Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions

BACKGROUND Pancreatic cystic lesions(PCLs) are common in clinical practice. The accurate classification and diagnosis of these lesions are crucial to avoid unnecessary treatment of benign lesions and missed opportunities for early treatment of potentially malignant lesions.AIM To evaluate the role of cyst fluid analysis of different tumor markers such as cancer antigens [e.g., cancer antigen(CA)19-9, CA72-4], carcinoembryonic antigen(CEA), serine protease inhibitor Kazal-type 1(SPINK1), interleukin 1 beta(IL1-β), vascular endothelial growth factor A(VEGF-A), and prostaglandin E2(PGE2)], amylase, and mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions.METHODS This study included 76 patients diagnosed with PCLs using different imaging modalities. All patients underwent endoscopic ultrasound(EUS) and EUS-fine needle aspiration(EUS-FNA) for characterization and sampling of different PCLs.RESULTS The mean age of studied patients was 47.4 ± 11.4 years, with a slight female predominance(59.2%). Mucin stain showed high statistical significance in predicting malignancy with a sensitivity of 87.1% and specificity of 95.56%. It also showed a positive predictive value and negative predictive value of 93.1% and 91.49%, respectively(P < 0.001). We found that positive mucin stain, cyst fluid glucose, SPINK1, amylase, and CEA levels had high statistical significance(P < 0.0001). In contrast, IL-1β, CA 72-4, VEGF-A, VEGFR2, and PGE2 did not show any statistical significance. Univariate regression analysis for prediction of malignancy in PCLs showed a statistically significant positive correlation with mural nodules, lymph nodes, cyst diameter, mucin stain, and cyst fluid CEA. Meanwhile, logistic multivariable regression analysis proved that mural nodules, mucin stain, and SPINK1 were independent predictors of malignancy in cystic pancreatic lesions.CONCLUSION EUS examination of cyst morphology with cytopathological analysis and cyst fluid analysis could improve the differentiation between malignant and benign pancreatic cysts. Also, CEA, glucose, and SPINK1 could be used as promising markers to predict malignant pancreatic cysts.

Spontaneous bacterial peritonitis:A severe complication of liver cirrhosis

This report presents a survey of current knowledge concerning one of the relatively frequent and severe complications of liver cirrhosis and associated ascites-spontaneous bacterial peritonitis. Epidemiology,aetiology,pathogenesis,clinical manifestation,diagnosis and present possibilities of treatment are discussed.

Hussein Hassan Okasha,Mahmoud Wahba,Eva Fontagnier,Abeer Abdellatef,Hani Haggag,Sameh

BACKGROUND Almost half of the patients with colorectal cancer(CRC)will experience localregional recurrence after standard surgical excision.Many local recurrences of colorectal cancer(LRCC)do not grow intraluminally,and some may be covered by a normal mucosa so that they could be missed by colonoscopy.Early detection is crucial as it offers a chance to achieve curative reoperation.Endoscopic ultrasound(EUS)is mainly used in CRC staging combined with cross-section imaging study.EUS can provide an accurate assessment of sub-mucosal lesions by demarcating the originating wall layer and evaluating its echostructure.EUS fineneedle aspiration(FNA)provides the required tissue examination and confirms the diagnosis.CASE SUMMARY We report a series of five cases referred to surveillance for LRCC with negative colonoscopy and/or negative endoscopic biopsies.EUS-FNA confirmed LRCC implanted deep into the third and fourth wall layer with normal first and second layer.CONCLUSION Assessment for LCRR is still problematic and may be very tricky.EUS and EUSFNA may be useful tools to exclude local recurrence.

Eosinophilic Gastroenteritis in Tropical Area: about 6 Cases from Senegal

The aetiologies of hypereosinophilia are dominated by digestive parasitosis and drug intake. In the tropics, because of the frequency of parasitosis, eosinophilic digestive pathologies of primary origin, which are rare, may be overlooked. We report 6 cases of eosinophilic gastroenteritis with polymorphic digestive manifestations testifying to the different locations of eosinophilic infiltration in the digestive parietal layer. Three patients had ascites rich in eosinophils, indicative of serous involvement, while the other two had a muscular form, and the last a mucosal involvement. The evolution was favourable in all cases with corticosteroid therapy, but a recurrence was noted in 4 cases when treatment was stopped.