Search

Background: Stromal tumors of the digestive tract are undifferentiated connective tissue tumors which are difficult to characterize even with immunohistochemistry., Case Report: A stromal tumor of the duodenum (the most frequently encountered location) was resected entirely. Histochemistry was unable to provide a precise identification of the histological nature. The tumor was considered to be low grade due to the low mitosis index despite its large size and the presence of necrosis. Careful surveillance was indicated., Discussion: The risk of these tumors is uncertain and may be assessed on the basis of histological prognosis factors such as tumor size, mitosis index and ploidy. Echoendoscopy can be particularly useful for diagnostic purposes providing information on location in the duodenal musculosa.

Tuberculous splenic abscess is an exceptional disease with silent presentation in disseminated tuberculosis infection. Imaging procedures allow to suspect this diagnosis in case of multilocular nodules of the spleen, or unilocular pseudotumoral macronodule. We report three cases of tuberculous splenic abscesses in two patients with acquired immunodeficiency syndromes and one with polycythemia vera. Under antituberculous treatment, clinical evolution was good with regression of the radiological features.

We report the case of a 32-year-old Malian man with abdominal tuberculosis revealing acquired immunodeficiency syndrome. A gastroscopy was made for epigastric pain and showed caseum in a digestive fistula with acid fast bacilli. Mycobacterium tuberculosis infection was confirmed by sputum culture. An early antituberculous therapy was prescribed. Outcome was good with rapid fistula closing and slower mass diminution of the abdominal lymph nodes. This case report confirms nodal tuberculosis as a possible cause of digestive fistulae. Rapid endoscopic diagnosis of this tuberculous fistula led to diagnosis of acquired immunodeficiency syndrome and early adapted medical treatment without invasive diagnostic methods.

The authors report two cases of esophageal polypoid pseudosarcoma with favorable outcome after endoscopic and medical treatment. Neither of the two patients could undergo general anesthesia. Endoscopic resection or monopolar electrocoagulation of the tumor was associated with chemotherapy and radiation therapy. A complete response of the tumor was observed in both cases. The two patients were alive and well with no evidence of recurrence or metastasis 3 and 5 years after diagnosis. Immunohistochemical study of those two tumors with monoclonal antibodies to intermediate filaments (keratin and vimentin) suggests duality in the spindle cell component. It may explain the biological behaviour of these particular cancers that have a better prognosis than other types of squamous cell carcinomas of the esophagus.

The aspects of abdominal ultrasonography and computed tomography (CT) were studied in 4 patients (3 African and 1 Haitian) with abdominal tuberculosis. All were markedly debilitated and three patients had protracted fever. Tuberculosis was documented in all cases by demonstrating Mycobacterium tuberculosis in cultures of lymph nodes taken during laparotomy and/or cultures of products of gastric aspiration. Ultrasonography showed enlarged lymph nodes in the pancreatic and peripancreatic areas and also in the mesenteric, perivascular and hepatic pedicle areas. CT showed hypertrophied lymph nodes with low tissue density ranging from 20 to 35 Hounsfield units. Although non pathognomonic, these aspects were suggestive of tuberculosis. Intravenous contrast medium administration failed to increase the density in the center of lymph nodes but disclosed the existence of a thick hyperdense rim surrounding the hypodense center of the caseous lymph nodes. Repeated ultrasound and CT examination allowed to control the efficacy of antituberculous chemotherapy.