Achalasia is an esophageal motility disorder marked by impaired lower esophageal sphincter relaxation and absent peristalsis. Rarely, it occurs as a paraneoplastic syndrome, especially with small cell lung cancer (SCLC) and anti-Hu antibodies. We report a 74-year-old woman with prior limited-stage SCLC who developed progressive dysphagia and weight loss. Workup showed anti-Hu positivity and type II achalasia on manometry, with stable lung nodules. Botulinum toxin and IVIG provided minimal benefit, but POEM led to significant symptom improvement and resolution of esophageal retention.
Lupus enteritis may precede recognition of systemic lupus erythematosus. A 40 year-old woman experienced self-limiting episodes of abdominal pain, nausea, vomiting, and diarrhea in April and May 2026. Upper gastrointestinal endoscopy in May, as symptoms were subsiding, showed no significant abnormalities; colonoscopy with rectal biopsy was nondiagnostic. In July, recurrent symptoms prompted admission. C-reactive protein was 0.16 mg/dL despite extensive small-bowel wall edema, mesenteric vessel engorgement, ascites, and bilateral urinary tract dilatation without mechanical obstruction on computed tomography. Routine stool culture and Clostridioides difficile toxin testing and culture were negative. High-titer antinuclear antibodies, anti-Sm antibodies, hypocomplementemia, and leukopenia supported a new diagnosis of systemic lupus erythematosus. The integrated findings favored lupus enteritis with suspected lupus-associated urinary tract involvement. Prednisolone treatment was followed by clinical and radiological improvement. At approximately 12 weeks, there was no clinical relapse, and prednisolone had been tapered to 15 mg/day. This case illustrates how recurrent apparently self-limiting gastrointestinal episodes, nondiagnostic interval endoscopy, a minimal C-reactive protein response despite extensive imaging abnormalities, and unexplained urinary tract dilatation can together prompt recognition of previously undiagnosed systemic lupus erythematosus.
Pancreatic metastasis from thymic carcinoma is exceedingly rare and difficult to distinguish from primary pancreatic neoplasms based on imaging alone. We report a case of pancreatic and hepatic metastases from thymic carcinoma diagnosed by endoscopic ultrasound-guided tissue acquisition (EUS-TA), which directly influenced therapeutic management. A 74-year-old woman with a history of resected thymic carcinoma and hepatic metastasectomy presented with newly detected pancreatic and hepatic masses. Contrast-enhanced computed tomography and magnetic resonance imaging demonstrated a hypoenhancing pancreatic lesion with heterogeneous enhancement. Although the findings were nonspecific, they were atypical for conventional pancreatic ductal adenocarcinoma because the main pancreatic duct remained patent without upstream dilatation or pancreatic atrophy. EUS-TA using a 22-gauge Franseen needle provided sufficient tissue for histopathological and immunohistochemical evaluation. The pancreatic lesion showed morphological and immunohistochemical concordance with both the previously resected primary thymic carcinoma and hepatic metastasis, confirming metastatic disease. Histological diagnosis established systemic recurrence, avoided unnecessary pancreatic resection, and led to stereotactic body radiation therapy followed by systemic chemotherapy, resulting in tumor regression. This case highlights the pivotal role of EUS-TA in establishing an accurate diagnosis and guiding appropriate therapeutic management.
Double common bile duct (DCBD) is an extremely rare biliary anomaly with subtype-dependent oncological risk. We report a case of DCBD (Choi classification type Vb) complicated by gallbladder cancer. A 75-year-old woman was incidentally found to have a gallbladder fundus tumor on screening ultrasonography. Preoperative imaging suggested gallbladder cancer within clinical T3 or less. Biliary evaluation by magnetic resonance cholangiopancreatography (MRCP), drip infusion cholangiography-computed tomography (DIC-CT), and endoscopic retrograde cholangiopancreatography (ERCP) confirmed Choi type Vb DCBD without pancreaticobiliary maljunction (PBM). The patient underwent open extended cholecystectomy with a stepwise intraoperative strategy guided by frozen section analysis. Frozen section confirmed adenocarcinoma; as the cystic duct margin was tumor-free, lymph node dissection was limited to the cystic duct nodes without hepatoduodenal ligament dissection. Final pathology: adenocarcinoma (well to moderately differentiated), pT1b, pN0 (0/3), pStage IB (Union for International Cancer Control [UICC] 9th edition), pR0. The patient was discharged on postoperative day 11 and remained recurrence-free at 6 months. To our knowledge, this is the fourth reported type Vb DCBD case in the English-language literature and the first associated with gallbladder cancer. Preoperative evaluation of biliary anatomy, including PBM status, and a stepwise intraoperative approach are essential for safe and oncologically appropriate management.
An 82-year-old woman underwent endoscopic submucosal dissection for a 10-mm early gastric cancer lesion on the lesser curvature of the gastric angle. The lesion was resected en bloc without any adverse events, and the patient was discharged uneventfully. Follow-up esophagogastroduodenoscopy performed 2 months later showed healing of the post-endoscopic submucosal dissection ulcer. However, at 4 h after the esophagogastroduodenoscopy procedure, the patient developed hematemesis while in the hospital and underwent cardiopulmonary resuscitation because of a weakly palpable carotid pulse. Contrast-enhanced computed tomography revealed a pseudoaneurysm in the right gastric artery along the lesser curvature of the gastric angle, with extravasation of contrast medium into the stomach. Emergency interventional radiology was performed, and hemostasis was achieved by transcatheter arterial embolization with N-butyl-2-cyanoacrylate. Although there are very few reported cases of ruptured pseudoaneurysm leading to hemorrhagic shock after gastric endoscopic submucosal dissection, pseudoaneurysm rupture should be considered among differential diagnoses when patients present with hematemesis or melena accompanied by shock, and contrast-enhanced computed tomography should be performed.
