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Volume 85 - 2022 - Fasc.4 - Clinical images

Black pigmented dysphagia

A 63-year-old male of Turkish origin was referred to our department for further investigation of dysphagia for solids since 2 years with recent occurrence of food impaction. The patient had no significant medical history besides smoking. There was no mention of weight loss or other systemic complaints. Upper gastrointestinal endoscopy showed a large subobstructive pedunculated mass in the lower thoracic esophagus. The lesion was remarkably pigmented and seemed to be infused with Chinese ink (see figure 1). Biopsies were taken.


A case of dysphagia post-surgery

A 71-year-old male patient presented to the outpatient clinic with ongoing dysphagia, intermittent bouts of severe epigastric pain and weight loss. He had undergone hiatal hernia repair four years prior due to similar complaints, but this did not alter his symptoms. Postoperative evaluation with gastroscopy, esophageal manometry and esophageal X-ray was suggestive of distal esophageal spasms, for which nitroglycerine and calcium channel blockers were tried, without effect. Four years after surgery, he reports worsening dysphagia for solid but not for liquid meals, with a recent weight loss of 5kg over a few months. Repeat endoscopy and abdominal CT scan were unremarkable except for the postoperative state, esophageal X-ray showed reduced primary peristalsis with tertiary contractions and limited stasis of contrast in a slightly dilated distal esophagus.


Cholestasis in a cancer patient: think about the unicorn

A 76-year-old male was referred for ongoing cholestasis of unclear origin. He had a stage IIIA non-small-cell lung carcinoma, treated for six months with adjuvant durvalumab after initial treatment with chemoradiotherapy. Durvalumab was halted three months ago after achieving stable disease for four consecutive months. Cholestasis was moderate with alkaline phosphatase (ALP) 5 x upper limit of normal (ULN), gamma-glutamyltransferase (GGT) 21 x ULN and normal bilirubin. There was one single episode of spontaneously transient postprandial abdominal pain a couple weeks before, besides absence of fever and pruritus. Viral serology and an auto-immune panel were negative, IgG4 was low. Computed tomography (CT) evaluation during his oncological follow up is shown in Figure 1. Relevant findings of an endosonographic (EUS) evaluation are shown in Figure 2.


A yellow sign indicating danger ahead

A 59-year-old man presented with chronic complaints of dyspepsia and early satiety. Pantoprazole 20mg once daily did not relieve his symptoms. He did not report dysphagia nor any unintentional weight loss. A gastroscopy was performed and showed diffuse atrophic gastritis. In the gastric antrum a yellow lesion was seen, which felt hard upon palpation with the biopsy forceps (figure 1). Inspection of the duodenum and esophagus was normal. What is your diagnosis?