Volume 88 - 2025 - Fasc.1 - Case reports
Pancreatic cystic lymphangioma in an adult: a rare clinical entity
We report the case of a 24-year-old patient with abdominal
discomfort and weight loss. On imaging, a large unilocular cystic
lesion originating from the pancreatic body and tail was seen.
Endoscopic fine needle aspiration revealed a slightly elevated lipase,
suggesting a connection with the pancreatic duct. Furthermore, the
liquid appeared chylous, and markedly elevated triglycerides were
noted. A transgastric drainage and biopsies of the cyst wall were
performed. The diagnosis of a pancreatic cystic lymphangioma was
made. Our patient was successfully managed conservatively by an
echoendoscopic transgastric drainage.
An unusual hidden secret of a Meckel’s diverticulum: a rare case of small bowel adenocarcinoma
A Meckel’s diverticulum (MD) is the most prevalent congenital
anomaly of the gastro-intestinal tract and the life-long risk for
complications is estimated to be around 4%, mostly resulting in
bleeding, obstruction, diverticulitis or intussusception. Although
rare, about 3.1-5.1% of the complications are due to malignant
evolution of the MD.
Case: We present a 50-year old patient with progressive
subobstructive symptoms leading the diagnosis of a complicated
MD. Peroperative findings were suggestive for malignancy and the
histopathological samples confirmed the presence of a metastatic
adenocarcinoma, arising from the MD.
Conclusion: This case illustrates a rare, malignant complication
of a MD. This finding is of utmost clinical importance because the
diagnosis may be challenging and early detection may improve
the outcome of these patients. The clinician should be aware that
malignant evolution of a MD exists and should be excluded in
complicated cases.
Unexplained portal hypertension and confusion in an elderly patient: a late presentation of congenital hepatic fibrosis
A 71-year old male patient with myelodysplastic syndrome
presented with severe signs of portal hypertension. There was
no underlying cirrhosis nor portal vein thrombosis. Despite liver
stiffness being high, hepatic vein catheterisation failed to show
an increased hepatic venous pressure gradient compatible with
clinically significant portal hypertension. Finally, a liver biopsy
showed enlarged fibrotic portal tracts with multiple dilated
immature bile ducts compatible with congenital hepatic fibrosis
– there was no macroscopic biliary disease. Mostly presenting in
childhood or adulthood, congenital hepatic fibrosis is an uncommon
cause of non-cirrhotic portal hypertension that can also have a
late presentation. Treatment is supportive with management of
portal hypertension (and its complications); liver transplantation
is curative but is reserved for cases with liver failure or recurrent
cholangitis (mostly in Caroli syndrome).
An unusual case of acute cholestatic hepatitis: visceral leishmaniasis with secondary haemophagocytic lymphohistiocytosis
Visceral leishmaniasis (VL) is a severe vector-borne parasitic
disease, endemic in various tropical countries but also in the
Mediterranean Basin. We report the case of a 64-year-old
immunocompetent male, who presented with jaundice, fever,
splenomegaly, hyperferritinaemia and cytopenias after a recent trip
to Portugal. Clinical and biochemical findings were consistent with
the diagnosis of an acute cholestatic hepatitis and haemophagocytic
lymphohistiocytosis (HLH), secondary to visceral Leishmania
infantum which was later confirmed by bone marrow examination.
Despite adequate therapy with liposomal amphotericin B, the
disease and HLH relapsed. Retreatment with higher dosing was
eventually successful. This case highlights the risk of acquiring VL
in southern Europe and its possible unusual presentations, causing
diagnostic delay, as well as its complex management that requires
appropriate multidisciplinary communication.
