Simultaneous diagnosis of well-differentiated neuroendocrine tumour and gastrointestinal stromal tumour of the stomach: an infrequent finding.

We present the case of a 75-year-old female patient who was referred to gastroenterology consultation due to vitamin B12 deficiency. Anti-parietal cell and anti-intrinsic factor antibodies were positive. An upper gastrointestinal endoscopy was performed for the suspicion of autoimmune gastritis, identifying in the greater curvature of the gastric corpus a 25 mm spherical, subepithelial lesion, suggestive of gastrointestinal stromal tumour (GIST). A 2 mm sessile polyp was observed adjacent to it. Biopsies from both lesions were taken. Histological examination of the submucosal lesion showed mucosa with neuroendocrine cell dysplasia. The polypoid lesion was compatible with a well-differentiated neuroendocrine tumour (G1) with affected margins. A SPECT-CT scan was performed, showing the lesion compatible with GIST expression of somatostatin receptors. There were no signs of distant extension. Using endoscopic ultrasound, the subepithelial lesion was described as a hypoechoic bulge of the fourth layer, measuring 25 x 18 mm. It was not possible to visualize the polyp. EUS-guided fine needle aspiration was performed, and cytology was negative for malignancy. Finally, it was decided to perform an atypical, laparoscopic gastric greater curvature resection. Neuroendocrine tumours (NETs) are epithelial neoplasms derived from cells of the diffuse neuroendocrine system. Gastrointestinal stromal tumours (GISTs), although they represent 1-3% of gastrointestinal neoplasms, are the most common mesenchymal tumours, arising from interstitial Cajal cells. The synchronous finding in the stomach of a well-differentiated NET and a GIST is rare, having been described in a low percentage of cases.

Hepatosplenic schistosomiasis: a rare cause of chronic liver disease with portal hypertension diagnosed by abdominal ultrasound.

Hepatosplenic schistosomiasis (HSS) is a major cause of chronic liver disease with portal hypertension (pHTN) in Africa, Asia, and America. Abdominal ultrasound is essential for diagnosis.

Compassionate use of tocilizumab in severe SARS-CoV2 pneumonia.

INTRODUCTION: Tocilizumab (TCZ) is an interleukin-6 receptor antagonist, which has been used for the treatment of severe SARS-CoV-2 pneumonia (SSP), which aims to ameliorate the cytokine release syndrome (CRS) induced acute respiratory distress syndrome (ARDS). However, there are no consistent data about who might benefit most from it. METHODS: We administered TCZ on a compassionate-use basis to patients with SSP who were hospitalized (excluding intensive care and intubated cases) and who required oxygen support to have a saturation >93%. The primary endpoint was intubation or death after 24 h of its administration. Patients received at least one dose of 400 mg intravenous TCZ from March 8, 2020 to April 20, 2020. RESULTS: A total of 207 patients were studied and 186 analyzed. The mean age was 65 years and 68% were male patients. A coexisting condition was present in 68% of cases. Prognostic factors of death were older age, higher IL-6, d-dimer and high-sensitivity C-reactive protein (HSCRP), lower total lymphocytes, and severe disease that requires additional oxygen support. The primary endpoint (intubation or death) was significantly worst (37% vs 13%, p < 0·001) in those receiving the drug when the oxygen support was high (FiO2 >0.5%). CONCLUSIONS: TCZ is well tolerated in patients with SSP, but it has a limited effect on the evolution of cases with high oxygen support needs.