The cross-sectional imaging patterns of GBC consist of a mass replacing the gallbladder (40%–65% of cases) [pattern A], focal or diffuse wall thickening (20%–30%) Protease Inhibitor Library [pattern B]. In pattern C (15%–25%)—as in the present case—GBC is manifested as a polypoid lesion (usually larger than 1 cm in diameter) with
a thickened implantation base. The differential diagnosis should include adenomatous or cholesterol polyps, carcinoid or melanoma metastasis. It has been reported that conventional MRI with associated Magnetic Resonance Angiography (MRA) and MRCP can disclose the disease and simultaneously detect liver or vascular invasion, biliary tract and/or lymph node involvement. Contributed by “
“A 49-year-old male was referred to our hospital for chronic diarrhea and
weight loss. Patient was previously treated for articular rheumatism with immunosuppressive therapy for 7 years without significant benefit. Upon admission, hypochromic microcytic anemia, low serum cholesterol, elevated C-reactive protein and erythrocyte sedimentation rate were observed. Anti-transglutaminase antibodies were normal. Computed tomography (CT) showed multiple intra and retroperitoneal lymphadenopathy suspicious of lymphoma, admixed with some fatty tissue areas. Ultrasonography (US) performed to obtain PARP inhibitor fine-needle biopsy failed to demonstrate a target lesion, but the retroperitoneum appeared thickened by a diffuse non-homogeneous, hyperechoic fatty-like tissue (Figures 1A and B). Endoscopy showed erythema and erosions of the duodenum. Histology of duodenal biopsies showed modifications suggestive of Whipple’s disease (WD) (Figures 2A and B), confirmed by specific polymerase-chain-reaction. The patient selleck products was given twice daily sulfametoxazole/trimetroprim
for one year. The symptoms improved after 3 weeks of treatment and completely disappeared after 3 months. Follow-up CTs showed a progressive reduction of lymphadenopathy. WD is a chronic multi-organ infectious disease caused by Tropheryma whipplei, commonly affecting middle-aged white men. About 1000 cases have been reported. Tropheryma whipplei is a ubiquitous pathogen. The transmission mode is still unclear although faecal-oral way has been suggested. The decreased production of interleukin-12 with reduced release of interferon-gamma by T-cells and defective macrophage activation might represent the predisposing pathogenetic mechanism. Several studies have shown that macrophages accumulating within the lamina propria appear unable to degrade phagocytosed bacteria. WD may interest every organ. Gastrointestinal involvement occurs in 70% of cases with weight loss, diarrhoea and abdominal pain. Extraintestinal manifestations can involve joints, heart, lymphatic system, skin and central nervous system.