Caecal tumor biopsy with a rigid sigmoidoscope - Ileorectal intussusception

Colorectal intussusception with rectal prolapse related to cecal lipoma in adult: A rare case report and review of the literature

Colonic intussusception due to lipoma is extremely rare. Very few cases were reported in the literature of cecal lipoma leading to the intussusception of the whole proximal colon till the rectum. We report a rare case of a 39-year-old female patient with cecal lipoma causing colo-colonic intussusception involving the entire length of the proximal colon and the overall mass prolapsed into the pelvis that could be palpated in rectal examination. The case presented with a giant mass with clinical manifestations of obstruction. An extended right hemicolectomy and end ileostomy were performed due to intestinal dilation and intra-abdominal contamination. To the best of our knowledge, this is the second case of cecal lipoma leading to intussusception of the whole proximal colon till to the rectum reported in the relevant literature. Whenever a colonic mass results in intussusception, the incidence of malignancy is slightly higher (60%), so a proper oncological resection should be performed if the pathology is not known preoperatively.

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Colonic intussusception due to lipoma is extremely rare. Very few cases were reported in the literature of cecal lipoma leading to the intussusception of the whole proximal colon till the rectum.

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To the best of our knowledge, this is the second case of cecal lipoma leading to intussusception of the whole proximal colon till to the rectum reported in the relevant literature.

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Whenever a colonic mass results in intussusception, the incidence of malignancy is slightly higher (60%), so a proper oncological resection should be performed if the pathology is not known preoperatively.

Malignant solitary fibrous tumor of the pancreas: a case report

Background

Solitary fibrous tumors (SFTs) are rare tumors, mostly derived from connective tissue mesenchymal cells that arise from the pleura. There are very few reports of primary pancreatic SFT. Preoperative diagnosis is difficult owing to the lack of distinctive radiological findings. We report a case of pancreatic SFT with particularly rare malignant findings.

Case presentation

A 60-year-old man was referred to the hospital because of a right upper quadrant mass and abnormal liver function test results. Contrast-enhanced computed tomography (CT) showed a well-defined enhanced tumor measuring approximately 8 cm in the pancreatic head. Magnetic resonance imaging (MRI) showed T1WI hypointensity, T2WI hyperintensity, and DWI hyperintensity. The main pancreatic duct and common bile duct were dilated owing to obstruction by the tumor. The following tumor markers were mildly elevated: carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), SPan-1, and DUPAN-2. The histological diagnosis obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was negative for pancreatic ductal carcinoma, malignant lymphoma and neuroendocrine tumor, suggesting the possibility of mesenchymal tumor, but the diagnosis was not confirmed. The patient was judged suitable for surgery and underwent subtotal stomach-preserving pancreatoduodenectomy with D2 lymph node dissection. On histopathological examination of the resected specimen, infiltrating spindle-shaped cells had proliferated, containing numerous mitotic figures, with necrotic findings inside the tumor. Immunostaining was positive for cluster of differentiation-34 (CD34), B cell CLL/lymphoma-2 (Bcl-2), and signal transducer and activator of transcription (STAT6). On the basis of these findings, a diagnosis of malignant pancreatic SFT was made. The patient remains free of recurrent disease after 12 months of follow-up without adjuvant therapy and he is being carefully followed up as an outpatient.

Conclusions

We experienced a case of malignant pancreatic head SFT. Immunohistochemical staining of the extracted specimens was useful for diagnosis.

A rare cause of obstructive defecation in a 29-year-old woman: Ileo-colo-colonic intussusception treated by subtotal colectomy with posterior rectopexy

Adult intussusception is a rare clinical condition. In majority of adult cases, there is an underlying cause such as polyps or colon cancers. In the present study, a 29-year-old woman with intermittent and colicky abdominal pain, constipation, and painful defecation, accompanied with distention and sense of rectal fullness, was evaluated with computed tomography. Ileo-colo-colic intussusception was determined. Subtotal colectomy with posterior rectopexy was performed. After the surgery, she was doing well at 13-month follow-up.

A case of a "wandering" mobile solitary fibrous tumor occurring in the pancreas

A 73-year-old male with a complaint of abdominal discomfort was examined by abdominal ultrasonography and found to have a hypoechoic mass in the upper abdomen. On abdominal computed tomography (CT), there was a 5-cm, hypervascular mass between the stomach and aorta. Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) showed a homogeneous mass with hypointensity on T1-weighted images, accompanied by stenosis of the main pancreatic duct of the pancreatic head. On endoscopic ultrasonography, the mass was depicted as a round homogeneous, hypervascular mass attached to the pancreatic head. Surprisingly, the mass was located on the right side of the aorta on the second CT. Histological examination of the resected specimen showed that the lesion was composed of spindle cells with cord-like arrangement, the features of which were compatible with a mobile solitary fibrous tumor.