Acute pancreatitis due to osteosarcoma metastasis.

We present the case of a young patient with acute pancreatitis (AP) secondary to osteosarcoma metastasis. It is necessary to assess tumor etiology in the study of any acute pancreatitis without clear cause. Pancreatic metastases are rare and difficult to diagnose and differentiate from other primary tumors such as neuroendocrine tumors (NET). It is essential to have a high degree of clinical suspicion and the use of radiological and endoscopic ultrasound imaging techniques.

Primary adenocarcinoma of the fourth portion of the duodenum, an unsuspected diagnosis.

Small bowel adenocarcinoma is a rare tumor accounting for only 0.3-0.4% of all gastrointestinal tumors, with duodenal adenocarcinoma being the most common subtype. In most patients, it presents with nonspecific signs and symptoms, often leading to a delay in diagnosis. Therefore, it is essential to establish an adequate initial clinical suspicion to carry out an adequate diagnostic approach, being necessary to perform both radiological and endoscopic diagnostic techniques.

Dubin-Johnson syndrome as a laparoscopic finding.

We present the case of a 35-year-old female with a history of polycystic ovary syndrome, treated with oral contraceptives. She was under study due to nine months evolution of pain in the right iliac fossa, associated with hyporexia and mild hyperbilirubinemia with a predominance of the conjugated fraction (total Bi 3.7 mg/dl, conjugated Bi 2.9 mg/dl). An abdominal computed tomography (CT) was performed showing homogeneous hepatosplenomegaly and adenopathies in both iliac chains, the largest in the right external iliac chain of 1.6 x 3.6 cm.

[Rituximab as rescue therapy in refractory esophageal lichen planus]. / Rescate con rituximab en paciente con liquen plano esofágico refractario.

Esophageal lichen planus (ELP) is a rare condition with unknown prevalence that can sometimes be underestimated due to the subtle and nonspecific findings of diagnostic workup. Oral lesions rarely extend to the esophageal mucosa, but when they do, the most frequent symptoms are dysphagia and odynophagia. There is often a significant delay in diagnosis and inadequate treatment. We report the case of a 59-year-old woman diagnosed with ELP, successfully treated with rituximab, a chimeric monoclonal antibody that depletes CD20+B cells. To our knowledge, this is only the second report of this treatment in ELP.

Endoscopic mucosal resection for proximal superficial lesions: efficacy and safety study in 59 consecutive resections.

INTRODUCTION: endoscopic mucosal resection is an accepted technique for the treatment of proximal gastrointestinal tract superficial lesions. OBJECTIVES: to evaluate the efficacy and safety of this procedure in the proximal gastrointestinal tract. MATERIAL AND METHODS: forty one consecutive patients (23 males and 18 females, mean age of 61 ± 11.5 years) were included in our study. Fifty nine resections were performed in these patients in 69 sessions. Lesions treated consisted of elevated lesions with high grade dysplasia in the context of Barrett's esophagus (group A), high grade dysplasia appearing in random biopsies taken during the follow-up of Barrett's esophagus (group B) and superficial gastroduodenal lesions (group C). Snare resection after submucosal injection, band ligator-assisted or cap-assisted mucosal resection were the chosen techniques. RESULTS: we resected 7 elevated lesions with high grade dysplasia in the context of Barrett's esophagus, 6 complete Barrett's esophagus with high grade dysplasia in 16 sequential sessions and 46 gastroduodenal superficial lesions (10 adenomas, 9 gastric superficial carcinomas, 18 carcinoid tumours and 9 lesions of different histological nature). Resections in the two first groups were complete in 100% of the cases, and in 97.9% of the cases in group C. Complications included 2 cases of limited deferred bleeding (groups A and B) and another two cases of stenosis with little clinical relevance in Group B. CONCLUSIONS: a) endoscopic mucosal resection is an efficient technique for the treatment of proximal gastrointestinal tract superficial lesions; b) it is a safe procedure with a low percentage of complications, which can generally be managed endoscopically; and c) in contrast with other ablative techniques, endoscopic mucosal resection offers the possibility of a pathologic analysis of the samples.

[Jaundice secondary to giant pancreatic serous cystoadenoma]. / Ictericia secundaria a cistoadenoma seroso pancreático gigante.

Serous cystadenoma is the second most frequent pancreatic cystic neoplasm and accounts for 1-2% of exocrine neoplasms of the pancreas. Recently, they have been identified more frequently, due to the improvement in imaging techniques. Differential diagnosis should be performed with mucinous cystoadenoma, due to the latter´s potential for malignant transformation. We present the case of a female patient who underwent examination for painless jaundice and cholestasis, with a final diagnosis of pancreatic serous cystoadenoma.