Pancreatoscopy of intraductal papillary mucinous neoplasm of the pancreas.

Video 1Pancreatoscopy of intraductal papillary neoplasm of the pancreas.

Metastatic neuroendocrine carcinoma presenting with left lateral rectus enlargement and orbital cellulitis.

Neuroendocrine tumors (NETs) of the orbit are a rare but increasingly recognized clinical phenomenon. The vast majority of orbital NETs are metastatic, and most metastasize from the gastrointestinal system to the extraocular muscles. While orbital metastasis typically occurs in the setting of a known primary neoplasm, some cases represent the initial manifestation of disease and can precede detection of the primary tumor by many months. We report a 58-year-old woman who presented with diplopia, unilateral orbital pain, erythema, and chemosis as the primary presentation of a metastatic small intestine NET. This case serves as a reminder that identification of orbital NETs should prompt investigation for primary gastrointestinal or pulmonary NETs. Goals of surgery include obtaining a tissue sample, debulking the lesion, and preserving visual function.

Frequency of metastasis to the gastrointestinal tract determined by endoscopy in a community-based gastroenterology practice.

Metastasis to the gastrointestinal tract is rare. We performed a retrospective analysis to identify patients with metastatic disease to the gastrointestinal tract using two databases containing pathology results from all endoscopic procedures conducted by nearly 200 gastroenterologists in a community setting over a 14-year period. Forty-nine patients were diagnosed with metastasis to the gastrointestinal tract by endoscopy during the study period. Most were women (71%). The most common metastases to the gastrointestinal tract identified by endoscopy were breast cancers (n = 18), followed by melanomas (n = 12), ovarian cancers (n = 7), kidney cancers (n = 5), prostate cancers (n = 2), lung cancer (n = 1), and pancreatic cancer (n = 1). Three patients had unknown primary sites. Among women, the three leading known primary tumor sites were breast, ovary, and melanoma. Among men, the three leading primary tumor sites were melanoma, kidney, and prostate. The stomach was the most common portion of the gastrointestinal tract involved by metastases. Most affected women and were most frequently encountered in the stomach.

The Indian gut microbiota-Is it unique?

Colonization of the gut by microbes depends on a number of factors including age, diet, genetic makeup, gender, geographic location, and health status of an individual. India is a megadiverse country and includes 4 biodiversity hot spots. These features, along with the transitioning Indian sociodemographic profile, make the gut microbiota of Indian subjects an interesting area to study. In this review, we critically discuss the present status of the gut microbiome in the Indian population and its difference from other populations. We also discuss the aberrations in the available study designs that could introduce heterogeneity. An ideal study to evaluate the core gut microbiota of healthy Indians should involve a large homogeneous population across the country and use the same technology and data analytics tools. The "Landscape of Gut Microbiome-Pan India Exploration" (LogMPIE) is such a study that confirmed the most predominant organisms in Indians to be Prevotella copri and Faecalibacterium prausnitzii.

Diffuse Villous Tumor Arising in Barrett's Esophagus Presenting With Aspiration Pneumonitis.

Barrett's esophagus (BE) is associated with an increased incidence of adenocarcinoma. The dysplasia in BE that precedes cancer is usually endoscopically flat. Unlike in the colon, polypoid dysplastic lesions superimposed on BE are uncommon. Furthermore, villous tumors of the esophagus are rare, and few cases have been reported in the literature. We report an 85-year-old man who was found to have a circumferential villiform-appearing esophageal tumor with mucus secretions with recurrent bronchopulmonary aspiration. A diffuse villiform tumor of the entire esophagus with mucin production is rare and, to our knowledge, has not been previously described in the literature.