Video capsule endoscopy in the diagnosis of gastrointestinal Kaposi’s sarcoma

Abstract

A 47−year−old Hispanic man who had no significant past medical history was ad− mitted to the Wyckoff Heights Medical Center with nausea and headache, which were followed by seizures. The patient had had significant weight loss and an ab− dominal computed tomographic scan re− vealed thickening of the stomach wall (l " Figure 1). The patient initially refused upper endoscopy but agreed to undergo video capsule endoscopy, which showed lesions suggestive of Kaposi's sarcoma in the small bowel (l " Figure 2). He subse− quently agreed to undergo upper endos− copy for biopsy of the lesion and this ex− amination revealed purplish nodular le− sions in the esophagus, stomach, and duodenum. Push−enteroscopy showed typical Kaposi's lesions in the jejunum (l " Figure 3). A biopsy of one of the le− sions showed spindle−cell proliferation with vascular splits, an appearance con− sistent with a diagnosis of Kaposi's sarco− ma (l " Figure 4). Immunohistochemical testing for human herpesvirus 8 (HHV−8) showed a strong positive reaction (l " Fig− ure 5). The patient was subsequently found to have a very low absolute CD4 count and he tested positive for human inmmunodeficiency virus, with a high viral load. The patient was started on highly active antiretroviral therapy (HAART) and was feeling much better when seen on follow−up 2 weeks later.

Transthoracic Esophagectomy After Endoscopic Mucosal Resection in Patients with Early Esophageal Carcinoma

“…1,2 The rationale for this different therapeutic strategy is the pattern of lymphatic spread observed for mucosal and submucosal carcinomas. [3][4][5] For mucosal esophageal carcinomas, a metastatic spread to the locoregional lymph nodes rarely occurs. On the other hand, the rate of nodal metastases increases with depth of submucosal infiltration and reaches up to 75% for the deepest layer of the submucosa.…”