Hepatic epidermoid cyst

open6noWe describe the extraordinary finding of a hepatic epidermoid cyst in a 5-year-old patient, treated successfully with laparoscopic deroofing and mucosal stripping. The pathologic examination revealed a cyst with the same features of a true epithelial splenic cyst whose origin is still controversial, even though a coelomic derivation is the most accredited hypothesis. A cyst in this anatomic district with such characteristics has never been described in existent literature.openDi Salvo, N.*; Libri, M.; Gargano, T.; Salfi N; Ruggeri, G.; Lima, M.Di Salvo, N.*; Libri, M.; Gargano, T.; Salfi N; Ruggeri, G.; Lima, M

A rare cause of melena in lung cancer

A 67-year-old woman was admitted to our department for one-month duration of asthenia. She was previously operated of upper right lobectomy for a high-grade sarcomatoid carcinoma. The patient was hemodynamically stable. Hemoglobin was 5.4\u2009g/dL, and she was transfused with three blood units. An upper gastrointestinal endoscopy was carried out and it was unremarkable; a colonoscopy was then performed and a voluminous ulcerated polyp with a large base of implantation of the proximal descending colon was seen and removed without complications ( Fig. 1a). The pathological examination of the polyp was compatible with a metastasis of the lung cancer ( Fig. 1b). Because the appearance of melena requiring further hemotrasfusions, the patient underwent capsule endoscopy that showed a bleeding spontaneously large ulceration of the jejunum ( Fig. 2). She was operated and 9\u2009cm of jejunum were resected ( Fig. 2); after surgical exploration another segment of ileum of 12\u2009cm was resected ( Fig. 2). The pathological examination of the surgical specimens demonstrated metastases of the lung cancer ( Fig. 2)

Colorectal polyposis as a clue to the diagnosis of Cowden syndrome: Report of two cases and literature review

Cowden Syndrome (CS) is an autosomal dominant disorder characterized by hamartomatous growth in several organs and by an increased risk of malignancies, which makes its recognition essential to undertake risk reduction measures. Although the involvement of gastrointestinal tract is extremely common, awareness of this entity among gastroenterologists appears limited. We report on two unrelated patients: a 46-year-old male and a 38-year-old woman, who were referred to the Genetic Clinic because of the endoscopic finding of multiple colorectal polyps. Despite both displayed striking clinical (and, in the first case, familial) manifestations of Cowden Syndrome (PTEN Hamartoma Tumor Syndrome-PHTS), they had not been recognized before. Diagnosis of PHTS was confirmed by the detection of causative PTEN variants. Pathological examination of the polyps showed multiple histology types: hyperplastic, juvenile, serrated and lymphoid. Hyperplastic polyps analyzed from both patients failed to show BRAF V600E and KRAS codon 12/13 mutations, which provides evidence against their potential to evolve to colorectal cancer through the serrated pathway. We then reviewed the literature on gastrointestinal polyps detected in patients with Cowden Syndrome, in order to provide a comprehensive scenario of presentations: among a total of 568 patients reported in the literature, 91.7 % presented with colon polyps, with 63.0 % having two or more different histological types of polyps; besides, 58.5 % had extra-colonic polyps (located either in stomach and/or in small intestine). Finding multiple polyps with mixed and/or unusual histology should alert gastroenterologists and pathologists about the possible diagnosis of Cowden Syndrome and prompt the search for other manifestations of this condition in the patient

A rare association of inlet patch with laryngospasm: a report of two children and literature review.

The inlet patch (IP) is an area of heterotopic gastric mucosa in the cervical esophagus commonly seen during upper endoscopy. Although generally asymptomatic IP has been associated with esophageal and supraesophageal symptoms and, though rare, in adult with malignant transformation. We describe two cases of recurrent episodes of laryngospasm associated with IP. In both cases there was a good response to prolonged acid suppression therapy