Mass-like lesions including a rare case of Melena causing Masson's Hemangioma among the capsule endoscopy cases of the Semmelweis university-2nd department of internal medicine during 2014

Capsule endoscopy is a relatively safe and sensitive examination in detecting small intestinal bleeding and mass-like lesions. We aimed to evaluate small intestinal mass-like cases among patients who underwent capsule endoscopy with MiroCam system in the 2nd Department of Internal Medicine during 2014. The age range of total 54 cases, who underwent capsule endoscopy in 2014, was 17 – 84 years (mean: 56.2), 35 were female, 19 were male. All cases were referred to our clinic to assess the cause of obscure gastrointestinal bleeding, and all underwent careful workup on gastrointestinal bleeding by esophagogastroduodenoscopy and colonoscopy. Five (9.3%) out of 54 had small intestinal mass-like lesion. All had histopathological confirmation following surgical resection. 1st case, 65 year old female had direct progression of colonic adenocarcinoma to small intestine at multiple sites. 2nd case, 69 year old female had grade I small intestinal adenocarcinoma causing severe stenosis. 3 rd case, 65 year old male previously diagnosed and treated for metastatic GIST tumor had his primary tumor been found. 4th case, 43 year old male had clear cell sarcoma of the ileum. 5th case, 64 year old female had a Masson's hemangioma. Masson's hemangioma, also known as intravascular papillary endothelial hyperplasia (IPEH), is a sporadic disease with either benign dermal/mucosal presentation or rarely as major GI bleeding. In the literature 10 gastrointestinal IPEH has been reported, out of which 4 were found in the small intestine presenting with melena. Here we report a 64 year old woman who was referred to our clinic to perform microcytic anemia workup caused by obscure gastrointestinal bleeding. On capsule endoscopy we observed an intraluminal polyp-like mass in the mid small intestine with superficial ulceration and fresh coagulum. Small intestinal bowel resection resolved the obscure bleeding symptoms. Pathologic examination of the surgical specimen showed IPEH after careful exclusion of other vascular malformations, i.e. angiosarcoma. To our knowledge, the pathognomonic feature of IPEH during capsule endoscopy has not yet been described in medical literature, here we present its feature. Capsule endoscopy can be a useful guide in further endoscopic or surgical treatment of intestinal mass like lesions.