EUS mini probes in diagnosis of cystic dystrophy of duodenal wall in heterotopic pancreas:A case report

Cystic dystrophy of the duodenal wall is a rare condition characterized by the development of cysts in heterotopic pancreatic tissue localized in the duodenal wall. A 38-year-old man was admitted to the hospital for abdominal pain and vomiting after food intake. The diagnosis of acute pancreatitis was initially suspected. Abdominal ultrasound examination revealed thickening of the second portion of duodenal wall within which, small cysts (diameter, less than 1 cm) were present in the vicinity of pancreatic head.The head of pancreas appeared enlarged (63 mm×42 mm)and hypoechoic. Upper endoscopy and barium X-ray series were performed revealing a severe circumferential deformation, as well as 4 cm long stenosis of the second portion of the duodenum. CT examination revealed multiple cysts located in an enlarged, thickened duodenal wall with moderate to strong post-contrast enhancement. We suspected that patient had cystic dystrophy of duodenal wall developed in the heterotopic pancreas and diagnosis was confirmed by endoscopic ultrasound (EUS). Endoscopi cutrasound (EUS) revealed drcular stenosis from the duodenal bulb onwards. A twenty megaHertz mini-probe examination further showed diffuse (intramural) infiltration of duodenal wall limited to the submucosa and muscularis propria of the second portion of duodenum with multiple microcysts within the thickened mucosa and submucosa, a. Patient was successfully surgically treated and pancreatoduodenectomy was performed. The pathological examination confirmed a diagnosis of cystic dystrophy of a heterotopic pancreas.Endoscopic ultrasonography features allow preoperative diagnosis of cystic dystrophy of a heterotopic pancreas in duodenal wall, with inb'alumina120 MHz mini probe sonography being more efficient in cases of luminal stenosis.

Primary gastric mucosa associated lymphoid tissue lymphoma: Clinical data predicted treatment outcome

AIM: To determine clinical characteristics and treatment outcome of gastric lymphoma after chemotherapy and immuno-chemotherapy. METHODS: Thirty four patients with primary gastric mucosa associated lymphoid tissue (MALT) lymphoma (Ann Arbor stages Ⅰ to Ⅳ) were enrolled. All had upper gastric endoscopy, abdominal ultrasonography, CT and H pylori status assessment (histology and serology). After anti-H pylori treatment and initial chemotherapy, patients were re-examined every 4 mo. RESULTS: Histological regression of the lymphoma was complete in 22/34 (64.7%) and partial in 9 (26.5%) patients. Median follow up time for these 31 responders was 60 mo (range 48-120). No regression was noted in 3 patients. Among the 25 (73.5%) H pylori positive patients, the eradication rate was 100%.CONCLUSION: Using univariate analysis, predictive factors for overall survival were international prognostic index (IPI) score, hemoglobin level, erythrocyte sedimentation rate (ESR), and platelet numbers (P < 0.005). In addition to this, Cox proportion hazard model differentiate IPI score, ESR, and platelets as predictors of survival.

Biochemical markers for non-invasive assessment of disease stage in patients with primary biliary cirrhosis

AIM: To evaluate different biochemical markers and their ratios in the assessment of primary biliary cirrhosis (PBC) stages. METHODS: This study included 112 patients with PBC who underwent a complete clinical investigation. We analyzed the correlation (Spearman's test) between ten biochemical markers and their ratios with different stages of PBC. The discriminative values were compared using areas under receiver operating characteristic (ROC) curves. RESULTS: The mean age of patients included in the study was 53.88 ± 10.59 years, including 104 females and 8 males. We found a statistically significant correlation between PBC stage and Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) to platelet ratio (APRI), ALT/platelet count, AST/ALT, ALT/AST and ALT/Cholesterol ratios, with the values of Spearman's rho of 0.338, 0.476, 0.404, 0.356, 0.351 and 0.325, respectively. The best sensitivity and specificity was shown for AST/ALT, with an area under ROC of 0.660. CONCLUSION: Biochemical markers and their ratios do correlate with different sensitivity to and specificity of PBC disease stage. The use of biochemical markers and their ratios in clinical evaluation of PBC patients may reduce, but not eliminate, the need for liver biopsy.

EUS diagnosis of ectopic opening of the common bile duct in the duodenal bulb: A case report

Among the various congenital anomalies of the biliary system,an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male was admitted to hospital for severe right upper quadrant abdominal pain,followed by fever, chills, elevated body temperature and mild icterus. The diagnosis of ectopic opening of CBD in the duodenal bulb was established on endoscopic ultraso-nography (EUS),which clearly demonstrated dilated CBD, with multiple stones and air in the lumen, draining into the bulb. A normal pancreatic duct, which did not drain into the bulb, was also observed. This finding was confirmed on ERCP and surgery.As far as we know, this is the first case of this anomaly diagnosed by EUS. Ectopic opening of the CBD in the duodenal bulb is not an incidental finding, but a pathologic condition which can be associated with clinical entities such as recurrent or intractable duodenal ulcer, recurrent biliary pain,choledocholithiasis or acute cholangitis. Endoscopic ultrasonography features allow preoperative diagnosis of this anomaly and can replace ERCP as a first diagnostic tool in such clinical circumstances. Embryology of the anomalies of the extrahepatic biliary tree has been also reviewed.

Right liver lobe/albumin ratio:Contribution to non-invasive assessment of portal hypertension

瞄准：学习价值生物化学并且在存在的预言和食道的静脉曲张的尺寸的 ultraso-nographic 参数。方法：学习包括经历了一个完全的生物化学的工作在上面的选择肝脏硬化症的病人，上面内视镜的 digestive 和 ultrasonographic 考试。白朊 / 权利肝脑叶直径和血小板计数 / 脾直径比率是计算的。在食道的静脉曲张的计算比率和存在和度之间的关联被评估。结果：94 个题目(62 男性， 32 女性) ，与 52.32 +/- 的吝啬的年龄 13.60 年，被学习。孩子呸班 A 占了 42.6% ，班 B 37.2% ，而班 C 20.2% 。，食道的静脉曲张(OE ) 没被上面的消化内视镜检查法在 24.5% 表明我在 22.3% 病人，被发现的 OE 等级在 33.0% 分级 II，在 16.0% 分级 III，并且分级在 4.3% 的 IV。正确的肝脑叶直径 / 白朊比率的吝啬的价值是 5.51 +/- 1.82 (从 2.76 ～ 11.44 的范围) 当吝啬的血小板计数 / 脾直径比率是 1017.75 +/- 时 729.36 (从 117.39 ～ 3362.50 的范围) 分别地。统计上重要的关联被枪兵在 OE 等级和计算比率之间的测试证明。P 价值是 0.481 并且 -0.686, 分别地。结论：正确的肝脑叶直径 / 白朊和血小板计数 / 脾直径比率是提供对食道的静脉曲张，并且他们与肝肝硬化在病人分级的存在的决心恰当的精确信息的非侵略的参数。

Mechanism of diarrhea in microscopic colitis

AIM: To search the pathophysiological mechanism of diarrhea based on daily stool weights, fecal electrolytes,osmotic gap and pH.METHODS: Seventy-six patients were included: 51 with microscopic colitis (MC) [40 with lymphocytic colitis (LC);11 with collagenous colitis (CC)]; 7 with MC without diarrhea and 18 as a control group (CG). They collected stool for 3 d. Sodium and potassium concentration were determined by flame photometry and chloride concentration by titration method of Schales. Fecal osmotic gap was calculated from the difference of osmolarity of fecal fluid and double sum of sodium and potassium concentration.RESULTS: Fecal fluid sodium concentration was significantly increased in LC 58.11±5.38 mmol/L (P＜0.01)and CC 54.14±8.42 mmol/L (P＜0.05) than in CG 34.28±2.98 mmol/L. Potassium concentration in LC 74.65±5.29 mmol/L (P＜0.01) and CC 75.53±8.78 mmol/L (P＜0.05) was significantly less compared to CG 92.67±2.99 mmol/L.Chloride concentration in CC 36.07±7.29 mmol/L was significantly higher than in CG 24.11±2.05 mmol/L (P＜0.05).Forty-four (86.7%) patients had a secretory diarrhea compared to fecal osmotic gap. Seven (13.3%) patients had osmotic diarrhea.CONCLUSION: Diarrhea in MC mostly belongs to the secretory type. The major pathophysiological mechanism in LC could be explained by a decrease of active sodium absorption. In CC, decreased Cl/HCO3 exchange rate and increased chloride secretion are coexistent pathways.

Splenectomy with chemotherapy vs surgery alone as initial treatment for splenic marginal zone lymphoma

AIM:To evaluate the clinical characteristics of splenic marginal-zone lymphoma (SMZL) following antigen expression and the influence of therapeutic approaches on clinical outcome and overall survival (OS).METHODS: A total of 30 patients with typical histological and immunohistochemical SMZL patterns were examined. Splenectomy plus chemotherapy was applied in 20 patients, while splenectomy as a single treatment-option was performed in 10 patients. Prognostic factor and overall survival rate were analyzed.RESULTS: Complete remission (CR) was achieved in 20 (66.7%), partial remission (PR) in seven (23.3%), and lethal outcome due to disease progression occurred in three (10.0%) patients. Median survival of patients with a splenectomy was 93.0 mo and for patients with splenectomy plus chemotherapy it was 107.5 mo (Log rank=0.056, P>0.05). Time from onset of first symptoms to the beginning of the treatment (mean 9.4 mo) was influenced by spleen dimensions, as measured by computerized tomography and ultra-sound (t=2.558, P=0.018). Strong positivity (+++) of CD20 antigen expression in splenic tissue had a positive influence on OS (Log rank=5.244, P<0.05). The analysis of factors interfering with survival (by the Kaplan-Meier method) revealed that gender, general symptoms, clinical stage, and spleen infiltration type (nodular vs diffuse) had no significant (P>0.05) effects on the OS. The expression of other antigens (immunohistochemistry) also had no effect on survival-rate, as measured by a χ2 test (P>0.05).CONCLUSION: Initial splenectomy combined with chemotherapy has been shown to be beneficial due to its advanced remission rate/duration; however, a larger controlled clinical study is required to conf irm our findings.

Adenosquamous carcinoma arising within a retrorectal tailgut cyst: Report of a case

Retrorectal, developmental tail gut cysts, include dermoid cysts, rectal duplication cysts and retrorectal cyst-hamartomas. Retrorectal cyst-hamartomas (RCH) are derived from remnants of the tail gut, the most caudal part of the embryonic hind gut, which normally involutes by the 8th wk of embryonic development (3-8 mm stage). They have specific radiological and histopathological features that distinguish them from other similar formations (dermoid cysts, enteric duplication cysts and teratomas). We report a patient with adenosquamous carcinoma arising within RCH, who underwent complete resection of the cyst through anterior laparotomy, and reached complete (recurrencefree for 14 mo, so far) functional recovery. The cyst was incidentally discovered during hysterectomy 12 years ago.Diagnostic, therapeutic and histopathological aspects of this rare case are discussed. The mentioned period between diagnosis and surgical treatment suggests that RCH, given enough time, can develop malignant degeneration, and should be resected at the time of diagnosis.

An unusual presentation of “silent” disseminated pancreatic neuroendocrine tumor

To present a patient diagnosed with pancreatic carcinoidthat was extremely rare and produced an atypical carcinoidsyndrome. We reported a 58-year old male patient whopresented with long standing, prominent cervicallymphadenopathy and occasional watery diarrhea.Pathohistologicaf and immunohistochemical examinationof lymph node biopsy showed a metastatic neuroendocrinetumor, which was histological type A of carcinoid (EMA+,cytokeratin+, CEA-, NSE+, chromogranin A+, synaptophysin+,insulin-). Bone marrow biopsy showed identical findings.Primary site of the tumor was pancreas and diagnosis wasmade according to cytological and immunocytochemicalanalysis of the tumor cells obtained with aspiration biopsyof pancreatic mass (12 mm in diameter) under endoscopicultrasound guidance. However, serotonin levels in bloodand urine samples were normal. It is difficulty to establishthe precise diagnosis of a "functionally inactive" pancreaticcarcinoid and aspiration biopsy of pancreatic tumor underendoscopic ultrasound guidance can be used as a newpotent diagnostic tool.

Gallbladder villous adenoma in a patient with acromegaly:A case report

Villous adenomas are benign epithelial lesions with malignant potential that can occur in any part of the gastrointestinal tract. We present a case of a middle age woman with acromegaly who was investigated for nonspecifi c gastrointestinal complaints. Ultrasonography and subsequent endosonography diagnosed a large (4.5 cm), hyperechoic, sessile polyp with numerous pedicles. An open cholecystectomy was performed and revealed a villous adenoma with several foci of carcinoma in situ. Detailed investigations showed no other tumors of the gastrointestinal tract. After fi ve years of follow-up, the patient reports no complaints, and the results of laboratory testing and imaging studies are within the normal range.

A rare case of enteropathy-associated T-cell lymphoma presenting as acute renal failure

联系 Enteropathy 的 T 房间淋巴瘤(EATCL ) 是一个高等级，通常有细胞毒素的显型的多形外设 T 房间淋巴瘤。我们与为它作为尖锐肾衰竭表明的两个肾的暴发性的功课和侵略是显著的 EATCL 描述病人的第一个盒子。病人是有乳糜泻的长历史的 23 岁女人。她与尖锐肾衰竭被介绍并且扩大了单音的原子渗入的肾。tubulointerstitial 肾炎和多浆膜炎的诊断与类固醇治疗的连续脉搏剂量被证实。在恢复以后，她二个月以后传播了疾病。磁性的回声成像显示出变厚的肠墙，极其扩充的肾，有胆总管的额外钠的压缩的扩大 intra 腹的淋巴结。有 mesenterial adipous 组织和淋巴腺活体检视的剖腹术被做。连续 pathophysiological 和免疫组织化学的分析证实了 EATCL 的诊断：CD45RO+ ， CD43+ ， CD3+ 。肾的病理生理学的修订证实了诊断。病人收到了化疗，但是不幸地，她死了表明肿瘤房间引起的肺栓塞的符号。