Endoscopic classification and pathological features of primary intestinal lymphangiectasia

BACKGROUND The appearance of the intestinal mucosa during endoscopy varies among patients with primary intestinal lymphangiectasia(PIL).AIM To classify the endoscopic features of the intestinal mucosa in PIL under endoscopy,combine the patients’imaging and pathological characteristics of the patients,and explain their causes.METHODS We retrospectively analyzed the endoscopic images of 123 patients with PIL who were treated at the hospital between January 1,2007 and December 31,2018.We compared and analyzed all endoscopic images,classified them into four types according to the endoscopic features of the intestinal mucosa,and analyzed the post-lymphographic computed tomography(PLCT)and pathological characteristics of each type.RESULTS According to the endoscopic features of PIL in 123 patients observed during endoscopy,they were classified into four types:nodular-type,granular-type,vesicular-type,and edematous-type.PLCT showed diffuse thickening of the small intestinal wall,and no contrast agent was seen in the small intestinal wall and mesentery in the patients with nodular and granular types.Contrast agent was scattered in the small intestinal wall and mesentery in the patients with vesicular and edematous types.Analysis of the small intestinal mucosal pathology revealed that nodular-type and granulartype lymphangiectasia involved the small intestine mucosa in four layers,whereas ectasia of the vesicular-and edematous-type lymphatic vessels largely involved the lamina propria mucosae,submucosae,and muscular layers.CONCLUSION Endoscopic classification,combined with the patients’clinical manifestations and pathological examination results,is significant and very useful to clinicians when scoping patients with suspected PIL.

Identification of exosomal miRNAs as diagnostic biomarkers for cholangiocarcinoma and gallbladder carcinoma

Dear Editor,Extracellular vesicles,especially exosomes,have emerged as promising diagnostic sources for cancers due to their easy and quick accessibility.1,2 Additionally,it has been demonstrated that circulating miRNAs serve as promising biomarkers for the diagnosis of multiple diseases.3,4 Cholangiocarcinoma(CCA)and gallbladder carcinoma(GBC)are two malignant biliary tract cancers.It has been estimated that patients with unresectable GBC have a 5-year survival of only less than 5%,while CCA patients suffer from an overall 5-year survival of~10%.5 Hence,circulating diagnostic biomarkers would benefit the diagnosis and treatment of GBC and CCA patients.We sequenced exosomal small RNA from five CCA patients and four GBC patients before and after surgery and enrolled 40 healthy individuals,45 more CCA patients and 24 more GBC patients to validate the sequencing results to identify diagnostic biomarkers for GBC and CCA.