Colonic involvement by non-Hodgkin lymphoma is uncommon and can closely mimic colorectal adenocarcinoma on endoscopic and radiological grounds. We report the case of a 56-year-old woman presenting with abdominal pain and anemia, in whom colonoscopy revealed a large cecal mass extending into the ascending colon. Histological and immunohistochemical evaluation confirmed diffuse large B-cell lymphoma of non-germinal center phenotype. Staging studies revealed extensive nodal involvement, including supradiaphragmatic lymphadenopathy, establishing stage IV disease inconsistent with a strictly primary colorectal lymphoma. Systemic immunochemotherapy (R-CHOP) was initiated; after four cycles, a partial response was observed on analytical and radiological grounds, without the need for surgery to date. This case highlights the diagnostic challenge posed by bulky cecal masses mimicking colorectal cancer and underscores the importance of adequate biopsy, immunophenotypic characterization, and complete staging to guide appropriate multidisciplinary management.

Pancreatic duct disruption may cause massive pancreatic ascites and mimic malignant or inflammatory peritoneal disease. A 57-year-old man developed progressive abdominal distension after blunt upper-abdominal trauma. Ascitic-fluid amylase was markedly elevated, whereas magnetic resonance cholangiopancreatography showed only mild pancreatic duct dilatation without a visible leak. After approximately 20 days of unsuccessful conservative treatment, endoscopic retrograde pancreatography was performed. Following failed major-papilla cannulation, access through the minor papilla demonstrated a partial pancreatic duct disruption at the pancreatic neck. The guidewire was advanced into the upstream pancreatic duct, and a 5-Fr × 7-cm single-pigtail plastic stent was placed across the leak. Ascitic-fluid amylase rapidly decreased and the ascites markedly improved. The stent was removed 3 months later, and no recurrent ascites occurred during the subsequent 6-month follow-up. Minor-papilla access may provide a rescue route for bridging pancreatic duct disruptions when conventional access fails.

We read with great interest the article by Caballeros Lam et al. The authors show that low-dose thoracic computed tomography (CT) enables the detection of severe coronary artery calcifications in liver transplant recipients. As expected, severe coronary artery calcifications were associated with adverse cardiovascular events. The authors conclude that low-dose CT should be performed for lung cancer screening and for cardiovascular risk stratification in liver transplant recipients who smoke. Their findings are similar to the recently published from the Danish Comorbidity in Liver Transplant Recipients (DACOLT) study, although DACOLT used coronary CT angiography and these examinations are not interchangeable. DACOLT data show that living with a transplanted liver is associated with higher odds of any coronary atherosclerosis (odds ratio [OR]: 2.2), obstructive coronary atherosclerosis (OR: 2.7), and obstructive-extensive coronary atherosclerosis (OR: 3.9). Moreover, among individuals with any coronary atherosclerosis, liver transplant recipients had higher odds of having high-risk plaque than population control subjects (OR: 2.1). DACOLT investigators were unable to find an association of tobacco with coronary atherosclerosis, although this was probably related to limited power and confounding factors. Koshy et al. were also unable to find a significant association between tobacco consumption and progression of coronary atherosclerosis, although this could be expected due to the low number of liver transplant recipients they studied (n=30).

Follicular cholangitis is a rare entity that may closely mimic cholangiocarcinoma, leading to high-impact therapeutic decisions. We report the case of a 50-year-old woman with asymptomatic cholestatic liver enzyme abnormalities whose imaging studies were initially interpreted as infiltrating intrahepatic cholangiocarcinoma. However, histopathological examination of the surgical specimen established the diagnosis of follicular cholangitis. Persistence of cholestatic liver enzyme abnormalities after surgery prompted the initiation of immunosuppressive therapy, resulting in a favourable clinical and biochemical response. This case highlights the diagnostic challenges posed by follicular cholangitis and suggests that the inflammatory process may extend beyond the macroscopically identifiable lesion.

Sinusoidal obstruction syndrome (SOS) is an uncommon hepatic vascular complication classically associated with haematopoietic stem cell transplantation, although it may also occur following oxaliplatin-based chemotherapy. We report the case of a 52-year-old woman with stage III colon adenocarcinoma treated with adjuvant CAPOX who developed jaundice, ascites, rapid weight gain, thrombocytopenia, and severe liver dysfunction three weeks after completing chemotherapy. After other causes of acute liver injury had been excluded, Doppler ultrasound demonstrated reversal of portal venous flow and signs of portal hypertension consistent with SOS. Given the severity and rapid progression of the condition, treatment with defibrotide was initiated alongside supportive care, resulting in rapid clinical, biochemical, and radiological improvement. This case highlights that SOS may occur early, even after limited exposure to oxaliplatin in the adjuvant setting. Early recognition and assessment with hepatic Doppler ultrasound are essential to establish the diagnosis and initiate prompt treatment.

Esophagogastric intramural hematoma is rare and may mimic varices or an upper gastrointestinal neoplasm. We report a hemodynamically stable patient receiving long-term aspirin therapy who developed melena after gastroscopy and colonoscopy at a referring hospital. Contrast-enhanced computed tomography showed a continuous hyperattenuating mural lesion extending approximately 16 cm from the distal esophagus across the esophagogastric junction into the cardia and gastric fundus, with a 3.8 × 2.6 cm mass-like fundal component and no active contrast extravasation, perforation or radiological evidence of portal hypertension. Endoscopy revealed bluish, varix-like submucosal bulging. Conservative treatment and temporary aspirin withdrawal resulted in substantial hematoma regression within six days, with subsequent ulcer formation in the distal esophagus and cardia. Biopsy of the cardial ulcer showed no evidence of malignancy. No recurrent bleeding or related symptoms occurred during one-month follow-up.

Eosinophilic gastrointestinal disorders (EGIDs) comprise a group of rare diseases characterized by eosinophilic infiltration of the gastrointestinal tract exceeding that observed under physiological conditions. Non-esophageal EGIDs are uncommon, with an estimated prevalence of 1-20 cases per 100,000 individuals, and the majority of reported cases occur in adolescent males. We describe a rare case of eosinophilic gastroenteritis most likely associated with egg allergy in a 70-year-old patient. Implementation of an egg-elimination diet resulted in complete clinical remission and marked improvement in laboratory parameters, including peripheral eosinophil counts and total as well as egg-specific IgE levels. Significant reductions were also observed in IgE sensitization to egg white, egg yolk, and major egg allergens, including ovalbumin and ovomucoid. To our knowledge, only a few cases of eosinophilic gastroenteritis have been reported in elderly patients, and no cases associated with food allergy in this age group have been identified in the published literature.

The Spanish Society of Gastroenterology (SEPD) has developed a position paper on the strategic analysis of the gastroenterology specialty in relation to the current situation and future outlook of the Spanish healthcare system. The analysis and its proposals were based on the consensus of a group of experts with recognized expertise in the specialty, selected by the ESG, who conducted an external and internal analysis and developed the SWOT and CAME matrices to identify strategic lines and general objectives for the gastroenterology specialty. As a result of this analysis, six strategic lines were defined: 1. to develop the concept of "comprehensive digestive health"; 2. to contribute to the transformation of the healthcare system towards a model of care that more effectively achieves the "quintuple aim"; 3. to adapt the training of gastroenterology specialists to current needs, both in specialty training and in continuing professional development; 4. improve the quality of digestive healthcare; and 5. ensure an adequate level of quality across all centres and regions, promote research and innovation, and 6. To position the gastroenterology specialty as a reference for healthcare policy decision-making and for the society. These strategic priorities should help position the specialty of Gastroenterology as a key area for public health, technological innovation, quality of care, and the sustainability of the Spanish National Health System.

Colonic diverticular bleeding (CDB) is the most common cause of lower gastrointestinal bleeding. Endoscopic hemostasis plays a critical role in the management of CDB; however, even after initially successful hemostasis, CDB is still associated with a high rebleeding rate. We report a case of CDB successfully managed with a combination of thermal coagulation and clipping. For selected cases, this combined approach may help reduce the risk of recurrence of CDB.

Gastric metastasis from clear cell renal cell carcinoma is uncommon and may mimic a primary gastric neoplasm. We report a man in his late sixties with a 0.6-cm reddish protruding gastric lesion initially interpreted as fundic gland-type adenocarcinoma, mainly on the basis of morphology and an initial immunohistochemical panel. Targeted forceps biopsy showed small nests of tumor cells in the lamina propria. Endoscopic submucosal dissection, performed under the working diagnosis of early primary gastric neoplasia, showed no residual malignancy, probably because the minute focus had been largely removed by biopsy. Subsequent nephrectomy confirmed clear cell renal cell carcinoma. Additional immunohistochemistry of the gastric biopsy showed PAX8, CAIX, CK8/18, partial CD10 and focal RCC marker positivity, supporting gastric metastasis. This case highlights the importance of renal-lineage immunohistochemistry in small gastric lesions with unusual morphology.