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    • In Bancroft reviewed cases of hemangioma of the sigmoid

    2018-11-12

    In 1931, Bancroft reviewed 14 cases of hemangioma of the sigmoid colon. Only three patients improved after treatment; five patients died due to hemorrhage or complications. The mortality rate was high and the outcome was poor. Colonic hemangioma is now recognized as a benign disease of the submucosal vascular system, and a complete resection of the lesion has a good prognosis. However, many patients with colonic hemangioma suffer continued morbidity and mortality due to misdiagnosis. A crucial clue in the diagnosis of colonic hemangioma is the presence of centrally grouped phleboliths at the sacrococcygeal level relative to the anatomic position of the RS colon, found in 26–50% of patients. Other diagnostic tools include the barium enema buy liothyronine sodium study, colonoscopy, CT scans, and MRI. Typical barium enema contrast studies find mucosal nodular filling defects with narrowing of the bowel lumen and widening of the presacral space. Bluish submucosal dilated venous lesions in the bowel wall are observed during colonoscopy. Endoscopic biopsy of these lesions is not recommended because of a 29% risk of massive bleeding. Although colonic hemangioma is a benign disease, cases in which it has invaded other nearby pelvic organs have been reported. Therefore, CT scanning or MRI is necessary to locate the border of a lesion and its position relative to adjacent organs prior to surgery. A CT scan often shows a thickened bowel wall with transmural enhancement. Hyperintensity of the colonic wall and pericolic fat with tubular structures corresponding to the feeding vessels of the hemangioma is observed on T2-weighted MR images. These imaging characteristics are specific to colonic hemangioma. Although similar findings may be seen for patients with hemorrhoids, colonic hemangiomas can readily be distinguished by their location. The definitive treatment of colonic hemangioma is complete surgical resection. Prior to 1971, abdominoperineal resection was the advocated treatment for RS hemangioma, but this required permanent colostomy that seriously affected patients’ quality of life. In 1988, McMullin reported the first successful low anterior resection, used to treat a cavernous hemangioma at the RS colon, which used autostapler techniques and a covering colostomy. Oner and Altaca recommended low anterior resection as the treatment for rectosigmoid hemangioma in 1993, and it remains the current treatment standard because it preserves the sphincter, which is important for the maintenance of quality of life. Endoscopic polypectomy is an alternative treatment option if the hemangioma is a pedunculated lesion larger than 2.5 cm and it’s depth is limited to the submucosal layer. Sclerotherapy and cryosurgery should be used only for temporary symptom relief because it has a high recurrence rate.
    Introduction Prostate cancer is one of the most common malignancies and the sixth leading cause of death in men worldwide. Commonly affected sites include the bones, lymph nodes, lungs, and liver. However, prostate cancer can also invade the ureters either by local extension of the cancer or by external compression of the enlarged metastasized lymph nodes. Ureteral obstruction caused by metastasis in patients without obvious periureteral or retroperitoneal lymph node involvement has rarely been reported. Here, we present an unusual case with advanced-stage prostate adenocarcinoma and right hydronephroureter secondary to the obstruction of the discrete ureteral metastasis.
    Case Report A 65-year-old man presented to our hospital with lower urinary tract symptoms lasting for 1 year. Digital rectal examination revealed an enlarged prostate gland (6 cm×5 cm) with an irregular surface and firm consistency palpated over the bilateral lobes. The initial prostate-specific antigen (PSA) level was 372 ng/mL, and the serum creatinine level was 1.8 mg/dL (normal range: 0.7–1.4 mg/dL). Transrectal ultrasound-guided prostate biopsy showed adenocarcinoma with a Gleason score of 9 (4+5). The tumor cells showed enlarged nuclei, prominent nucleoli, and a focal signet-ring cell-like feature (Figure 1).