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Lege Artis Medicinae

OCTOBER 18, 2006

[SIMULTANEOUS PRESENCE OF GIST AND MALT-LYMPHOMA OF THE STOMACH IN A HELICOBACTER PYLORI NEGATIVE PATIENT]

KOVÁCS Ferenc, GYÖKERES Tibor, TAKÁCS Imre Géza, PADÁNYI István, FEKETE Csaba, OROSZ Zsolt, PAP Ákos

[INTRODUCTION - The simultaneous presence of gastric mucosa-associated lymphoid tissue lymphoma (MALT) and a gastrointestinal stromal tumor (GIST) is an extremely rare finding that has not been published until now. CASE REPORT - The authors report on a 78- year-old man who was referred to their department with an emergency upper gastrointestinal bleeding. Urgent gastroscopy revealed a bleeding ulcer in the middle third of the stomach. On the follow-up endoscopy 6 weeks later, an umbilicated polypoid lesion was found proximal to the healed ulcer, which was subsequently removed by elective surgery. Histology and immunohistochemical staining of the specimen for c-Kit confirmed the diagnosis of gastrointestinal stromal tumour. A few weeks later the patient was readmitted because of haematemesis. Upon detailed histological examination of the biopsy specimens taken from the multiple superficial ulcers found near the previous lesion, MALT-lymphoma was diagnosed. The absence of Helicobacter pylori was confirmed by repeated histological examinations, serology and urea breath test. CONCLUSION - This is the first report on a patient with simultaneous presence of a gastrointestinal stromal tumour and gastric mucosaassociated lymphoid tissue lymphoma with H. pylori negativity. Several observations suggest that the development of malignant tumours of the stomach is also associated with H. pylori infection. In view of the reported case, the possibility of a common aetiology of these two neoplasms other than H. pylori infection is discussed.]

Hungarian Radiology

OCTOBER 20, 2006

[Successful radiological diagnostics in Bouveret’s syndrome]

KISS Katalin, FARKAS Szabolcs, LUKOVICH Péter, MAGYAR Péter, MESTER Ádám, MAKÓ Ernő

[INTRODUCTION - Bouveret’s syndrome I is a rare clinical entity, a special form of gallstone ileus. Based on a case study the authors describe the clinical presentation, the complications and diagnostic work up of the Bouveret’s syndrome I. CASE REPORT - A 75-year-old female patient with repeated vomiting and haematemesis was examined. Known gallstones and obstructive jaundice was noted in the case history. Urgent gastroscopy was performed at admission, which proved haemorrhagic esophagitis as the cause of the haematemesis. A gallstone was found by endoscopy distal to the pyloric region obstructing the bowel lumen. Radiological examinations proved the presence of the stone exactly at the localization that was given. Surgery confirmed the diagnosis. CONCLUSION - Bouveret’s syndrome I should be considered in patients with repeated and long lasting vomiting and bile stone in the case history. Conventional X-ray may be sufficient to establish the diagnosis, however further imaging studies are needed to clarify exact anatomical situation and potential complications of the disease.]