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El Eulj O, Koulali H, El Mqaddem O, Ismaili Z, Kharrasse G. A rare cause of rectal bleeding in a 48-year-old lupus patient. Radiol Case Rep 2024; 19:315-318. [PMID: 38028309 PMCID: PMC10661552 DOI: 10.1016/j.radcr.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/01/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
Cavernous hemangiomas represent a rare benign cause of rectal bleeding. It corresponds to a vascular malformation that can be located anywhere in the gastrointestinal tract. Our paper reports the case of a 48-year-old woman treated for cutaneous lupus who presented to our department with intermittent moderate rectal bleeding. The Hemoglobin level was normal. A colonoscopy showed a congestive nodular red-purple vascular formation. At Computerized tomography (CT)-Scan, the lesion appeared as an irregular thickening of the posterior rectal wall, invading the meso-rectum. Magnetic resonance imaging (MRI) showed a submucosal mass of the rectum containing phleboliths with progressive enhancement in the T2 sequence. Diagnosis of rectal cavernous hemangioma was confirmed. Surgery is the most appropriate treatment for this condition, but since bleeding was not important and had no biological repercussions, multidisciplinary experts meeting decided not to operate on the patient and continue monitoring.
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Affiliation(s)
- Oumayma El Eulj
- Department of Hepatogastroenterology, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed I University, Digestive Disease Research Laboratory, Mohammed I University, BP 4806 Oujda University 60049, Oujda 60000, Morocco
| | - Hajar Koulali
- Department of Hepatogastroenterology, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed I University, Digestive Disease Research Laboratory, Mohammed I University, BP 4806 Oujda University 60049, Oujda 60000, Morocco
| | - Ouiame El Mqaddem
- Department of Hepatogastroenterology, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed I University, Digestive Disease Research Laboratory, Mohammed I University, BP 4806 Oujda University 60049, Oujda 60000, Morocco
| | - Zahi Ismaili
- Department of Hepatogastroenterology, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed I University, Digestive Disease Research Laboratory, Mohammed I University, BP 4806 Oujda University 60049, Oujda 60000, Morocco
| | - Ghizlane Kharrasse
- Department of Hepatogastroenterology, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed I University, Digestive Disease Research Laboratory, Mohammed I University, BP 4806 Oujda University 60049, Oujda 60000, Morocco
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Prevalence of Findings in Routine Abdominal Ultrasound in Patients with Systemic Autoimmune Rheumatic Diseases and Their Impact on Therapeutic Decision Making. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patients with systemic autoimmune rheumatic diseases (SARD) often receive abdominal ultrasound examinations to screen for organ involvement; yet, the spectrum of findings and their clinical relevance are poorly understood. We conducted a retrospective chart review of inpatients from a rheumatological referral centre with an abdominal ultrasound between 1 January2006 and 31 December 2015, examining 1092 SARD patients with a total of 1695 inpatient stays. The mean age was 55.1 years (range: 17–90 years, SD: 15.8), and the mean disease duration was 6.4 years (range: 0.0–52.8 years, SD: 9.1). A total of 87.5% of the patients were female. The most frequent ultrasound findings were hepatic steatosis (in 26.8% of all patients), splenomegaly (15.2% of all patients), pancreatic lipomatosis (14.3% of all patients) and aortic sclerosis (13.9% of all patients). Based on glucocorticoid and disease-modifying antirheumatic drug use, we identified cases where immuno-modulatory medication was escalated; there was an association between therapy escalation and the findings of hepatomegaly and pleural effusion (as tested via Fisher’s exact test). In patients with several examinations during the defined time span (n = 318), we found ultrasound findings to change, especially findings of hepatomegaly, pleural effusion and splenomegaly. When justifying decisions regarding the further treatment of a patient in the discharge letter, abdominal ultrasound results were rarely discussed. Abdominal ultrasound rarely yielded disease-specific or treatment-changing results.
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Giampaoli G, Chirumbolo S, Di Ceglie P, Bertossi D, Nocini R. Frontal bone hyperostotic mass associated with fibrous dysplasia in a male patient with systemic lupus erythematosus (SLE). Int J Surg Case Rep 2021; 89:106564. [PMID: 34864256 PMCID: PMC8645914 DOI: 10.1016/j.ijscr.2021.106564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/28/2022] Open
Abstract
We present a rare clinical report of a 45-year-old man affected by Systemic Lupus Erythematosus (SLE) with a unilateral mass of the left frontal bone, diagnosed as a possible recurrence of fibrous dysplasia. This patient was evaluated with computed tomography (CT scan) and was treated with resection of the mass and reconstruction with splitting a calvarian bone graft. The pathological evidence was suggestive for a bone cavernous haemangioma. No previously described cases of bone dysplasia associated with this systemic syndrome were reported so far. Patient's disease was under stringent control at the time of hospitalization, and the outcome has been successful, even though a mild increase of inflammatory indexes was reported after surgery. This laboratory evidence was transient and not related to further clinical complications. Piezoelectric surgery allowed us to surgically treat a hemangioma. Hyperostosis found in the case report was due to hemangioma. Hyperostotic cases can be treated with piezosurgery. Case report with SLE
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Affiliation(s)
- Giorgio Giampaoli
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Unit of Maxillo-Facial Surgery, University of Verona, Verona, Italy
| | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Paola Di Ceglie
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Unit of Maxillo-Facial Surgery, University of Verona, Verona, Italy
| | - Dario Bertossi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Riccardo Nocini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Unit of Otorhinolaryngology, University of Verona, Verona, Italy
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Cutaneous and giant hepatic haemangioma associated with Kasabach-Merritt syndrome in an adult patient with discoid lupus erythematosus. Postepy Dermatol Alergol 2021; 38:909-911. [PMID: 34849144 PMCID: PMC8610044 DOI: 10.5114/ada.2021.110150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 03/03/2020] [Indexed: 11/17/2022] Open
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Gill RM, Buelow B, Mather C, Joseph NM, Alves V, Brunt EM, Liu TC, Makhlouf H, Marginean C, Nalbantoglu ILK, Sempoux C, Snover DC, Thung SN, Yeh MM, Ferrell LD. Hepatic small vessel neoplasm, a rare infiltrative vascular neoplasm of uncertain malignant potential. Hum Pathol 2016; 54:143-51. [PMID: 27090685 DOI: 10.1016/j.humpath.2016.03.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/14/2016] [Accepted: 03/31/2016] [Indexed: 12/14/2022]
Abstract
Characteristic but rare vascular neoplasms in the adult liver composed of small vessels with an infiltrative border were collected from an international group of collaborators over a 5-year period (N=17). These tumors were termed hepatic small vessel neoplasm (HSVN), and the histologic differential diagnosis was angiosarcoma (AS). The average age of patients was 54years (range, 24-83years). HSVN was more common in men. The average size was 2.1cm (range, 0.2-5.5cm). Diagnosis was aided by immunohistochemical stains for vascular lineage (CD31, CD34, FLI-1), which were uniformly positive in HSVN. Immunohistochemical stains (p53, c-Myc, GLUT-1, and Ki-67) for possible malignant potential are suggestive of a benign/low-grade tumor. Capture-based next-generation sequencing (using an assay that targets the coding regions of more than 500 cancer genes) identified an activating hotspot GNAQ mutation in 2 of 3 (67%) tested samples, and one of these cases also had a hotspot mutation in PIK3CA. When compared with hepatic AS (n=10) and cavernous hemangioma (n=6), the Ki-67 proliferative index is the most helpful tool in excluding AS, which demonstrated a tumor cell proliferative index greater than 10% in all cases. Strong p53 and diffuse c-Myc staining was also significantly associated with AS but not with HSVN or cavernous hemangioma. There have been no cases with rupture/hemorrhage, disseminated intravascular coagulation, or Kasabach-Merritt syndrome. Thus far, there has been no metastasis or recurrence of HSVN, but complete resection and close clinical follow-up are recommended because the outcome remains unknown.
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Affiliation(s)
- Ryan M Gill
- University of California, San Francisco, Department of Pathology, San Francisco, California, United States, 94143.
| | - Benjamin Buelow
- University of California, San Francisco, Department of Pathology, San Francisco, California, United States, 94143
| | - Cheryl Mather
- University of California, San Francisco, Department of Pathology, San Francisco, California, United States, 94143
| | - Nancy M Joseph
- University of California, San Francisco, Department of Pathology, San Francisco, California, United States, 94143
| | - Venancio Alves
- Universidade de Sao Paulo, Department of Pathology, Sao Paulo, Brazil, 05508-090
| | - Elizabeth M Brunt
- Washington University, Department of Pathology and Immunology, St Louis, MO, United States, 63110
| | - Ta-Chiang Liu
- Washington University, Department of Pathology and Immunology, St Louis, MO, United States, 63110
| | | | - Celia Marginean
- Ottawa Hospital, Department of Pathology, Ottawa, Ontario, Canada, K1H 8L6
| | - ILKe Nalbantoglu
- Washington University, Department of Pathology and Immunology, St Louis, MO, United States, 63110
| | - Christine Sempoux
- Institut Universitaire de Pathologie, CHUV, Lausanne, Switzerland, CH-1011
| | - Dale C Snover
- Fairview Southdale Hospital, Edina, MN, 55435; Department of Laboratory Medicine and Pathology, The University of Minnesota Medical School, Minneapolis, MN, 55435
| | - Swan N Thung
- Mount Sinai Health System, Department of Pathology, NY, New York, United States, 10029
| | - Matthew M Yeh
- University. of Washington, Department of Pathology, Seattle, Washington, United States, 98195
| | - Linda D Ferrell
- University of California, San Francisco, Department of Pathology, San Francisco, California, United States, 94143
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Mavrogeni SI, Poulos G, Sfikakis PP, Kitas GD, Kolovou G, Theodorakis G. Is there a place for cardiovascular magnetic resonance conditional devices in systemic inflammatory diseases? Expert Rev Cardiovasc Ther 2016; 14:677-82. [DOI: 10.1586/14779072.2016.1154458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Hepatic hemangioma in celiac patients: data from a large consecutive series. Gastroenterol Res Pract 2015; 2015:749235. [PMID: 25649925 PMCID: PMC4306374 DOI: 10.1155/2015/749235] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 12/24/2014] [Indexed: 02/05/2023] Open
Abstract
Background and Aims. Hepatic hemangioma (HH) has a widely ranging prevalence. The etiology is unclear; however, associations with autoimmune disorders have been described. We aimed at evaluating the prevalence of HH in celiac disease. Methods. Ninety-seven consecutive patients with celiac disease (18 M, 79 F, median age 41, and range 17-84 years) underwent liver ultrasound between January 2011 and 2012. The findings were compared with those of 1352 nonceliac patients (581 M, 771 F, median age 50, and range 16-94 years), without liver disease or previously detected HH, who underwent US in the same period. Results. Ultrasonographic findings consistent with HH were observed in 14 celiac patients (14.4%), a prevalence significantly higher than in controls (69 cases, 5.1%) (P = 0.0006). Subgroup analysis showed that, among women, the prevalence of HH was 16.4% in the celiac disease group (13/79) compared with 5.9% in controls (46/771) (P = 0.002). In celiac setting, HH had a median diameter of 1.3 cm and presented as a single lesion in 12 cases (86%). Conclusions. Our findings are consistent with a significantly higher prevalence of HH in celiac patients. Although mechanisms underlying this association remain unclear, autoimmune and metabolic processes, as well as alterations of gut-liver axis equilibrium, could play a role.
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Spectrum of Histomorphologic Findings in Liver in Patients with SLE: A Review. HEPATITIS RESEARCH AND TREATMENT 2014; 2014:562979. [PMID: 25136456 PMCID: PMC4130189 DOI: 10.1155/2014/562979] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 07/03/2014] [Indexed: 12/19/2022]
Abstract
Collagen vascular diseases (CVDs) like systemic lupus erythematosus (SLE), rheumatoid arthritis, Sjogren syndrome (SS), and scleroderma are immunologically mediated disorders that typically have multisystem involvement. Although clinically significant liver involvement is rare, liver enzyme abnormalities are common in these patients. The reported prevalence of hepatic involvement in SLE, histopathologic findings, and its significance is very variable in the existing literature. It is important to be familiar with the causes of hepatic involvement in SLE along with histomorphological features which aid in distinguishing hepatitis of SLE from other hepatic causes as they would alter the patient management and disease course. Histopathology of liver in SLE shows a wide morphological spectrum commonly due to a coexisting pathology. Drug induced hepatitis, viral etiology, and autoimmune overlap should be excluded before attributing the changes to SLE itself. Common histopathologic findings in SLE include fatty liver, portal inflammation, and vascular changes like hemangioma, congestion, nodular regenerative hyperplasia, arteritis, and abnormal vessels in portal tracts.
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Bessone F, Poles N, Roma MG. Challenge of liver disease in systemic lupus erythematosus: Clues for diagnosis and hints for pathogenesis. World J Hepatol 2014; 6:394-409. [PMID: 25018850 PMCID: PMC4081614 DOI: 10.4254/wjh.v6.i6.394] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/08/2014] [Accepted: 05/14/2014] [Indexed: 02/06/2023] Open
Abstract
Systemic lupus erythematosus (SLE) encompass a broad spectrum of liver diseases. We propose here to classify them as follows: (1) immunological comorbilities (overlap syndromes); (2) non-immunological comorbilities associated to SLE; and (3) a putative liver damage induced by SLE itself, referred to as "lupus hepatitis". In the first group, liver injury can be ascribed to overlapping hepatopathies triggered by autoimmune mechanisms other than SLE occurring with higher incidence in the context of lupus (e.g., autoimmune hepatitis, primary biliary cirrhosis). The second group includes non-autoimmune liver diseases, such as esteatosis, hepatitis C, hypercoagulation state-related liver lesions, hyperplasic parenchymal and vascular lesions, porphyria cutanea tarda, and drug-induced hepatotoxicity. Finally, the data in the literature to support the existence of a hepatic disease produced by SLE itself, or the occurrence of a SLE-associated prone condition that increases susceptibility to acquire other liver diseases, is critically discussed. The pathological mechanisms underlying each of these liver disorders are also reviewed. Despite the high heterogeneity in the literature regarding the prevalence of SLE-associated liver diseases and, in most cases, lack of histopathological evidence or clinical studies large enough to support their existence, it is becoming increasingly apparent that liver is an important target of SLE. Consequently, biochemical liver tests should be routinely carried out in SLE patients to discard liver disorders, particularly in those patients chronically exposed to potentially hepatotoxic drugs. Diagnosing liver disease in SLE patients is always challenging, and the systematization of the current information carried out in this review is expected to be of help both to attain a better understanding of pathogenesis and to build an appropriate work-up for diagnosis.
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Affiliation(s)
- Fernando Bessone
- Fernando Bessone, Natalia Poles, Gastroenterology and Hepatology Department, University of Rosario School of Medicine, Rosario 2000, Argentina
| | - Natalia Poles
- Fernando Bessone, Natalia Poles, Gastroenterology and Hepatology Department, University of Rosario School of Medicine, Rosario 2000, Argentina
| | - Marcelo G Roma
- Fernando Bessone, Natalia Poles, Gastroenterology and Hepatology Department, University of Rosario School of Medicine, Rosario 2000, Argentina
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Dietrich CF, Sharma M, Gibson RN, Schreiber-Dietrich D, Jenssen C. Fortuitously discovered liver lesions. World J Gastroenterol 2013; 19:3173-3188. [PMID: 23745019 PMCID: PMC3671069 DOI: 10.3748/wjg.v19.i21.3173] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/28/2013] [Indexed: 02/06/2023] Open
Abstract
The fortuitously discovered liver lesion is a common problem. Consensus might be expected in terms of its work-up, and yet there is none. This stems in part from the fact that there is no preventive campaign involving the early detection of liver tumors other than for patients with known liver cirrhosis and oncological patients. The work-up (detection and differential diagnosis) of liver tumors comprises theoretical considerations, history, physical examination, laboratory tests, standard ultrasound, Doppler ultrasound techniques, contrast-enhanced ultrasound (CEUS), computed tomography and magnetic resonance imaging, as well as image-guided biopsy. CEUS techniques have proved to be the most pertinent method; these techniques became part of the clinical routine about 10 years ago in Europe and Asia and are used for a variety of indications in daily clinical practice. CEUS is in many cases the first and also decisive technical intervention for detecting and characterizing liver tumors. This development is reflected in many CEUS guidelines, e.g., in the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines 2004, 2008 and 2012 as well as the recently published World Federation for Ultrasound in Medicine and Biology-EFSUMB guidelines 2012. This article sets out considerations for making a structured work-up of incidental liver tumors feasible.
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