Giant Filiform Polyposis not Associated with Inflammatory Bowel Disease: A Case Report

Background

Filiform polyposis (FP) is an uncommon cause of non-neoplastic and non-syndromic polyposis. Several hypotheses concerning its pathogenesis have been published. FP is most frequently associated with a post-inflammatory reparative process; indeed, the most frequent association is with inflammatory bowel disease (IBD). FP is characterized by one to hundreds of uniform, slender, arborizing, vermiform projections of the large bowel mucosa and submucosa lined by normal or inflamed colonic mucosa. The most common sites for these polyps are the transverse and descending colon.

Case Report

In this report we present a case of giant FP associated with locally invasive adenocarcinoma of the right colon in a 73-year-old man with no past medical history of IBD.

Conclusion

Few of these cases have been reported in the literature, and out of the approximately 20 of such case reports only one other was associated with colorectal adenocarcinoma.

Multifocal blue nevus of the prostate: a case report

BACKGROUND

Blue nevus of the prostate is rare and is most commonly discovered incidentally in patients presenting with classic symptoms of prostatic hyperplasia. Only 32 cases have been reported to date in the literature. We describe the first case of multifocal blue nevus of the prostate gland.

CASE

A 69-year-old man presented with obstructive urinary symptoms. The preoperative clinical and radiological fndings had shown a massive increase in the volume of the prostate. Suprapubic prostatectomy was performed with good postoperative course. The histopathological examination disclosed benign hyperplasia with large areas characterized by abundant fibromuscular component. In the context of this hyperplasia were observed a dozen foci of pigmented cells measuring 0.1-1 cm in diameter. Histochemical and immunohistochemical stains confirmed the pigment as melanin.

CONCLUSION

A review of the literature shows that the blue nevus of the prostate is an incidental finding and is most often associated with a benign disease of the prostate, as indeed occurred in our case. All the cases reported are monofocal. Ours is the first reported multifocal case and, as the material has not been fully sampled, consists of at least 12 different outbreaks of varying sizes. Even in our case blue nevus was asymptomatic, and the patient showed no symptoms related to the same blue nevus.

Validity of ultrasonography and measures of adult shoulder function and reliability of ultrasonography in detecting shoulder synovitis in patients with rheumatoid arthritis using magnetic resonance imaging as a gold standard

OBJECTIVE

To assess the intra- and interobserver reproducibility of musculoskeletal ultrasonography (US) in detecting inflammatory shoulder changes in patients with rheumatoid arthritis, and to determine the agreement between US and the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, using magnetic resonance imaging (MRI) as a gold standard.

METHODS

Eleven rheumatologists investigated 10 patients in 2 rounds independently and blindly of each other by US. US results were compared with shoulder function tests and MRI.

RESULTS

The positive and negative predictive values (NPVs) for axillary recess synovitis (ARS) were 0.88 and 0.43, respectively, for posterior recess synovitis (PRS) were 0.36 and 0.97, respectively, for subacromial/subdeltoid bursitis (SASB) were 0.85 and 0.28, respectively, and the NPV for biceps tenosynovitis (BT) was 1.00. The intraobserver kappa was 0.62 for ARS, 0.59 for PRS, 0.51 for BT, and 0.70 for SASB. The intraobserver kappa for power Doppler US (PDUS) signal was 0.91 for PRS, 0.77 for ARS, 0.94 for SASB, and 0.53 for BT. The interobserver maximum kappa was 0.46 for BT, 0.95 for ARS, 0.52 for PRS, and 0.61 for SASB. The interobserver reliability of PDUS was 1.0 for PRS, 0.1 for ARS, 0.5 for BT, and 1.0 for SASB. P values for the SPADI and DASH versus cuff tear on US were 0.02 and 0.01, respectively; all other relationships were not significant.

CONCLUSION

Overall agreements between gray-scale US and MRI regarding synovitis of the shoulder varied considerably, but excellent results were seen for PDUS. Measures of shoulder function have a poor relationship with US and MRI. Improved standardization of US scanning technique could further reliability of shoulder US.

Intrahepatic subcapsular biloma. A rare complication of laparoscopic cholecystectomy

Bile leaks leading to bilomas in the subhepatic space are amongst the most common complications of laparoscopic cholecystectomy (LC). We describe the case of a large (1,100 cc) intrahepatic biloma that presented with pain and fever 14 days post LC. The diagnosis was suspected as a result of ultrasound and CT scan and the problem was solved by percutaneous catheter drainage. We believe this intrahepatic biloma was caused by a lesion of an abnormal bile duct near the bed of the gallbladder during a difficult dissection due to severe contraction and fibrosis.