HighlightsNodular Fasciitis, also known as infiltrative or pseudosarcomatous fasciitis, is a benign soft tissue tumour of fibroblastic/myofibroblastic differentiation.Magnetic Resonance Imaging was done and showed an irregular mass in the right axilla in the muscular- subcutaneous plane measuring 10.8 × 8.8 × 12 cm.Positive staining with alpha smooth muscle actin(SMA) is a feature of nodular fasciitis suggesting a myofibroblastic differentiation and less possibility of a sarcoma.Treatment options include, observation, as spontaneous regression has been reported, intra-lesional steroid or wide local excision.Magnetic Resonance Imaging along with histopathology and immunohistochemistry are key to diagnosis.
HighlightsEsophageal Tuberculosis accounts for only 2.8% of all cases of Gastrointestinal Tuberculosis.Upper gastrointestinal endoscopy revealed an ulcerative growth in the distal esophagus.Dysphagia is the commonest presenting feature of esophageal tuberculosis.Histopathology and TB-PCR are the key to confirm the diagnosis.
Colorectal neuroendocrine tumors are rare entities, with large cell neuroendocrine carcinomas occurring less frequently. We report a case of an 83-year-old male who presented with symptoms of intestinal obstruction. A computed tomography scan of the abdomen and pelvis revealed a high-grade large bowel obstruction secondary to an irregular exophytic soft tissue mass within the ascending colon, with extensive metastatic disease. He subsequently underwent a right hemicolectomy. Histologic evaluation revealed large cell neuroendocrine carcinoma of the colon. Standardized treatment modalities have not been established; however, chemotherapy is often used as the first-line or adjuvant therapy with surgery. Unfortunately, our patient succumbed to postoperative complications on day 30 of the hospital stay.
Introduction: Esophageal diverticula are a rare finding with an estimated incidence of 1:500 000 per year and a prevalence of 0.015-2%. It is usually associated with esophageal motility disorders, particularly Achalasia. The suspected mechanism is secondary to increased intraluminal pressure from the primary esophageal motility disorder, which leads to herniation of the mucosa and submucosa through the muscular layer. It is usually asymptomatic but can present with dysphagia, regurgitation, nausea, vomiting, aspiration, heartburn, weight loss, and retrosternal pain. Here we offer a case of a large esophageal diverticulum in a 52-year-old male who has been having symptoms for years. Given the symptomatic nature of his diverticulum, he underwent surgical repair. Case Description/Methods: A 52-year-old patient with no significant past medical history presented with complaints of dysphagia that was worsening over several years, associated with halitosis and food regurgitation. The patient was having a routine screening colonoscopy when he had an episode of coffee-ground emesis. He subsequently underwent an esophagogastroduodenoscopy which revealed a large epiphrenic esophageal diverticulum. He then had an esophagogram and Computer Tomography (CT) of chest and abdomen, which confirmed the presence of the diverticulum and significant narrowing of the GE junction. Esophageal manometry was not pursued, given the difficulty of placing the probe and the risk of perforation. He subsequently underwent left thoracotomy with resection of the large esophageal diverticulum, long myotomy (11 cm), and Besley fundoplication. Esophagram following surgery was negative for any leak (Figure). He was started on a clear liquid diet that was later advanced to full liquid, with the patient tolerating it well. He was subsequently discharged home. Discussion: Esophageal diverticula are rare findings with an estimated incidence of 1:500 000 per year and a prevalence of 0.015-2%. Most esophageal diverticula are acquired and present in older adults. Surgical repair is associated with mortality of 0 to 9% and morbidity of 20%. This case serves as a reminder to keep a broad differential diagnosis when approaching a patient with symptoms of a motility disorder. Early detection can provide timely management and prevent further complications.
Gastrointestinal (GI)-predominant myasthenia gravis (MG) is rare and presents a complex clinical scenario. We report the case of a 73-year-old female with dysphagia and intractable nausea found to have bulbar MG. Her symptoms persisted despite conventional MG management with plasma exchange therapy and anticholinergics. We review existing literature and discuss the clinical manifestations, diagnosis, and treatment of bulbar MG. This case highlights the need for novel MG treatment modalities in patients like ours with anomalous, GI-predominant MG who might not respond to conventional management.
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