• corticosteroids
• eosinophilic enteritis
• eosinophilic gastrointestinal disorders
• low saag ascites
• peripheral eosinophilia

• anus
• children
• inflammatory fibroid polyp
• review
• vanek tumour

Vanek’s Tumor (inflammatory fibroid polyp) is a rare benign mesenchymal lesion occurring throughout the digestive tract. Classical Vanek’s tumor (“gastric”) contains concentric formations of proliferating spindle cells, which are CD34 positive. Atypical-inflammatory pseudotumor-like Vanek’s tumor (“intestinal”) lacks concentric formations and is CD34 negative. A 70-years-old man patient presented during hematochemical routine tests, sideropenic anemia and leukopiastrinosis. The patient performed osteomyelitis biopsy and esophagogastroduodenoscopy (EGD) showing a gastric wall with nodular appearance and, in antrum pre-pyloric, a polypoid pedunculated lesion, measuring approximately 3 cm in diameter, surrounded by hyperemic mucosa. The lesion then was removed by en bloc endoscopic mucosal resection (EMR) and histo-morphological, immune-cytochemical and biomolecular evaluations were performed. The data were compatible with a benign polyp fibroid inflammatory (Vanek’s Tumor). The results of this study suggest that endoscopic mucosal resection is a safe and efficacy solution for the resection of these gastrointestinal polyps and the two morphological patterns of Vanek’s tumor more probably represent only variants of one type of tumor than two different lesions. BRAF mutations were not shown growth PDGFRA wild-type Vanek’s tumor. (www.actabiomedica.it)

• chronic abdominal pain
• egg allergy
• endoscopy
• eosinophilic gastroenteritis
• eosinophilic mucosal infiltration
• git endoscopy

Eosinophilic gastroenteritis (EGE) is a digestive disorder in children and adults that is characterized by eosinophilic infiltration in the stomach and intestine. The underlying molecular mechanisms predisposing to this disease are unknown, but it seems that hypersensitivity response plays a major role in its pathogenesis, as many patients have a history of seasonal allergies, food sensitivities, asthma, and eczema. Symptoms and clinical presentations vary, depending on the site and layer of the gastrointestinal wall infiltrated by eosinophils. Laboratory results, radiological findings, and endoscopy can provide important diagnostic evidence for EGE; however, the cornerstone of the diagnosis remains the histological examination of gastric and duodenal specimens for evidence of eosinophilic infiltration (>20 eosinophils per high-power field), and finally clinicians make the diagnosis in correlation with and by exclusion of other disorders associated with eosinophilic infiltration. Although spontaneous remission is reported in around 30%–40% of EGE cases, most patients require ongoing treatment. The management options for this disorder include both dietary and pharmacological approaches, with corticosteroids being the mainstay of therapy and highly effective. The subsequent course is quite variable. Some patients have no recurrences, while a few experience recurrent symptoms during or immediately after corticosteroid interruption. An alternative therapeutic armamentarium includes mast-cell stabilizers, leukotriene antagonists, antihistamines, immunomodulators, and biological agents. In this review, we provide a summary of the different diagnostic tools utilized in practice, as well as the different therapeutic approaches available for EGE management.

• abdominal pain
• eosinophilic gastroenteritis
• eosinophils
• steroids

A distended, mucous-filled appendix is known as an appendiceal mucocele. They are a rare form of an appendiceal mass and develop from both benign and malignant processes. Mucoceles can develop secondarily to an obstruction, such as from a fecalith, scarring or, rarely, endometriosis. Only 12 cases of non-neoplastic appendiceal mucoceles caused by endometriosis have been previously described. The association between neoplastic appendiceal mucoceles in the presence of endometriosis is described for the first time in this report.

A 57-year-old woman presented with a chief complaint of worsening abdominal pain over the past 3 months. Imaging studies revealed an appendiceal mass. Laparoscopic evaluation confirmed an appendiceal mucocele, and the patient underwent complete appendectomy. No evidence of mucinous or endometrial deposits were present within the abdominal cavity. Pathological diagnosis revealed low-grade appendiceal mucinous neoplasm (LAMN) with evidence of endometriosis within the muscularis propria of the appendix. The patient recovered without complications and her abdominal pain completely resolved.

Endometriosis of the appendix is a rare manifestation and is most often identified as an incidental finding. Endometriosis leading to an obstructive mucocele of the appendix is an exceedingly rare finding, having only been described 12 times in the medical literature. LAMN in the presence of endometriosis of the appendix is described for the first time in this report. The association between appendiceal neoplasms in the presence of endometriosis requires further research in order to optimize operative treatment.

• Endometriosis
• Low-grade appendiceal mucinous neoplasm
• Mucocele
• Pseudomyxoma peritonei

• Inflammatory fibroid polyp
• benign neoplasms of the gastrointestinal tract
• gastric polyp
• platelet derived growth factor receptor alpha
• vanek tumor

Eosinophilic gastrointestinal disorders are a rare and complex group of disorders that are characterized by eosinophilic infiltration of the gastrointestinal tract. Patients often present with a wide range of signs and symptoms as any length or layer of the GI tract can be involved such as mucosal, muscular, or serosal. As a part of the workup, patients frequently undergo computed tomography scans and multiple endoscopies before the diagnosis is finally made as was true in our case of a 59-year-old male patient presenting with 2 months of nausea, abdominal pain, and weight loss. He underwent esophagogastroduodenoscopies, colonoscopies, video capsule study, and balloon enteroscopy before the diagnosis was confirmed histologically. Endoscopic and radiographic findings can be variable and are usually unpredictable. The diagnosis is confirmed on histopathological examination of biopsies that must show >15-50 eosinophils/high-power field based on the location in the GI tract. In our patient, erythema, scalloping, whitish exudate, and patches of villous blunting were noted in the duodenum to proximal ileum endoscopically with >50 eosinophils/high-power field confirming the diagnosis of eosinophilic enteritis. This class of diseases is often found in patients with a history of allergic disorders suggestive of hypersensitivity in the etiology of the disease although our patient had no such known history. Elimination diets and steroids are the mainstay of therapy and often lead to complete resolution of symptoms as well as endoscopic and radiographic findings in up to 90% of patients as was seen in our patient, although some patients have a chronic remitting course.

• abdominal pain
• endoscopy
• eosinophilia
• pathology
• small bowel

• case report
• children
• duodenum
• inflammatory fibroid polyp
• literature review
• vanek's tumor

• Adolescent
• Diagnosis, Differential
• Duodenal Diseases/diagnosis
• Duodenal Diseases/pathology
• Duodenal Diseases/surgery
• Duodenum/pathology
• Duodenum/surgery
• Female
• Humans
• Intestinal Polyps/diagnosis
• Intestinal Polyps/pathology
• Intestinal Polyps/surgery

• Eosinophil
• Eosinophilic colitis
• Eosinophilic gastroenteritis

• Animals
• Colitis/diagnosis
• Colitis/epidemiology
• Colitis/etiology
• Colitis/therapy
• Combined Modality Therapy
• Diagnosis, Differential
• Enteritis/diagnosis
• Enteritis/epidemiology
• Enteritis/etiology
• Enteritis/therapy
• Eosinophilia/diagnosis
• Eosinophilia/epidemiology
• Eosinophilia/etiology
• Eosinophilia/therapy
• Gastritis/diagnosis
• Gastritis/epidemiology
• Gastritis/etiology
• Gastritis/therapy
• Humans
• Treatment Outcome

• Eosinophilic gastrointestinal disorders
• eosinophilia
• eosinophilic colitis
• eosinophilic esophagitis
• eosinophilic gastritis
• eosinophilic gastroenteritis
• pharmacological treatment
• therapeutic management

• Animals
• Colitis/drug therapy
• Colitis/physiopathology
• Drug Design
• Dyspepsia/etiology
• Enteritis/drug therapy
• Enteritis/physiopathology
• Eosinophilia/drug therapy
• Eosinophilia/pathology
• Eosinophilia/physiopathology
• Eosinophilic Esophagitis/drug therapy
• Eosinophilic Esophagitis/physiopathology
• Gastritis/drug therapy
• Gastritis/physiopathology
• Gastrointestinal Agents/adverse effects
• Gastrointestinal Agents/therapeutic use
• Gastrointestinal Tract/physiopathology
• Humans

AIM: To detect the expression of eosinophil chemotactic factor-3 (Eotaxin-3) in eosinophilic gastroenteritis (EG) and investigate the effect of glucocorticoid on Eotaxin-3 expression.

METHODS: Forty-eight patients with EG and 24 healthy controls were included. Patients with EG were equally divided into two groups, a placebo group and a prednisone group. Eotaxin-3 expression was measured by enzyme-linked immunosorbent assay in the serum and tissue samples of all subjects.

RESULTS: The expression levels of Eotaxin-3 in serum and tissue were significantly elevated in the EG group compared to normal controls (P < 0.05). Eotaxin-3 in serum and tissue significantly decreased after treatment (P < 0.05), although its change had no significance in the placebo group. A positive correlation was observed between eosinophil (Eos) count and Eotaxin-3 in serum and tissue in the EG group.

CONCLUSION: Eotaxin-3 may be involved in the pathophysiological process of EG. Hormone therapy may inhibit the expression of Eotaxin-3. Serum Eotaxin-3 may be used as a non-invasive index for evaluating the treatment effect in EG.

• Eosinophilic gastroenteritis
• Eosinophil count
• Eosinophil chemotactic factor-3
• Glucocorticoids

• celiac disease
• collagenous colitis
• eosinophilic colitis
• lymphocytic colitis
• microscopic colitis

• T32 CA126607 NCI NIH HHS

• Vanek's tumor
• cardia
• inflammatory fibroid polyp
• laparoscopy
• stomach

Inflammatory fibroid polyp (IFP) represents a rare cause of gastrointestinal polypoid disease in childhood. Τhe lesion has been described by various names beyond the currently accepted term, including “Vanek's tumour,” eosinophilic or submucosal granuloma, gastric fibroma with eosinophilic infiltration, inflammatory pseudotumor, and hemangiopericytoma. The etiopathogenesis and origin of the mesenchymal spindle-shaped cells that comprise the polyp remains enigmatic. Recent studies have shown familial occurrence, expression of platelet-derived growth factor receptor (PDGFRA) and oncogenic PDGFRA mutations in the majority of lesions, suggestive of a neoplastic nature. We present a rare case of a 10-year-old boy with an IFP of the terminal ileum, who presented acutely with intussusception and was treated with a right hemicolectomy. Postoperative course was uneventful and the patient has been asymptomatic during follow-up. Histopathology and immunohistochemical analysis excluded inflammatory myofibroblastic tumor (negative for Alk1, desmin, smooth muscle actin [SMA]), gastrointerstinal stromal tumors (GIST) (negative for CD117) and schwannoma (negative for S100). The lesion was positive for CD34 and faintly for vimentin. Despite the classification of IFPs as a mesenchymal benign neoplasm, in the vast majority of cases, surgical excision alone was curative, and no reports exist of a malignant transformation. A cautious approach with periodic surveillance of the affected children seems reasonable though.

• fibroid
• inflammatory
• intussusception
• polyp

Eosinophilic gastroenteritis (EGE) is a rare disorder characterized by eosinophilic infiltration of the bowel wall with various gastrointestinal manifestations. Till date only 280 cases have been described in the literature. A high index of suspicion, by excluding other causes of peripheral eosinophilia, is a pre requisite for accurate diagnosis. EGE is an uncommon gastrointestinal disease affecting both children and adults. It was first described by Kaijser in 1937. Presentation may vary depending on location as well as depth and extent of bowel wall involvement and usually runs a chronic relapsing course. This condition can respond to low dose steroid therapy, thereby preventing grave complications like ascites and intestinal obstruction that might need surgical intervention. The natural history of EGE has not been well documented. Eosinophilic gastroenteritis is a chronic, waxing and waning condition. Mild and sporadic symptoms can be managed with reassurance and observation, whereas disabling gastrointestinal (GI) symptom flare-ups can often be controlled with oral corticosteroids. When the disease manifests in infancy and specific food sensitization can be identified, the likelihood of disease remission by late childhood is high. GI obstruction is the most common complication. Fatal outcomes are rare.

• Eosinophilic gastroenteritis
• Unusual type
• Review of literature

• Adrenal Cortex Hormones/administration & dosage
• Age Factors
• Digestive System Surgical Procedures
• Enteritis/diagnosis
• Enteritis/epidemiology
• Enteritis/therapy
• Eosinophilia/diagnosis
• Eosinophilia/epidemiology
• Eosinophilia/therapy
• Gastritis/diagnosis
• Gastritis/epidemiology
• Gastritis/therapy
• Gastrointestinal Agents/administration & dosage
• Humans
• Remission Induction
• Risk Factors
• Treatment Outcome

Eosinophilic gastroenteritis is a rare disease of the gastrointestinal tract characterized by crampy abdominal pain, nausea, vomiting, diarrhea, gastrointestinal bleeding, and weight loss associated with peripheral eosinophilia leading to eosinophilic infiltrates in stomach and intestine, usually in a patient with a prior history of atopy. In this article, we describe our encounter with a 59-year-old female presenting with severe abdominal pain, nausea, vomiting, and weight loss with an extensive evaluation including an upper endoscopy with biopsies resulting in a diagnosis of eosinophilic gastroenteritis. The patient was eventually treated with oral prednisone for three weeks with complete resolution of her symptoms.

• Desensitization
• Eosinophilic gastroenteritis
• Erythematous
• Infiltration
• Mucosal
• Samter's triad

• Inflammatory fibroid polyp
• PDGFRA
• Rectum
• Sacrum

Inflammatory fibroid polyp (IFP) is a rare benign polypoid lesion of the gastrointestinal tract. Most IFPs occur in the stomach and colonic occurrence is very rare. Histologically IFP is characterized by a mixture of numerous small vessels, fibroblasts and edematous connective tissue associated with marked inflammatory infiltration by eosinophils. We present a rare case of a pedunculated IFP in the hepatic flexure of the colon treated successfully with a combination of argon plasma coagulation, endoclipping and polypectomy. A 74-year-old asymptomatic female underwent a screening colonoscopy in our hospital. A 12-mm pedunculated polyp was found at the hepatic flexure of the colon. After saline injection, we attempted to remove the polyp with a hot snare. However the polyp stalk was extremely difficult to resect despite several attempts with the hot snare. We placed an endoclip at the base of the stalk and then applied argon plasma coagulation at 1.0 l/min and 40 W. After these measures we were able to resect the stalk and the polyp was retrieved. Histologically the polyp was located in the submucosa of the gastrointestinal tract. Proliferation of spindle cells and infiltration of inflammatory cells such as plasma cells and eosinophils were observed. The spindle cells were positive for CD34 and S100 but negative for c-kit and muscle markers. These findings are consistent with a histopathological diagnosis of IFP.

• Argon plasma coagulation
• Endoclipping
• Inflammatory fibroid polyp
• Polypectomy

• colitis
• eosinophilic colitis
• eosinophilic gastrointestinal disorder
• eosinophilic proctocolitis
• eosinophils
• gastrointestinal

• Colitis/diagnosis
• Cytokines/metabolism
• Enteritis/diagnosis
• Eosinophilic Esophagitis/diagnosis
• Eosinophils/pathology
• Eosinophils/physiology
• Gastritis/diagnosis
• Gastrointestinal Tract/cytology
• Gastrointestinal Tract/metabolism
• Humans

• Age Factors
• Child
• Child, Preschool
• Eosinophil Cationic Protein/analysis
• Eosinophil Cationic Protein/blood
• Eosinophils/chemistry
• Eosinophils/cytology
• Feces/chemistry
• Female
• Humans
• Immunoglobulin E/blood
• Infant
• Infant, Newborn
• Leukocyte Count
• Male
• Reference Values
• White People
• alpha 1-Antitrypsin/analysis

• Adult
• Female
• Humans
• Intestinal Polyps/complications
• Intestinal Polyps/diagnosis
• Intestinal Polyps/surgery
• Intussusception/etiology
• Intussusception/surgery

A case of an inflammatory fibroid polyp occurring in the transverse colon and diagnosed by endoscopic biopsy is reported. The patient was an 82-year-old man who visited our hospital for further evaluation of occult blood in stool. The Colonoscopy revealed a small, red, and peduncular polyp, about 6 mm in diameter, in the transverse colon. Histological examination of the biopsy specimen obtained from the polyp revealed proliferation of fibroblasts and infiltration of inflammatory cells such as plasma cells and eosinophils. This polyp was diagnosed as an inflammatory fibroid polyp, which can appear in many different locations throughout gastrointestinal tract, though still rare in the transverse colon.

• Inflammatory fibroid polyp
• Colonoscopy
• Inflammation
• Type II pit pattern

• Aged, 80 and over
• Biopsy
• Colon, Transverse/pathology
• Colonic Polyps/complications
• Colonic Polyps/diagnosis
• Colonic Polyps/pathology
• Colonoscopy
• Eosinophils/pathology
• Fibroblasts/pathology
• Humans
• Inflammation/etiology
• Inflammation/pathology
• Male
• Occult Blood
• Plasma Cells/pathology

• Bile Ducts, Intrahepatic/pathology
• Cholangiopancreatography, Endoscopic Retrograde
• Dilatation, Pathologic
• Eosinophilia/complications
• Eosinophilia/pathology
• Gastric Mucosa/pathology
• Gastroenteritis/complications
• Gastroenteritis/pathology
• Humans
• Jaundice, Obstructive/etiology
• Male
• Middle Aged
• Pancreatic Diseases/complications
• Pancreatic Pseudocyst/diagnostic imaging
• Tomography, X-Ray Computed

• Cell Adhesion
• Cell Movement
• Cells, Cultured
• Chemotaxis
• Dose-Response Relationship, Drug
• Eosinophils/cytology
• Epithelial Cells/cytology
• HL-60 Cells
• Humans
• Intestines/cytology
• L-Selectin/metabolism
• Ligands
• Membrane Glycoproteins/metabolism
• Oligosaccharides/chemistry
• Polysaccharides/chemistry
• Selectins/metabolism
• Selectins/physiology
• Sialyl Lewis X Antigen

Eosinophilic gastrointestinal disorders are an emerging disease entity characterized by eosinophilic infiltration of the intestinal wall. Oral steroids can be still considered as first line treatment. Unfortunately relapses are quite common. Usually long term low-dose prednisone or immunosuppressive therapy is required, which is especially problematic in young patients. Thus a reliable steroid sparing agent with low side effects suitable for long term use is needed. There are strong hints to a similar pathophysiology of eosinophilic gastrointestinal disorders to that of asthma. Indeed leukotriene D4 plays an important role in the recruitment of eosinophils into the intestinal tissue causing damage. This patho-mechanism provides the rationale for the treatment with a leukotriene D4 receptor antagonist. Recently there have been first reports about successful short term use of Montelukast in eosinophilic gastrointestinal disorders.

We report the case of a 17 year old girl with a long history of severe abdominal complaints leading to several hospitalizations in the past. Mimicking the picture of an intestinal tuberculosis she received an anti mycobacterial treatment without any success. Marked eosinophilia in blood, ascites and tissue samples of the intestinal tract finally lead to the diagnosis eosinophilic gastroenteritis. Tapering off prednisone caused another severe episode of abdominal pain. At that point leukotriene antagonist Montelukast was started at a dose of 10 mg once daily. Steroids could be tapered off completely within six weeks. The patient has been free of symptoms for over two years by now. Routine examinations, blood tests and endoscopy have rendered regular results. So far no side effects were noted.

Here report about successful long term remission of eosinophilic gastroenteritis under Montelukast. Further randomized control trials are required to asses the full benefits of Montelukast therapy in the whole spectrum of eosinophilic gastrointestinal disorders.

• Acetates/therapeutic use
• Adolescent
• Cyclopropanes
• Eosinophilia/drug therapy
• Female
• Gastroenteritis/drug therapy
• Humans
• Leukotriene Antagonists/therapeutic use
• Quinolines/therapeutic use
• Remission Induction
• Sulfides

• Abdominal Pain/etiology
• Diagnosis, Differential
• Eosinophilia/diagnosis
• Eosinophilia/physiopathology
• Eosinophilia/therapy
• Gastroenteritis/diagnosis
• Gastroenteritis/physiopathology
• Gastroenteritis/therapy
• Humans

• Adolescent
• Child
• Child, Preschool
• Colon/pathology
• Eosinophilia/pathology
• Female
• Humans
• Infant
• Inflammatory Bowel Diseases/diagnosis
• Intestinal Mucosa/pathology
• Irritable Bowel Syndrome/diagnosis
• Male
• Retrospective Studies

• Acetylcholine/metabolism
• Adult
• Allergens/pharmacology
• Antimicrobial Cationic Peptides/metabolism
• Antimicrobial Cationic Peptides/toxicity
• Chemotactic Factors/metabolism
• Eosinophilia/etiology
• Eosinophilia/physiopathology
• Eosinophils/metabolism
• Esophagitis/pathology
• Esophagitis/physiopathology
• Esophagus/pathology
• Gastroenteritis/pathology
• Gastroenteritis/physiopathology
• Histamine/metabolism
• Humans
• Intestinal Mucosa/pathology
• Mast Cells/drug effects
• Mast Cells/metabolism
• Muscle Contraction
• Muscle Fibers, Skeletal/physiology
• Platelet Activating Factor/metabolism

• Adult
• Antibodies, Antinuclear/blood
• Eosinophilia/complications
• Eosinophilia/diagnosis
• Eosinophilia/drug therapy
• Female
• Gastroenteritis/complications
• Gastroenteritis/diagnosis
• Gastroenteritis/drug therapy
• Glucocorticoids/therapeutic use
• Humans
• Intestine, Small/pathology
• Intestine, Small/surgery
• Laparoscopy
• Laparotomy
• Lupus Erythematosus, Systemic/complications
• Lupus Erythematosus, Systemic/diagnosis
• Lupus Erythematosus, Systemic/drug therapy
• Prednisone/therapeutic use
• Treatment Outcome

• Adult
• Female
• Fibroblasts/pathology
• Gastrointestinal Neoplasms/chemistry
• Gastrointestinal Neoplasms/pathology
• Humans
• Immunohistochemistry
• Intestinal Mucosa/chemistry
• Intestinal Mucosa/pathology
• Intestinal Polyps/chemistry
• Intestinal Polyps/pathology
• Male
• Middle Aged
• Vimentin/analysis

• Cell Movement/drug effects
• Cell Movement/physiology
• Chemokine CCL11
• Chemokines, CC/pharmacology
• Chemotactic Factors, Eosinophil/physiology
• Eosinophils/drug effects
• Eosinophils/physiology
• Fluorescence
• HL-60 Cells
• Humans
• Intestinal Mucosa/cytology
• Leukocyte Count
• N-Formylmethionine Leucyl-Phenylalanine/pharmacology
• Platelet Activating Factor/pharmacology
• Time Factors

• Abdominal Pain/diagnostic imaging
• Abdominal Pain/etiology
• Abdominal Pain/therapy
• Adolescent
• Ascites/diagnostic imaging
• Ascites/etiology
• Ascites/therapy
• Enteritis/complications
• Enteritis/diagnostic imaging
• Enteritis/therapy
• Eosinophilia/complications
• Eosinophilia/therapy
• Female
• Glucocorticoids/therapeutic use
• Humans
• Radiography
• Treatment Outcome