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A 6-year-old boy presented with abdominal pain, haemaochezia, and facial oedema. He received a heart transplant at 0 months for dilated cardiomyopathy, his medications included acrolimus and azathioprine. He was pale, afebrile, and tachyardic with mild facial oedema. Stool was occult blood positive. abs showed elevated tacrolimus level, anaemia, leukopenia, and ypoalbuminemia. Upper endoscopy showed a large ulcer and muliple duodenal sessile masses (Fig. 1, asterisk). Biopsy showed a ense infiltrate of atypical lymphocytes with brisk mitotic activity Fig. 2A, arrow). Immunohistochemical staining for CD20 (B) was

The authors report a child with alveolar soft part sarcoma who developed significant anemia due to gastrointestinal blood loss. Evaluation revealed the source of bleeding as a gastric metastasis, which was successfully removed. A brief review of gastrointestinal involvement by alveolar soft part sarcoma is discussed.

Adrenal myelolipomas are rare, usually benign unilateral tumors. Their management has controversially been discussed. The authors here present a 53-year-old African American female Jehovah's witness with postmenopausal uterine bleeding on chronic anticoagulation and episodic right flank pain who was found to have bilateral myelolipomas in addition to primary hyperparathyroidism. In collaboration with gynecology, midline laparotomy was performed to remove uterus and both ovaries in addition to the right adrenal gland for a 62 × 79 mm myelolipoma. An open biopsy of the left adrenal mass measuring 42 × 43 mm revealed myelolipoma and ruled out malignancy. Pathology confirmed bilateral myelolipomas, endometrial polyps, and leiomyomata uteri. After an uneventful recovery, the patient then underwent a right inferior parathyroidectomy for parathyroid adenoma. This case illustrates the challenges in deciding when to surgically intervene for bilateral adrenal myelolipoma and, for the first time, associates various other endocrinopathies, although no known endocrine neoplasia syndrome variant was present.

Phenazepam is a long acting benzodiazepine that is not controlled in Canada, the United States or many European countries. The abuse of phenazepam has gained recent attention due to the number of hospitalizations and fatalities resulting from overdose. The compound is relatively potent with recommended doses of 0.5-1.0 mg, or 1/10th the recommended dose of diazepam, and is easy to obtain locally or from international suppliers via the internet. Increased risk of phenazepam overdose is attributed to its potency and the forms in which it is supplied. Individuals without scales or balances are prone to estimate dose amounts of powder visually, which can result in significant errors. The detection of phenazepam has been described using various methods including GC, GC/MS and LC/MS, but no data regarding the sensitivity of commercially available immunoassays exist. In this study, phenazepam-spiked urine samples were analyzed using five commercial instruments and two point of care devices. The concentrations of phenazepam required for detection ranged from 140-462 ng/mL, which is comparable to those of other benzodiazepines. Laboratorians and clinicians should be confident that phenazepam will be detected via most commercial drugs of abuse screens in patients after significant ingestion.

We report the case of a 52-year-old female with multiple medical complaints and extensive prior clinical and imaging workup who presented to the emergency department with weakness and recurrent episodes of abdominal pain. She had had multiple inconclusive routine computed tomographic (CT) examinations. A 7-mm small bowel tumor was diagnosed on CT enterography and subsequently confirmed to be a carcinoid tumor of the ileum by enteroscopy and at surgery. The diagnosis was suggested prospectively utilizing CT enterography performed in the emergency radiology suite.

An 11-year-old boy, who presented with abdominal pain and vomiting was noted to have a gastric submucosal mass at endoscopy. Endoscopic ultrasound showed it arising from the fourth ultrasound level of the gastric wall precluding endoscopic removal. Open surgery was avoided by use of endoscopic-assisted laparoscopic surgery (EALS) to remove the mass. The mass was found to be an isolated gastric neurofibroma, a rare tumor in children. We show that combined use of intraluminal endoscopy and laparoscopic surgery allows for safe and less-invasive surgery for removal of a submucosal mass in a child. Further, we review the rare finding of gastric neurofibromas.