Treponema Whipplei Endocarditis Masquerading as a Calcified Amorphous Aortic Valve Tumor

Whipple’s endocarditis is a rare culture-negative endocarditis caused by Tropheryma whipplei, an intracellular gram-positive organism. Here, we present a case of a 60-year-old male who presented with transient ischemic attack and was found to have an aortic valve mass. Following successful excision, histopathologic assessment of the lesion was consistent with calcified amorphous aortic tumor, a rare non-neoplastic hamartomatous mass of the heart. However, 16s rRNA and 18s rRNA sequencing detected Tropheryma whipplei, and the diagnosis of Whipple’s endocarditis was made.

Laparoscopic Resection of Subclinical Functioning Para-aortic Paraganglioma

Introduction: Extra-adrenal pheochromocytomas (paragangliomas) are neuroendocrine tumors derived from extra-adrenal chromaffin cells. Although laparoscopic resection of adrenal pheochromocytomas is a common procedure, there are few reports of the use of this approach in extra-adrenal para-aortic paragangliomas. Here, we report the case of a patient with a subclinical functioning para-aortic paraganglioma that was successfully resected laparoscopically. Case presentation: A 58-year-old man was referred to our department for treatment of a para-aortic tumor after endoscopic submucosal dissection of early-stage colorectal cancer. Positron emission tomography-computed tomography showed abnormal accumulation by the para-aortic tumor. During its laparoscopic resection, the patient's blood pressure unexpectedly rose to over 180 mmHg, which suggested that the tumor was a paraganglioma. The diagnosis was confirmed by immunohistochemical staining, which showed chromogranin-positive cells forming a Zellballen pattern. The operation was successfully completed, and the patient's postoperative course was uneventful. Conclusion: Laparoscopic resection may be a suitable procedure for the treatment of retroperitoneal paraganglioma.

Primary Endothelial Sarcoma of the Thoracic Aorta

Primary malignant tumors of the aorta are extremely rare. The case of a 64-year-old woman who presented with peripheral embolism to both femoropopliteal arteries is reported. The search for a source revealed a polypoid lesion severely narrowing the lumen of the distal thoracic aorta. Differential diagnosis included thrombus and primary aortic tumor. Extirpation of the tumorous lesion was performed. Histologic examination revealed intimal aortic sarcoma of endothelial cell origin. Although the liver was the only site of suspected metastases at the time of operation, during the 18-month follow-up until the patient's death, generalized metastatic spread had developed. This case report thus demonstrates the generally poor prognosis of this rare variety of aortic sarcoma, in particular when symptoms have already occurred.

Epithelioides Angiosarkom der Aorta

Primary malignant tumors of the aorta are extremely rare. Review of the literature indicates that there are nearly 100 recorded cases of primary malignant tumors of the aorta. The purpose of this article is to present an additional case of the primary malignant tumors of the aorta which initially has been misinterpretated as atherosclerosic disease. This aortic tumor was of endothelial origin and immunohistochemical studies classified the tumor as an epithelioid angiosarcoma. The treatment resulted in an abdominal aortic repair. MRI of the spine revealed multifocal metastastic disease of the axial skeleton and a subsequent chemotherapy was performed. The patient died 17 months after the initial diagnosis.