Intraoperative enteroscopy is a valuable method for localizing gastrointestinal bleeding of obscure origin. The insertion and manipulation of an endoscope through an enterotomy, however, may result in significant trauma to the intestinal wall, as well as contamination of the abdominal cavity. We have devised a new technique for the introduction of the endoscope that lessens trauma to the bowel wall and allows a complete enteroscopy with minimal contamination.

Sarcomatoid mesothelioma is an aggressive disease secondary to its propensity to undergo rapid growth, show inconsistent expression of tumor markers and invade surrounding tissues. Therefore, there are numerous obstacles that clinical researchers face as they look for new methods to diagnose and treat the malignancy. We present a case of sarcomatoid mesothelioma, originally thought to be metastasis from renal cell carcinoma.

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.comNeuroendocrine tumor of the breast:Is it primary or metastatic?Ornela A. Dervishaj, Alexandra S. Renzi, Romulo Genato, Philip Q. Xiao, Armand P. Asarian ABSTRACT Introduction: Neuroendocrine breast carcinoma is a rare form of tumor that may be either primary or metastatic. Case Report: We present the case of a patient who was referred to our outpatient office with the diagnosis of a triple negative invasive breast carcinoma on an ultrasound-guided core needle biopsy. The patient subsequently underwent a lumpectomy with sentinel lymph node biopsy. Postoperative pathology revealed neuroendocrine carcinoma of the breast with sentinel lymph node biopsy negative for carcinoma. The tumor cells were positive for AE1/AE3, chromogranin, synaptophysin and CD-56 but negative for estrogen, progesterone and HER2. To exclude a primary carcinoma elsewhere, we obtained a whole body PET scan which showed a mildly hypermetabolic mesenteric mass in the midline with curvilinear calcification. Computed tomography scan of the abdomen and pelvis with oral and IV contrast showed a mass-like soft tissue within the terminal ileum with thickening of the cecum. An octreotide scan of the whole body revealed abnormal activity in the midline of the lower abdomen 6 hours and 24 hours after administration of octreotide. Colonoscopy showed a nodular friable mass in the ileocecal valve extending from the terminal ileum. Biopsy from the colonoscopy demonstrated a neuroendocrine carcinoma. The patient subsequently underwent a right hemicolectomy with primary anastomosis. Postoperative pathology was concordant with a neuroendocrine carcinoma and 9 of the 20 lymph nodes were positive for carcinoma. We performed a literature review to explore the reported incidence, diagnosis and treatment of this rare tumor metastasizing to the breast. Conclusion: Differentiating between primary and metastatic tumor of the breast represents a challenge, albeit an important one, as the first disease can subject the patient to the morbidities of a mastectomy with axillary node dissection and the other is locally controlled.

Epididymal leiomyosarcomas are rare malignant tumors of smooth muscle origin. We present a case of a low-grade tumor with negative margins managed with a high-radical inguinal orchiectomy. Our review of the literature suggests that low-grade and localized tumors with negative margins can be managed with simple epididymectomy and imaging surveillance.

Prostate cancer is the most common cancer among men, with the most common metastatic sites in bone, regional lymph nodes, liver and thorax. It is most commonly diagnosed in the early stages with clinical findings of enlarged prostate on digital rectal exam and positive prostate specific antigen. Distant metastases associated with prostate cancer commonly occur to bone. It is imperative to be cautious in assuming primary breast, lung or head and neck malignancy in patients presenting with lymphadenopathy in the upper aerodigestive pathways. Cervical lymphadenopathy due to prostate cancer is becoming more prevalent since previously reported. Here we present a case of prostate cancer recurrence found through metastasis to supraclavicular lymph nodes and we also highlight homeobox protein CDX2 as a potential clinico-pathological marker in metastatic prostate cancer.