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Primary pancreatic lymphoma (PPL) is an extremely rare type of non-Hodgkin's lymphoma (NHL). It accounts for 0.1% of all lymphomas and less than 1% of pancreatic tumors. Within this subtype, T-cell lymphomas only account for up to 6.7% of pancreatic lymphomas. In this study, we present the case of a 78-year-old Hispanic man who presented with obstructive jaundice associated with a mass within the head of the pancreas; pathologic analysis of the tumor revealed a mature T-cell lymphoma, not otherwise specified (NOS).

INTRODUCTION: Duplicated gallbladder (DG) is a rare congenital anomaly, affecting approximately 1 in 4000 births. Few reports exist describing acute cholecystitis in DG patients, with even less case reports of chronic cholecystitis. In this case we present a case of CC in a Hispanic woman with a DG. CASE DESCRIPTION/METHODS: A 49-year-old Hispanic woman with a history of dyslipidemia and diabetes presents to the ED with a 5-hour history of 10/10 crampy, mid-epigastric, non-radiating abdominal pain associated with subjective fevers, nausea and non-bloody, non-bilious vomiting. Patient had similar pain episodes in the past requiring hospital admissions. She was hemodynamically stable with a physical exam remarkable for moderate distress from pain and significant epigastric and right lower quadrant abdominal tenderness on palpation. Laboratory exam was significant for WBC- 12 th/uL (N: 4.8-10.9 th/uL), hemoglobin - 9.0 gm/dL (10.8-14.7 gm/dl) and ALP- 133 IU/L (N: 34-104 IU/L). Urinalysis was positive for WBC, bacteria, leukocyte esterase and nitrite. Abdominal ultrasound, CT abdomen and HIDA scan were suggestive of a DG. The patient was taken for a cholecystectomy. In the OR she was found to have a DG with 2 fundi merged at the Hartman's pouch, likened to the Boyden's vesica fellea divisa classification type. Pathology results revealed chronic cholecystitis and cholesterolosis in the DG. Patient continues to maintain significant clinical improvement post-surgery and she continues to be under close follow-up. DISCUSSION: CC is defined by the histopathologic appearance of chronic inflammation of the gallbladder and is believed to develop due to the presence of gallstones, although cases of acalulous CC also exist. As in our case, patients typically present with pain, however pain severity and liver enzyme alterations do not usually correlate with disease presence. To the best of our knowledge, no similar cases have been reported in the Hispanic population. In patients presenting to the ER, a high index of suspicion is recommended to improve overall patients' outcomes especially in patients presenting with multiple disease processes.

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INTRODUCTION: A few cases of cocaine induced hepatotoxicity (CIH) have been reported in humans. Most of these cases were associated with chronic use in males, with only one case reported in females. We present a rare case of CIH associated with a binge in a female Hispanic patient with a chronic history of illicit drugs use. CASE DESCRIPTION/METHODS: A 32-year-old Hispanic woman with no known medical history presented to the emergency room (ER) for the evaluation of abdominal pain. Pain was said to have commenced about 10 hours prior, located in the right upper quadrant (RUQ), radiating to the back and epigastric area. Pain was described as sharp and only said to be associated with nausea. She denied the use of any illicit drugs. She was hemodynamically stable and physical examination revealed a woman in moderate painful distress and she was anicteric. Abdomen examination was significant for tenderness to palpation in the RUQ. Initial laboratory investigation was significant for elevated AST- 1236 IU/L (N: 13-39 IU/L), ALT- 955 IU/L (N: 7-52 IU/L), ALP- 127 IU/L (N: 34-104 IU/L), and normal total bilirubin. LDH was also elevated 826 IU/L (N: 140-271 IU/L). An extensive work-up was ordered. Interestingly, urine drug screen returned positive for amphetamine, barbiturates, cocaine and tetrahydrocannabinol. She later admitted using drugs on the day prior to admission. All the other results were not significant. At this point, symptoms had significantly improved with conservative management and she was discharged on the 2nd day of admission. DISCUSSION: The pattern of liver enzymes in our patient appears to be characteristic of what has been described in prior case reports of CIH. Worth mentioning that, in mice models, there appears to be a difference in the manifestation and pattern of injury by gender. In a study conducted by Visalli et al, both male and female mice were exposed to the same amount of cocaine, but male mice had significantly more severe disease. Lopez Patino et al also described similar gender differences in zebrafish. It is entirely unclear why these gender differences exist; however, it has been postulated that there is a possibility that males and females metabolize some of the enzymes differently. Our review showed the potential role of gender in cocaine metabolism. In patients presenting to the ER, a high index of suspicion is required to improve overall patients' outcomes and avoid unnecessary procedures. Lastly, there is a need for continued research in the area of CIH.