For many years, there has been a concern that inflammatory bowel disease carries an increased lymphoma risk. At the same time, patients with intestinal lymphomas are occasionally misdiag-nosed as having Crohn’s disease. We report a case of T-cell lymphoma of the bowel misdiag-nosed as Crohn’s disease, which illustrates the diagnostic challenges posed by peripheral extranodal lymphomas. A 68-year old female presented with clinical symptoms (diarrhoea, abdominal pain, poor appetite and significant weight loss), and colonoscopic and initial histological findings that were similar to inflammatory bowel disease. She was diagnosed with Crohn’s disease and received treatment with sulfasalazine with subsequent improvement of symptoms. Eight months after the initial diagnosis the patient experienced sudden abdominal pain. Laparotomy revealed necrosis in the small and large intestine and ileostomy was performed. On day 10 of a complicated postoperative period the patient died. Post-mortem histopathological examination of small and large intestine revealed highly malignant peripheral T-cell lymphoma, not otherwise specified. Differentiation of intestinal T-cell lymphoma from Crohn’s disease continues to be a challenge, because clinical, colonoscopic, radiological and histopathological findings can mimic Crohn’s disease. Careful multi-disciplinary assessment and knowledge of this rare disorder is crucial for timely diagnosis.
Liver cirrhosis is the end stage of chronic liver diseases. The current gold standard for diagnosing this condition, liver biopsy, has too many drawbacks, and research for better alternatives is ongoing. One major diagnostic arsenal includes various serological composition scores or so-called formulas. They are constantly being validated for development of new formulas. In our retrospective study of 215 patients case files who had confirmed cirrhosis of various etiologies, we examined the sensitivity and set new cut-offs for five of the most well-documented formulas. Data was obtained from the Rīga East University Hospital from 2012 to 2017 and analysed using SPSS V.22.00. In our study we found that FIB-4 at cut-off > 1.45 had over 95% sensitivity for excluding advanced fibrosis regardless of cirrhosis etiology. None of evaluated formulas had high sensitivity for detecting cirrhosis of alcohol etiology. For the viral hepatitis C genesis group, the best choice was deRitis index with almost 90% sensitivity. FIB-4 at cut-off > 2.75 was the best choice for the combined alcohol and viral hepatitis C group; BONACINI at score 8+ and FIB-4 at > 3.25 were the most sensitive in the main group containing all patients irrespective of cirrhosis etiology.
Esophageal stenting is used in patients with malignant esophageal tumours to reduce dysphagia and inanition. The objective of this study was to analyse the main reasons for esophageal stenting in Rīga East Clinical University Hospital (RECUH) and their association with dysphagia and mortality. A cross-sectional study of all patients hospitalised in RECUH who received esophageal self-expanding metal stents (SEMS) from October 2013 to December 2015 was performed. A total of 29 patients, 24 (82.8%) male and 5 (17.2%) female, with mean age 63.7 ± 11.3 years, underwent the procedure. The most common indications for stenting were tumour-related stenosis (52.9%) and fistulae (17.6%). Mean time from establishing the diagnosis of esophageal cancer to stent placement was 338.6 days. Median survival after stenting was 4.8 months. A complex case of a patient requiring placement of three palliative stents illustrates the challenges of esophageal cancer care. Esophageal stent placement is an effective palliative method for treating tumour-related symptoms but carries risks of stent complications and fistula development over time. SEMS are being successfully used in cancer patient treatment in Latvia.