Pulmonary lymphangitic carcinomatosis (PLC) is a well-known form of tumour metastasis to the pulmonary lymphatic system or to the adjacent interstitial tissue resulting in thickening of the bronchovascular bundle and septa. Another type of tumour metastasis to the lung involves the pulmonary vascular system and is known as pulmonary tumour thrombotic microangiopathy (PTTM). In this article, we will describe the unusual case of a young Chinese woman with gastric adenocarcinoma revealed by atypical radiographic lesions consistent with both PLC and PTTM. We will discuss the existing evidence and hypotheses about the pathophysiology of both conditions.
We present the case of a 59-years-old woman with a history of abdominal pain and iron-deficiency anemia. Upper and lower gastrointestinal endoscopy turned out negative and further investigation with wireless videocapsule showed an inflammatory stricture in the middle of the small bowel with retention of the videocapsule. Treatment with budesonide was initiated and allowed the spontaneous evacuation of the videocapsule. Retrograde motorized spiral enteroscopy was performed and confirmed an ulcerative stricture 60 cm proximal to the ileocaecal valve. Clinical, iconographic, endoscopic and histological results were compatible with a rare entity described as cryptogenic multifocal ulcerative stenosing enteritis (CMUSE). After the diagnosis budesonide was replaced by azathioprine 100 mg/d as an immunosuppressor. However, azathioprine induced mild pancreatitis and a second course of
A 52 year-old man was referred with a history of anemia and fatigue. There was no melena and he was not taking any medication Blood analysis revealed microcytic anemia, with a hemoglobin of 9,7 g/dl (NR 13-18 ), MCV of 65,8 fl (NR 80-100) and serum ferritine was below 5 ng/ml (NR 30-400) with normal coagulation.There was no inflammation, no renal insufficiency and liver function tests were normal. Vitamine B12 and folic acid were normal. He underwent endoscopic work-up. Colonoscopy was normal. Gastroscopy revealed a large pedunculated polyp (5x2 cm) localized in the duodenal bulb and it was eroded on the top (Figure 1A and B). Multiple biopsies were taken showing no abnomarlity. There was no Helicobacter pylori nor metaplasia.
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