Volume 78 - 2015 - Fasc.1 - Case reports
Solitary cavernous lymphangioma of the duodenum : a case report
Duodenal lymphangioma is an extremely rare benign tumor of the gastrointestinal tract. In this case report, we describe the case of a 39-year-old Lebanese female with cystic lymphangioma of the duodenum diagnosed by exploratory laparotomy and immuno- histochemical analysis. Herein our findings are described. (Acta gastroenterol. belg., 2015, 78, 60-61).
IgG4-related cholangitis : Case report and literature review
Case Presentation : We describe a case of a patient who presents with jaundice, elevated cholestatic liver enzymes, an extreme weight loss and a midcholedochal stricture very suspect for a cholangiocarcinoma. In the conviction of malignancy, although the absence of anatomopathological prove, the patient underwent a choledochal resection. The anatomopathological specimen revealed no malignancy. In the year following resection, the patient keeps presenting with bile duct strictures and further weight loss. Ultimately the diagnosis of Ig G4-related cholangitis is withheld. Therapy with corticosteroids is initiated with a spectacular clinical, biochemical and radiographical result.
Discussion : IgG4-related cholangitis is the biliary presentation of IgG4-related disease, a recently discovered entity of fibroinflam- matory masses which can affect virtually every organ in the body. It is characterized by a dense lymphoplasmacytic infiltrate, stori- form fibrosis, obliterative phlebitis and a presence of > 30 IgG4- positive plasma cells per high power field. Main differential diagnosis contains cholangiocarcinoma and primary sclerosing cholangitis. Corticoids are cornerstone of therapy, with azathio- prine frequently used as a maintenance in case of relapse.
Conclusion : With this case we want to draw the attention to a rather uncommon cause of biliary obstruction, easily mistaken for a cholangiocarcinoma. (Acta gastroenterol. belg., 2015, 78, 62-64).
Idiopathic acute eosinophilic hepatitis : does it exists ?
Until now, "eosinophilic hepatitis" has not been recognized as a separate disease entity. We report a case of a middle-aged women with an acute febrile, severe cholestatic hepatitis accompanied with rash and quincke oedema, and an elevated serum IgE level. Liver biopsy showed lymphocytic inflammation with a remarkably high number of eosinophils. She responded rapidly to methylpredniso- lone treatment, which could be quickly tapered off and stopped without relapse. The term 'idiopathic acute eosinophilic hepatitis' seems to be the best fitting diagnostic term. (Acta gastroenterol. belg., 2015, 78, 65-68).
