Duodenal Ganglioneuroma: A Rare Tumor Causing Upper Gastrointestinal Bleed

Neuroblastic tumors (NTs) include neuroblastoma, ganglioneuroblastoma, and ganglioneuroma (GN). They are very rare in adults. The Surveillance, Epidemiology, and End Results identified 144 patients ≥20 years old at diagnosis (6.1%) from 1973 to 2002. GNs account for 14% of all localized NT. Since 1957, a total of four cases of GN of the duodenum have been reported. We report a novel case of GN of the periampullary region in the duodenum in a 41-year-old man presenting with chronic upper gastrointestinal bleed. Given the rarity of GNs in this age group and the nonspecificity of radiological features, this diagnosis is often missed until histopathology is done. This may negatively affect the prognosis of an otherwise well-prognosticated disease.

Solid Pseudopapillary Neoplasm of the Pancreas - A rare entity with emphasis on the differential diagnosis.

Solid Pseudopapillary Neoplasm of Pancreas (SPNP) is a rare, low-grade malignant solid-cysticneoplasm with papillary architecture. It accounts for 2% to 3% of pancreatic neoplasms and 0.9% to2.7% of exocrine pancreatic neoplasms. It occurs almost exclusively in young women and has anexcellent postsurgical curative rate. Metastasis is rare although it may be locally aggressive. Thesolid pseudopapillary neoplasm of the pancreas pose a diagnostic challenge both clinically andradiologically as it has a nonspecific clinical presentation with vague radiologic features.Histopathological evaluation and immunohistochemistry remains the gold standard in reaching adefinitive diagnosis. Due to its low incidence, the clinical and pathologic features of SPNP have notbeen extensively studied. We report a case of a 32-year-old lady with solid pseudopapillaryneoplasm of the pancreas that was suspected on abdominal CECT as a well-defined mass in theampullary-periampullary region abutting head of the pancreas and confirmed on histopathologicalevaluation with immunohistochemistry.

Haemobilia in a previously stented hilar cholangiocarcinoma: successful haemostasis after the insertion of fcSEMS

Haemobilia describes blood loss from the biliary tract and classically presents as Quincke’s triad: upper gastrointestinal bleeding (UGIB), jaundice and right upper quadrant abdominal pain. We discuss the case of a 70-year-old male with a previously stented Bismuth 1 hilar cholangiocarcinoma who presented with haematemesis. He had a similar presentation a month ago where a forward viewing gastroscope identified fresh and altered blood in the distal stomach but no clear source of bleeding. During this admission, a side-viewing duodenoscope identified bleeding from the periampullary region, which was managed by inserting a fully covered self-expanding metal stent (fcSEMS) within his pre-existing uncovered SEMS to tamponade the haemorrhage. This case highlights the importance of using a side-viewing duodenoscope for patients with UGIB on a background of a stented cholangiocarcinoma and inserting a fcSEMS within an uncovered SEMS is feasible and effective in managing these patients.