Cystic pancreatic lesions,the endless dilemma

Cystic pancreatic lesions involve a wide variety of pathological entities that include neoplastic and non-neoplastic lesions.The proper diagnosis,differentiation,and staging of these cystic lesions are considered a crucial issue in planning further management.There are great challenges for their diagnostic models.In our time,new emerging methods for this diagnosis have been discovered.Endoscopic ultrasonography-guided fine-needle aspiration cytology with chemical and molecular analysis of cyst fluid and EUS-guided fine needlebased confocal laser endomicroscopy,through the needle microforceps biopsy,and single-operator cho-langioscopy/pancreatoscopy are promising methods that have been used in the diagnosis of cystic pancreatic lesions.Hereby we discuss the diagnosis of cystic pancreatic lesions and the benefits of various diagnostic models.

Serum vascular endothelial growth factor as a tumor marker for hepatocellular carcinoma in hepatitis C virus-related cirrhotic patients

BACKGROUND Hepatocellular carcinoma(HCC)accounts for 8.2%of all cancer-related deaths worldwide.Being a vascular tumor,vascular endothelial growth factor(VEGF)plays a vital role in HCC pathogenesis,growth,and spread.AIM To determine the accuracy of serum VEGF and VEGF/platelet(PLT)as tumor markers in the early detection of HCC cases in patients with hepatitis C virus(HCV)-related liver cirrhosis.METHODS We conducted a case-control study with HCV patients from the outpatient and inpatient hepatology clinics.Patients were classified into three groups:(1)HCC group;(2)Cirrhosis group;and(3)HCV without cirrhosis(control group).Patients were clinically evaluated,and blood samples were drawn for the analysis;serum VEGF levels were measured by a specific VEGF human recombinant enzyme-linked immunosorbent assay kit.Data from the three study groups were compared by the one-way analysis of variance or Kruskal-Wallis test.Receivers operating characteristic curves were constructed to determine the optimal cut-off values of alpha fetoprotein(AFP),VEGF,and VEGF/PLT that provided the best diagnostic accuracy.The sensitivity and specificity at the optimal cut-off value of each biomarker were then calculated.RESULTS This study included one hundred patients(HCC,cirrhosis,and control groups:n=40,30,30,respectively).HCC patients had significantly higher serum VEGF and VEGF/PLT levels than the non-HCC groups(P=0.001).Serum VEGF and VEGF/PLT showed significant positive correlations with and HCC tumor size,stage,vascular invasion,and Child-Pugh classification.Moreover,a VEGF cut-off the value of 250 pg/mL provided 80%sensitivity and 81.7%specificity for discriminating HCC patient from non-HCC patients.Similarly,the ratio of VEGF/PLT provided sensitivity and specificity of 77.5%and 80%,respectively which is higher than the accuracy provided by AFP.The combination of AFP,VEGF,and VEGF/PLT increases the accuracy of diagnosing HCC to>95%.CONCLUSION In HCV patients,serum VEGF and VEGF/PLT separately or in combination with AFP are reliable biomarkers for early and accurate HCC diagnosis.

Cronkhite-Canada syndrome:First case report from Egypt and North Africa

BACKGROUND Gastrointestinal(GI)polyposis is a rare condition in GI diseases.To date about 500 cases of Cronkhite-Canada syndrome(CCS)have been reported worldwide.CASE SUMMARY We report a 60-year-old female patient who presented with dyspepsia,abdominal pain,and weight loss of 1-year duration.Her physical examination showed alopecia and onychodystrophy.Upper endoscopy revealed diffuse markedly thickened gastric mucosa involving the whole stomach with thickened gastric rugae and numerous polypoidal lesions.Histopathological examination showed marked hyperplasia of the foveolar glands with inflammatory cell infiltration.Endoscopic ultrasound showed a significantly hypertrophic mucosa and muscularis mucosa,while the submucosa and the muscularis propria were spared,favouring its benign nature.Colonoscopy showed multiple sessile polyps scattered at different parts of the colon.Histopathological examination revealed tubular adenomatous polyps with low-grade dysplasia.Differential diagnoses included CCS,Menterier disease(MD),other polyposis syndromes,lymphoma,amyloidosis,and gastric malignancies.The presence of alopecia,nail dystrophy,GI polyposis,markedly thickened gastric mucosa and folds,abdominal pain,weight loss,and marked foveolar gland hyperplasia;all was in favour of CCS.Lymphoma was excluded due to sparing of the muscularis propria.The presence of colonic polyps and antral and duodenal infiltration,and the absence of hypoproteinaemia decreased the possibility for MD.CONCLUSION The patient was diagnosed as having CCS.