Appendiceal Adenocarcinoma Presenting as Palpable Breast Masses.

Appendiceal tumors are rare and are most commonly diagnosed incidentally during surgical removal of the appendix for acute appendicitis. Appendiceal adenocarcinomas are the most common appendiceal cancers, and their metastasis to the breast is extremely uncommon. We report a case of mucinous appendiceal adenocarcinoma presenting with breast metastasis.

Migrated Plastic Biliary Stent Causing Cecal Perforation.

Plastic biliary stents can spontaneously dislodge from the common bile duct and migrate distally into the bowels. Most migrated plastic biliary stents get passed with stools without any complication. However, in rare cases, migrated biliary stents can cause bowel perforation requiring urgent intervention.

Endoscopic Internal Drainage Achieving Successful Closure of Iatrogenic Pharyngoesophageal Fistula.

Endoscopic internal drainage (EID) is a minimally invasive endoscopic technique that effectively closes upper gastrointestinal fistulas. We report the successful closure of an oropharyngeal fistula in a 78-year-old man with a history of supraglottic squamous cell carcinoma. He presented with inspiratory stridor after biopsy of a lateral wall lesion in the piriformis sinus.

A Poorly Differentiated Esophageal Neuroendocrine Carcinoma With Brain Metastasis.

Esophageal neuroendocrine carcinomas (NECs) are a rare type of esophageal neoplasm that can initially present with vague signs and symptoms. Gastrointestinal manifestations, such as dysphagia and abdominal discomfort, are the most common symptoms of neuroendocrine neoplasms. Although there is a potential for distant metastases because of esophageal NEC, few cases of brain metastasis have been reported.

An Atypical Presentation of Hemosuccus Pancreaticus Manifesting as Hematochezia.

Hemosuccus pancreaticus is a rare cause of upper gastrointestinal bleeding that is often associated with chronic pancreatitis. The bleeding usually manifests as melena because the source originates superior to the ligament of Treitz. We present a patient who was admitted for acute-on-chronic pancreatitis and ultimately developed hematochezia.

Unexplained Fatal Hyperammonemia in a Patient With New Diagnosis of Acute Monoblastic Leukemia.

Idiopathic hyperammonemia is a serious condition that can arise after induction of chemotherapy and is characterized by plasma ammonia levels greater than two times the normal upper limit but within the context of normal liver function. While this dangerous complication usually appears several weeks after the start of chemotherapy, we report a fatal case of idiopathic hyperammonemia that was detected only nine days after induction chemotherapy in a 22-year-old man with no liver pathology or other risks for hyperammonemia. The patient's initial emergent presentation was altered mental status.

Sjögren-related cardiomyopathy presenting with cardiogenic shock.

Previous reports have described non-ischaemic cardiomyopathy related to a variety of autoimmune diseases. However, very few case reports describe Sjögren disease as a contributing factor to cardiomyopathy. We report the case of a 69-year-old woman with a history of Sjögren disease who presented with cardiogenic shock.