Kaposi sarcoma is a mesenchymal tumor associated to a human herpes virus-8. It often occurs in human immunodeficiency virus-positive subjects. Colorectal localization is rare. We report the case of a colorectal Kaposi sarcoma complicating a refractory ulcerative colitis treated with surgery after the failure of immunomodulator therapy in a human immunodeficiency virus-negative heterosexual man.
A 55-year-old man, operated for perforated bulbar ulcer 28 years ago. He was admitted in January 2015 in the gastroenterology department of Mohamed Tahar Maamouri Hospital (Nabeul / Tunisia) with a 1-month history of abdominal pain, vomiting and weight loss. History of smoking 1 pack of cigarettes per day for 30 years. Physical examination revealed jaundice and tumoural hepatomegaly. Laboratory tests showed normocytic-normochromic anemia (Hb=8.3g/dL), biological inflammatory syndrome (CRP = 130mg/L),Tumour markers (ACE/CA19-9) were normal. Abdominal ultrasound showed a diffuse infiltration of the liver by multiple hyperechoic nodules with hypoechoic center, suggestive of metastases [Table/ Fig-1]. Investigations to find the primitive tumour included a chest x-ray which showed multiple, large, round and bilateral nodules suggestive of pulmonary metastases [Table/ Fig-2]. Then, upper gastrointestinal endoscopy was performed and revealed two ovalshaped and ulcerated masses of the fundus, both measuring 6 cm in diameter 4]. Several biopsies of the masses were realised and histological examination with immunohistochemistry revealed a poor-differentiated squamous cell carcinoma (SCC), p63+ with keratinization. No evidence of glandular differentiation was identified . Therefore, a probable primary SCC of the stomach with liver and lung metastases was evoked. The patient died 10 days after he was admitted because of tumour progression, before any therapeutic decision. An autopsy with histopathological examination of the whole stomach was not performed. DisCussionPrimary SCC of the stomach is extremely rare, with an incidence ranging between 0.04 and 0.09 % and < 100 cases have been reported Primary squamous cell carcinoma of the stomach is very rare. Its pathogenesis is unclear and the treatment strategy is controversial. We report an agressive primary squamous cell carcinoma of the stomach with liver and lung metastases in a 55-year-old man. The patient presented with a 1-month history of abdominal pain, vomiting and weight loss. Abdominal ultrasound revealed multiple liver metastases. Endoscopic examination showed two tumour masses on the fundus of the stomach. Biopsy of the lesions revealed squamous cell carcinoma of the stomach. Chest x-ray showed multiple large pulmonary nodules highly suggestive of pulmonary metastases. The patient died ten days after he was admitted because of progression of the tumour and before any therapeutic decision.[
HHV8/EBV-associated germinotropic lymphoproliferative disorder (GLD) is a challenging diagnosis given its rarity, the particular clinical presentation, and the lack of expression of markers usually used in establishing hematopoietic lineage. We report a new case of HHV8/EBV GLD in an immunocompetent 78-year-old woman. The diagnosis was made in an incidentally discovered lymphadenopathy. Histological examination showed a nodular lymphoid proliferation centered by aggregates of atypical plasmablastic cells admixed with small lymphoid cells. Tumor cells were strongly positive with EMA, HHV8, LMP1, CD38, CD138, and kappa light chains. They were negative with common lymphoma-associated markers (CD20, CD3, CD15, CD30, CD10, and bcl2). In situ hybridization confirmed the monotypic kappa light chains and the EBV infection (EBER+). A polyclonal pattern of Ig gene rearrangement was detected by PCR analysis. In the adjacent lymph node parenchyma, some germinal centers mimicked Castleman disease. In this case, the differential diagnosis was discussed with an early stage of large B-cell lymphoma arising in HHV8-associated multicentric Castleman disease. The clinical presentation, the immunophenotype, and the molecular results helped to make the accurate diagnosis. Through the review of the nine previously reported cases in literature, we discuss the clinical and pathologic features and the differential diagnosis of HHV8/EBV GLD.
Desmoid tumors are benign neoplasms that most often arise from muscle aponeurosis and have been associated with both trauma and pregnancy. The etiology of desmoids has not been determined. We report the case of anterior abdominal wall desmoid tumor in a female patient with previous history of cesarean section. Preoperative ultrasound and computed tomography demonstrated a large mass mimicking a large hematoma or an intraabdominal mass. The tumor was removed by wide excision with safe margins. The abdominal wall defect was reconstructed with polypropylene mesh. Subsequent histology revealed a desmoid tumor. Desmoid tumors in females are often associated with pregnancy or occur post-partum. The reasons behind this association are unclear. The most common sites are in the abdominal muscles.
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