Multiple Submucosal Nodules Research Articles

Cheilitis Glandularis: A clinicopathologic study with emphasis on etiopathogenesis.

Cheilitis Glandularis (CG) is an uncommon entity of obscure etiology. A cases series is presented with emphasis on etiopathogenesis. Fourteen CG cases were analyzed according to their demographic and clinicopathologic characteristics. The mean age of the patients with CG was 68.1years, while a male-to-female ratio of 1.8:1 was observed. One or more potential causative factors were identified for each patient, including long-term smoking (9 cases), xerostomia (4 cases), cosmetic filler injections (2 cases), and actinic cheilitis (1 case). The lesions were located on the lips, buccal mucosa, or both in 7, 2, and 5 cases, respectively. Multiple submucosal nodules with dilated ductal orifices and mucous or purulent discharge were observed in all cases. Histopathologically, ductal ectasia with metaplasia, intraductal mucin, and chronic or mixed inflammation were noted, as well as pools of hyaluronic acid in 2 cases with a history of cosmetic filler injections. CG etiopathogenesis is probably multifactorial. Reduced salivary flow rate and increased viscosity of saliva, potentially caused by long-term smoking, diabetes mellitus, and drug-induced xerostomia, may participate in the initial pathogenesis, while local irritants, for example, poor oral hygiene and local trauma, may further contribute to the development and aggravation of the condition.

Kaposi's Sarcoma Presenting as a Bulky Tumor Mass of the Colon

t m A homosexual man presented with lower abdominal pain several times a day and diarrhea of -months duration. He was diagnosed with human immunoeficiency virus (HIV) infection 2 years before presentation and ad not received highly active antiretroviral therapy (HAART). is CD4 count was 11 cells/ L, and his HIV RNA viral load was .3 105 copies/mL. He had slight anemia, with hemoglobin of 1.4 g/dL. On physical examination we found a firm purple odule throughout the body. Stool examinations for ova, parsites, bacteria, and mycobacteria were negative. Two tests for ecal occult blood were positive. Colonoscopy revealed the rectum and sigmoid colon were rossly normal. However, the descending colon contained a ulky mass surrounding the entire colon where the epithelium ad a deep red color (Figure A) after indigo carmine dye (Figure B). There was a stricture of the colon through which the endoscopic fiber barely passed (Figure B). Computed tomography scan on the same site also revealed a massive lesion. Hematoxylin-eosin staining of biopsy specimen showed moderate chronic inflammation and proliferation of spindle cells with vascular slits and hemorrhage, consistent with Kaposi’s sarcoma (KS) (Figure C). The viral load of KS-associated herpesvirus in the blood was high at 7 104 copies/mL. Systemic treatment with HAART and pegylated liposomal doxorubicin was started. After 2 months of treatment, his symptoms had improved. A repeat colonoscopy revealed that the lesion subsequently became smaller. KS is the most common neoplasm in patients with acquired immune deficiency syndrome (AIDS).1 KS is especially common among homosexual patients with AIDS and those with particularly low CD4 counts.1,2 In KS, the gastrointestinal tract is the hird most affected site after the skin and lymph nodes. Most astrointestinal lesions might be asymptomatic, but advanced lesions might cause bleeding, diarrhea, and abdominal pain and require immediate treatment.1 In this case, there was a risk of bstruction and hemorrhage of the colon. On endoscopy, gastrointestinal KS is characterized by feaures such as multiple submucosal nodules with deeply red ucosa.3 Lesions might also have features of polypoid nodules, have maculopapular appearance, manifest as mass lesions, and rarely present bulky tumor like this case.3 The prognosis of HIV infection has improved since the introduction of HAART. Furthermore, early diagnosis of KS in the colon can improve prognosis and quality of life. Endoscopy should not be hesitated on for patients with abdominal symptoms, especially those with particularly low CD4 counts who are homosexual.

Gastrointestinal Bleeding in Infants and Children

1. John T. Boyle, MD* 1. *Clinical Professor of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pa; Division of Pediatric Gastroenterology, Hepatology & Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pa After completing this article, readers should be able to: 1. Develop a differential diagnosis based on the clinical presentation of gastrointestinal (GI) blood loss. 2. Discuss the age-related causes of upper and lower GI bleeding. 3. Delineate the sequence of evaluation and decision process in a child who has GI bleeding. 4. Describe new medical therapies and endoscopic maneuvers to control GI bleeding. A previously well 3-week-old female infant presented with a 2-day history of rectal bleeding. Her parents described three to five loose stools per day mixed with bright and dark red blood and mucus. Associated symptoms included episodic nonbilious, nonbloody emesis and an erythematous rash on her arms and legs. The infant was receiving standard cow milk formula. Her weight gain and linear growth were excellent. The abdominal examination revealed no tenderness or organomegaly, and there were no anal fissures. Stool was guaiac-positive. The complete blood count (CBC) revealed normal hematocrit, mean corpuscular volume (MCV), platelet count, and white blood cell count. The total eosinophil count was mildly increased at 0.55×103/mm3. The stool culture was negative . Clostridium difficile toxin was present. Three days after having been switched to a protein hydrolysate formula, the infant's bowel frequency decreased to twice a day. Although the baby continued to appear well, with good weight gain and growth, her stools still contained gross strands of blood and mucus intermittently over the next 3 weeks. Flexible sigmoidoscopy at that time revealed moderate nodular lymphoid hyperplasia in the rectosigmoid region(Fig. 1). The colonic mucosa appeared normal otherwise. Biopsies from the sigmoid and rectum showed six eosinophils per high-power field, normal crypt architecture, and lymphoid nodules. The infant continued to receive the protein hydrolysate formula, and gross bleeding gradually resolved over the next 2 weeks . Figure 1. Nodular lymphoid hyperplasia: multiple submucosal nodules in the …

Computed Tomography Colonographic Findings of Pneumatosis Cystoides Coli

Pneumatosis cystoides coli (PCC) is an uncommon condition in which multiple gas-filled cysts in the walls of the colon. Patients with PCC initially complain of various symptoms including abdominal discomfort, constipation, diarrhea, hematochezia, vomiting, and fever. We recently diagnosed PCC by computed tomography (CT) colonography in 2 patients. Two patients visited the outpatient clinic presenting with hematochezia, diarrhea, or abdominal pain. No underlying cause of PCC was found. Colonoscopy revealed multiple submucosal nodules covered with normal mucosa in the colon. However, CT colonography showed multiple gas-filled cysts within the walls of colon.

Esophageal Plexiform Schwannoma.

We report a patient with a plexiform schwannoma located in the cervical part of the esophagus. A large pedunculated intraluminal polyp, originating in the postcricoid region and protruding into the oropharynx, was found in association with multiple submucosal nodules. Both the intraluminal polyp and submucosal nodules consisted of cellular schwannomatous tissue. The patient showed no signs of neurofibromatosis or schwannomatosis. Plexiform schwannomas are uncommon tumors, mainly confined to the dermis and subcutis of trunk, head, and neck region and upper extremities. Visceral examples are vanishingly rare, and a location in the esophagus has not yet been described. The intruiging mode of presentation in the present case, mimicking that of so-called giant esophageal fibrovascular polyp, probably relates to mechanical factors inherent to the unique esophageal location, Int J Surg Pathol 8(4):353-357, 2000

Double-contrast radiographic assessment of lupus-associated enteropathy

To describe the double-contrast radiographic features of lupus-associated enteropathy. Six patients with systemic lupus erythematosus involving the small bowel were assessed by double-contrast radiography of the duodenum and small intestine, with reference to clinical manifestations and jejunoscopic findings. Lupus-associated enteropathy could be categorized into two types: acute onset enteritis in four patients and protein-losing enteropathy with hyperlipidaemia in two patients. The former group presented with irregular thickening and spiculation in the folds of the multiple segments of the duodenum to the terminal ileum, and they were frequently accompanied by thumbprinting, suggestive of ischaemic change. The latter group was characterized by mildly thickened folds with multiple submucosal nodules in the upper portion of the jejunum. In one patient from this group, jejunal biopsy demonstrated lymphangiectasia. Both groups were successfully treated by high-dose prednisolone. Follow-up radiography in the former group showed a complete improvement within 2-7 weeks, whereas radiographic abnormalities in the latter remained even after 2 months. Lupus-associated enteropathy cases may be divisible into two types; an acute ischaemic enteritis type and a protein-losing enteropathy type, each presenting distinct radiographic features.

Internal hemorrhoids: diagnosis with double-contrast barium enema examinations.

The authors retrospectively studied 43 patients suspected of having internal hemorrhoids at double-contrast barium enema examination. At endoscopy, 24 patients (56%) had internal hemorrhoids, four (9%) had other pathologic lesions in the rectum without evidence of hemorrhoids, and 15 (35%) had no reported abnormalities in the rectum. Internal hemorrhoids were found at endoscopy in 10 of 20 patients (50%) with lobulated folds extending 3 cm or less from the anorectal junction and 10 of 13 patients (77%) with multiple submucosal nodules. However, no patients with these characteristic radiographic findings were found to have other pathologic lesions in the rectum that had been mistaken for hemorrhoids at barium enema examination. Conversely, three of four patients with lobulated folds extending more than 3 cm from the anorectal junction and one of six patients with solitary nodules had proctitis or rectal neoplasms. Thus, specific criteria are suggested for the diagnosis of internal hemorrhoids on double-contrast barium enema examinations. Suspected hemorrhoids that do not fulfill these criteria should be evaluated endoscopically to rule out other more serious pathologic lesions in the rectum.

The roentgenologic spectrum of small intestinal carcinoid tumors.

THE ROENTGENOLOGIC SPECTRUM OF SMALL INTESTINAL CARCINOID TUMORSNICHOLAS H. BANCKS, M.D., HARVEY M. GOLDSTEIN, M.D. and GERALD D. DODD, JR., M.D.Audio Available | Share