Giant duodenal polyp

A 52 year-old man was referred with a history of anemia and fatigue. There was no melena and he was not taking any medication Blood analysis revealed microcytic anemia, with a hemoglobin of 9,7 g/dl (NR 13-18 ), MCV of 65,8 fl (NR 80-100) and serum ferritine was below 5 ng/ml (NR 30-400) with normal coagulation.There was no inflammation, no renal insufficiency and liver function tests were normal. Vitamine B12 and folic acid were normal. He underwent endoscopic work-up. Colonoscopy was normal. Gastroscopy revealed a large pedunculated polyp (5x2 cm) localized in the duodenal bulb and it was eroded on the top (Figure 1A and B). Multiple biopsies were taken showing no abnomarlity. There was no Helicobacter pylori nor metaplasia.

Proton Pump Inhibitor-Associated Large Hyperplastic Polyp in Non-Helicobacter pylori-Infected Stomach

A proton pump inhibitor (PPI)-associated hyperplastic polyp (HP) in the non-<i>Helicobacter pylori</i>-infected stomach is rare, and its endoscopic features remain poorly described. A 42-year-old man with tarry stool was referred to our hospital for examination and treatment. He had taken PPI for 14 years and was confirmed to be <i>H. pylori</i>-negative. Transnasal endoscopy revealed bleeding from a 20-mm, reddish pedunculated polyp with a nodular surface, located in the greater curvature of the upper gastric body. Endoscopic mucosal resection was performed, and the lesion was diagnosed as an HP. To our knowledge, this report represents a valuable addition to the HP literature describing a rare case of PPI-associated large HP in the non-<i>H. pylori</i>-infected stomach.

Anorectal polyp

A 71-year-old female with hypertension presented with painless rectal bleeding and found to have a soft mass on rectal exam. The colonoscopy revealed a large pedunculated polyp with patchy discoloration arising from the dentate line (Fig. 1). Biopsies of the polyp were obtained.

Clear cell neuroendocrine tumor in the gallbladder diagnosed as a benign polyp preoperatively: a case report

Background Gallbladder neuroendocrine neoplasm is a rare disease that is divided into neuroendocrine tumors (NETs) and neuroendocrine carcinomas (NECs). Clear cell NETs of the gallbladder are extremely rare. We report the case of a patient with polypoid clear cell NET G1 of the gallbladder who underwent laparoscopic cholecystectomy. Case presentation A 10-mm pedunculated polyp in the gallbladder neck was detected on a follow-up abdominal ultrasound in a 60-year-old man with chronic hepatitis and hepatitis B without medication. Six months later, an abdominal ultrasound revealed that the tumor had enlarged to 12 mm in size. He was asymptomatic and had no abnormalities in other laboratory examinations, including the tumor markers, carcinoembryonic antigen and CA19-9. Abdominal ultrasound showed a 12-mm polyp in the neck of the gallbladder with perfusion and focal thickening of the gallbladder wall. A gallbladder stone was also seen in the fundus. An enhanced computed tomography scan and magnetic resonance imaging revealed a polypoid lesion and gallbladder stone located at the neck of the gallbladder and the fundus, respectively. Malignancy could not be excluded, and hence, a laparoscopic cholecystectomy was performed. Pathologically, a pedunculated polyp (14 × 11 × 15 mm) was observed in the neck of the gallbladder, and the polypoid lesion comprised nests or trabecular growths of clear NET cells in the lamina propria (ENETS: T1N0M0; AJCC: T1aN0M0). Immunohistochemical staining with synaptophysin, chromogranin A, and CD56 was confined to the tumor. The pathological diagnosis was clear cell NET G1 of the gallbladder. Although clear cell NET is often described as a distinct manifestation of von Hippel-Lindau disease (VHL), the patient had no past medical or family history of VHL. Until his one-and-a-half-year follow-up, the patient was doing well and without any signs of recurrence. Conclusion We report an extremely rare case of gallbladder clear cell NET G1. When NET G1 is incidentally identified in a gallbladder surgical specimen, clinical information and pathological findings should be considered as references.

Adenoid cystic carcinoma of arytenoid: a rare tumor at a rare site

<p>Pedunculated primary adenoid cystic carcinoma of larynx is an uncommon form of malignant neoplasm. This case is an extremely rare entity and hence reported. Until today this type of carcinoma is not reported in medical literature. A 55 year old female patient came with 6 months history of dyspnoea and foreign body sensation in throat and occasional change of voice. Micro laryngeal surgical excision of the pedunculated polyp was done under general anaesthesia using diathermy cautery and specimen was sent for histopathological examination, perineural spread of the tumour is highlighted. The pedunculated polyp from the arytenoid looked like a benign lesion and histopathological examination showed the lesion to be adenoid cystic carcinoma. </p>

Lipoma of the coecum with secondary changes of the surface

Our endoscopically and histopathologically well documented case report is about a lipoma of the colon, which is a relatively rare benign mesenchymal tumor found in the large intestine. The lipoma was cha­racterized as a pedunculated polyp in the cecum, intermittently translocating into terminal ileum and obstructing Bauhin’s valve, resulting in clinical symptoms. During patient examination, lipomas present with differential diagnosis challenges due to their close resemble to other disorders, which might occur much more commonly are more probable to be malignant. Furthermore, bigger lipomas can also harbour secondary changes, such as erosion, ulceration, bleeding and necrosis. Although endoscopic and ima­ging techniques offer assistance in characterizing lipomas, the final diagnosis still relies heavily on the resecting and histologic examination of the entire polypoid/tumor-like outgrowth of the mucosa. Superficial sampling might also lead to misdiagnosis. Our case had inflammatory, erosive and also hyperplastic surface which could have been concluded as a hyperplastic polyp of colon, a much more common occurrence.

P157 GIANT PEDUNCULATED OESOPHAGEAL LIPOSARCOMAS: A CASE AND REVIEW OF RESECTION TECHNIQUES

Aim Liposarcomas are rare causes of oesophageal tumours, accounting for <1% of tumours. We present a case of giant oesophageal liposarcoma with a discussion focusing on resection techniques. Background & Methods A 54-year-old gentleman presented to the hospital with symptoms of anaemia and weight loss for 3 months. A CT scan and oesophagogastroduodenoscopy (OGD) showed a giant, pedunculated polyp extending from the cervical oesophagus to cardioesophageal junction (CEJ) with mucosal ulceration at its distal aspect. Endoscopic ultrasound (EUS) revealed a 24 x 6 cm submucosal pedunculated mass with lipomatous regions and core biopsy only showed rare groups of spindle cells with no malignancy. Resection was advised in view of occult bleeding from polyp and endoscopic resection was deemed unsuitable in view of a highly vascular stalk and large size of polyp. He underwent surgical resection via a left cervical oesophagostomy with gastrostomy for polyp retrieval. Final histology showed a dedifferentiated liposarcoma arising within a giant fibrovascular polyp. Results Open surgery has classically been standard of treatment, but endoscopic resection is less morbid and invasive. Endoscopic techniques described include using a retraction suture followed by division of the polyp stalk using ultrasonic shears, using a snare, endoscopic submucosal dissection (ESD), and application of hemoclips following diathermy. In cases where endoscopic resection is not feasible, surgery such as oesophagostomy, oesophagectomy and laparotomy for resection and retrieval of the tumour have been described. Main reason for oesophagectomy was the presence of a submucosal (rather than polypoid, pedunculated) large tumour. For resection via oesophagostomy, stalk transection can be performed via stapling devices or suture ligation. Conclusion Giant oesophageal liposarcomas are very rare tumours. Such tumours are usually polypoid, arising from a pedicle in the proximal oesophagus. Resection techniques have shifted from oesophagectomy to less invasive means such as endoscopic resection or oesophagostomy. Decision on type of resection technique depends on tumour characteristics and location; with the guiding principle being resection with clear margins in order to prevent local recurrence.