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The article presents a case study of a 79 year old female with a prior cholecystectomy experiencing jaundice due to a common bile duct obstruction. It is reported that biopsies revealed pancreatic heterotopia in the choledochus, a rare condition where pancreatic tissue is anatomically separate from the main gland. It is further reported that pancreatic heterotopia in the bile duct may present symptoms mimicking malignancy.

Background & Aims: Real-world assessments of efficacy and safety of advanced therapies used for inflammatory bowel disease (IBD) patients are limited. We aimed to report safety, efficacy and treatment persistence of new molecules (infliximab, adalimumab, vedolizumab, tofacitinib, ustekinumab) in a retrospective multicentric national Romanian analysis. Methods: We conducted a nationwide, retrospective observational multicentric study. Data were collected retrospectively from electronic and paper files. Patients who started on one of the five investigated molecules during December 2019-December 2021 were included. The main outcome measures were clinical remission, endoscopic healing, persistence on treatment and safety data. Results: A total of 678 adult patients from 24 Romanian IBD centers with a diagnosis of ulcerative colitis or Crohn's disease were included. Participants had previously failure to one (268, 39.5%), two (108, 15%) or more treatment lines and only 38% (259) were biologic naïve. In the 24 months study period, most patients were started on vedolizumab (192, 28%), followed by adalimumab, infliximab, ustekinumab and tofacitinib. In biologic-naïve patients, most physicians (72%) preferred anti-TNF treatment as first line biologic (93 patients started on infliximab, 92 on adalimumab), followed by vedolizumab, ustekinumab and tofacitinib. During follow-up, 71% (470, p=0.05) of patients achieved clinical remission and 36% (134, p=0.03) achieved mucosal healing. The 6 months milestone for persistence was reached in 78% (530) of cases. Almost half of patients (47%, 316 patients) persisted on their current treatment for over 12 months. Overall, an adverse reaction was reported for 67 (10.4%) patients, with no lethal events. Conclusions: Population of biologic-experienced IBD patients in Romania is increasing and is becoming more difficult to achieve long-term disease control. Discontinuation rates for advanced therapies are high. [ABSTRACT FROM AUTHOR]

Adenoma-like adenocarcinoma is a rare subtype of colorectal carcinoma recognized by WHO in 2019 that has a histological appearance similar to that of adenomatous polyps. These tumors are characterized by the presence of dysplastic glandular structures that resemble those found in adenomas. Compared to other subtypes of conventional colorectal carcinomas, patients have significantly lower rate of nodal metastasis, distant metastasis and mortality. We present the case of a 68 years old male, with complex cardio-vascular pathology associated, chronic renal failure and diabetes mellitus, who was endoscopically evaluated two years ago. At that moment, the patient was diagnosed with an apparently benign transverse polyp, having the indication for polypectomy but was therapeutically neglected. During the current year, the patient was referred to our service for colonoscopic reevaluation. We identified the prior described sesile polyp, measuring 3cm, with glandular architecture KUDO V, with a strong macroscopic malignant aspect so we didn't considered it appropriate for endoscopic resection. For this reason, we took multiple tissue samples and tattooed the lesion for surgical further management. The pathology reported high grade dysplasia adenoma so the patient received the recommendation of endoscopic resection. At the second colonoscopy in our department, efficient elevation was obtained injecting methylene blue solution with subsequent diathermic en-block resection. The final pathology report concluded adenoma like adenocarcinoma subtype of CRC with resection margins < 0.5mm from the submucosal invasion, without tumoral budding or perineural and lympho-vascular invasion. After the tumor board discussion, the patient was referred for surgical treatment. Segmentary colectomy was performed, with favorable outcome in the absence of oncological treatment necessity. In conclusion, adenoma-like adenocarcinoma is a particular subtype of colorectal carcinoma that has a challenging endoscopic and histological diagnosis, as it can mimic adenoma on biopsy in the context of a macroscopic malignant appearance, therefore influencing treatment decisions. [ABSTRACT FROM AUTHOR]