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We report a case of a 40-year-old female with cirrhosis, hepatocellular carcinoma, and upper gastrointestinal bleeding who developed multiple pulmonary emboli after endoscopic injection sclerotherapy for gastric variceal bleeding. The patient did not have any respiratory symptoms after the sclerotherapy. A chest radiograph obtained one day after the procedure for the evaluation of fever showed few small nodular radio-opacities in both hilar regions. Computed tomography (CT) demonstrates the existence of multiple radio-opaque emboli within the pulmonary and left common iliac arteries with no evidence of associated pulmonary parenchymal changes. She had no further symptoms, and the radiologic opacities persisted on CT obtained 4 months later.

Objective: To evaluate the overall incidence of microsatellite instability (MSI), hereditary non polyposis colorectal cancer, and tumor supressor gene (TP53) mutations in Saudi colorectal carcinomas., Methods: We studied the MSI pathway in Saudi colorectal cancers (CRC) from 179 unselected patients using 2 methods: MSI by polymerase chain reaction, and immunohistochemistry detection of mutL homologs 1 and mutS homologs 2 proteins. The TP53 mutations were studied by sequencing exons 5, 6, 7, and 8., Results: Of the 150 colorectal carcinomas analyzed for MSI, 16% of the tumors showed high level instability (MSI-H), 19.3% had low-level instability (MSI-L) and the remaining 64% tumors were stable. Survival of the MSI-H group was better as compared to the MSI-L or microsatellite stable group (p=0.0217). In the MSI-H group, 48% were familial MSI tumors, which could be attributable to the high incidence of consanguinity in the Saudi population. The TP53 mutations were found in 24% of the cases studied., Conclusion: A high proportion of familial MSI cases and a lower incidence of TP53 mutations are some of the hallmarks of the Saudi colorectal carcinomas, which need to be explored further.