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- W3110982607 abstract "A 52 year-old male with a recent acute myocardial infarction, treated with coronary angioplasty and stenting, and on dual antiplatelet therapy (DAPT), was admitted at our Gastroenterological Emergency Department for acute gastrointestinal bleeding (melena) and haemodynamic instability (blood pressure 95/55 mmHg, heart rate 112 bpm). He had haemoglobin 6.8 g/dL and metabolic acidosis. After resuscitation, he underwent urgent esophagogastroduodenoscopy (EGD), which did not reveal any sign of upper gastrointestinal bleeding. A colonscopy was performed: caecum was entirely occupied by a large, ulcerated, spontaneously bleeding, polylobated, 5 cm polyp, with a NICE I/Kudo II pit pattern (Fig. 1A-B). After an accurate inspection, the polyp revealed a long and large peduncle crossing the ileo-cecal valve, implanted in terminal ileum at about 10 cm (Fig. 1C). Due to DAPT, polypectomy was postponed 7 days later, after suspending clopidogrel. Polypectomy was technically difficult because of polyp location and dimensions: after injecting 1:10.000 diluted adrenaline and placing 2 haemoclips at peduncle base (Fig. 1D), polyp with part of peduncle was then cut “en bloc”, and EndoLoop was finally placed in the terminal ileum to reinforce haemostasis (Fig. 1E). Polyp was then retrieved with some difficulties due to high dimensions (Fig. 1F). Macroscopically, polyp was hard and ulcerated. Histology revealed fickle cellularity with a great amount of spindle cells, plasma cells, lymphocytes, eosinophils and large, thick-walled capillaries (Fig. 2A-C). On immunohistochemistry, the spindle cells were positive for CD34 and negative for cytokeratin, CD117 and S-100 (Fig. 2D). These morphological characters were consistent with the diagnosis of Vanek's tumor. Fig. 2Histopathology of Vanek's tumor. Fickle cellularity with a great amount of spindle cells, plasma cells, lymphocytes, eosinophils and large, very thick-walled capillaries (A-C). Immunohistochemistry positive for CD34 and negative for cytokeratin, CD117 and S-100 (D). View Large Image Figure Viewer Download Hi-res image" @default.
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- W3110982607 date "2020-12-01" @default.
- W3110982607 modified "2023-09-27" @default.
- W3110982607 title "Vanek's tumor, a very rare case of massive acute gastrointestinal bleeding" @default.
- W3110982607 doi "https://doi.org/10.1016/j.dld.2020.11.032" @default.
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