Granulomatous Hepatitis Secondary to Histoplasmosis in an Immunocompetent Patient

Histoplasma capsulatum is the most common endemic mycosis in the United States and usually occurs in certain geographic areas, such as the Mississippi or Ohio River valleys. Histoplasmosis usually causes a mild disease in the immunocompetent but can progress to disseminated disease in patients with impaired immunity. Granulomatous hepatitis as a manifestation of disseminated histoplasmosis in immunocompetent patients is extremely rare. We report the case of a 62-year-old immunocompetent gentleman with a history of histoplasmosis who presented with abdominal pain, elevated liver enzymes, who was diagnosed with granulomatous hepatitis secondary to histoplasmosis

Small Bowel Metastasis as a Presentation of Testicular Seminoma

Testicular germ cell tumors account for 95% of testicular cancers in men with approximately 71,000 patients being diagnosed with testicular cancer every year. The overall survival of testicular germ cell tumors is approximately 95%. However, the prognosis becomes less favorable when distant metastasis is present. Gastrointestinal (GI) tract metastasis occurs in less than 5% of patients with non-seminomatous tumors, and in less than 1% in patients with pure seminomas. GI metastasis usually involves the colon, esophagus, and stomach with the most common symptoms of GI metastasis being diarrhea, nausea, vomiting, and obstruction. We discuss the case of a 42-year-old male patient with GI manifestations as the first presentation of testicular seminoma with metastasis to the small bowel. Computed tomography of the abdomen and pelvis revealed a small bowel mass, and the diagnosis was confirmed with histopathologic examination of endoscopic biopsy samples. The patient subsequently underwent chemotherapy treatment with close surveillance. Clinicians should maintain a high index of suspicion in the differential diagnosis of abdominal pain in young male patients, especially when associated with symptoms like unexplained weight loss, constitutional symptoms, and testicular pain or swelling. Metastasis to the GI tract from the testis should be promptly diagnosed and managed, as the overall survival rates can significantly decrease with the delay of diagnosis

The association between microscopic colitis and celiac disease: a systematic review and meta-analysis

BACKGROUND: Multiple studies suggested that celiac disease (CD) may be associated with microscopic colitis (MC); however, most were limited by a small sample size or the main scope of interest. We aimed to analyze previously published literature on this association to determine its extent and significance. METHODS: A systematic review was conducted in PubMed, Embase, PubMed Central, Cochrane, and ScienceDirect databases from inception through January 2022. The PRISMA guideline was followed for data extraction. Effect estimates were extracted and combined using random effect, the generic inverse variance method of DerSimonian and Laird and pooled odds ratio (OR), and event rates (ER) were calculated. The Newcastle-Ottawa scale was used to evaluate the risk of bias. Forest plots were generated and publication bias assessed via conventional techniques. RESULTS: Twenty-six studies with a total of 22,802 patients with MC were included in this analysis. CD was significantly associated with MC (odds ratio [OR] 8.276, 95% confidence interval [CI] 5.888-11.632; P\u3c0.001). The ER for MC in CD patients was 6.2% (95%CI 4.1-9.2%; P\u3c0.001), while the ER for CD in MC patients was 6.1% (95%CI 3.9-9.5%; P\u3c0.001). CD was prevalent in both types of MC: 5.2% (95%CI 2.2-12.1%; P\u3c0.001) in collagenous colitis and 6.3% (95%CI 3.4-11.5%; P\u3c0.001) in lymphocytic colitis. We found no publication bias, according to funnel plots and Egger\u27s regression asymmetry testing. CONCLUSIONS: Our meta-analysis confirms a statistically significant association between CD and MC, with a high prevalence of CD in both types of MC. Gastroenterologists should be wary of this association when evaluating patients with either disease, particularly patients with a suboptimal response to first-line therapy

Multiple Primary Malignancies in Gynecologic Cancer Patients in Thai Tertiary Care Center: a 10-Year Retrospective Study

Objective: To investigate the incidence, pathologic features, clinical characteristics, oncologic outcomes, and prognostic factors in gynecologic cancer patients with multiple primary malignant tumors (MPMT). Methods: This single-center retrospective study included the medical records of gynecologic cancer patients diagnosed with MPMT according to Warren and Gates’s criteria who were treated at the Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Siriraj Hospital during January 2006 and December 2016. Relevant demographic, clinical, and pathologic data were collected and analyzed. Results: Of 8,076 cases of gynecologic cancer during the study period, 146 women with MPMT were included. Ninety-four women had multiple primary gynecologic cancers (MPGC), and 52 had gynecologic cancer coexisting with non-gynecologic cancer (GNC). The prevalence of MPGC was 1.2%. Synchronous cancer, nulliparous, premenopause, and early stage of endometrial and ovarian cancer were significantly more common among MPGC than GNC. Five-year recurrence-free survival (RFS) was significantly longer in the MPGC group (87.3% vs. 79.6%). Coexisting endometrial and ovarian cancer was the most frequently observed MPGC, with a 5-year overall survival (OS) and RFS of 98.1% and 86.0%, respectively. Specific to this cancer combination, residual tumor and depth of myometrial invasion were found to be independently associated with shorter RFS. Conclusion: The prevalence of MPGC in this study was 1.2%. Five-year RFS was significantly longer among MPGC than among GNC. Three-quarters of MPGC patients had synchronous endometrial-ovarian cancer. Residual tumor and the depth of myometrial invasion were identified as prognostic factors that were independently associated with RFS in the patients with synchronous endometrial-ovarian cancer

Marijuana use among adult liver transplant candidates and recipients

BackgroundData regarding marijuana (MJ) use among liver transplant (LT) candidates are limited. We set out to determine the incidence and pre­ and post­LT outcomes of adult LT candidates with a self‐reported history of MJ use.MethodsBaseline clinical characteristics, waitlist, and post‐LT outcomes of adult LT candidates from January 2010 to March 2017 were compared.ResultsAmong 2690 LT candidates, 630(23%) and 298(11%) reported a history of MJ use and use within the past 12 months, respectively. Although the proportion of MJ users increased over time(β = .76, p = .03), the proportion listed and transplanted did not change. Listing for LT increased with male (OR 1.24, 95% CI 11.01–1.52), MELD score (OR 1.08, 95% CI 1.01–1.15), HCC (OR 1.83, 95% CI 1.39–2.41) but decreased among MJ users (OR 0.67, 95% CI 0.50–0.91, p = .01). The median time to listing was longer among MJ users compared to non‐users (115 vs. 87 days, p < .0005). Post­LT survival was similar in 83 MJ users and 306 non‐users.ConclusionThe proportion of MJ users among LT candidates is increasing. MJ users have a greater burden of psychosocial issues which may contribute to longer evaluations and lower rate of LT listing. Post‐LT survival was not impacted by self‐reported MJ use history.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168445/1/ctr14312.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168445/2/ctr14312_am.pd