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EDITOR’S QUIZ: GI SNAPSHOT

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From question on page 178

Contrast enhanced computed tomography (fig 1A) revealed small, multiple, spherical, non-enhancing hypodense lesions in both lobes of the liver, suggestive of metastases. The colonoscopy image (fig 1B) showed a caecal amoeboma. Histopathological examination of the colonic lesion revealed ulceration and necrosis. The lamina propria was heavily infiltrated with neutrophils, eosinophils, lymphocytes, and plasma cells. No dysplastic or malignant cells were seen. Granulomas or trophozoites of amoeba were absent even after PAS staining. However, serum entamoeba histolytica antibodies were markedly elevated. The patient responded well to metronidazole treatment for 21 days. Hepatic scan a year later revealed disappearance of the liver lesions.

Amoebomas are tumour-like lesions of the colonic wall and may be multiple. Metastatic hepatic abscesses occur when amoebae reach the liver in the portal vein from the gut. In the tropics, this condition may be indistinguishable from colonic cancer with malignant secondary deposits in the liver. Amoebic serology and colonic biopsies will clarify the diagnosis.

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