A 62-year-old man with comorbidities of stroke and diabetes under treatment with oral anticoagulants presented with severe anemia (hemoglobin 6 g/dl). Upper esogastroduodenoscopy showed normal aspect. At colonoscopy, a pedunculated, ulcerated, necrotized giant tumor of about 5 cm with a thick stalk of 1.5 cm was found at the ileo-cecal valve (Fig. 1). Biopsies were taken, but the results were inconclusive. The patient opted for endoscopic removal, after being informed about the risk of perforation and bleeding. Dabigatran therapy was interrupted two days prior to the procedure. Endoloop insertion was attempted, but the tumor was too large to fit into it. Hemoclips were inserted at the base of the stalk and the tumor was excised by electrosurgical snare (200W). The base of the resected specimen, no longer attached to the large polyp, entered back into the small bowel. Hemoclips were placed in the small bowel to close the ulcer margins (Fig. 2). No complications were recorded and the patient was discharged 48 h later from the hospital. The anticoagulant therapy was resumed. The pathology examination surprisingly revealed an atypical lipoma, without malignancy (Fig. 3, H&E x5).Colonic lipomas rarely cause symptoms and are usually detected incidentally. However, if the tumor is large, it may produce symptoms, such as abdominal pain, rectal bleeding, obstruction, intussusception. Large colonic lipomas can be mistaken for malignancy, which may result in extensive surgical operations [1,2].
Gastrointestinal stromal tumors (GISTs) are rare neoplasms, colorectal location being met in less than 5% of cases. Knowledge about this site related particularities are limited. The aim of this study is to present our experience with colorectal GISTs between 2005 and 2018 from the clinical, morphological, and immunohistochemical perspectives, with emphasis on prognostic factors. From a total of 203 gastrointestinal stromal tumors registered, 12 were colorectal (6%). The number of colonic tumors surpassed that of the rectum (9 : 3) and on the right side were registered more cases than on the left side (6/3). 9 were primary tumors and 3 were recurrences. Men and women were represented equally and the age range was between 22 and 76. Tumor dimensions varied between 0.5 and 14 cm. Microscopically, spindle cell type was dominant. Mitotic rate was variable between 1 and 115/50HPFs. Accordingly, for primary tumors progression risks were assigned (low risk: 2 cases, intermediate risk: 3 cases and high risk: 4 cases). All GISTs were CD117 and DOG1 positive. Four of the patients died of the disease.
Renal cell carcinoma (RCC) causes significant morbidity and mortality. Clear cell RCC (ccRCC) is the most common histologic subtype, with worse prognosis compared with other histologic subtypes. The indolent variant of ccRCC is the multilocular cystic RCC (McRCC). Imaging features reflect the various histological findings of each histologic subtypes. Recent advances in imaging technology permit early and more appropriate diagnosis of RCC and facilitate optimal management.
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