Images in clinical medicine. Taenia saginata.
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Biomedical subjects
Publications and source records attributed to Y Lenormand.
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This case report documents severe autoimmune thrombocytopenia in a 20 yrs. old patient with ulcerative colitis. Diagnosis of idiopathic thrombocytopenic purpura was made on the presence of bound antiplatelet antibodies and on the absence of any other disorder capable of provoking a platelet fall. Colonic lesions were moderate but were resistant to steroids and total parenteral nutrition. Thrombocytopenia resisted to steroids and vincristine and a major fall in the platelet count (less than 10,000/mm3) occurred in two instances. However, platelets rose transiently after high-dose intravenous gamma-globulins. The patient underwent splenectomy, colectomy and ileostomy because of life-threatening colonic hemorrhage. The platelet count rose to normal levels within one week after surgery. Ileorectal anastomosis was subsequently performed. One year later the patient was in good health and his platelet count had returned to normal.
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A nonimmunodeficient patient with diffuse nodular lymphoid hyperplasia of the small bowel and a jejunal malignant lymphoma of mixed lymphocytic-histiocytic type is reported. Surface marker and immunohistologic studies of the malignant lymphoma and of histologically benign lymphoid nodules proximal to the tumor showed a similar pattern of monoclonality (IgM-kappa) and gave suggestive evidence of a cytogenetic relation of the lymphoma to nodular lymphoid hyperplasia. It is suggested that intestinal nodular lymphoid hyperplasia may be a condition leading to lymphoid malignancy; its exact incidence in patients with both malignant lymphoma of the gut and a primary immunodeficiency syndrome should warrant further consideration.
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Duplications of the small bowel are an uncommon group of congenital malformations whose symptoms rarely occur in adults. We report the case of a 21 year-old man who suffered during four years from symptoms related to the ulceration of ectopic gastric mucosa in an ileal duplication (spontaneously resolving peritonitis, pelvic abscess, recurrent gastrointestinal bleeding and chronic abdominal pain). Radiological and endoscopic explorations and a first laparotomy failed to provide the diagnosis. 99m pertechnetate (99mTcO4) scintigraphy demonstrated ectopic gastric mucosa and guided the radiological detection of an ileal ulceration. Injection of 99mTcO4 during a second laparotomy located the ectopic gastric mucosa at the level of a tumefaction found on the mesenteric side of the terminal ileum. Duplication was only recognized at pathological examination of the ileal resection. This case emphasizes the need to evoke a duplication in clinical circumstances like those described in this patient as well as the usefulness of 99mTcO4 in the diagnosis of such a malformation.