Metástasis pancreática de carcinoma de células de Merkel: una rara neoplasia del páncreas / No disponible

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Pancreatic metastasis of Merkel-cell carcinoma: a rare neoplasm of the pancreas.

Only 2-3.9% of pancreatic malignancies represent metastases from other sites, the most common origins being the lungs, kidneys, and gastrointestinal tract. Differentiating between primary and secondary lesions may be challenging with imaging techniques but EUS-guided FNA is a safe, accurate procedure for obtaining a tissue diagnosis. We report the case of a 70-year-old male who, following satisfactory treatment for a Merkel-cell carcinoma in the right groin, presented with jaundice and an indurated, vascularized, adherent nodule on the right thigh. Endoscopic ultrasound identified a mass at the pancreatic head as well as a perilesional adenopathy with no evidence of vascular involvement. FNA revealed cell proliferation, which was immunohistochemically positive for CD56, synaptophysin, and chromogranin, these findings being consistent with poorly-differentiated neuroendocrine carcinoma. Given the patient's history we considered this lesion to be a pancreatic metastasis of Merkel-cell carcinoma, which represents a rare finding.

Adenocarcinoma rabdoide cavitado en yeyuno, un caso excepcional por enteroscopia / No disponible

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Rhabdoid cavitated adenocarcinoma in the jejunum, an exceptional case by enteroscopy.

We have read the article published by Abdulkader I et al., which described two cases of a rhabdoid tumor of the small bowel diagnosed by surgery. We present a similar case in the jejunum diagnosed by double balloon enteroscopy (DBE). We present the case of a 64-year-old patient with multifactorial anemia and transfusional requirements and a flat lesion of 2 cm in the colon, which showed undifferentiated adenocarcinoma on histopathological analysis.

Tumor neuroendocrino simulando un tumor de Klatskin / Klatskin-mimicking neuroendocrine tumor

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Klatskin-mimicking neuroendocrine tumor.

With regard to the article published in your journal by Konstantinos Tsalis et al on Klatskin-mimicking lesions, we recently diagnosed a neuroendocrine tumor (NET) in the proximal biliary tract of a 78-year-old female with obstructive jaundice manifestations. A chest-abdomen-pelvis CT scan identified infiltrating ductal cholangiocarcinoma (Klatskin tumor, type IV in the Bismuth-Corlette classification with cT2N1 staging) and a liver mass in segment IV.

Regresión de pseudopólipo gigante en paciente con enfermedad de Crohn del colon tras tratamiento con infliximab / Regression of a giant pseudopolyp in a patient with colonic Crohn's disease after therapy with infliximab

Los pseudopólipos inflamatorios gigantes (> 15 mm) son una complicación infrecuente de la enfermedad inflamatoria intestinal (EII). Es difícil el diagnóstico diferencial con adenomas y carcinomas. Aunque suelen ser asintomáticos, debido a su tamaño pueden ocasionar obstrucción o invaginación intestinal. El manejo habitual se realiza con biopsias de la lesión y extirpación endoscópica de la misma en casos seleccionados, reservando la cirugía para complicaciones inherentes a su tamaño o bien ante la duda anatomopatológica. Presentamos el caso de una paciente de 43 años con enfermedad de Crohn (EC) de colon en remisión clínica y sin tratamiento específico para la enfermedad en la que en una colonoscopia de cribado se identificó un pseudopólipo gigante (40 mm). Se inició tratamiento con infliximab y azatioprina para intentar reducir tamaño y permitir resección endoscópica posteriormente. Tras dosis de inducción, en las semanas 0, 2 y 6 se realizó una nueva colonoscopia que evidenció una clara reducción de tamaño de la lesión. Se intentó resección mucosa pero no fue posible por la intensa fibrosis que impedía elevación de la lesión tras inyección en su base. Una nueva colonoscopia de control a los tres meses confirmó, sin embargo, la desaparición completa de la lesión. Los datos en la literatura respecto al manejo terapéutico de los pseudopólipos gigantes son escasos, pero se ha publicado que es poco frecuente que desaparezcan con tratamiento médico, requiriendo resección quirúrgica o endoscópica

Giant inflammatory pseudopolyps (> 15 mm) are an uncommon complication of inflammatory bowel disease (IBD) and a differential diagnosis with adenomas and carcinomas is challenging. Although usually asymptomatic, they may result in intestinal obstruction or intussusception due to their size. The standard management involves lesion biopsies and endoscopic excision for selected cases; surgery is usually reserved for size-associated complications or an uncertain pathology. We report the case of a 43-year-old female patient with Crohn's disease (CD) in clinical remission, with no specific treatment at the time. A giant pseudopolyp of 40-mm was found during a screening colonoscopy. Therapy was initiated with infliximab and azathioprine in an attempt to reduce the size of the polyp and allow an endoscopic resection. Additional colonoscopies were performed following induction doses at weeks 0, 2, and 6, which revealed a reduced lesion size. Mucosal resection was attempted but failed due to severe fibrosis, which prevented base injections from lifting up the polyp. However, a follow-up colonoscopy three months later showed that the lesion had completely disappeared. The evidence in the literature regarding giant pseudopolyp management is scarce, but reports indicate that they rarely disappear with medical therapy alone and usually require surgery or endoscopic resection

Quiste de colédoco Todani Ia degenerado en paciente con páncreas divisum / A degenerate Todani Ia choledochal cyst in a patient with pancreas divisum

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A degenerate Todani Ia choledochal cyst in a patient with pancreas divisum.

Bile duct cysts represent congenital abnormalities associated with biliopancreatic maljunction that may undergo malignant degeneration. We report herein the case of a 72-year-old male patient with cholangitis. MR-cholangiography and abdominal CT revealed a mass at the biliary-pancreatic-duodenal crossroads, extrahepatic biliary dilation up to 38 mm, and pancreas divisum. Gastroscopy found an infiltrative bulbar mucosa with adenocarcinoma in biopsy samples, and extrinsic bulging of the second duodenal portion. Endoscopic ultrasound showed a choledochal cystic dilation with solid contents, and FNA findings were nonspecific. ERCP confirmed an adenomatous papilla at the lower portion of the extrinsic formation, and a large cystic, saccular dilation of extrahepatic bile ducts (Todani Ia). Fistulotomy was required for deep cannulation of the proximal biliary tract, and attention was drawn to extruding polypoid lesions originating in the biliary epithelium, identified in biopsies as adenoma with dysplasia. Finally, a diagnosis was made of advanced adenocarcinoma in choledochal cyst.

Regression of a giant pseudopolyp in a patient with colonic Crohn's disease after therapy with infliximab.

Giant inflammatory pseudopolyps (> 15 mm) are an uncommon complication of inflammatory bowel disease (IBD) and a differential diagnosis with adenomas and carcinomas is challenging. Although usually asymptomatic, they may result in intestinal obstruction or intussusception due to their size. The standard management involves lesion biopsies and endoscopic excision for selected cases; surgery is usually reserved for size-associated complications or an uncertain pathology. We report the case of a 43-year-old female patient with Crohn's disease (CD) in clinical remission, with no specific treatment at the time. A giant pseudopolyp of 40-mm was found during a screening colonoscopy. Therapy was initiated with infliximab and azathioprine in an attempt to reduce the size of the polyp and allow an endoscopic resection. Additional colonoscopies were performed following induction doses at weeks 0, 2, and 6, which revealed a reduced lesion size. Mucosal resection was attempted but failed due to severe fibrosis, which prevented base injections from lifting up the polyp. However, a follow-up colonoscopy three months later showed that the lesion had completely disappeared. The evidence in the literature regarding giant pseudopolyp management is scarce, but reports indicate that they rarely disappear with medical therapy alone and usually require surgery or endoscopic resection.

Mediolisis arterial segmentaria de arterias esplácnicas: causa infrecuente de dolor abdominal / Segmental arterial mediolysis in splanchnic arteries: an uncommon cause of abdominal pain

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Segmental arterial mediolysis in splanchnic arteries: an uncommon cause of abdominal pain.

Segmental arterial mediolysis is an uncommon arterial disease that primarily involves splanchnic arteries; abdominal pain is the most common clinical manifestation. We report the case of a 53-year-old male with postprandial diffuse abdominal pain of one month's standing. Physical examination was uneventful, and laboratory tests revealed no abnormal findings. Abdominopelvic CT/Angio-CT showed an increased caliber of the superior mesenteric artery resulting from eccentric circumferential wall thickening. The patent lumen had a segment with fusiform aneurysmal dilatation, 7 x 26 mm long. These vascular changes extended along a number of distal jejunal branches, which also presented complete lumen obliteration. Abdominal arteries were free from signs of arteriosclerotic disease. Findings were consistent with segmental arterial mediolysis.

Síndrome de Sweet tras inicio de vedolizumab en paciente con enfermedad de Crohn / Sweet syndrome after treatment with vedolizumab in a patient with Crohn's disease

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Sweet syndrome after treatment with vedolizumab in a patient with Crohn's disease.

Sweet syndrome is a common extraintestinal manifestation in inflammatory bowel disease (IBD). In this research, a 42-year-old man case with colon Crohn's disease is been described. After failure with two anti-TNF therapies, in treatment with azathioprim, it was decided to start a therapeutic target change to Vedolizumab due to a severe outbreak refractory to corticosteroids. 24 hours after the infusion of the new drug, skin lesions appear along with leukocytes with neutrophilia, all suggestive of sweet syndrome later confirmed by histology. In this clinical case, the importance of knowing the possible side effects of recently commercialized drugs for IBD is shown, being this topic important for gastroenterologists due to the wide therapeutic arsenal that is becoming available for this pathology.

La enteropatía de intestino delgado por antiinflamatorios no esteroideos y la hemorragia digestiva de origen oscuro / Nonsteroidal anti-inflammatory drugs-induced small bowel enteropathy and obscure gastrointestinal bleeding

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