Anjana Sathyamurthy

Obstructive jaundice due to a rare periampullary tumor

Gangliocytic paraganglioma is a rare neuroendocrine tumor predominantly arising in the second part of the duodenum with rare local recurrence or metastasis to regional lymph nodes. A 92-year-old female presented with obstructive jaundice. On exam she had pale conjunctiva and icteric sclera. Abdominal examination revealed tenderness in the upper abdomen. Laboratory data was consistent with obstructive jaundice. Computed tomography of the abdomen revealed a dilated gall bladder and a common bile duct (CBD) with no evidence of liver lesions or pancreatic head mass. Endoscopic ultrasonography revealed a 1 cm isoechoic submucosal nodule at the periampullary area, dilated CBD (9 mm), a prominent pancreatic duct (4.1 mm) and a hydropic gall bladder with no stones. Endoscopic retrograde cholangiopancreaticography was performed to relieve obstruction and showed a 1 cm periampullary mass which underwent an en-bloc snare resection. Histopathology analyses with immunohistochemical stains were positive for cytokeratin, synaptophysin, S-100 protein, neuron specific enolase and negative for actin and desmin consistent with periampullary gangliocytic paraganglioma. Periampullary gangliocytic paraganglioma is a rare benign tumor of the small bowel. Common presentation includes abdominal pain and obstructive jaundice which should be included in differential diagnosis of obstructive jaundice. Endoscopic resection is a curative therapy in the absence of local invasion or distant metastasis.

Synchronous Gastrointestinal Carcinoid Tumor and Colon Adenocarcinoma: Case Reports and Literature Review

BACKGROUND Coexistence of carcinoid tumor and colorectal adenocarcinoma is rare. In this report, we present two cases and review the current literature for synchronous carcinoid tumor and colorectal carcinoma occurrence. CASE REPORT In both cases, the rectal carcinoid tumors and sigmoid colon adenocarcinomas were detected by colonoscopy. The colon adenocarcinomas were effectively treated with a laparoscopic sigmoidectomy and the carcinoids were successfully removed endoscopically. Our 40-year-old patient was the youngest among 17 reported patient cases. CONCLUSIONS These two cases demonstrate that the diagnosis of gastrointestinal carcinoid requires a complete assessment of the remainder of the colon for another primary cancer to achieve a timely treatment management strategy.Case series Patient: Male, 40; Male, 70 Final Diagnosis: Synchronous gastrointestinal carcinoid tumor and colon adenocarcinoma Symptoms: Weakness Medication: — Clinical Procedure: Colonoscopy Specialty: Gastroenterology and Hepatology Objective: Rare co-existance of disease or pathology Background: Coexistence of carcinoid tumor and colorectal adenocarcinoma is rare. In this report, we present two cases and review the current literature for synchronous carcinoid tumor and colorectal carcinoma occurrence. Case Reports: In both cases, the rectal carcinoid tumors and sigmoid colon adenocarcinomas were detected by colonoscopy. The colon adenocarcinomas were effectively treated with a laparoscopic sigmoidectomy and the carcinoids were successfully removed endoscopically. Our 40-year-old patient was the youngest among 17 reported patient cases. Conclusions: These two cases demonstrate that the diagnosis of gastrointestinal carcinoid requires a complete assessment of the remainder of the colon for another primary cancer to achieve a timely treatment management strategy.

Culprit for recurrent acute gastrointestinal massive bleeding: "Small bowel Dieulafoy's lesions" - a case report and literature review.

A Dieulafoys lesion is a dilated, aberrant, submucosal vessel that erodes the overlying epithelium without evidence of a primary ulcer or erosion. It can be located anywhere in the gastrointestinal tract. We describe a case of massive gastrointestinal bleeding from Dieulafoys lesions in the duodenum. Etiology and precipitating events of a Dieulafoys lesion are not well known. Bleeding can range from being self-limited to massive life- threatening. Endoscopic hemostasis can be achieved with a combination of therapeutic modalities. The endoscopic management includes sclerosant injection, heater probe, laser therapy, electrocautery, cyanoacrylate glue, banding, and clipping. Endoscopic tattooing can be helpful to locate the lesion for further endoscopic re-treatment or intraoperative wedge resection. Therapeutic options for re-bleeding lesions comprise of repeated endoscopic hemostasis, angiographic embolization or surgical wedge resection of the lesions. We present a 63-year-old Caucasian male with active bleeding from the two small bowel Dieulafoys lesions, which was successfully controlled with epinephrine injection and clip applications.

Extra-thoracic Extrinsic Compression: An Unusual Cause of Dysphagia

BACKGROUND Dysphagia affects one in twenty-five adults yearly in the United States. OBJECTIVE While dysphagia may be common, the prevalence of dysphagia may be underestimated primarily due to under-reporting. Dysphagia may be caused by intraluminal, intrinsic, extrinsic, or motility disorders. METHOD/RESULTS We present a case of dysphagia caused by extra-thoracic extrinsic compression due to bra use. CONCLUSION Despite many published reports on dysphagia caused by other diagnoses, we occasionally overlook extrinsic abdominal compression as the cause for dysphagia.

Are we ready to change our colorectal cancer screening practice? Traditional serrated adenomas or serrated adenomas with dysplasia should be regarded as advanced adenomas with high grade dysplasia.

Colorectal cancers (CRCs) develop mostly via adenomacarcinoma sequence. Serrated pathway is an alternative way in one third of CRCs and is associated with serrated adenoma/ polyp (1,2). Serrated adenomas are typically three types as sessile serrated adenoma/ polyp (SSA/P), traditional serrated adenoma (TSA) and hyperplastic polyp (HP) (3,4). Some serrated adenomas used to be misdiagnosed as HPs before the mid-2000s. Therefore they received minimal intervention and inappropriate follow up after polypectomy. SSA/P and TSA are now distinguished from HP and are recognized as precursors to CRC (5,6).