A 73-year-old woman who presented with anaemia and gastroscopy revealed a 30 mm firm ulcer with raised edges at the lesser curve of the stomach. A CT scan revealed features within the ulcer that were suspicious for malignancy. She was treated with a proton pump inhibitor and sucralfate but the ulcer failed to heal over a 1-year period. Three sets of biopsies from the ulcer edge during this time revealed benign changes only. There was no history of non-steroidal anti-inflammatory drug usage and urinary salicylate estimation was negative. The serum gastrin concentration was not raised. Her medical history included insulin-dependent diabetes mellitus and ischaemic heart disease. There was no history of a systemic inflammatory disorder. Due to the continued concern of occult malignancy she proceeded to laparotomy with partial gastrectomy, after which she made an uneventful recovery.
Macroscopic examination of the resection specimen revealed a 30 mm mucosal ulcer...]]>
Lymphoepithelioma-like carcinoma (LELC) of the liver is extremely rare. To our knowledge, only 16 cases of pure LELC or LELC with ordinary adenocarcinoma arising in the hepatobiliary tract have been reported in the English literature.
A 31-year-old woman (gravida 0, para 0) was noted to have high-grade squamous intraepithelial lesion at routine two-yearly cervical smear. At colposcopy, three separate acetowhite areas were seen. The colposcopic impression was of low-grade squamous intraepithelial lesion and chronic inflammatory change. A Lletz biopsy of the cervix was performed. The patient had been on microgynon 50, which she had ceased before the last period. The last menstrual period was 3 weeks prior to the colposcopy. No significant gynaecological or medical history was noted.
The gross specimen consisted of an intact Lletz biopsy of cervix measuring 17x10 mm and resected to a depth of 15 mm. The tissue was transected and blocked in toto. Histologically, high-grade squamous intraepithelial lesion (CIN 2) and associated koilocytosis consistent with human papillomavirus was seen. Background changes of moderate chronic cervicitis and associated squamous metaplasia were present. An additional finding noted were three...]]>
A patient with hypertension, ischaemic heart disease, atrial fibrillation and recurrent strokes was admitted for acutely worsening abdominal distension and breathlessness. There was a history of persistent abdominal distension and diarrhoea, which were treated conservatively. Endoscopy done had shown reflux oesophagitis, peptic ulceration and right-sided ischaemic colitis. Per-rectal examination revealed blood clots mixed with mucus. CT of the abdomen and pelvis showed no evidence of mesenteric vascular occlusion or masses.
The patient subsequently became hypotensive and underwent emergency laparotomy. Intraoperatively, ischaemic changes of left colon and patchy oedema of the mesentery were noted. Left hemicolectomy with colostomy was performed. Postoperatively, the...]]>