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Narasimha S, Zackria R, Hughes J, Jayaraman V. A Common Symptom With an Uncommon Diagnosis: A Case of Primary Esophageal Diffuse Large B-cell Lymphoma. Cureus 2024; 16:e51885. [PMID: 38327936 PMCID: PMC10849818 DOI: 10.7759/cureus.51885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/09/2024] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma. Although it can have gastrointestinal involvement, there are limited recorded cases that show primary esophageal DLBCL. This report discusses the case of an 85-year-old female who initially presented with weight loss associated with dysphagia and was later diagnosed with an esophageal mass by endoscopy. Pathology showed large, atypical lymphocytes, and the final morphologic, immunohistochemical, and molecular findings were most consistent with a diagnosis of primary esophageal DLBCL.
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Affiliation(s)
- Shruthi Narasimha
- Gastroenterology and Hepatology, Sunrise Health Graduate Medical Education (GME) Consortium, Las Vegas, USA
| | - Rasiq Zackria
- Gastroenterology and Hepatology, Sunrise Health Graduate Medical Education (GME) Consortium, Las Vegas, USA
| | | | - Vijay Jayaraman
- Gastroenterology, Comprehensive Digestive Institute of Nevada, Las Vegas, USA
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2
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Ghobrial Y, Zackria R, Chauhan S, Brockway M, Shah P, Asgeri M. A Rare Case of a Rectal Gastrointestinal Stromal Tumor (GIST) Discovered During a Routine Colonoscopy. Cureus 2023; 15:e41030. [PMID: 37519537 PMCID: PMC10373512 DOI: 10.7759/cureus.41030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
A gastrointestinal stromal tumor (GIST) is a rare malignancy, accounting for only 0.1% to 3% of all gastrointestinal (GI) malignancies. Although GISTs are the most common mesenchymal tumor of the GI tract, they are primarily found within the stomach, with rectal GISTs rarely reported. They may present with rectal bleeding, constipation, pain, or a palpable mass while some are found incidentally. The incidence of GISTs has been on the rise, possibly due to advancements in diagnostic technology. In this case report, we present a 50-year-old female who presented with intermittent constipation and rectal pain and was found to have a submucosal rectal mass during a routine diagnostic colonoscopy. Further evaluation confirmed the presence of a spindle-cell neoplasm, which was mildly cellular and showed positive expression of CD34 and CD117 on immunohistochemistry, consistent with the diagnosis of GIST of the rectum. This case report emphasizes the importance of routine colonoscopies in the early detection of neoplastic lesions of the colon and highlights the rare incidence of GISTs, their risk factors, pathogenesis, and common sites of occurrence.
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Affiliation(s)
| | - Rasiq Zackria
- Gastroenterology and Hepatology, Sunrise Health Graduate Medical Education (GME) Consortium, MountainView Hospital, Las Vegas, USA
| | | | | | - Pranati Shah
- Internal Medicine, Touro College of Osteopathic Medicine, Las Vegas, USA
| | - Mehrdad Asgeri
- Gastroenterology, Desert Regional Medical Center, Palm Springs, USA
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3
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Chauhan S, Zackria R, Trad G, Wojtanowski A, Ryan JK. Gallstone Ileus Caused by Migration of Gallstone Through Cholecystoduodenal Fistula Resulting in Small Bowel Obstruction. Cureus 2023; 15:e37962. [PMID: 37096199 PMCID: PMC10122065 DOI: 10.7759/cureus.37962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 04/26/2023] Open
Abstract
Gallstone ileus is a rare condition characterized by mechanical obstruction of the intestine due to gallstone impaction. Diagnosis is based on clinical history, symptoms, and characteristic Computed Tomography (CT) scan findings. Treatment typically involves surgical extraction of gallstones, with laparoscopy as an effective and potentially safer approach. Here, we describe a case of an 84-year-old woman with gallstone ileus presenting with small bowel obstruction.
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Affiliation(s)
| | - Rasiq Zackria
- Gastroenterology, Sunrise Health GME Consortium, Las Vegas, USA
| | - George Trad
- Internal Medicine, Mountainview Hospital, Las Vegas, USA
| | | | - John K Ryan
- Gastroenterology and Hepatology, Comprehensive Digestive Institute of Nevada, Las Vegas, USA
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4
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Chauhan S, Zackria R, Mukhopadhyay DK. Autoimmune Hepatitis in the Setting of Iron Overload Secondary to Heterozygous HFE Gene Mutation. Cureus 2022; 14:e27614. [PMID: 36059344 PMCID: PMC9436270 DOI: 10.7759/cureus.27614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 11/27/2022] Open
Abstract
Autoimmune hepatitis (AIH) is an inflammatory condition of the liver that is characterized by high titers of certain autoantibodies in the serum. As in other chronic inflammatory conditions, the transferrin saturation in patients with AIH is typically low. However, in rare instances, AIH has been reported to be associated with elevated transferrin saturation secondary to heterozygous HFE gene (H63D) mutation. This report describes one such case in which the patient had characteristic histopathologic findings of AIH but was also found to have iron overload and heterozygous H63D mutation on genetic testing, leading to the initial dual differential diagnosis of AIH and hemochromatosis, which highlighted the further need of obtaining a liver biopsy.
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5
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Zackria R, Jayaraman V. The Gastrointestinal Stromal Tumor (GIST) of a Pancreatic Cyst. Cureus 2022; 14:e26197. [PMID: 35891821 PMCID: PMC9306679 DOI: 10.7759/cureus.26197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare tumors and rarely occur outside of the gastrointestinal (GI) tract. When GISTs originate from outside the GI tract, they are called extra-gastrointestinal stromal tumors (EGISTs). In this article, we discuss a case of a 74-year-old woman who presented due to a growing pancreatic lesion on imaging and was subsequently diagnosed with pancreatic EGIST on endoscopic ultrasound with fine-needle aspiration.
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6
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Zackria R, Choi EH. Esophageal Schwannoma: A Rare Benign Esophageal Tumor. Cureus 2021; 13:e15667. [PMID: 34277259 PMCID: PMC8281782 DOI: 10.7759/cureus.15667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/23/2022] Open
Abstract
Benign primary tumors are uncommon, with the majority of these tumors being leiomyomas; schwannomas of the esophagus are rare. Here, we present a case of a 78-year-old woman referred for complaints of intermittent dysphagia with a chest computed tomography scan showing a homogenous mass, compressing the esophagus. Upper gastrointestinal endoscopy revealed a submucosal mass, which was eventually diagnosed as a schwannoma after an endoscopic ultrasound with fine-needle aspiration and subsequent pathologic and immunohistochemical examination. Schwannomas could be managed conservatively.
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Affiliation(s)
- Rasiq Zackria
- Internal Medicine, University of California, Riverside - School of Medicine, Riverside, USA
| | - Eric H Choi
- Gastroenterology, Riverside Medical Clinic, Riverside, USA
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7
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Hamid R, Zackria R, Sharma JS. A Curious Case of Acute Acalculous Cholecystitis. Cureus 2021; 13:e14948. [PMID: 34123645 PMCID: PMC8190144 DOI: 10.7759/cureus.14948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute acalculous cholecystitis is inflammation of the gallbladder without any evidence of gallstones. Although acalculous cholecystitis is less common than its calculous counterpart, it can be fatal if not treated. It is essential to rule out the cause of acalculous cholecystitis to aid in the treatment and management of the patient. We present a case of acalculous cholecystitis wherein a comprehensive workup found the etiology to be viral. Albeit rare, hepatitis A and cytomegalovirus can be causes of acute cholecystitis. Both viruses were observed simultaneously in this patient, proving it to be a unique case. This early diagnosis allowed conservative management of the patient, sparing him from unnecessary surgical intervention.
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Affiliation(s)
- Ruqaiyyah Hamid
- Internal Medicine, Dow International Medical College, Karachi, PAK
| | - Rasiq Zackria
- Internal Medicine, University of California Riverside, Riverside, USA
| | - Jyotsna S Sharma
- Internal Medicine, University of California Los Angeles, Los Angeles, USA
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8
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Abstract
Drug-induced liver injury (DILI) is among the most common causes of acute liver injury and acute liver failure in the United States. Kratom is an herbal supplement made from the leaves of a tropical evergreen tree (Mitragyna speciosa) that is native to Southeast Asia. Due to its psychotropic and opioid-like activity, there has been an increase in its use as a recreational drug. Despite this increase, little is known regarding the toxicities and adverse effects though it is known to cause DILI. We present two cases of DILI associated with Kratom use.
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Affiliation(s)
- Mahesh Botejue
- Graduate Medical Education, Riverside Community Hospital, Riverside, USA
| | - Gurjot Walia
- Internal Medicine, University of California (UC) Riverside, Riverside, USA
| | - Omar Shahin
- Internal Medicine, Riverside Community Hospital/University of California (UC) Riverside, Riverside, USA
| | - Jyotsna Sharma
- Internal Medicine, Riverside Community Hospital, Riverside, USA
| | - Rasiq Zackria
- Internal Medicine, Riverside Community Hospital/University of California (UC) Riverside, Riverside, USA
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9
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Zackria R, Botejue M, Hwang AW. Primary Duodenal Periampullary Adenocarcinoma: An Uncommon Presentation. Cureus 2021; 13:e14323. [PMID: 33968533 PMCID: PMC8101686 DOI: 10.7759/cureus.14323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Periampullary carcinoma is a broad term used to define the group of carcinomas arising from the head of the pancreas, the distal common bile duct, and the duodenum. It is clinically important to differentiate ampullary from periampullary carcinoma as this can affect resectability and prognosis. Atypical left-sided chest pain is an atypical presentation of periampullary duodenal adenocarcinoma. A 58-year-old man presented with a two-month duration of worsening intermittent, atypical, migratory left-sided chest pain. Imaging studies were unremarkable; however, endoscopic evaluation demonstrated a duodenal mass. While most periampullary carcinomas are generally curable with pancreaticoduodenectomy, if left untreated, these tumors are uniformly fatal.
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Affiliation(s)
- Rasiq Zackria
- Internal Medicine, University of California, Riverside School of Medicine, Riverside, USA.,Graduate Medical Education, Riverside Community Hospital, Riverside, USA
| | - Mahesh Botejue
- Graduate Medical Education, Riverside Community Hospital, Riverside, USA
| | - Andrew W Hwang
- Internal Medicine, University of California, Riverside School of Medicine, Riverside, USA.,Graduate Medical Education, Riverside Community Hospital, Riverside, USA
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10
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Lev‐Tov H, Larsen L, Zackria R, Chahal H, Eisen D, Sivamani R. Microneedle‐assisted incubation during aminolaevulinic acid photodynamic therapy of actinic keratoses: a randomized controlled evaluator‐blind trial. Br J Dermatol 2016; 176:543-545. [DOI: 10.1111/bjd.15116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- H. Lev‐Tov
- Department of Dermatology and Cutaneous Surgery Miller School of Medicine University of Miami Miami FL U.S.A
| | - L. Larsen
- Department of Dermatology University of California Davis CA U.S.A
| | - R. Zackria
- Department of Dermatology University of California Davis CA U.S.A
| | - H. Chahal
- Department of Dermatology University of California Davis CA U.S.A
| | - D.B. Eisen
- Department of Dermatology University of California Davis CA U.S.A
| | - R.K. Sivamani
- Department of Dermatology University of California Davis CA U.S.A
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