The ideal treatment of large full-thickness chondral lesions in the knee, especially "kissing lesions" and osteoarthritis, has not been determined. Microdrilling surgery augmented with injections of peripheral blood stem cells and hyaluronic acid has been used to treat patients with a wide range of articular cartilage disease including patients with bipolar lesions and joint space narrowing. Excellent results in this difficult patient population have been reported, and second-look biopsy has shown repair tissue very similar to native hyaline cartilage. Because of Food and Drug Administration regulations, this technique is not currently allowed in the United States. We describe a Food and Drug Administrationecompliant modification of this technique using microdrilling augmented with intra-articular bone marrow aspirate concentrate, platelet-rich plasma, and hyaluronic acid.

infiltrate with t(11;14)(q13;q32) on FISH analysis and the patient was diagnosed with MCL. Patient's symptoms resolved and given the asymptomatic and localized nature with isolated gastrointestinal extranodal disease he is monitored with serial imaging. Discussion: Primary gastrointestinal MCL is a rare disease with a variety of clinical presentations. The diagnosis can be challenging as patients who are symptomatic present with vague reports of anorexia, bloating or abdominal pain. Radiographically the lymphoma may or may not be apparent. Endoscopically the MCL can range from normal appearing mucosa to polypoid or ulcerated lesions. In this patient, it is likely that the ileal lesion periodically prolapsed into the colon-explaining the imaging findings. In the initial colonoscopy, the prolapsed segment spontaneously reduced, leaving only the falsely reassuring normal colon. High clinical suspicion based on subsequent imaging led to repeat colonoscopy with ileal intubation and tissue sampling, yielding the diagnosis.

Discussion: Villous adenomas, normally a benign condition, can present with a life-threatening electrolyte derangements and volume depletion which makes the ability to diagnose and adequately treat MWS critical. Patients typically have multiple admissions with watery or mucous diarrhea, nausea, and vomiting. Labs significant for hyponatremia, hypokalemia, AKI, and leukocytosis. The tumors are large and often past the splenic flexure and low in the rectum, therefore flexible sigmoidoscopy can be reliably used rather than colonoscopy, which often delays diagnosis due to patients' inability to prep. Treatment includes aggressive fluid and electrolyte repletion until tumor can be surgically resected. Few case reports suggest using indomethacin or octreotide as a bridge to surgery or as medical management for patients who are not surgical candidates. However, patients who are managed medically have a mortality rate up to ;61-100%. Surgical management to definitively resolve symptoms, although minimally invasive options are being explored. A high index of suspicion and a systematic approach is critical to diagnose and provide life-saving treatment for MWS patients.Tumor biopsy demonstrating positive to immunohistochemical stain for SOX-10, a common marker for malignant melanoma. C) Tumor biopsy with immunohistochemical stain for Melan-A positivity.