Gastroenterology & Hepatology Letters

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It is believed that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved and developed with broad tissue tropism as hospitalized coronavirus disease (COVID)-19 patients have been showing non-respiratory manifestations. As evidenced in recent clinical studies, even if the results of oral or nasal swab test were negative, the tests on rectal swab, feces, and blood samples in recovered patients could still be positive. The viral shedding in these specimens provides a cautionary warning that fecal-oral route may represent a hidden trigger of rampant spread of COVID-19 in developing countries with poor sanitization. In addition, the presence of SARS-CoV-2 in rectal, fecal, and blood samples endorses gastrointestinal and hepatic origins for the pathogenesis of COVID-19. These observations highlight the importance for the infected patients to obtain accurate and timely diagnosis as well as the treatment of COVID-19 and its associated non-respiratory symptoms to reduce the risk of spreading the infection through unexpected routes. This review also discusses the potential implications of fecal-oral transmission of COVID-19 for healthcare resource-deficient countries.

Pathologists commonly report non-specific colitis (NSC) in the pathology reports of colon biopsies when they fail to characterize features of the colonic inflammation and diagnose the disease based on specific forms of colitis. Several conditions, ranging from irritable bowel syndrome, diverticular disease, celiac disease, to other systemic diseases have been proposed to be associated with the reporting of NSC in the colon pathology reports. Specifically, NSC could be a preceding pathological condition associated with these diseases before their symptoms and signs become more apparent. Based on a few studies, NSC may not be a particular disease, but rather a transient presentation of inflammatory bowel disease. This gist of this mini-review article is the failure of sharing demographic, clinical, laboratory, and endoscopic data between endoscopist and pathologist are the most important underlying cause of failed characterization of colitis by pathologists. Therefore, enhancement of endoscopist-pathologist communication would reduce the incidence of this misnomer and indirectly improve the diagnosis that helps with more accurate treatment.

Metastatic melanoma to liver is rare in adults. Melanoma can arise from the skin and uveal tract of eyes and metastasizes to other organs, including liver. A middle-aged man who had right eye enucleation 5 years ago due to choroidal melanoma was presented with nonspecific abdominal symptoms for a 6-month duration. He had mild tenderness in the right hypochondriac region. An abdominal ultrasound examination showed two hypoechoic lesions that are suggestive of metastatic deposits. Triphasic computed tomography scan of the abdomen showed heterogeneously enhancing lesion that is indicative of hepatoma. Magnetic resonance imaging revealed T2 iso- to hyperintense lesion, giving differential diagnoses of focal nodular hyperplasia, hepatic adenoma, and fibrolamellar carcinoma. Immunohistochemistry results showed that the tumor cells derived from liver biopsy contain melanin as they are positive for both S-100 and MART-1, indicating that the tumor is melanoma. The histopathological examination should be performed on tumor cells from patients who have an increased risk for metastatic melanoma in the liver due to choroidal melanoma.