Manraj Khosla

Gorgojos Chinos (Flour Beetle): Incidental Finding during Colonoscopy

A screening colonoscopy in a 50-year-old Hispanic woman revealed bead-like objects throughout her colon (a). Closer inspection showed that dead insects were occupying her colon from the cecum (b) to the ascending colon (c). When questioned, the patient acknowledged ingesting “gorgojos chinos,” a type of beetle from the Cucolionoioidea superfamily and better known as the flour bug or the Chinese weevil. The practice appears to be a growing tradition in the Hispanic population. It is believed that when these insects die in the stomach they secrete an enzyme that can strengthen the body’s defenses against various diseases, including AIDS and diabetes. Positive anecdotal information has been posted in online forums, but there is limited, if any, scientific literature on gorgojos chinos and the associated health claims. To our knowledge, we report the first case of gorgojos chinos found incidentally during colonoscopy. (Informed consent was obtained from the patient to publish these images.)

Giant Brunner’s Gland Hamartoma as a Cause of Iron Deficiency Anemia

Transduodenal resection per hepatobiliary surgery revealed a 3 x 12-cm polyp (Figure 3). Surgical evaluation also revealed ulcerations of the mucosa surrounding the polyp, which were thought to be the cause of his iron deficiency anemia. Pathology revealed Brunner’s gland hyperplasia with secondary polyp formation that extended to the margin. The interface between normal small intestine and the polyp was visible. Both showed an intact unremarkable mucosal surface without inflammation. The transition from small nests of Brunner’s glands and other submucosal elements to a multinodular proliferation composed entirely of closely spaced Brunner’s glands was also noted (Figure 4). On follow-up one month after resection, the patient’s hemoglobin level normalized and he no longer required iron supplementation.

EUS-guided decompression of a large mucinous cyst through an electrocautery-enhanced lumen-apposing metal stent

re 1. A, Endoscopic view revealing extrinsic gastric compression on the cardia of the stomach. B, Coronal CT revealing a large pancreatic cystic lesion extrinsic compression on the lesser curvature. C, Linear EUS view of the mucinous cyst with solid debris. D, Additional ultrasound view of the large lesion with mucinous debris. E, Endoscopic view of LAMS 1 month post-procedure. F, Endosonographic view of ceramic-tipped cautery catheter. G, sonographic view of LAMS deployment within the cystic lesion. H, Gastric view of the cystgastrostomy created via LAMS. I, Mucin expression noted LAMS.

Invasive Gallbladder Cancer With a Cholecystoduodenal Fistula Allowing Direct Gallbladder Biopsy Through EGD.

Invasive Gallbladder Cancer With a Cholecystoduodenal Fistula Allowing Direct Gallbladder Biopsy Through EGD

Paranasal Sinus Lymphoma Presenting as an Orbital Mass

The paranasal sinuses are rare sites for origination of primary Non-Hodgkin’s lymphoma (NHL). Most often, primary paranasal lymphomas are diffuse large B-cell lymphomas (DLBCL) associated with a poor prognosis. This paper describes an uncommon case of ethmoid sinus lymphoma with lateral displacement of the left orbit and involvement of the nasal vault, skull base, and frontal sinuses. Excisional biopsy and flow cytometry findings favored the diagnosis of DLBCL, non-germinal center type. Moreover, CT showed an epigastric mass and enlarged lymph nodes along the left iliac chain and spleen. Radiation therapy was immediately started and the patient achieved significant symptomatic relief after four treatments. Accurate diagnosis of extranodal NHL lymphomas through a thorough history, physical exam, imaging, and immunopathology is necessary to initiate prompt treatment of this rare, aggressive disease.