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.

Gastric ulcer due to mucormycosis in a critical patient.

We have read the article published by Sánchez-Velázquez P et al., which described a clinical case of gastrointestinal hemorrhage secondary to gastric ulcer due to Mucor. We present a similar clinical case, as an example of one identified by gastroscopy. The case was a 71-year-old female with multiple organ failure secondary to nosocomial pneumonia who required mechanical ventilation, vasoactive drugs, corticosteroids, antibiotherapy and continuous venovenous hemofiltration. Her room was adjacent to a building under construction. The patient had severe upper gastrointestinal bleeding and therefore, an urgent upper gastrointestinal endoscopy was performed. A small amount of blood was identified, as well as a large ulcer without a white base extending from the fundus to the antrum region of the stomach, with bleeding due to rubbing and nodular edges that suggested degeneration.

Recurrent small-bowel bleeding from a Dieulafoy's lesion after combined endoscopic treatment.

INTRODUCTION: Dieulafoy's lesion of the small bowel is an uncommon cause of gastrointestinal (GI) bleeding that often recurs after endoscopic treatment. MATERIAL AND METHODS: we report an observational, descriptive, retrospective, single-center study in 15 patients with small bowel bleeding who were diagnosed with a Dieulafoy's lesion by capsule endoscopy or double-balloon enteroscopy. RESULTS AND CONCLUSIONS: all patients underwent combined endoscopic treatment. During a median follow-up of 33.5 months (range, 2-145), three of the 12 cases that stayed in follow-up (25 %) recurred, all within 48 hours after treatment. Two were successfully re-treated with a repeat endoscopic procedure.

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.

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.