Clinical Case Summary

Background: Acute liver failure (ALF) due to metastatic melanoma is rare and may mimic other hepatic pathologies, including Budd-Chiari syndrome. In the absence of cutaneous lesions, diagnosis can be delayed, complicating timely management.
Case Presentation: A 61-year-old male with a history of hypertension and dyslipidemia presented with a two-week history of abdominal pain, anorexia and jaundice. He had no prior liver disease or alcohol use. Laboratory workup revealed hyperbilirubinemia (90 µmol/L), coagulopathy (INR 1.72), and hepatocellular injury (ALT 500 IU/L, AST 800 IU/L). Viral hepatitis were excluded. Ultrasound maging demonstrated hepatomegaly, heterogeneous liver parenchyma and minimal ascites. The patient developed hepatic encephalopathy (GCS 11, West Haven grade 3) with hyperammonemia (300 µmol/L) and was transferred to a transplant center. MSCT revealed a massively enlarged liver (32x25x31 cm), fatty infiltration, right and middle hepatic vein compression, left hepatic vein thrombosis and intrahepatic IVC obliteration, suggesting Budd-Chiari syndrome syndrome and urgent pre-transplant workup. Rapid deterioration ensued with encephalopathy, renal failure (eGFR 30), worsening coagulopathy (INR 3.5), hyperbilirubinemia (190 µmol/L), lactic acidosis and hypoglycemia, requiring ICU care, intubation, vasopressors and dialysis. Percutaneous liver biopsy showed near-total hepatic replacement by necrotic spindle-shaped, HMB-45-positive pigmented tumor cells, confirming metastatic melanoma. Liver transplantation was contraindicated, and the patient died two days later. A uveal melanoma origin was suspected but unconfirmed due to lack of autopsy.
Conclusion: Metastatic melanoma can present without skin lesions and may mimic Budd-Chiari syndrome. Infiltrative malignancy should be considered in ALF of unclear etiology. Liver biopsy remains essential for diagnosis. Early multidisciplinary evaluation is critical to guide prognosis and avoid futile interventions.

Introduction

Chronic pancreatitis (CP) is a progressive inflammatory disorder that predisposes patients to various complications, including vascular events. Among these, splenic vein thrombosis (SVT) represents a siginficant, but often underdiagnosed complication, with reported prevalence rates varying widely. SVT may lead to sinistral portal hypertension, resulting in gastric varices and, in severe cases, life-threatening gastrointestinal hemorrhage. This systematic review and meta-analysis aims to determine the true pooled prevalence of SVT in CP patients and to evaluate the bleeding rate among those with splenic thrombosis by synthesizing data from studies in which all participants underwent appropriate imaging for SVT detection.

Aims & Methods

An exploratory search was conducted to identify key articles reporting on the prevalence of SVT among CP patients. Four studies were selected based on their provision of relevant, poolable data on prevalence with the use of proper imaging techniques for detecting SVT, encompassing a total of 1,973 patients. A random effects meta‐analysis was performed using SPSS, and a forest plot was genrated to visually represent both individual and overall prevalence estimates. An ongoing PRISMA compliant systematic literature search continues to capture all pertinent studies on this topic.

Results

Analysis of data from the four selected studies (n = 1,973) revealed a pooled SVT prevalence of 12.7% in CP patients. Although individual study estimates varied, likely reflecting differences in study design, CP etiology, and follow-up duration, the overall result indicates that approximately one in eight patients with CP develops SVT.

Conclusion

Our preliminary findings demonstrate that, when appropriate imaging is employed, SVT occurs in approximately 12.7% of chronic pancreatitis cases. These results underscore the clinical importance of SVT, particularly given its association with an increased risk of gastrointestinal hemorrhage. Routine evaluation for SVT in CP patients should be considered, and further research is warranted to elucidate underlying risk factors and to refine management strategies for this potentially life-threatening vascular complication.

Introduction

Aims & Methods

The purpose of this study is to evaluate the feasibility of extracting RNA in sufficient quantity and quality to perform genomic analyses from specimens obtained through EUS-fine needle aspiration (EUS-FNA) of PanNENs, comparing three methods of RNA preservation and extraction.

Results

Conclusion

Introduction

Pancreatic neuroendocrine tumors (NETs) are rare neoplasms that are classified as functional (F-NET) or nonfunctional (NF-NET) depending on the presence or absence of excess hormone production. Endoscopic Ultrasound guided fine needle aspiration (EU-FNA) is often used to diagnose NETs but there are limited data on its sensitivity for this purpose.

Aims & Methods

To determine the sensitivity of EUS-FNA for the diagnosis of a NET.
A prospective randomized trial study, from May 2013 to Abril 2025 was performed in a referred Gastrointestinal hospital in Brazil. A total of 184 patients underwent EUS for suspected NETS and collected materials from fine needle aspiration and sent to histopathology analyzes. The diagnosis of a NET was confirmed by: 1) EUS-FNA with or without confirmatory immune chemistry (ICC) with synaptophysin and chromogranin form pancreatic mass or metastatic site; or 2) an alternative biopsy method and/or surgical resection of the pancreas or other metastatic site

Results

184 patients (112 male; median age: 54 yrs, range: 21-78 yrs) with 68 (37%) F-NETs and 116 (63%) NF-NETs were identified. By EUS, the tumors were located in the pancreas head, body, tail or were multifocal in 76 (41%), 54 (29%), 38 (21%) and 16 (18%), respectively. Of these 184, 152 (83%) underwent EUS-FNA of a pancreatic mass, 72 (47%) of whom also had a EUS-FNA of an alternative (nonpancreatic) site including liver (n=30; 16%), another lesion in the pancreas (n=14; 8%), or lymph node (n=18; 10% peripancreatic in 10, celiac in 6 and mediastinal in 2). Immunohistochemistry was performed in 102/152 (67%) EUS-FNA specimens and the result were: ICC-positive (n=88), ICC-negative (n=10), not interpretable (n=2) or inadequate for interpretation (n=2), Surgery was performed in 82 (54%): distal pancreatectomy (n=32), Whipple procedure (n=20), enucleation (n=20) and subtotal (n=4) and total pancreatectomy (n=2). The remaining four who underwent surgery had an exploration laparotomy only. 132 patients had a confirmed diagnosis of NET and the sensitivity of EUS-FNA was respectively: all patients 84%, F-NET 78%, NF-NET (89%) and lesions less than or equal to 13 mm (62%). The results of the false-negative EUS-FNA biopsies of pancreas (n=24) were interpreted as: normal in 4; suspicious in 4, nondiagnostic in 10, adenocarcinoma in 4, and a solid pseudopapillary tumor in 2.

Conclusion

EUS-FNA is a sensitive method for the diagnosis of pancreatic NETS but yield is lower in tumor smaller than 13mm in diameter.

Introduction

Malnutrition is an early yet frequently overlooked dimension of pancreatic cancer, often present at diagnosis due to systemic inflammation, cachexia, or silent pancreatic exocrine insufficiency (PEI). Low body mass index (BMI) and hypoalbuminemia are individually recognized as risk factors for poor outcomes, but their combined evaluation may offer a more robust tool for risk stratification. The Nutritional Risk Index (NRI), which integrates both parameters, is a simple, validated score that remains underused in pancreatic oncology.

Aims & Methods

This study aimed to evaluate whether undernutrition at diagnosis, assessed by BMI, albumin, and NRI, predicts non-resectability and early mortality in patients with pancreatic cancer.
We retrospectively analyzed all pancreatic cancer cases diagnosed at a tertiary center between January 2020 and December 2024. BMI was categorized as <20 vs. ≥20 kg/m². Serum albumin levels were collected, and NRI was calculated using the simplified formula: 1.519 × albumin (g/L), due to unavailable weight loss data. Patients were stratified according to NRI into no risk (≥97.5), moderate risk (83.5–97.4), and severe risk (<83.5). Tumor stage and resectability were assessed through imaging (resectable) or histology (non-resectable). A subgroup analysis was performed on patients with available 3-month survival data. Statistical comparisons used chi-square and non-parametric tests.

Results

Among 293 patients (mean age 64±11 years; 55% male), BMI data were available for 248 cases. Of these, 101 (38.4%) had a BMI <20 kg/m². This group showed lower rates of curative surgery (8.8% vs. 16.9%; p=0.04), more frequent metastatic disease (52.7% vs. 34.2%; p=0.01), and higher rates of hypoalbuminemia (44% vs. 21%; p<0.01).
Serum albumin was available for 289 patients. According to NRI, 39% had severe nutritional risk (NRI <83.5) and 42% had moderate risk. Severe NRI was strongly associated with metastatic disease (61% vs. 28%; p=0.002) and early mortality.
Among 112 patients with 3-month survival data, 83 (74%) had died. Mortality was significantly higher in patients with BMI <20 (82.6% vs. 66.1%; p=0.03) and was even more pronounced in those with NRI <83.5 (87.1% vs. 58.2%; p<0.01).

Conclusion

Undernutrition at diagnosis—whether assessed by BMI, albumin, or NRI—is a strong and early indicator of poor prognosis in pancreatic cancer. The NRI, by combining two simple and routinely available markers, could serve as a practical triage tool to support early nutritional interventions and treatment decisions. Its integration into initial staging workflows may improve outcomes, especially if pancreatic exocrine insufficiency is also considered. Further multivariate analyses are needed to validate NRI as an independent predictor and to facilitate its routine use in multidisciplinary care planning.

Introduction

We aimed to assess the role of islet autoimmunity and family history of diabetes in the presence of CFRD in children with CF.

Aims & Methods

Data from 78 children were analysed from the CF-related Pancreatic Disorders Registry. Pancreatic islet autoantibodies (AABs) (glutamic acid decarboxylase (GAD), insulin (IAA), islet antigen-2 (IA-2) and zinc transporter 8 (ZnT8) were measured and family history of diabetes was collected in a cross-sectional manner. Family history of T1DM and T2DM was assessed using the criterion by Blackman et al., 2009 and Ferrat et al., 2020. Fischer, Kruskal-Wallis and Mann-Witney U test were used.

Results

Males comprised 55% of the study population, with a median age of 8.7 years (IQR: 5.4–14.0 years). 51 children were on CFTR modulator therapy. Children with CFRD were significantly older with a median age of 15.9 years (IQR: 7.5–18.7) for any AAB-positive CFRD compared to 8.0 years (IQR: 6.2–12.4) for non-CFRD, and 12.1 years (IQR: 9.9–13.5) for AAB-negative CFRD compared to 7.9 years (IQR: 4.0–13.6) for non-CFRD. Any AAB and single AAB positivity was significantly associated with CFRD (Table 1). Only two children reported T1DM in any relative. Family history of diabetes showed no association with CFRD. Any AAB positivity frequency was comparable among children with positive and negative family history (Blackman criteria p=0.136; Ferrat criteria p=0.133).

Conclusion

Islet AAB positivity is associated with CFRD in children with CF. CFRD, regardless of autoantibody status, is more common in older individuals, which aligns with known disease progression in cystic fibrosis. The usefulness of family history of diabetes as a prognostic factor in the development of CFRD is limited.

Introduction

Pancreatic fluid collection (PFC) often necessitates drainage or necrosectomy. Recently, minimally invasive endoscopic treatments have emerged as the first-line approach. However, limited data are available on the outcomes of such treatments in elderly patients.

Aims & Methods

This study aimed to evaluate the clinical outcomes of endoscopic treatment for PFC in elderly patients using a large-scale, multicenter cohort from Japan. This retrospective analysis included 349 patients who underwent endoscopic ultrasound-guided pancreatic fluid drainage (EUS-PFD) for PFC. The study cohort, derived from 11 institutions within the WONDERFUL study group between 2010 and 2021, was stratified into an elderly group (n = 54, aged ≥75 years) and a non-elderly group (n = 295). Treatment outcomes were compared between the two groups.

Results

The Charlson Comorbidity Index (CCI) of ≥2 was significantly more prevalent in the elderly group (28.4% vs. 10.1%, p < 0.001). No significant differences were observed between the groups in terms of gender, BMI, etiology of pancreatitis, or indications for treatment. PFC characteristics, including lesion proportion, size, morphology, and the prevalence of walled-off necrosis (WON), were comparable between the groups. However, pre-treatment white blood cell counts were significantly higher in the elderly group (10,250/μL vs. 8,060/μL, p= 0.003), and pre-treatment albumin levels were significantly lower (2.35 g/dL vs. 2.85 g/dL, p < 0.001). Clinical success rates of endoscopic treatment were similar between the elderly and non-elderly groups (82% vs. 87%, p = 0.29), as were rates of endoscopic necrosectomy (24.1% vs. 31.9%, p = 0.54), adverse events (16.7% vs. 17.6%, p = 0.99), surgical conversion (1.9% vs. 7.1%, p = 0.22), PFC recurrence (1.9% vs. 9.4%, p = 0.10), time to clinical success (41 days vs. 46 days, p = 0.49), number of endoscopic treatments (2 vs. 3, p = 0.19), and total treatment duration (86 minutes vs. 114 minutes, p = 0.54). However, the mortality rate was significantly higher in the elderly group (16.7% vs. 5.1%, p = 0.005). Multivariate analysis identified a statistically significant association between CCI ≥2 and mortality (odds ratio [OR]: 5.37, 95% confidence interval [CI]: 1.59–11.4, p = 0.007), while the elderly group showed a trend toward significance (OR: 3.31, 95% CI: 0.93–11.7, p = 0.06).

Conclusion

Elderly patients undergoing endoscopic treatment for PFC exhibited higher comorbidity burdens compared to their younger counterparts, as reflected by higher CCI scores. Despite comparable safety and clinical efficacy outcomes, mortality was significantly higher in the elderly cohort. These findings underscore the importance of comprehensive risk assessment, particularly considering systemic comorbidities, prior to initiating endoscopic treatment for PFC in elderly patients.