Herein, we report a rare case of pancreatic metastasis originating from a malignant phyllodes tumor of the breast. A 45-year-old woman initially underwent a partial mastectomy for malignant phyllodes tumor of the left breast, followed by a total mastectomy for local recurrence. Six years later, the patient presented with abdominal pain. Computed tomography revealed a heterogeneous mass with cystic degeneration in the pancreatic tail, morphologically resembling the previously resected breast lesions. Based on the patient's history and imaging findings, pancreatic metastasis from malignant phyllodes tumor was suspected. Endoscopic ultrasound-guided fine-needle aspiration of the solid component was performed, and histopathological examination revealed a sheet-like proliferation of atypical cells with spindle-shaped enlarged nuclei within an eosinophilic stroma. Immunohistochemical staining for AE1/3 cytokeratin was negative, consistent with metastatic malignant phyllodes tumor. The patient declined further treatment and died approximately two months after diagnosis.

Plozasiran (Redemplo®) is a small interfering RNA that reduces hepatic production of apolipoprotein C-III and circulating triglycerides. It degrades ApoC-III mRNA and results in reduced levels of hepatic and serum ApoC-III protein, which leads to an increased clearance of serum triglycerides. In the phase 3 PALISADE trial, plozasiran 25 mg reduced fasting triglyceride levels by approximately 80% at 10 months in patients with familial chylomicronemia syndrome (FCS) and was associated with a lower incidence of pancreatitis compared with placebo. This provides supportive, yet not definitive, evidence for pancreatitis prevention as the PALISADE trial was powered to investigate triglyceride lowering. Across completed clinical studies, plozasiran demonstrated a generally favorable safety profile, with a low incidence of thrombocytopenia and adverse events primarily limited to abdominal pain, nasopharyngitis, headache, and nausea. Hyperglycemia was observed in some patients with preexisting diabetes or prediabetes at baseline. Ongoing phase 3 trials (SHASTA-3, SHASTA-4, SHASTA-5, SHASTA-10, MUIR-3 and CAPITAN) are further evaluating the efficacy and safety of plozasiran in broader populations with hypertriglyceridemia, including its potential role in reducing cardiovascular risk and preventing pancreatitis. Compared with earlier ApoC-III-targeted antisense oligonucleotides, plozasiran offers the advantages of less frequent dosing, sustained pharmacodynamic effects, and potentially a more favorable tolerability profile based on indirect evidence, positioning it as a promising therapeutic option for patients with FCS and other severe hypertriglyceridemia disorders inadequately managed with existing therapies.

Histoplasmosis is an endemic mycosis in certain regions of Brazil and represents a rare opportunistic infection in solid organ transplant recipients. This report describes the case of a 68-year-old female liver transplant recipient (due to Caroli disease) who presented with abdominal pain, nausea, vomiting, and a distended, tender abdomen. Abdominal computed tomography revealed parietal thickening of the bowel wall, and colonoscopy identified polymorphic ulcers and ileocecal stenosis. Given the suspicion of tuberculosis, chest computed tomography was performed, which demonstrated pulmonary opacities. Although testing for acid-fast bacilli was negative, fungal staining was positive for Histoplasma capsulatum. Antifungal therapy with amphotericin B was initiated; however, due to clinical refractoriness, surgical intervention was required, including ileocecal resection with ileo-ascending anastomosis. A reoperation was performed due to postoperative complications, resulting in the creation of a terminal ileostomy. Following this intervention, the patient showed clinical improvement and tolerated an oral diet. This case highlights an atypical presentation of disseminated histoplasmosis with pulmonary and intestinal involvement, culminating in intestinal subocclusion in a late-stage liver transplant recipient. It underscores the importance of considering histoplasmosis in the differential diagnosis of immunosuppressed patients and the need for early investigation and treatment.

Cystic lymphangiomas of the abdominal cavity are rare benign lymphatic malformations that can be difficult to distinguish from other cystic abdominal tumors on preoperative imaging. The present study reported a rare case of a giant abdominopelvic cystic lymphangioma in a 16-year-old female who presented with abdominal pain following exercise and was initially suspected to have a benign ovarian tumor. Despite comprehensive imaging evaluation, however, a definitive diagnosis could not be established preoperatively. The final diagnosis of abdominal cystic lymphangioma was confirmed by histopathological examination following surgical resection. The present case has highlighted the rarity and diagnostic challenge of differentiating abdominal cystic lymphangiomas from large benign ovarian tumors in adolescents. It underscores the importance of maintaining a broad differential diagnosis when evaluating abdominopelvic cystic masses in young females. Surgical resection remains the cornerstone of treatment and is associated with favorable outcomes, and regular postoperative follow-up is essential to detect recurrence.

Abdominal masses in solid organ transplant recipients present a diagnostic challenge, as immunosuppression increases the risk of malignancies such as post-transplant lymphoproliferative disorder (PTLD) and gastrointestinal stromal tumors (GISTs). These entities frequently involve the bowel and may manifest with nonspecific or vague abdominal symptoms, making differentiation between benign and malignant small bowel obstruction (SBO) critical for appropriate management and prognosis. We present the case of a kidney transplant recipient on chronic immunosuppression who developed intermittent abdominal pain and nausea, ultimately diagnosed with partial SBO. Cross-sectional imaging revealed a jejunal mass concerning for lymphoma. However, surgical exploration demonstrated jejunal erosion by a previously placed surgical mesh with an associated fecalith, mimicking neoplastic disease. The patient underwent segmental bowel resection with mesh removal, leading to complete resolution of symptoms. This case highlights the importance of maintaining a broad differential diagnosis when evaluating intra-abdominal masses in transplant recipients, particularly in those with a history of prior surgery and mesh placement. Awareness of this potential mimic is essential to avoid misdiagnosis and ensure timely surgical management.

Ulcerative colitis (UC) demonstrates a bimodal incidence distribution, with a significant second peak and the highest prevalence observed in individuals aged ≥60 years. The pathogenesis of elderly UC involves immunosenescence-manifested by Th17/Treg imbalance and the accumulation of cells with a pro-inflammatory senescence-associated secretory phenotype (SASP)-alongside age-related dysbiosis, increased intestinal permeability, and mitochondrial dysfunction that impairs mucosal regeneration. Clinically, older patients more frequently present with left-sided colitis, characterized by anemia and weight loss, while abdominal pain is less common. Managing geriatric UC is challenging due to inadequate colonoscopy preparation and complex differential diagnosis (e.g., colorectal cancer, ischemic colitis). Furthermore, older adults face a fivefold increased risk of Clostridioides difficile infection and a sharply rising risk of colorectal cancer if diagnosed after 70 years of age. While 5-aminosalicylic acid remains the first-line therapy, it requires renal monitoring. Conversely, steroids increase infection and osteoporosis risks, thiopurines are restricted due to myelotoxicity and malignancy risks, and among biologics, vedolizumab offers better safety than anti-TNF agents. Ultimately, managing UC in older adults requires a comprehensive, multidisciplinary approach that accounts for multimorbidity, polypharmacy, nutritional status, and mental health to optimize pharmacotherapy and mitigate high-risk surgical interventions.

Hypophosphatemia is a complex electrolyte disturbance with diverse etiologies, including decreased intestinal absorption, increased renal loss, intracellular redistribution, and medication effects. We present a diagnostically challenging case of severe, persistent hypophosphatemia in a 39-yr-old female with a history of renal transplantation, chronic gastrointestinal disease, and osteoporosis. The patient presented with acute abdominal pain, nausea, and constipation and was found to have profound hypophosphatemia (<0.3 mmol/L), hypocalcemia, and hypokalemia. Her recent medical history included administration of i.v. ferric carboxymaltose and denosumab, both known to induce hypophosphatemia via FGF23-mediated renal phosphate wasting and secondary hyperparathyroidism. Additional contributing factors in her case included renal tubular acidosis, tertiary hyperparathyroidism, tacrolimus-induced tubular dysfunction, and significant gastrointestinal losses due to prior bowel resections and acute ileus. Despite aggressive i.v. and oral phosphate supplementation, hypophosphatemia persisted, necessitating prolonged therapy and multiple hospital admissions. Reduction of tacrolimus and correction of acidosis improved phosphate reabsorption, but recurrent episodes highlighted the multifactorial nature of her condition. This case underscores the importance of a systematic, multidisciplinary approach to diagnosing and managing hypophosphatemia, particularly in patients with overlapping risk factors and complex medical histories. Clinicians should maintain a high index of suspicion for delayed and persistent hypophosphatemia in at-risk populations especially following parenteral iron and antiresorptive therapies. Early recognition, regular monitoring, and individualized management are essential to prevent serious complications and improve patient outcomes.