Case Reports in Gastroenterology最新文献

{"title":"Transformation of Primary Small Intestinal Follicular Lymphoma to CD20-Negative Diffuse Large B-Cell Lymphoma following Rituximab Treatment: A Case Report.","authors":"Masafumi Kitamura, Hirotsugu Sakamoto, Satoshi Shinozaki, Mio Sakaguchi, Tomonori Yano, Noriyoshi Fukushima, Hironori Yamamoto","doi":"10.1159/000548909","DOIUrl":"10.1159/000548909","url":null,"abstract":"<p><strong>Introduction: </strong>Follicular lymphoma is an indolent B-cell lymphoma that can involve the gastrointestinal tract, most commonly the small intestine. Although rituximab-based therapy is effective, transformation to diffuse large B-cell lymphoma (DLBCL) can occur and becomes difficult to diagnose after CD20 loss.</p><p><strong>Case presentation: </strong>We report the case of a 64-year-old woman initially diagnosed with primary small intestinal follicular lymphoma who subsequently developed transformation to DLBCL 2 years after rituximab therapy. Double-balloon enteroscopy revealed progression of mucosal lesions, raising suspicion of histologic transformation. However, endoscopic biopsy was inconclusive because of the loss of CD20 expression, likely resulting from prior rituximab therapy. Surgical resection was performed to relieve intestinal obstruction and to establish a definitive diagnosis. Histopathological examination confirmed transformation to CD20-negative DLBCL.</p><p><strong>Conclusion: </strong>This case highlights the diagnostic limitation of endoscopic biopsy following rituximab therapy. Therefore, clinicians should be cautious in relying solely on endoscopic findings and remain open to surgical intervention to achieve a timely and accurate diagnosis.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"718-725"},"PeriodicalIF":0.6,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12659653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophageal Cancer Secondary to Achalasia: A Case Series Study.","authors":"Wenli Xu, Yanqin Long, Bo Li, Fenming Zhang, Hongtan Chen","doi":"10.1159/000548622","DOIUrl":"10.1159/000548622","url":null,"abstract":"<p><strong>Introduction: </strong>Achalasia is a primary motility disorder affecting the esophageal body and lower esophageal sphincter. Although the linkage between achalasia and elevated esophageal cancer risk is already known, the precise mechanisms remain poorly elucidated due to the disease's relative scarcity. We aim to summarize the clinical characteristics of esophageal cancer (EC) secondary to achalasia and improve the understanding of achalasia combined with EC and further reduce the risk of ECs.</p><p><strong>Case presentations: </strong>Retrospective statistics were conducted on patients with ECs secondary to achalasia in our hospital from 2009 to 2023. We categorized all achalasia cases with their initial treatment and recorded subsequent interventions when the symptoms recurred. Additionally, we performed detailed analyses of both EC characteristics and therapeutic regimens. We present a case series comprised of 5 patients with achalasia who presented with EC. Three of the patients diagnosed with achalasia were treated by endoscopy or operation to improve symptoms. One patient was treated by pneumatic dilation. All were histologically diagnosed as squamous cell carcinoma. The validity period of endoscopic treatment has been lost in all patients. The erosions were all distributed over the thoracic esophagus.</p><p><strong>Conclusion: </strong>The high relative risk of ECs was demonstrated in achalasia patients, even in the treated achalasia patients. Therefore, surveillance endoscopy may be recommended regularly in the treated patients.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"711-717"},"PeriodicalIF":0.6,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12659639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local Recurrence due to Needle Tract Seeding after Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Pancreatic Tail Cancer: A Case Report.","authors":"Kengo Matsumoto, Dai Nakamatsu, Masashi Yamamoto, Shiro Hayashi, Koji Fukui, Masafumi Yamashita, Junzo Shimizu, Tsutomu Nishida","doi":"10.1159/000548554","DOIUrl":"10.1159/000548554","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an essential diagnostic tool for pancreatic tumors, but rare complications such as needle tract seeding (NTS) may cause local recurrence.</p><p><strong>Case presentation: </strong>A 79-year-old man with a history of right hemicolectomy for colon cancer presented during follow-up in 2020 with a 16-mm pancreatic tail mass. He was asymptomatic, and laboratory findings including carcinoembryonic antigen and carbohydrate antigen 19-9 were normal. EUS-FNA confirmed adenocarcinoma (cT3N0M0, stage IIA), and after neoadjuvant chemotherapy, laparoscopic distal pancreatectomy was performed. No recurrence was observed until 2022, when elevated tumor markers and fluorodeoxyglucose positron emission tomography/computed tomography revealed a lesion near the stomach. Chemotherapy with gemcitabine and nab-paclitaxel was initiated, but the lesion persisted. Repeat EUS-FNA confirmed adenocarcinoma, suggesting NTS from the initial FNA. Subsequently, partial gastrectomy was performed, and pathology confirmed pancreatic adenocarcinoma.</p><p><strong>Conclusion: </strong>This case illustrates the risk of NTS following EUS-FNA for pancreatic tail cancer, particularly when the puncture route is not resected during pancreatectomy. Despite neoadjuvant chemotherapy, NTS occurred, indicating that this risk cannot be fully prevented. Surgical resection achieved disease control, underscoring the importance of vigilant follow-up and timely intervention in managing this rare but clinically significant complication.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"704-710"},"PeriodicalIF":0.6,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12659200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Single Colonic Polyp Having Both Tubular Adenoma and Mantle Cell Lymphoma: A Case Report.","authors":"Dua Abuquteish, Ahmed Al-Azzeh, Sami Bannoura","doi":"10.1159/000548048","DOIUrl":"10.1159/000548048","url":null,"abstract":"<p><strong>Introduction: </strong>Mantle cell lymphoma (MCL) is a distinct subtype of B-cell non-Hodgkin lymphoma. MCL lymphoma can occur in the gastrointestinal tract (GIT) as a primary lymphoma; more commonly, the GIT can be secondarily involved. A colonic polyp simultaneously having MCL with overlying adenomatous changes is highly unusual, and few cases were reported. Herein, we describe a unique instance of a single adenomatous polyp in the left colon overlying a small lymphoid population proven to be MCL in a patient recently diagnosed with MCL. We believe this report will increase the awareness of pathologists and clinicians of such a unique and unusual clinical presentation.</p><p><strong>Case presentation: </strong>A 53-year-old male patient presented with a history of generalized lymphadenopathy, bilateral pleural deposits, and splenomegaly. Axillary lymph node excisional biopsies were sent for pathology and reported MCL, diffuse pattern, classic variant. Three weeks later, the patient underwent upper and lower endoscopy for mild upper abdominal discomfort. Upper endoscopy showed mild gastropathy, and colonoscopy revealed a small polyp at the descending colon. Pathology of the colonic polyp showed a tubular adenoma with low-grade dysplasia overlying a well-circumscribed mucosal/submucosal nodular lymphoid aggregate. The lymphoid aggregate exhibited histological and immunohistochemical features of MCL. Thus, a diagnosis of tubular adenoma coexisting with MCL in the same polyp was made.</p><p><strong>Conclusion: </strong>Tubular adenoma with MCL is an exceedingly rare phenomenon with unclear pathogenesis. We report this case to highlight the importance of examining lymphoid tissue in adenomas and to increase the awareness among clinicians and pathologists of such a unique presentation.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"696-703"},"PeriodicalIF":0.6,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12659201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Adolescent Case of Ulcerative Colitis Complicated by Toxic Megacolon.","authors":"Masaki Kato, Masaki Yamashita, Mitsuto Tsukui, Yoshihiko Iijima, Kenichi Araki, Naoki Shikano, Shiori Saji, Kyoko Tsukamoto, Jun Ishida, Takumi Komatsu, Yusuke Nakamoto, Akiyo Kawashima, Akira Endo, Ayako Matsunaga, Yoshinori Sato, Tadateru Maehata, Keisuke Tateishi","doi":"10.1159/000547911","DOIUrl":"10.1159/000547911","url":null,"abstract":"<p><strong>Introduction: </strong>Toxic megacolon is a serious complication of ulcerative colitis (UC), characterized by marked colonic dilatation, abnormal bowel function, and systemic toxicity. Although toxic megacolon is rare in children and adolescents, it should remain in the differential diagnosis for acute severe UC in this group because delayed diagnosis and treatment can be fatal. The treatment for UC complicated by toxic megacolon is either immediate emergency surgery or short-term intensive drug therapy. If the latter does not result in significant improvement, emergency surgical intervention is necessary. Current treatment guidelines do not establish a standard medical approach for this condition.</p><p><strong>Case presentation: </strong>In this report, we describe an adolescent case of UC complicated by toxic megacolon. In this patient, the condition was initially controlled with steroid pulse therapy followed by oral tacrolimus. However, due to an inadequate response, treatment was escalated to infliximab (IFX), leading to remission and successful avoidance of surgical intervention.</p><p><strong>Conclusion: </strong>When opting for conservative treatment of UC complicated by toxic megacolon, intensive steroid pulse, tacrolimus, and IFX therapy should be considered as a potentially effective treatment option.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"688-695"},"PeriodicalIF":0.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12659222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe <i>Pneumocystis jirovecii</i> Pneumonia That Was Difficult to Diagnose due to Complications of Postoperative <i>Candida</i> Sepsis in an Elderly Patient with Ulcerative Colitis: A Case Report.","authors":"Kenichiro Toritani, Hideaki Kimura, Manabu Maebashi, Kota Imanishi, Minoru Homma, Kazuki Kurimura, Serina Haruyama, Yoshinori Nakamori, Reiko Kunisaki, Itaru Endo","doi":"10.1159/000548096","DOIUrl":"10.1159/000548096","url":null,"abstract":"<p><strong>Introduction: </strong>Pneumonia is a leading cause of postoperative mortality in elderly patients with ulcerative colitis (UC), and close attention should be paid to the possibility of <i>Pneumocystis jiroveci</i> pneumonia (PJP) in patients with immunosuppression. We present the case of a patient with severe PJP that was challenging to diagnose because of postoperative <i>Candida</i> sepsis complications in an elderly patient with acute severe ulcerative colitis (ASUC) with immunosuppression.</p><p><strong>Case presentation: </strong>A 70-year-old man was transferred to our hospital and was diagnosed with ASUC. The patient underwent laparoscopic subtotal colectomy for prednisolone and granulocyte and monocyte adsorptive apheresis-resistance UC 22 days after transfer. On postoperative day (POD) 9, the central venous catheter (CVC) was removed because CVC-related blood stream infection (CRBSI) was suspected. On POD 12, fluconazole was administered for <i>Candida parapsilosis</i> sepsis due to CRBSI, and a septic pulmonary embolism was suspected. The patient's hypoxemia worsened; trimethoprim-sulfamethoxazole was administered because PJP was suspected on POD 19; however, ventilatory support was started on POD 21. PJP was diagnosed based on bronchoalveolar lavage on POD 25, and high-dose prednisolone therapy was initiated. The patient was weaned off the ventilator on POD 27 and was discharged home on POD 54. Proctectomy and stapled ileal pouch-anal anastomosis were performed at 10 months postoperatively, and the patient is currently alive at 1 year and 6 months after surgery.</p><p><strong>Conclusion: </strong>Postoperative hypoxemia in elderly patients with ASUC should be considered in the differential diagnosis of PJP, even during the treatment of <i>Candida</i> sepsis.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"675-681"},"PeriodicalIF":0.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Full-Thickness Resection of a Non-Lifting Adenoma in an Ulcerative Colitis Patient Using OVESCO: A Case Report.","authors":"Fei Yang Pan, Rupert Leong, Saurabh Gupta, Talia Fuchs, Viraj Kariyawasam","doi":"10.1159/000548329","DOIUrl":"10.1159/000548329","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with longstanding ulcerative colitis (UC) face an increased risk of colorectal cancer, necessitating regular surveillance. Chronic inflammation frequently leads to submucosal fibrosis, making the resection of non-lifting lesions difficult with standard techniques like endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD).</p><p><strong>Case presentation: </strong>We present a 76-year-old UC patient with a splenic flexure adenoma that was unresectable via EMR/ESD. Given the high surgical risk, the OVESCO system was used, achieving clear margins and avoiding colectomy.</p><p><strong>Conclusion: </strong>This case highlights full-thickness resection devices as a minimally invasive alternative for challenging polyps in UC, preserving bowel function while avoiding major surgery or stoma formation.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"682-687"},"PeriodicalIF":0.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double Plastic Stents as a Bridging Strategy for Large Common Bile Duct Stones: A Case Report of Two Patients.","authors":"Anupam Kumar Gupta","doi":"10.1159/000548211","DOIUrl":"10.1159/000548211","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is the standard treatment for common bile duct (CBD) stones. However, in 10-15% of cases involving large or multiple stones, this approach is inadequate. Advanced techniques such as lithotripsy, dilation, balloon extraction, or surgery may be required.</p><p><strong>Case presentation: </strong>We present 2 post-cholecystectomy patients with large (>1.5 cm), multiple impacted CBD stones. Initial ERCP attempts, including sphincterotomy and 15-mm balloon dilation, failed to clear the stones. As a bridging strategy, two plastic stents (10 Fr and 7 Fr) were placed, and ursodeoxycholic acid therapy was started. On re-evaluation at 50 and 80 days, stone clearance was achieved using simple balloon extraction - without lithotripsy or cholangioscopy - using the same tools as the initial ERCP.</p><p><strong>Conclusion: </strong>Double plastic stent placement can serve as an effective interim measure for complex CBD stones, facilitating complete clearance in subsequent ERCP with standard equipment.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"670-674"},"PeriodicalIF":0.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Lactulose-Induced Intussusception: A Rare Complication of Juvenile Colonic Polyp.","authors":"Haizhi Tan, Xiaobing Xiao, Taotao Zhang, Shuyan Li","doi":"10.1159/000547462","DOIUrl":"10.1159/000547462","url":null,"abstract":"<p><strong>Introduction: </strong>As an osmotic laxative, lactulose offers superior palatability and comparable bowel-cleansing efficacy to PEG, making it suitable for resource-limited settings, but its hypertonicity may potentially increase the risk of intussusception in susceptible individuals (such as children with intestinal polyps).</p><p><strong>Case presentation: </strong>This first reported case describes a 2-year-old boy with intermittent hematochezia who developed acute descending colonic intussusception confirmed by CT within hours of receiving lactulose (20 mL) for bowel preparation. Laparoscopic reduction and subsequent colonoscopy identified a large pedunculated juvenile polyp (25 × 28 mm) as the pathological lead point, which was endoscopically resected. The temporal link between lactulose administration and symptom onset, combined with its known pharmacological effects, strongly suggests lactulose-induced hyperperistalsis precipitated intussusception by mechanically displacing the occult polyp.</p><p><strong>Conclusion: </strong>This highlights a novel risk of osmotic laxatives in children with undiagnosed intestinal polyp.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"659-663"},"PeriodicalIF":0.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Candida tropicalis</i> Spontaneous Fungal Peritonitis in a Patient with Liver Cirrhosis: A Case Report.","authors":"Adam Rushford, Joshua Haron Abasszade, Bryan Tan, Rupa Kanapathipillai, Sally J Bell","doi":"10.1159/000547976","DOIUrl":"10.1159/000547976","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous fungal peritonitis is a less common yet serious complication of liver cirrhosis with high mortality rates. Awareness of spontaneous fungal peritonitis may improve patient outcomes by increasing early identification and treatment.</p><p><strong>Case presentation: </strong>We present a case of a 66-year-old female who was admitted to an Australian tertiary hospital with abdominal tenderness and distension on a background of Child-Pugh C liver cirrhosis secondary to increased alcohol intake. Ascitic fluid culture identified the fungus <i>Candida tropicalis</i> as the causative pathogen of spontaneous fungal peritonitis.</p><p><strong>Conclusion: </strong>We outline appropriate investigations, and management in treating <i>C. tropicalis</i> spontaneous fungal peritonitis, a rare pathogen in spontaneous peritonitis complicating cirrhosis.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"664-669"},"PeriodicalIF":0.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}