Intestinal amoebiasis is a parasitic infection caused by Entamoeba histolytica. It is commonly found in developing countries with poor hygiene. A rare, life-threatening complication of amoebiasis is fulminant necrotizing amoebic colitis (FulNAC). We report a 59-year-old male with acute lower right abdominal pain. Before coming to our institution, he was diagnosed with acute appendicitis. Extensive necrosis near the caecum involving the appendix and colon was observed intraoperatively. The patient underwent a right hemicolectomy, followed by an ileostomy and colostomy. Histopathologic examination confirmed the diagnosis of FulNAC. After the surgery, the patient was transferred to the high care unit and treated with metronidazole after histopathologic findings confirmed the etiology. The patient showed excellent response to the antibiotic prescribed, and the symptoms subsided. He was discharged from the hospital on day nine. Additionally, we reviewed fifty-one existing case reports on invasive intestinal amoebiasis worldwide, confirmed by histopathological examination following their preoperative diagnosis, surgery, pharmacology treatment, and outcomes. The learning point of this case is that intestinal amoebiasis should be considered a differential diagnosis for patients around fifty years old with bowel symptoms and travel history or living in tight quarters. Blood tests, radiological examinations, and serological evaluations are valuable diagnostic modalities. Metronidazole should be given as early as possible, and health promotion is recommended to prevent this disease in the population.

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) have variable biological behavior although they are all malignant. This study presents the 10-year prevalence along with the clinicopathologic characteristics of GEP-NETs and their association with tumor grade at a national referral hospital in Indonesia. This is a retrospective cross-sectional study of patients with GEP-NET confirmed by histomorphology and immunohistochemistry who presented to Cipto Mangunkusumo Hospital from 2009 to 2019. Clinical characteristics included age, sex, primary site, tumor stage, metastasis, hormone status, and chief complaints. Pathological characteristics included the type of GEP-NET, specimen type, grade, and presence of lymphovascular invasion (LVI). Statistical analysis was performed to determine the association between characteristics and tumor grade. A total of 84 cases of GEP-NET from 2009 to 2019 were included; of these, 38.1% were neuroendocrine tumors (NETs), 28.6% were neuroendocrine carcinomas (NECs), and 33.3% were mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN). The mean patient age was 48.36 years, and the male to female ratio was 1. GEP-NETs predominantly originated from the rectum (21.4%) and were mostly non-functioning (90.5%) with an average tumor size of 4.77 cm. Most tumors were localized (53.6%), but metastasis was found in 28.6% cases. LVI was positive in 35.7% cases. High-grade tumors were more common (54.3%) than low-grade tumors. High-grade tumors were associated with unknown primary sites, dissemination, LVI, and larger tumor size. To conclude, GEP-NETs can arise from any site in the gastrointestinal tract and have variable clinicopathologic characteristics. Primary site, stage, LVI, and tumor size are associated with grade.

A 7-year-old Asian male presented with abdominal pain and enlarging abdomen status post-partial hepatectomy for mesenchymal hamartoma (MH) 2 years ago. The lesion was present at the resection margin during the initial procedure. Current imaging studies revealed a 4 cm hepatic lesion in segment 5 and 8, suggestive of recurrent MH. The patient underwent partial hepatectomy and macroscopic examination of the surgical specimen demonstrated a well-circumscribed, tan-white lesion with both solid and cystic components ( Figure 1A). Histologically, the lesion showed a myxomatous mesenchymal cell proliferation with cystic dilatation of bile ducts and entrapped hepatocytes, characteristic of hepatic MH ( Figure 1B). Focal white and firm area was identified at the edge of the lesion (Figure 2A) which histologically corresponded to lamellar bone with marrow formation, consistent with an osseous metaplasia.Hepatic MH is a benign tumour which is predominantly seen within the first 2 years of life. 1 Its pathogenesis is unclear, however, it shares recurrent chromosomal abnormalities involving chromosome 19q13.4 with its malignant counterpart, undifferentiated embryonal sarcoma of the liver. 1,2 Resection with a clear margin is the treatment of choice whenever possible. To our knowledge, this is the first case of recurrent hepatic MH with osseous metaplasia. The heterotropic bone formation is most likely a secondary reaction from previous procedure 3 as it was located at the periphery of the lesion and bone is not known to be a MH component.Recognizing this phenomenon is important to distinguish it from other entities, particularly mesenchymal component of hepatoblastoma.