Clinical Journal of Gastroenterology最新文献

This case report describes a man in his early 70 s who developed hemophagocytic syndrome following administration of durvalumab plus tremelimumab (Dur/Tre) for advanced hepatocellular carcinoma (HCC). The diagnosis was suspected based on fever and cytopenia, and confirmed by bone marrow aspiration and blood tests, including measurements of soluble interleukin-2 receptor and ferritin. The condition was refractory to steroid therapy but improved after the administration of tocilizumab. This is the first reported case of hemophagocytic syndrome occurring after Dur/Tre treatment for HCC. Furthermore, this case suggests that tocilizumab may be an effective therapeutic option for steroid-refractory hemophagocytic syndrome.

An 86-year-old woman presented with abdominal pain and ascites. Contrast-enhanced computed tomography revealed ascites, thickening of the greater omentum, mild peritoneal thickening, and a low-density tylosis-like cyst in the pelvic peritoneum. To achieve a definitive diagnosis, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the ascitic fluid and peritoneal lesions was performed. Histopathological analysis of aspirated fluid and peritoneal biopsy specimens confirmed the diagnosis of peritoneal pseudomyxoma (PMP). In this case, EUS-FNA played a crucial role in accurately diagnosing PMP as the underlying cause of idiopathic ascites.

A woman in her 60s presented with epigastric pain and was diagnosed with acute cholangitis caused by a papillary tumor based on laboratory findings and imaging studies. An endoscopic evaluation was subsequently planned. Endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography revealed a pedunculated or subpedunculated polypoid lesion within a choledochocele. Histopathological examination of a biopsy specimen confirmed the diagnosis of intra-ampullary papillary-tubular neoplasm (IAPN), and an endoscopic papillectomy (EP) was performed. Choledochoceles are associated with an increased risk of cholangiocarcinoma due to pancreatic juice reflux. Although endoscopic treatments such as sphincterotomy and papillectomy have been reported, to our knowledge, no previous cases have described a tumor confined entirely within a choledochocele that was completely resected via EP. We report a rare case of IAPN within a choledochocele that was successfully treated with en bloc resection using the EP technique.

This case presents a rare instance of ulcerative colitis (UC) relapse in the functionally isolated left colon following surgery for rectal cancer associated with UC. A 62-year-old man, suspected of having cancer based on positron emission tomography (PET)-computed tomography (CT) findings and elevated carcinoembryonic antigen levels, underwent robot-assisted low anterior resection and temporary transverse colostomy. Postoperatively, leakage and infection made it difficult to administer conventional local treatments or corticosteroids; however, remission was achieved with the oral α4-integrin inhibitor, carotegrast methyl, allowing for stoma closure. To our knowledge, this report is the first to describe the use of carotegrast methyl for recurrent UC in a diverted colon. This case demonstrates that carotegrast methyl may serve as an effective steroid-sparing option for UC relapse in complex postoperative anatomical contexts. It also highlights the potential utility of PET-CT as an adjunctive diagnostic tool for UC-associated cancer.

Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal neoplasms characterized by perivascular epithelioid cells. PEComas include angiomyolipoma (AML) of the kidney, clear-cell sugar tumor (CCST), lymphangioleiomyomatosis (LAM) and clear-cell tumors of other anatomical locations. PEComas other than AML, CCST and LAM are very rare tumors that have been referred to as PEComa-not otherwise specified (PEComa-NOS). Especially, colorectal PEComa-NOS remains very rare. A 15-year-old girl underwent a colonoscopy due to hematochezia, thus revealing a 30 mm intramural mass in the upper rectum. The patient was treated by laparoscopic high anterior resection under the diagnosis of Gastrointestinal stromal tumor. Histologically the tumor was positive for HMB45 (human melanoma black 45), TFE3 (transcription factor binding to IGHM enhancer 3), which suggested the diagnosis of PEComa-NOS. The patient remains recurrence-free at five years postoperatively. The treatment strategy, prognosis, and biological behavior of PEComa-NOS is still unclear. We also review the pertinent literature on colorectal PEComa-NOS.

A 67-year-old woman presented with abdominal pain and fever and was found to have multiple liver masses, up to 6 cm in size, that had not been detected on ultrasound 2 months earlier. The rapid onset of lesions, elevated inflammatory markers, and mildly increased liver enzymes initially suggested liver abscesses based on radiographic findings. However, the patient showed no response to antimicrobial therapy, and contrast-enhanced ultrasonography indicated a primary liver tumor. Biopsy revealed a poorly differentiated carcinoma or sarcoma, and the patient died 11 days after admission. Autopsy, combined with immunohistopathological analysis, confirmed primary hepatic epithelioid angiosarcoma (EAS). We presented a rare case of hepatic EAS, highlighting its clinical course, radiological features, and pathological findings.

We report a rare case of cefepime-induced encephalopathy (CE) after pancreaticoduodenectomy. An 83-year-old female patient underwent pancreaticoduodenectomy for a distal bile duct tumor. On postoperative day (POD) 6, she developed a pseudoaneurysm secondary to postoperative pancreatic fistula, for which interventional radiology (IVR) treatment was performed. A liver abscess developed after IVR treatment on POD 15. Multidrug-resistant P. aeruginosa was detected in a drain culture, prompting a change of antibiotic therapy to cefepime on POD 30. Antifungal therapy was initiated for fungemia; however, her renal function progressively deteriorated. On POD 56, the patient presented with vomiting, expressionlessness, and hypokinesia. However, brain computed tomography revealed no abnormalities. Involuntary movement of upper and lower limbs were noted on POD 64, but both magnetic resonance imaging and cerebrospinal fluid examination showed none remarkably abnormalities. On POD 66, epileptic waves were detected via an electroencephalogram (EEG). CE was suspected, and cefepime administration was discontinued on POD 69. The involuntary movements disappeared promptly after cefepime discontinuation (POD 70). By POD 80, her communication ability improved, and EEG findings normalized. The patient was discharged on POD 260. Clinicians should consider CE in any patient receiving cefepime who presents with altered mental status and neurological symptoms.

Introduction: In the treatment of metastatic liver tumors, identifying the primary cancer is crucial for determining the appropriate treatment strategy. The management of colorectal liver metastases often centers around surgical resection, whereas breast cancer liver metastases are predominantly treated with chemotherapy. To our knowledge, this case represents a rare example of dual primary liver metastasis.

Case presentation: A 55-year-old female underwent systemic therapy with tamoxifen plus T-DM1 after right breast cancer resection 3 years ago. Two years ago, the patient developed simultaneous sigmoid colon cancer with liver metastasis. Due to liver damage from T-DM1, she initially underwent sigmoid colon resection, followed 2 months later by partial S5/8 resection and caudate lobectomy. S5/8 lesion was histologically diagnosed as colon cancer liver metastasis, while the caudate lobe lesion was breast cancer liver metastasis. 6 months after surgery, five liver metastases recurred, and the patient was diagnosed with liver metastatic recurrence of colorectal cancer. Six cycles of chemotherapy FOLFOX + Cetuximab were administered before surgery. The largest lesion of S5/8 shrunk, and the other four lesions were slightly enlarged. The histological examination confirmed the shrunken lesion as colorectal liver metastasis and the other lesions as breast cancer liver metastases.

Conclusion: Although radiological differentiation of metastatic liver lesions is challenging, chemotherapy response and tumor localization can aid in diagnosis. Multi-disciplinary cooperation is essential in determining treatment strategies for dual primary liver metastases.

Cryopyrin-associated periodic syndrome (CAPS) is a rare, autosomal dominant inflammatory disorder linked to interleukin (IL)-1β dysregulation. Muckle-Wells syndrome (MWS) is a clinical subtype of CAPS that is often managed with canakinumab, an anti-IL-1β monoclonal antibody. Canakinumab has been approved for all phenotypes of CAPS, with no age restrictions, since 2011. Despite its efficacy in controlling systemic inflammation, its gastrointestinal side effects remain unclear. This report presents the case of a 28 year-old man who developed abdominal pain and diarrhea during treatment with canakinumab for MWS. Colonoscopy revealed findings suggestive of inflammatory bowel disease, and a diagnosis of IBD-unclassified (IBD-U) was made after exclusion of other conditions. Treatment with oral budesonide and vedolizumab led to marked clinical and endoscopic improvements, maintaining remission after budesonide discontinuation. Although the usefulness of systemic prednisolone and anti-TNFα antibody preparations for treating IBD-U in patients with MWS has been previously reported, to the best of our knowledge, this is the first report to highlight the therapeutic effects of budesonide and vedolizumab. Therefore, IBD-U should be considered in the differential diagnosis of patients with CAPS who develop gastrointestinal symptoms. Considering their favorable side-effect profiles, budesonide and vedolizumab may serve as promising treatment alternatives in the future.

A 70-year-old woman presented with a mass in the tail of the pancreas, which was incidentally detected during screening with plain computed tomography (CT). Dynamic CT revealed a 14-mm mass in the pancreatic tail, characterized by low density in the early arterial phase and delayed contrast enhancement from the portal to the equilibrium phase. Magnetic resonance imaging revealed that the tumor had slightly high signal intensity dorsally and slightly low signal intensity ventrally on T1-weighted fat suppressed images, and low signal intensity on T2-weighted images. Endoscopic ultrasonography revealed a well-demarcated hypoechoic mass. However, biopsy showed no definitive tumor cells. Due to the difficulty in ruling out acinar cell carcinoma, laparoscopic distal pancreatectomy was performed. Histologically, the lesion revealed an enlarged pancreatic duct and adenohypophysis with fibrosis, lacking concentric elastic fibers in the duct walls, peripheral nerves, and islets of Langerhans. The final pathological diagnosis was pancreatic hamartoma-a rare tumor with only 52 cases reported previously in the literature. Preoperative histological diagnosis is extremely challenging. Here, we report a case of pancreatic hamartoma that was difficult to distinguish from malignant tumor preoperatively.