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

World Journal of Gastroenterology 2004年第17期10卷 2609-2612页

作者： Ivan Jovanovic Srbislav Knezevic Miodrag Krstic marjan micev Clinic of Gastroenterology and Hepatology Institute of Digestive DiseasesBelgradeSerbia and Montenegro First Surgical Clinic BelgradeSerbia and Montenegro Clinical Center of Serbia BelgradeInstitute for Medical ResearchBelgradeSerbia and Montenegro

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 *** diagnosis of acute pancreatitis was initially *** 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 *** 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 *** examination revealed multiple cysts located in an enlarged,thickened duodenal wall with moderate to strong post-contrast *** suspected that patient had cystic dystrophy of duodenal wall developed in the heterotopic pancreas and diagnosis was confirmed by endoscopic ultrasound(EUS).Endoscopic ultrasound(EUS)revealed circular stenosis from the duodenal bulb onwards.A twenty megahertz mini-prope 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 *** was successfully surgically treated and pancreatoduodenectomy was *** 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 intralumina120 MHz mini probe sonography being more efficient in cases of luminal stenosis.

关键词： Pancreas Adult Choristoma Cysts Duodenal Diseases Humans Male

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Gastrin and antral G cells in course of Helicobacter pylori eradication: Six months follow up study

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World Journal of Gastroenterology 2005年第27期11卷 4140-4147页

作者： Aleksandra Sokic-Milutinovic Vera Todorovic Tomica Milosavljevic marjan micev Neda Drndarevic Olivera Mitrovic Clinic for Gastroenterology and Hepatology Department of Imunohistochemistry and Electron Microscopy Pathology Department

AIM： To assess long-term effects of Helicobacter pylori （H pylon} eradication on antral G cell morphology and function in patients with and without duodenal ulcer （DU）.METHODS： Consecutive dyspeptic patients referred to the endoscopy entered the study. Out of 39 Hpylori positive patients, 8 had DU （Hpylori ＋DU） and 31 gastritis （Hpylori＋G）. Control groups consisted of 11 uninfected dyspeptic patients （CG1） and 7 healthy volunteers （CG2）. Basal plasma gastrin （PGL）, antral tissue gastrin concentrations （ATGC）, immunohistochemical and electron microscopic characteristics of G cells were determined, prior to and 6 mo after ***： We-demonstrated elevated PGL in infected patients compared to uninfected controls prior to *** PGL were registered in all Hpylori＋patients （Hpylori＋DU： 106.78＋22.72 pg/mL, Hpylori＋G： 74.95＋15.63,CGI： 68.59＋17.97, CG2：39.24＋5.59 pg/mL, P〈0.01）.Successful eradication （e） therapy in Hpylori＋patients lead to significant decrease in PGL （Hpylori＋DU： 59.93＋9.40 and Hpylori＋Ge： 42.36＋10.28 pg/mL, P〈0.001）. ATGC at the beginning of the study were similar in infected and uninfected patients and eradication therapy lead to significant decrease in ATGC in Hpylori＋gastritis, but not in DU patients. In the Hpylori＋DU patients, the mean number of antral G cells was significantly lower in comparison with all other groups （P〈0.01）, but after successful eradication was close to normal values found in controls. By contrast, G cell number and volume density were significantly decreased （P〈0.01） in Hpylori＋Ge group after successful eradication therapy （294＋32 and 0.31＋0.02,respectively）, in comparison to values before eradication （416~40 and 0.48~0.09）. No significant change of the G cell/total endocrine cell ratio was observed during the 6 mo of follow up in any of the groups. A reversible increase in G cell secretory function was seen in all infected individuals, demonstrated by a more prominent secretory apparatus. However, differences b

关键词： Gastrin G cell Duodenal ulcer Gastritis He/icobacter py/ori

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

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World Journal of Gastroenterology 2007年第22期13卷 3144-3146页

作者： Miodrag Krstic Tamara Alempijevic Bojan Stimec marjan micev Miroslav Milicevic Dragan Micic Goran Jankovic Clinic for Gastroenterology Clinical Center of Serbia Belgrade Serbia Institute for Anatomy School of Medicine University of Belgrade Serbia Department of Pathohistology Clinical Center of Serbia Belgrade Serbia Clinic for Digestive Surgery Clinical Center of Serbia Belgrade Serbia Institute of Endocrinology Diabetes and Diseases of Metabolism Clinical Center of Serbia Belgrade Serbia

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 nonspecific 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 five years of follo up, the patient reports no complaints, and the results of laboratory testing and imaging studies are within the normal range.

关键词： Villous adenoma Gallbladder Acromegaly Endosonography

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Metastatic melanoma to the common bile duct causing obstructive jaundice:A case report

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World Journal of Gastroenterology 2007年第5期13卷 813-815页

作者： Radoje B Colovic Nikica M Grubor Miodrag D Jovanovic marjan T micev Natasa R Colovic Institute for Digestive Diseases First Surgical Clinic Clinical Center of Serbia Koste Todorovica 6 Belgrade 11000 Serbia

Metastatic melanoma to the common bile duct is very rare with only 18 cases reported so far. We report a 46 year old women who, 18 mo after excision of a skin melanoma, developped a painless progressive obstructive jaundice. At operation a melanoma within the distal third of the common bile duct was found. There were no other secondaries within the abdomen. The common bile duct, including the tumor, was resected and anastomosed with Roux-en-Y jejunal limb. The patient survived 31 mo without any sign of local recurrence and was submitted to three other operations for axillar and brain secondaries, from which she finally died. Radical resection of metastatic melanoma to the common bile duct may result in lifelong relief of obstructive jaundice. It is safe and relatively easy to perform. In other cases, a less aggressive approach, stenting or bypass procedures, should be adopted.

关键词： Metastatic melanoma Common bile duct Jaundice

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Abdominal neurenteric cyst

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World Journal of Gastroenterology 2008年第23期14卷 3759-3762页

作者： Radoje olovi marjan micev Miodrag Jovanovi Slavko Mati Nikica Grubor Henry Dushan E Atkinson Clinical Center of Serbia Institute for Digestive DiseasesBelgrade 11000Serbia Surgical Directorate Imperial College School of MedicineSt Mary's HospitalPraed StLondon W2 1NYUnited Kingdom

Neurenteric cysts are extremely rare congenital anomalies, often presenting in the first 5 years of life, and are caused by an incomplete separation of the notochord from the foregut during the third week of embryogenesis. They are frequently accompanied with spinal or gastrointestinal abnormalities, but the latter may be absent in adults. Although usually located in the thorax, neurenteric cysts may be found along the entire spine. We present a 24-year-old woman admitted for epigastric pain, nausea, vomiting, low grade fever and leucocytosis. She underwent cystgastrostomy for a Ioculated cyst of the distal pancreas at the age of 4 years, which recurred when she was at the age of 11 years. Ultrasound and computer tomograghy （CT） scan revealed a 16 cmx 15 cm cystic mass in the body and tail of pancreas, with a 6-7 mm thickened wall. Laboratory data and chest X-ray were normal and spinal radiographs did not show any structural abnormalities. The patient underwent a complete cyst excision, and after an uneventful recovery, remained symptom-free without recurrence during the 5-year follow-up. The cyst was found to contain 1200 mL of pale viscous fluid. It was covered by a primitive singlelayered cuboidal epithelium, along with specialized antral glandular parenchyma and hypoplastic primitive gastric mucosa. Focal glandular groups resembling those of the body of the stomach were also seen. In addition, ciliary respiratory epithelium, foci of squamous metaplasia and mucinous glands were present. The wall of the cyst contained a muscular layer, neuroglial tissue with plexogenic nerve fascicles, Paccini corpuscle-like structures, hyperplastic neuroganglionar elements and occasional psammomatous bodies, as well as fibroblast-like areas of surrounding stroma. Cartilagenous tissue was not found in any part of the cyst. Immunohistochemistry confirmed the presence of neurogenic elements marked by S-100, GFAP, NF and NSE. The gastric epithelium showed mostly CK7 and EMA immunoexp

关键词： Neurenteric cyst Congenital Abdomen Pancreas Surgical excision

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Tuberculous lymphadenitis as a cause of obstructive jaundice:A case report and literature review

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World Journal of Gastroenterology 2008年第19期14卷 3098-3100页

作者： Radoje Colovic Nikica Grubor Rada Jesic marjan micev Tanja Jovanovic Natasa Colovic Henry Dushan Atkinson Institute for Digestive Diseases First Surgical ClinicClinical Center of Serbia Institute of Microbiology Belgrade School of Medicine Imperial College School of Medicine St Mary’s Hospital

Obstructive jaundice secondary to tuberculosis (TB) is extremely rare. It can be caused by TB enlargement of the head of the pancreas, TB lymphadenitis, TB stricture of the biliary tree, or a TB mass of the retroperitoneum. A 29-year-old man with no previous history of TB presented with abdominal pain, obstructive jaundice, malaise and weight loss. Ultrasonography (US), computer tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP) were suggestive of a stenosis of the distal common bile duct (CBD) caused by a mass in the posterior head of the pancreas. Tumor markers, CEA and CA19-9 were within normal limits. At operation, an enlarged, centrally caseous lymph node of the posterior head of the pancreas was found, causing inflammatory stenosis and a fistula with the distal CBD. The lymph node was removed and the bile duct resected and anastomosed with the Roux-en Y jejunal limb. Histology and PCR based-assay confirmed tuberculous lymphadenitis. After an uneventful postoperative recovery, the patient was treated with anti-tuberculous medication and remained well 2.5 years later. Though obstructive jaundice secondary to tuberculous lymphadenitis is rare, abdominal TB should be considered as a differential diagnosis in immunocompromised patients and in TB endemic areas. Any stenosis or fistulation into the CBD should also be taken into consideration, and biliary bypass surgery be performed to both relieve jaundice and prevent further stricture.

关键词： obstructive jaundice Common bile duct stricture Tuberculous lymphadenitis, Surgical excision, Roux en Y

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Primary retroperitoneal mucinous cystadenoma:A case report

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World Journal of Gastroenterology 2015年第17期21卷 5427-5431页

作者： Srbislav Knezevic Igor Ignjatovic Snezana Lukic Slavko Matic Vladimir Dugalic Djordje Knezevic marjan micev Sanja Dragasevic Clinic for Digestive Surgery-First Surgical Clinic Clinical Center of SerbiaUniversity of Belgrade11000 BelgradeSerbia Clinic for Gastroenterology and Hepatology Clinical Center of SerbiaUniversity of Belgrade11000 BelgradeSerbia Department of Pathology Clinic for Digestive Surgery-First Surgical ClinicClinical Center of SerbiaUniversity of Belgrade11000 BelgradeSerbia

Primary retroperitoneal mucinous cystic tumors are extremely *** tumors can be classified as a primary retroperitoneal mucinous cystadenoma with or without borderline malignancy or primary retroperitoneal mucinous *** most common of these is primary retroperitoneal mucinous cystadenoma,which almost always occurs in female patients;only ten cases have been reported in *** most common clinical findings for this tumor type include nonspecific abdominal pain and a palpable abdominal mass.A definitive diagnosis is usually obtained from histopathology after surgical ***,we report the case of a 60-year-old female patient who complained of abdominal pain that had been present for 3 mo and presented with a palpable abdominal *** computed tomography scanning revealed a large,unilocular cystic mass in the left retroperitoneal *** intervention was performed and the tumor was completely *** examination confirmed that the tumor was a primary retroperitoneal mucinous *** years after surgery,the patient remains disease free.

关键词： Cystic tumor Differential diagnosis Histopathology Mucinous cystadenoma Retroperitoneum

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Expression of cytokeratins in Helicobacter pylori-associated chronic gastritis of adult patients infected with cagA+strains:An immunohistochemical study

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World Journal of Gastroenterology 2006年第12期12卷 1865-1873页

作者： Vera Todorovic Neda Drndarevic Olivera Mitrovic Institutefor MedicalResearch Aleksandra Sokic-Milutinovic Tomica Milosavljevic marjan micev Ivan Nikolic Thomas Wex Peter Malfertheiner Institute for Medical Research Department for Immunohistochemistry and Electron MicroscopyBelgradeSerbia and Montenegro Clinic for Gastroenterology and Hepatology Institute for Digestive DiseasesClinical Center of SerbiaBelgradeSerbia and Montenegro Pathology Department Institute for Digestive DiseasesClinical Center of SerbiaBelgradeSerbia and Montenegro Institute of Histology and Embryology Faculty of MedicineUniversity of NisSerbia and Montenegro Clinic for Gastroenterology Hepatology and Infectious DiseasesOtto-von-Guericke UniversityMagdeburgGermany

AIM： To investigate the expression of different cytokeratins （CKs） in gastric epithelium of adult patients with chronic gastritis infected with Helicobacter pylori （H pylon） cagA ＋ strains. METHODS： The expression of CK 7, 8, 18, 19 and 20 was studied immunohistochemically in antral gastric biopsies of 84 patients. All the CKs were immunostained in cagA＋Hpylori gastritis （57 cases）, non-Hpylori gastritis （17 cases） and normal gastric mucosa （10 cases）. RESULTS： In cagA＋ H pylori gastritis, CK8 was expressed comparably to the normal antral mucosa from surface epithelium to deep glands. Distribution of CK18 and CK 19 was unchanged, i.e. transmucosal, but intensity of the expression was different in foveolar region in comparison to normal gastric mucosa. Cytokeratin 18 immunoreactivity was significantly higher in the foveolar epithelium of H pylori-positive gastritis compared to both Hpylori-negative gastritis and controls. On the contrary, decrease in CK19 immunoreactivity occurred in foveolar epithelium of H pylori-positive gastritis. In both normal and inflamed antral mucosa without Hpyloriinfection, CK20 was expressed stronglyl moderately and homogenously in surface epithelium and upper foveolar region, but in H pylod -induced gastritis significant decrease of expression in foveolar region was noted. Generally, in both normal antral mucosa and H pylori-negative gastritis, expression of CK7 was not observed, while in about half cagA＋ H pylori-infected patients, moderate focal CK7 immunoreactivity of the neck and coiled gland areas was registered, especially in areas with more severe inflammatory infiltrate. CONCLUSION： Alterations in expression of CK 7, 18, 19 and 20 together with normal expression of CK8 occur in antral mucosa of H pylori-associated chronic gastritis in adult patients infected with cagA＋ strains. Alterations in different cytokeratins expression might contribute to weakening of epithelial tight junctions observed in H pylori-infected gastric m

关键词： cytokeratin 7 cytokeratin 8 cytokeratin18 cytokeratin19 cytokeratin20 Helicobacter pylori Gastritis CagA

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Cystic lymphangioma of the pancreas

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World Journal of Gastroenterology 2008年第44期14卷 6873-6875页

作者： Radoje B Colovic Nikica M Grubor marjan T micev Henry Dushan E Atkinson Vitomir I Rankovic Mihajlo M Jagodic Institute for Digestive Diseases Clinical Center of SerbiaFirst Surgical ClinicKoste Todorovica 6Belgrade11000Serbia Imperial College School of Medicine St Mary's HospitalPraed StreetLondon W21NYUnited Kingdom

Lymphangioma of the pancreas is an extremely rare benign tumour of lymphatic origin, with fewer than 60 published cases. Histologically, it is polycystic, with the cysts separated by thin septa and lined with endothelial cells. Though congenital, it can affect all age groups, and occurs more frequently in females. Patients usually present with epigastric pain and an associated palpable mass. Complete excision is curative, even though, depending on the tumour location, surgery may be simple or involve extensive pancreatic resection and anastomoses. The authors present a 49-year-old woman in whom a polycystic septated mass, 35 mm× 35 mm in size, was discovered by ultrasonography （US） in the body of the pancreas during investigations for epigastric pain and nausea. At surgery, a well circumscribed polycystic tumor was completely excised, with preservation of the pancreatic duct. The postoperative recovery was uneventful. Histology confirmed a microcystic lymphangioma of the pancreas. Immunohistochemistry showed cystic endothelial cells reactivity to factor Ⅷ -RA （＋＋）, CD31 （＋＋＋） and CD34 （-）. Postoperatively, abdominal pain disappeared and the patient remained symptomfree for 12 mo until now. Although extremely rare, lymphangioma of the pancreas should be taken into consideration as a differential diagnosis of a pancreatic cystic lesion, especially in women.

关键词： Pancreas Cystic lymphangioma Localsurgical excision

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Two synchronous somatostatinomas of the duodenum and pancreatic head in one patient

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World Journal of Gastroenterology 2009年第46期15卷 5859-5863页

作者： Radoje B olovi Slavko V Mati marjan T micev Nikica M Grubor Henry Dushan Atkinson Stojan M Latini The First Surgical Clinic Clinical Center of Serbia Surgical Directorate Imperial College School of MedicineSt Mary's HospitalPraed St

Somatostatinomas are extremely rare neuroendocrine tumors of the gastrointestinal tract,f irst described in the pancreas in 1977 and in the duodenum in *** may be functional and cause somatostatinoma or inhibi-tory syndrome,but more frequently are non-functioning pancreatic endocrine tumors that produce somatostatin *** are usually single,malignant,large lesions,frequently associated with metastases,and generally with poor *** present the unique case of a 57-year-old woman with two synchronous non-function-ing somatostatinomas,one solid duodenal lesion and one cystic lesion within the head of the pancreas,that were successfully resected with a pylorus-preserving Whipple's *** secondaries were found in the liver,or in any of the removed regional lymph *** patient had an uneventful recovery,and remains well and symptom-free at 18 mo *** is an extremely rare case of a patient with two synchro-nous somatostatinomas of the duodenum and the *** condition is discussed with reference to the literature.

关键词： Somatostatinoma Duodenal neoplasms Pancreatic neoplasms

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