed. International Journal of Human and Health Sciences Supplementary Issue: 2023 Page: S28

Menstrual changes after the thrombo-prophylaxis or anticoagulants used during the COVID-19 infection.

To detect the menstrual changes after the thrombo-prophylaxis or anticoagulants used during the COVID-19 infection. A total of 176 diagnosed with COVID-19 infection, were included in this retrospective study after giving informed consent. Participants were asked to complete an online questionnaire, and the collected participants` data were analysed using the χ2 test to detect the menstrual changes after the thrombo-prophylaxis or anticoagulants used during the COVID-19 infection. The number of participants` number who reported menstrual flow for 2 to < 5 days, and menstrual flow > 7 days after the COVID-19 infection [31/176 (17.6%), and 42/176 (23.9%), respectively] was significantly higher compared to the number of participants` who reported menstrual flow for 2 to < 5 days, and menstrual flow > 7 days before the COVID-19 infection [12/176 (6.8%), and 15/176 (8.5%), respectively], (p = 0.005, and 0.0009, respectively). The use of thrombo-prophylaxis or anticoagulants during the COVID-19 infection was also associated with significant menstrual pattern changes (37.8% increased menstrual flow, 18.5% menstrual flow for 2 to < 5 days, 59.7% menstrual flow > 7 days, 5.9% contact bleeding, and 6.7% abnormal menstrual pattern for one cycle). Significant menstrual changes were observed in this study after the COVID-19 infection infection (17.6% reported menstrual flow for 2 to < 5 days, and 23.9% reported menstrual flow > 7 days). The use of thrombo-prophylaxis or anticoagulants during the COVID-19 infection infection was associated with significant menstrual changes (37.8% increased menstrual flow, 18.5% menstrual flow for 2 to < 5 days, 59.7% menstrual flow > 7 days, 5.9% contact bleeding, and 6.7% abnormal menstrual pattern for one cycle).

Conservative short-term treatment of non-cirrhotic non-malignant portal vein thrombosis

Introduction. Portal vein (PV) thrombosis (PVT) is a partial or complete obstruction of blood f low as a result of a thrombus mass in the lumen of PV. In the acute phase, the symptoms such as right upper quadrant pain, nausea, and fever are unspecific. A diversity of subacute and chronic symptoms is associated with complications related to PVT and portal hypertension. Case report. A 50-year-old female was admitted to the hospital due to acute abdominal cramping pain. The pain lasted for 15 to 20 min and was followed by defecation of normal stool and hematochezia on three occasions. The abdominal pain recurred after several hours, again followed by hematochezia and tenesmus every 10 min. After admission, a colonoscopy was performed, and it revealed vulnerable, erythematous mucosa of the colon with contact bleeding from the lienal flexure to the rectosigmoid junction. During the colonoscopy, a biopsy was performed. A computed tomography (CT) scan revealed partial PVT of intrahepatic branches of PV, and thrombosis of the inferior mesenteric vein. After conservative treatment with low molecular weight heparin (LMWH) and other supportive measures, the digestive bleeding ceased, and defecation became normal. During the one-month follow-up, the patient had no complications, and the control CT scan revealed normal PV flow without thrombosis. Conclusion. Although rare, a non-malignant and non-cirrhotic PVT should not be neglected in the differential diagnosis because timely and vigilant therapy with LMWH can lead to complete resolution without serious complications.

Vaginal Carriage of Group B Streptococcus (GBS) in Pregnant Women, Antibiotic Sensitivity and Associated Risk Factors in Dakar, Senegal.

The eradication of neonatal Group B Streptococcus (GBS) infections, considered as a major public health priority, necessarily requires a mastery of the data on vaginal carriage in pregnant women. The aims of this study were to determine the prevalence of vaginal carriage of GBS in pregnant women, antibiotic susceptibility, and associated risk factors. This was a cross-sectional, descriptive study conducted over a period of 9 months (July 2020 to March 2021) in pregnant women between 34 and 38 weeks of gestation (WG) followed at the Nabil Choucair health center in Dakar. Identification and antibiotic susceptibility of GBS isolates were performed on the Vitek 2 from vaginal swabs cultured on Granada medium. Demographic and obstetric interview data were collected and analyzed on SPSS (version 25). The level of significance for all statistical tests was set at P < .05. The search of GBS vaginal carriage had involved 279 women aged 16 to 46 years, with a median pregnancy age of 34 (34-37) weeks' gestation. GBS was found in 43 women, for a vaginal carriage rate of 15.4%. In 27.9% (12/43) of volunteers screened, this carriage was monomicrobial, while in 72.1% (31/43) of women, GBS was associated with other pathogens such as Candida spp. (60.5%), Trichomonas vaginalis (2.3%), Gardnerella vaginalis (34.9%) and/or Mobiluncus spp. (11.6%). The level of resistance was 27.9% (12/43) for penicillin G, 53.5% (23/43) for erythromycin, 25.6% (11/43) for clindamycin and 100% for tetracycline. However, the strains had retained fully susceptible to vancomycin and teicoplanin. The main risk factor associated with maternal GBS carriage were ectocervical inflammation associated with contact bleeding (OR = 3.55; P = .005). The high rate of maternal vaginal GBS carriage and the levels of resistance to the various antibiotics tested confirm the importance of continuous GBS surveillance in our resource-limited countries.

Imported parasitosis as a diagnostic challenge in Primary Healthcare Clinic in the non-endemic region — a case study of schistosomiasis in English Division student

Schistosomiasis is a parasitosis, most commonly caused by Schistosoma mansoni or Schistosoma haematobium, eventually by other species from the genus Schistosoma (blood flukes). This study presents a case of schistosomiasis in an African-origin student cured in the Primary Healthcare Clinic (PHC) in Lublin, Poland. The young adult male patient from Zimbabwe, studying in Poland, presented to the PHC, due to pain in the left down quadrant of the abdomen, bloody stools, and a single episode of drooling with a blood-stained jelly-like mass, without fever. In blood tests, there was neutropenia, lymphocytosis and eosinophilia. In a colonoscopy, numerous lymphoid nodules were observed with small regions of mucosal erythema, faded vascular drawing, and delayed small contact bleeding. The patient had an elevated level of IgE (329,5 IU/mL; N &lt; 158) and minor abnormalities in the proteinogram. Abdominal CT showed calcification of intestinal walls, suggesting infection of flukes from the Schistosoma genus. The result of histopathological examination confirmed the presence of structures interpreted as parasite eggs in intestinal crypts, lamina propria and the lumen of mesenteric vessels. It is of great importance, that general medicine physicians working in schistosomiasis non-endemic regions are aware and pay attention to various risks as well as provide referrals to advanced imaging and endoscopic procedures in patients with unusual health problems. Keeping in mind, that early signs and symptoms of schistosomiasis, and results of blood tests may remain unspecific in contrast to a more complex gastrointestinal diagnostic approach, a chance of early diagnosis and successful therapeutic intervention may be facilitated.

Recurrent Adenocarcinoma from the Drain Site

A 42 year old gentleman who had a recto-sigmoid carcinoma and was operated six months ago presented with a fungating lesion at the right iliac fossa region. The fungating lesion was about 5x5 cm in size with contact bleeding. The patient defaulted his chemotherapy regime and claimed that the lesion grew in size progressively over the time. Onfuther examination we noted that the lesion was originating from the previous blake drain site that was inserted during the first operation. Biopsy of the lesion done and it confirms that it is adenocarcinoma from the colon. The patient was subjected to CT scan for re-staging and was referred to the oncology team for further management. This is a rare occasion where the tumor recur from the drain site probably due to tumor seeding from the previous operation.

S2123 Refractory Case of Malignant Eosinophilic Colitis Leading to Ischemic Colitis

Introduction: Eosinophilic colitis (EC) is a rare inflammatory condition involving eosinophilic infiltration of the mucosa in the absence of a secondary cause or peripheral eosinophilia. Clinically, EC presents with non-specific symptoms. We present a case of malignant EC that is refractory to different therapies. Case Description/Methods: A 30 years old male with known EC on azathioprine, pulmonary embolism and superior mesenteric venous (SMV) thrombosis onrivaroxaban, had multiple admissions with abdominal pain and hematochezia secondary to Clostridioides difficile (C. diff). His rivaroxaban and azathioprine were held given his hematochezia and recurrent infections. He presented a month later with worsening symptoms but C. diff was negative. CT abdomen/pelvis showed non-occlusive SMV and portal venous (PV) thrombosis with signs of ischemia of the sigmoid colon (Figure 1b). Patient underwent percutaneous transhepatic SMV/PV aspiration thrombectomy that was complicated by a large right hemothorax, causing hemorrhagic shock. Subsequent flexible sigmoidoscopy showed signs of colonic ischemia (Figure 1a). Colonic biopsies demonstrated active colitis without evidence of chronicity, and 60 eosinophils per high powered field. Patient underwent a subtotal colectomy with end ileostomy with clinical improvement immediately postoperatively. He was discharged on a steroid taper and apixaban. He was started on the interleukin-5 (IL-5) inhibitor benralizumab for his EC. Outpatient follow-up was notable for continued rectal bleeding. Flexible sigmoidoscopy showed diffuse severe erythema, contact bleeding, and friable mucosa throughout the rectal pouch (Figure 1c). Vedolizumab was started in combination with benralizumab, however, on long-term outpatient follow-up, no notable clinical or endoscopic improvements were noted on combination therapy. Multi-disciplinary decision in conjunction with patient resulted in planned proctocolectomy with permanent end ileostomy. Discussion: There are currently no FDA approved management options for EC. The IL-5 inhibitor Benralizumab is FDA approved for treatment of eosinophilic asthma and therefore it was worth a trial in this patient. In a small number of case reports, Vedolizumab has shown some clinical improvement as well as reduction in eosinophilia in EC patients. Due to the rarity of EC diagnosis, data for therapies in EC is severely lacking. To our knowledge, this is the first case of a patient with severe refractory EC that led to the development of ischemic colitis.Figure 1.: (a) shows an endoscopic image of ischemic colitis. (b), the red arrow points at the portal vein thrombosis and (c) shows diffuse severe erythema, contact bleeding, and friable mucosa throughout the rectal pouch.

S3496 You Shall Not Pass: Rare Duodenal Bulb Adenocarcinoma Causing Gastric Outlet Obstruction

Introduction: Duodenal carcinoma accounts for only 1-2% of diagnosed gastrointestinal cancers in the United States. Due to its insidious onset, advanced disease is often established at the time of diagnosis resulting in poor outcomes for patients. Although duodenal adenocarcinomas have been found to comprise around half of all small bowel adenocarcinomas, disease arising from within the duodenal bulb in the D1 segment is a vanishingly rare phenomenon. Case Description/Methods: A 52-year old female with a past medical history of morbid obesity with placement of laparoscopic adjustable gastric band 14 years prior presented with frequent emesis, inability to tolerate oral diet and a 22kg weight loss. Recent esophagogastroduodenoscopy during a previous admission revealed a cratered ulcer in the duodenal bulb. An upper GI series was obtained, showing a 2cm mass in the bulb apex which was confirmed by computed tomography. A repeat esophagogastroduodenoscopy was performed which identified a firm and friable ulcer with contact bleeding with complete obstruction of the duodenal bulb. Subsequent histopathology confirmed the presence of invasive, moderately differentiated adenocarcinoma. (Figure) Discussion: Small bowel tumors comprise about 2% of all GI tumors. Adenocarcinoma accounts for about 30% of all small bowel tumors. The duodenum comprises 53% of all small bowel neoplasms. Of duodenal tumors, about 57% occur in the D2 segment of the duodenum. One 2014 meta-analysis of small bowel cancers between 1990-2012 from an institutional registry (excluding ampullary cancers arising from the bile duct mucosa) identified only 30 cases of primary duodenal adenocarcinoma with none arising from D1. A previous 1991 literature review cites 47 cases of primary duodenal adenocarcinoma arising from D1, however, anatomic distinction between the duodenal bulb and the distal D1 segments was not made. Although small bowel tumors are the third leading cause of gastric outlet obstruction, lesions are typically asymptomatic. In a study of 217 primary duodenal adenocarcinoma, the median survival was 20 months with 35% presenting with metastatic disease (39% present with stage III disease). Although it is difficult to distinguish the prevalence of duodenal bulb neoplasms, it has been clearly demonstrated that neoplasms arising from the D1 segment of the duodenum are extremely rare. By presenting this case, we hope to increase the index of suspicion for small bowel neoplasms as part of the differential for gastric outlet obstruction.Figure 1.: CT demonstration of duodenal bulb mass causing gastric outlet obstruction; Figure 2: Endoscopic image of duodenal bulb tumor.

Endoscopic imaging in inflammatory bowel disease.

In inflammatory bowel disease, including Crohn's disease and ulcerative colitis, an excessive immune response due primarily to T-cell lymphocytes causes inflammation in the gastrointestinal tract. Lesions in Crohn's disease can occur anywhere in the gastrointestinal tract, i.e., from the oral cavity to the anus. Endoscopically, aphthoid lesions/ulcers believed to be initial lesions progress to discrete ulcers, which coalesce to form a longitudinal array and progress to longitudinal ulcers with a cobblestone appearance, which is a typical endoscopic finding. Before long, complications such as strictures, fistulas, and abscesses form. Lesions in ulcerative colitis generally extend continuously from the rectum and diffusely from a portion of the colon to the entire colon. Endoscopically, lack of vascular pattern, fine granular mucosa, erythema, aphthae, and small yellowish spots are seen in mild cases; coarse mucosa, erosions, small ulcers, bleeding (contact bleeding), and adhesion of mucous, bloody, and purulent discharge in moderate cases; and widespread ulcers and marked spontaneous bleeding in severe cases.

Primary Malignant Melanoma of the Female Urethra, A Rare Histologic Pathology Subtype and Poor Prognosis: Case Report

Introduction: Primary malignant melanoma of the genitourinary tract is extremely rare. The recommendations for management of this cancer still undefined due to paucity of literature. We report a case of primary malignant urethral melanoma developed in an elderly female patient. Presentation of case: 72 years old Thai female presented with palpable urethral mass with contact bleeding. On physical examination, there were no suspicious lesions on her skin. On external genital examination, a lesion at urethral meatus was observed and biopsied by rural doctor. The pathological diagnosis was malignant melanoma of urethra. Discussion: Despite major surgery, radiotherapy or immunotherapy malignant melanoma usually has a poor prognosis. We performed distal urethrectomy and followed up her clinical closely but unfortunately tumor recurrence in 15 months of the follow up. Conclusion: Primary malignant melanoma of female urethra is an extremely rare and poor prognosis. The histological and immunohistochemical findings can be helpful in making an accurate diagnosis.

Human Rhinosporidiosis of the Nasal Cavity: a Case Report

ABSTRACT Background: Rhinosporidiosis is a rare chronic granulomatous disease caused by Rhinosporidium seeberi. It is endemic in some parts of Asia and commonly involves the mucous membrane of the nose presenting with nasal obstruction, a nasal mass, and epistaxis. The main treatment for rhinosporidiosis remains surgical excision, although it may recur after excision. Rhinosporidiosis is a condition that clinicians should keep in mind when managing patients with nasal masses even in non-endemic areas. Case presentation: A 52-year-old housewife presented with a 9-month history of left progressive nasal obstruction and progressive enlarging left nasal growth associated with recurrent nasal bleeding and nasal discharge. She had a history of rearing animals and bathing in ponds as well as engaging in farming activities. Examination revealed a fleshy polypoid mass attached to the nasal septum by pedicle and filling the whole of the left nasal cavity covered with a mucopurulent nasal discharge with associated contact bleeding. She had endoscopic resection under local anaesthesia with cauterization of the base of the mass with a silver nitrate pencil. A histopathological diagnosis of rhinosporidiosis was made. Conclusion: Rhinosporidiosis is rare in our environment, its presentation mimics that of nasal tumours. Therefore, it should be part of the differential diagnosis; both clinicians and pathologists should have it at the back of their minds when managing patients with nasal masses even in non-endemic areas.

Development and validation of a clinical prediction model for endocervical curettage decision-making in cervical lesions

BackgroundIn the absence of practical and reliable predictors for whether the endocervical curettage (ECC) procedure should be performed, decisions regarding patient selection are usually based on the colposcopists’ clinical judgment instead of evidence. We aimed to develop and validate a practical prediction model that uses available information to reliably estimate the need to perform ECC in patients suspected of having cervical lesions.MethodsIn this retrospective study, 2088 patients who underwent colposcopy, colposcopically directed biopsy (CDB) and ECC procedures between September 2019 and September 2020 at the Second Hospital of Shanxi Medical University were included. The data were analyzed with univariate and multivariable logistic regression. Least absolute shrinkage and selection operator (LASSO) was used to select predictors for ECC positivity. The ECC prediction model was presented as a nomogram and evaluated in terms of discrimination and calibration. Furthermore, this model was validated internally with cross-validation and bootstrapping.ResultsSignificant trends were found for ECC positivity with increasing age (P = 0.001), menopause (P = 0.003), Human papillomavirus (HPV) status (P < 0.001), severity of ThinPrep Cytological Test (TCT) (P < 0.001), original squamous epithelium ectopia (P = 0.037) and colposcopy impression (P < 0.001) by multivariable logistic regression analysis. The ECC prediction model was developed based on the following predictors: age, menopause, symptom of contact bleeding, severity of TCT, HPV status, cervix visibility, original squamous epithelium ectopia, acetowhite changes and colposcopic impression. This model had satisfactory calibration and good discrimination, with an area under the receiver operator characteristic curve (AUC) of 0.869 (95% confidence interval 0.849 to 0.889).ConclusionsA readily applicable clinical prediction model was constructed to reliably estimate the probability of ECC positivity in patients suspicious of having cervical lesions, which may help clinicians make decisions regarding the ECC procedure and possibly prevent adverse effects.