These findings were compatible with Hirschsprung disease. To confirm the diagnosis, biopsy of all layers of the rectal wall was performed. Histological examination revealed numerous epithelioid cell granulomas (Fig. 2) involving the peripheral nerves and nerve plexuses of the muscular and the submucosal layers. Hyperplasia of acetylcholinesterase-positive fibers was
not found in the lamina propria. Therefore, she was diagnosed as having rectal sarcoidosis with secondary paralytic ileus. There was no hilar lymphadenopathy, granular changes, or opacification on chest X-ray and CT scan. Angiotensin-converting RAD001 purchase enzyme, a marker of sarcoidosis, was normal at 10.5 (8.3–21.4) IU/L, but serum soluble IL-2receptor antibody was very high at 1,901 (135–483) pg/ml. Tuberculin skin test was negative (0 × 0/6 × 6 mm). Bronchoscopy revealed a mucosal reticular network that was compatible with sarcoidosis. The CD4/CD8 cell
ratio was high (4.76) in the bronchial lavage fluid, but no granulomas were detected by transbronchial lung biopsy. We treated her for neurosarcoidosis with prednisolone at 60 mg/day. Her symptoms improved Selleckchem INCB024360 gradually, and she was discharged on oral prednisolone (30 mg/day). At that time, the mucosal reticular network had resolved on bronchoscopy. Sarcoidosis is a systemic disease that causes the formation of epithelioid granulomas. The incidence of symptomatic bowel obstruction due to sarcoidosis is 0.6%. However, all previous reported cases of bowel obstruction were from mechanical obstruction caused by sarcoid granulomas. A Pubmed search using the key words ‘sarcoidosis’ and ‘paralytic ileus’ from 1949 to 2009 did not reveal any previous publications on paralytic ileus induced by intramuscular sarcoid granulomas resembling adult-onset Hirschsprung disease. Contributed by “
“Cystic lesions of the liver represent a heterogeneous group of disorders, most of them with an indolent and benign course. Liver cysts are frequent and usually an incidental finding as a
result of widespread use of modern imaging. In some circumstances a surgical intervention is indicated by symptoms or to treat specific potential complications else and morbidity related to the etiology of the cyst. Thus, efforts to characterize these lesions and arrive at a specific diagnosis should be made. “
“Park EJ, Lee JH, Yu G-Y, He G, Ali SR, Ryan G. Holzer, et al. Dietary and Genetic Obesity Promote Liver Inflammation and Tumorigenesis by Enhancing IL-6 and TNF Expression. Cell 2010;140:197-208. (Reprinted with permission.) Epidemiological studies indicate that overweight and obesity are associated with increased cancer risk. To study how obesity augments cancer risk and development, we focused on hepatocellular carcinoma (HCC), the common form of liver cancer whose occurrence and progression are the most strongly affected by obesity among all cancers.