Unusual Case of Uterovesical Polyp in a Patient Following Repeated Caesarean Section

NE is a 36yr old petty trader who has had four previous caesarean sections. She went for her routine abdominal ultrasonography at 36weeks of her fifth pregnancy and an incidental posterior bladder polypoid mass was found with a normal singleton fetus. Patient declined cystoscopy but accepted exploration of bladder at same time with a caesarean section. At Surgery, a polyp was found arising from the lower uterine segment traversing the thin posterior bladder wall into the bladder. The polyp was carefully dissected out and separated from bladder. Bladder and uterus were repaired, and patient had uneventful recovery.

Thoracoscopic and laparoscopic resection of a huge oesophageal liposarcoma: a case report

Oesophageal liposarcomas are particularly rare, accounting for 1.2–1.5% of all gastrointestinal liposarcomas. Surgical resection is the usual treatment. Endoscopic resection is minimally invasive but still controversial. This current case report describes a rare case of a large oesophageal liposarcoma in a 52-year-old male that presented with 10-year history of dysphagia for dry and solid food that was exacerbated by a recent common cold. Thoracoscopic and laparoscopic oesophagectomy was performed. He did not have any dysphagia or dyspnoea 1 week postoperatively. The excised specimen consisted of a polypoid mass measuring 21.0 cm × 5.1 cm. Histological examination confirmed that it was an oesophageal liposarcoma. At 1-year postoperatively, there was no sign of recurrence. Thoracoscopy and laparoscopy can be used to treat large oesophageal masses. Long-term follow-up is required as oesophageal liposarcomas tend to recur.

Intracholecystic Papillary-Tubular Neoplasms (ICPNs): A Pathology Report

We presented a 60-year-old man who underwent a colonoscopy examination of a polypoid mass with a wound surface of 1.1 cm in hepatic flexure. An adenocarcinoma of intestinal type was diagnosed based on the biopsy report, and patient was referred to the hospital for colectomy. In colonoscopy and biopsy, the polypoid mass was completely removed, and despite different sections of the whole specimen in the colectomy specimen, any mass was not found, while only one out of three identified lymph nodes were involved. In laboratory tests, CBC had anemia: (Hb: 10.8 mg/ dl), elevated CEA tumor marker (range: 18 ng/ml), and lipid profile disorder together with high cholesterol (300 mg/dl), indicating colon cancer manifestation.

Endobronchial Mucoepidermoid Carcinoma in a child

Endobronchial mucoepidermoid tumors are rare neoplasms but most cases are reported in children. Due to nonspecific symptoms, diagnosis can be challenging, but early diagnosis and treatment are crucial for prognosis. We present the case of a boy, with chronic respiratory insufficiency due to bronchiolitis obliterans, that presented worsening exertional dyspnea at 12 years. Spirometry showed a frank deterioration of respiratory function and CT scan revealed an obstructive polypoid mass in the intermediate bronchus. Given the severe basal ventilatory compromise and risk associated with surgical treatment, rigid bronchoscopy and laser excision, and photocoagulation were performed, with clinical and functional improvement. The histological examination revealed a low-grade mucoepidermoid carcinoma. The option for a minimally invasive procedure requires careful follow-up due to the risk of tumor recurrence.

A145 ENDOSCOPICALLY NON-VISIBLE INTERVAL COLONIC ADENOCARCINOMA DESPITE HIGH-QUALITY SURVEILLANCE.

Background Colonoscopy remains the gold-standard for screening and surveillance of colorectal cancer (CRC). Regular colonoscopy with polypectomy has been associated with reduced CRC incidence and mortality. However, interval CRC, defined as cancer diagnosed between initial screening and subsequent surveillance colonoscopies, occurs at rates of 2–14%. Identified risk factors for interval cancers include patient-related factors (older age, diverticular disease, proximal CRC), endoscopy-related factors (colonoscopy by non-gastroenterologists or in an outpatient setting; endoscopists with low rates of completion, adenoma detection or polypectomy) and biologic factors (microsatellite instability (MSI), CpG island methylation). We report a patient with interval metastatic ileo-cecal adenocarcinoma despite multiple, high-quality surveillance colonoscopies, not endoscopically visible as no visible intra-luminal mucosal component was present. Aims To describe a case of an interval CRC without an endoscopically visible intra-luminal component. Methods Case description and literature review. Results A 69-year-old male, with a history of multiple advanced colonic polyps requiring multiple surveillance colonoscopies and polypectomies, presented with symptoms of bowel obstruction. An abdominal CT scan revealed findings of terminal ileitis and upstream small bowel obstruction. Colonoscopy was performed, revealing obstruction of the ileo-cecal valve with a firm cecal submucosal lesion without abnormal overlying mucosal abnormalities. Exploratory laparoscopy revealed a mass at the ileo-cecal valve with associated peritoneal deposits. A right hemicolectomy was performed, and pathological examination demonstrated metastatic invasive adenocarcinoma involving the cecum, the terminal ileum and ileo-cecal valve without extension into the lumen or formation of an overt polypoid mass. The tumour extended into the wall of the distal ileum in a circumferential fashion, involving the immediate deep serosa, but with only minimal, focal mucosal ileal involvement and no overt polypoid mass. An independent review of the case and resection specimen by a second pathologist confirmed absence of significant ileal or colonic mucosal involvement and no obstructing intraluminal component. Conclusions This case illustrates a rare presentation of an interval CRC that was not identified despite several high-quality surveillance colonoscopies, as only minimal mucosal involvement was present. As endoscopy remains the gold-standard for early detection and removal of pre-malignant lesions and early malignancy, the patient’s presentation with interval malignant bowel obstruction and metastatic disease, despite adequate quality surveillance, demonstrates an inherent limitation of colonoscopy. To our knowledge, this is only the third documented case of endoscopically non-visible interval CRC. Funding Agencies NoneNone

Ovarian adenocarcinoma with metastases in a white rhinoceros

A 36-y-old white rhinoceros ( Ceratotherium simum) was presented with respiratory distress, sanguineous vaginal exudate, and anorexia. The clinical signs progressed over 40 d, and the rhinoceros died. Autopsy revealed significant ascites; a unilateral, 12.5-cm diameter, polypoid mass in the left ovary; a white, firm transmural mass in the right uterine horn; a white, friable mass in the lung; and white-to-tan, friable small nodules in the diaphragm. Histologic examination revealed similar neoplastic cells in the masses in all 4 locations, composed predominantly of epithelial cells proliferating in a tubulopapillary pattern with significant nuclear atypia and numerous atypical mitotic figures (18–42 per 2.37 mm2). Immunohistochemistry for CK7 (cytokeratin 7) and CK20 (cytokeratin 20) suggest that the ovarian, pulmonary, and diaphragmatic lesions were of ovarian origin and that the ovary was the primary tumor site.

Uterine Tumor Resembling Ovarian Sex Cord Tumor: Clinicopathological Characteristics of a Rare Case

Uterine tumor resembling ovarian sex cord tumor (UTROSCT) is a rare indolent stromal neoplasm of unclear histogenesis with a distinct histopathological entity. Immunophenotypes of sex cord positivity are the most significant information to confirm the diagnosis. We present the case of a 61-year-old female with a polypoid mass in the uterus which was successfully removed by surgical resection as hysterectomy. The pathological diagnosis was UTROSCT, which was characterized microscopically by sex cord images and immunohistochemical features of calretinin, CD99, and WT1 positivity.

Endoscopic resection for giant oesophageal fibrovascular polyp

A fibrovascular polyp is a rare benign pseudotumour of the oesophagus and hypopharynx. Although patients usually present with dysphagia, aspiration related mortality may occur. If the tumour is too large and/or located in the proximal oesophagus, it may protrude from the mouth. The general approach to treatment is complete reconstruction with cervicotomy. We present our experience of a giant oesophageal fibrovascular polyp that was protruding from the mouth and treated with endoscopic resection. A 55-year-old man was admitted to our outpatient clinic complaining of a mass protruding from his mouth when he coughed. Endoscopy and bronchoscopy both revealed a 15–18cm long polypoid mass originating from the proximal oesophagus (at the level of the hypopharynx). Complete resection was performed via endoscopy.

Primary small intestinal epithelioid angiosarcoma: a potential diagnostic pitfall due to abnormal expression of cytokeratin

Background: Primary small intestinal epithelioid angiosarcoma (EAS) is a very rare tumor, which originates from endothelial cell with high mortality. Only 66 cases of small intestinal angiosarcoma including primary or metastatic were reported in the current literature. Histologically, hemangiosarcoma with epithelioid cell morphology is more rare, so we report a case of EAS which is easily misdiagnosed as poorly differentiated carcinoma. We also reviewed the literature about small intestinal angiosarcoma.Case presentation: The patient was a 60-year-old man, who initially presented black stool with no obvious inducement for 7 days, gradually feeling dizzy and fatigue for 3 days. Abdominal CT showed that the intestinal wall of the upper jejunum was thickened near the duodenum. After enhancement, the intestinal wall could be enhanced evenly. With the time going on, the contrast media could be concentrated gradually, and the active hemorrhage was considered. Enteroscopy revealed a 30 mm × 20 mm red polypoid mass in the jejunum. A biopsy of polypoid mass exhibited malignant tumor, histopathology considered poorly differentiated cancer. The patient subsequently underwent resection of the jejunal neoplasm. Immunohistochemistry vascular markers and cytokeratin were postive，but C-MYC protein was negative, and showed no amplification of C-MYC gene by Fluorescence in situ hybridization （FISH）. The histopathology with immunohistochemical and FISH studies confirmed the diagnosis of primary small intestinal EAS. 24 months after surgery, the patient had no evidence of recurrence and metastasis.Conclusion: Primary small intestinal EAS is a rare malignancy of endothelial origin with uncertain etiology and often has a poor prognosis.The abnormal cytokeratin expression in epithelioid angiosarcomas represents a potential diagnostic pitfall for pathologists. FISH detection of C-MYC gene amplification may have some value in the diagnosis of primary or metastatic small intestinal AS.An accurate pathological diagnosis relies on histopathology with immunohistochemical stains of endothelial markers. Surgical resection remains the best treatment option for small intestinal angiosarcoma.