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Section on gastroenterology. (Abstracts of Scientific Posters).


MALT lymphoma is a distinctive type of B-cell lymphoma that arises from the mucosa-associated lymphoid tissue in the GI tract, lung, salivary gland, and thyroid. In the GI tract, MALT lymphomas usually occur in the stomach and rarely in the large intestine. MALT lymphoma of the colon presenting with lower GI bleed is rare. We report a case of MALT lymphoma of the ascending colon presenting as chronic lower GI blood loss, with resultant iron deficiency anemia. Our patient is a 62-year-old white man seen for evaluation of anemia and marked weight loss. Several months ago he had bright red blood per rectum. A colonoscopy was attempted, but was abandoned due to poor preparation. He failed to keep up his follow-up appointment for a second colonoscopy. This time, he presented with marked weight loss of 32 pounds and anemia. He also developed increased stool frequency, which ranged from 3 to 4 stools a day, to one every two hours. His stool was guaiac positive. A colonoscopy was planned for the evaluation of lower G I bleed, which revealed a large, partially obstructive lesion in the ascending colon measuring approximately about 8 cm. Gross appearance was consistent with malignancy. Biopsies showed inflammatory and granulation tissue without evidence of malignancy. A CT scan of the abdomen and pelvis was done to rule out metastases, and revealed a 6.7-cm mass involving the ascending colon, most likely representing colon cancer, with no evidence of metastasis. A right hemicolectomy was performed for therapeutic (for impending obstruction) and diagnostic purposes. Histopathology was consistent with extranodal marginal-zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). An upper GI endoscopy was performed in search of possible MALT lymphoma of the stomach, which was negative. Both a serologic test and biopsy performed to test for H pylori infection were negative. Bone marrow biopsy was negative for lymphoma. A small-bowel study failed to reveal any abnormality. MALT lymphoma is a distinctive type of B -cell lymphoma that arises from the mucosa- associated lymphoid tissue in the GI tract, lung, salivary gland and thyroid. In the GI tract MALT lymphomas usually occur in the stomach and rarely in the large intestine. MALT lymphoma of the colon usually presents as multiple polypoid lesions. They could present with tenderness in the right lower quadrant and also as an obstructive lesion if they grow large enough. MALT lymphoma of the colon, as in the case of our patient, could present with chronic lower GI blood loss. Thus, like adenocarcinoma, MALT lymphoma of the colon should be considered in the differential diagnosis of iron deficiency anemia.


The term simultaneous multiple cancers means more than one cancer type diagnosed in a patient on a single occasion. Multiple simultaneous cancers in a patient are rare. Three different primary cancers occurring simultaneously not related to one another involving the GI tract have never been documented in literature. We describe here a case of three different primary cancers diagnosed in a patient simultaneously on a single admission. Our patient is a 54-year-old woman with no family history of cancer, who presented with epigastric discomfort and rectal bleeding. She had symptoms suggestive of chronic reflux in the past, but the rectal bleeding was new. The patient underwent upper GI endoscopy and colonoscopy. Upper GI endoscopy revealed gastric polyp and a duodenal polyp. Colonoscopy revealed two adenomatous polyps, one in the transverse colon, another one in the descending colon, and a fairly large one in the rectum. Biopsy of the stomach polyp revealed a carcinoid; the duodenal polyp revealed a B-cell lymph oma, and the rectal mass revealed adenocarcinoma. CT scan of the abdomen was done to rule out metastasis to the liver, and was negative. A bone marrow examination was positive for minimal involvement with low-grade lymphoma. The patient had radiotherapy for rectal carcinoma and subsequently underwent low anterior resection of the rectum. Pararectal lymph nodes were negative for malignancy. Mesenteric nodes were positive for lymphoma. Polypectomy was considered curative for carcinoid, since a subsequent octreotide scan falied to reveal any area of increased uptake suggestive of metastasis. Since the lymphoma was low grade, it was determined that no treatment is needed at present and the patient would need a close follow up. This is an extremely unusual presentation of three primary gastrointestinal cancers. There are currently no identified cancer syndromes or known genetic causes which would explain this triad of malignancies.

GA3-A. A COMPARATIVE ANALYSIS OF SURVIVAL OF VASCULAR ACCESSES USED IN HEMODIALYSIS. Ronald W. Ambe, BS, William E. Matory, MD, Martin Dillard, MD, Ata Atogho, BS, and Duane Smoot, MD. Howard University, Washington, DC.

Hemodialysis is statistically becoming the predominant mode of management of end-stage renal disease in the US. A suitable and durable vascular access is desired to facilitate the extracorporeal purification of blood in these patients. The purpose of this study is to compare the overall survival rate of each of four different types of vascular accesses at Howard University Hospital, taking into consideration their location on the body and their common complications. We studied 500 cases of vascular accesses from patient records in inpatient and outpatient hemodialysis units at Howard University Hospital. These cases were classified into four main access types: fistula (44 cases), graft (214 cases), PermCath (93 cases), and Shiley catheter (149 cases). Data analysis from the above 500 cases showed that fistula vascular accesses have the highest overall survival percentage after 8 years (11.4% of cases). Graft vascular accesses have the highest incidence of thrombus formation (50.5% of cases). Catheters have the lowest overall survival rates. This study shows that there is a disproportionately small number of fistula vascular accesses performed in hemodialysis patients at Howard University Hospital, although those patients have the highest survival rates and lowest incidence of complications. Increasing this type of access should help curb the cost and morbidity associated with vascular access complications.

GA4-E. ROLE OF LAPAROSCOPY IN EVALUATION OF EXUDATIVE ASCITES. Mitra Ghasemi, MD, Noosin Shirzad, MD, and Naser E. Daryani, MD. Knoxville, TN.

Laparoscopy is one of the diagnostic methods for intraabdominal diseases. In this study, we retrospectively analyzed 40 patients in whom laparoscopy was done for evaluation of ascites of unknown origin at Imam Khomeini hospital between 1996 and 1999. We reviewed and compared the macroscopic view of the peritoneum and bowels in laparoscopy with the pathology reports. In 90% of cases, laparoscopy helped to make a diagnosis. In the other 10%, biopsy was not done because the macroscopic view was completely normal or the lesion was in the retroperitoneal space. In 82.5% of cases, the diagnosis suggested by macroscopic view was accurate (compared with the pathology report). This rate was 92.8% in tuberculous peritonitis and 100% in peritoneal carcinomatosis. In 85% of our cases, no complications occurred, and in 12.5%, transient abdominal pain was the only complication. A significant complication, consisting of peritonitis and fistula, occurred in only one case (2.5%). In general, our study shows that laparoscopy i s a safe, fast, and valuable tool in evaluation ascites of unknown origin and ruling Out other causes of ascites in patients with cirrhosis or chronic renal failure.
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Publication:Southern Medical Journal
Article Type:Bibliography
Geographic Code:1USA
Date:Dec 1, 2002
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