Case Study in 2009

This article considers the case of a 58-year-old man with a history of type II diabetes, obesity and hypertension who presented with non-alcoholic steatohepatitis-related liver cirrhosis and hepatocellular carcinoma (HCC), and self-referred for a second opinion. He was diagnosed with unresectable HCC. The patient underwent radioembolization with Yttrium-90 glass microspheres, which substantially decreased the tumor mass. 1 year after initial diagnosis with HCC the patient underwent orthotopic liver transplantation (OLT). He remains negative for recurrence of HCC 2.5 years post-OLT.

This article considers the case of a 49-year-old woman with a history of hepatitis C and peptic ulcer disease who presented with massive hematemesis. She was diagnosed with gastric variceal hemorrhage and splenic vein thrombosis. The patient underwent splenic artery embolization and balloon-occluded retrograde transvenous obliteration of gastric varices. By 30 months post-treatment no evidence of gastric varices or splenic vein thrombosis remained.

Clostridium difficileinfection is increasingly recognized in patients who have undergone restorative proctocolectomy with ileal-pouch–anal anastomosis. The effect of this infection on patient outcomes is not clear. In this Case Study, Shen and colleagues describe a case of fulminantC. difficile-associated pouchitis with a fatal outcome that occurred after ileostomy closure.

This article considers the case of a 58-year-old man who presented with a 35-year history of Crohn's disease, pararectal fistulas and abscess formation. He had been taking azathioprine therapy for approximately 5.5 years. He was started on infliximab; however, his fistulas persisted and the abscess recurred. He was, therefore, switched to adalimumab. After development of pancytopenia, a bone marrow biopsy and a diagnostic splenectomy were performed, leading to a diagnosis of hepatosplenic T-cell lymphoma.

This article considers the case of a 49-year-old man who presented with fatigue and poor concentration. He was diagnosed with HCV genotype 1 infection and started on a 48-week course of pegylated interferon α2b plus ribavirin. Despite initial reductions in his serum HCV-RNA levels, HCV-RNA remained detectable at week 12; however, it was undetectable by week 24. The patient was classified as a slow responder and therapy was extended to 72 weeks.

This article considers the case of a 66-year-old white man who presented with a productive cough and pleuritic chest pain on his right side 6 months after undergoing transarterial chemoembolization for hepatocellular carcinoma. The patient was diagnosed with a biliopleural fistula, and this Case Study explores the diagnosis and management of this patient.

This article considers the case of a 73-year-old white man who presented with synchronous gastric carcinomas and a 20-year history of mixed polyposis. Genetic-testing and molecular-pathology analyses confirmed a diagnosis of Cowden's syndrome. The case explores the diagnostic challenges of differentiating between hamartomatous and adenomatous polyposis syndromes in patients with mixed polyposis, and emphasizes the need to characterize the risk of gastrointestinal cancer in patients with this syndrome.