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Early endoscopic management of an infected acute necrotic collection misdiagnosed as a pancreatic pseudocyst: A case report

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World Journal of Gastrointestinal Surgery 2024年第2期16卷 609-615页

作者： Hong-Ying Zhang Chen-Cong He Department of Gastroenterology Jinhua People's HospitalJinhua 321000Zhejiang ProvinceChina Department of General Medicine Jinhua Guangfu HospitalJinhua 321001Zhejiang ProvinceChina

BACKGROUND Infected acute necrotic collection(ANC)is a fatal complication of acute pancre-atitis with substantial morbidity and mortality.Drainage plays an exceedingly important role as the first step in invasive intervention for infected necrosis;however,there is great controversy about the optimal drainage time,and better treatment should be explored.CASE SUMMARY We report the case of a 43-year-old man who was admitted to the hospital with severe intake reduction due to early satiety 2 wk after treatment for acute pancre-atitis;conservative treatment was ineffective,and a pancreatic pseudocyst was suspected on contrast-enhanced computed tomography(CT).endoscopic ultra-sonography(EUS)suggested hyperechoic necrotic tissue within the cyst cavity.The wall was not completely mature,and the culture of the puncture fluid was positive for A-haemolytic Streptococcus.Thus,the final diagnosis of ANC in-fection was made.The necrotic collection was not walled off and contained many solid components;therefore,the patient underwent EUS-guided aspiration and lavage.Two weeks after the collection was completely encapsulated,pancreatic duct stent drainage via endoscopic retrograde cholangiopancreatography(ERCP)was performed,and the patient was subsequently successfully discharged.On repeat CT,the pancreatic cysts had almost disappeared during the 6-month fo-llow-up period after surgery.CONCLUSION Early EUS-guided aspiration and lavage combined with late ERCP catheter drainage may be effective methods for intervention in infected ANCs.

关键词： Infected acute necrotic collection Pancreatic pseudocyst endoscopic ultrasonography endoscopic retrograde cholangiopancreatography endoscopic ultrasound-guided fine-needle aspiration Case report

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Abdominal bronchogenic cyst:A rare case report

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World Journal of Clinical Cases 2022年第34期10卷 12671-12677页

作者： Chao Li Xin-Wei Zhang Chang-An Zhao Min Liu School of Public Health Xi’an Jiaotong UniversityXi’an 710061Shaanxi ProvinceChina Department of General Surgery Xi’an Gaoxin HospitalXi'an 710075Shaanxi ProvinceChina Department of Thoracic Surgery Shaanxi Provincial Cancer HospitalXi’an 710061Shaanxi ProvinceChina Department of Pathology School of Basic Medical ScienceXi’an Jiaotong UniversityXi’an 710061Shaanxi ProvinceChina

BACKGROUND Bronchogenic cysts are cystic masses caused by congenital abnormal development of the respiratory system,and usually occur in the pulmonary parenchyma or mediastinum.CASE SUMMARY A rare case of a bronchogenic cyst discovered in the abdominal cavity of a 35-year-old man is reported.Physical examination found a space-occupying lesion in the patient’s abdomen for 4 d.Laparoscopic exploration found the cyst tightly adhered to the stomach and its peripheral blood vessels;therefore,intraoperative laparotomy was performed.The cystic mass was resected en bloc with an Endo-GIA stapler.The final postoperative pathological diagnosis confirmed an abdominal bronchogenic cyst.CONCLUSION This is a rare case of a bronchogenic cyst that was discovered within the abdominal cavity of a male patient.The cyst is easily confused with or misdiagnosed as other lesions.Therefore,it is necessary to distinguish abdominal bronchogenic cyst from gastrointestinal stromal tumor,Meckel’s diverticulum,enteric duplication cyst,or lymphangioma.Although computer tomography and magnetic resonance imaging were the primary diagnostic approaches,endoscopic ultrasound-guided fine-needle aspiration could assist with clarification of the cytological or histopathological diagnosis before surgery.

关键词： Bronchogenic cyst Abdominal cavity endoscopic ultrasound-guided fine-needle aspiration Case report

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Bilateral thigh pyomyositis in an otherwise healthy middle-aged woman:A case report

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世界临床病例杂志 2023年第25期11卷 5977-5981页

作者： Min Cui Gang Zhang Na Zhang Lei Han Zai-Qi Ma Department of Pain Medicine Central Hospital Affiliated to Shandong First Medical UniversityJinan 250013Shandong ProvinceChina Department of Thoracic Surgery Qingdao Hiser Hospital Affiliated to Qingdao UniversityQingdao 266000Shandong ProvinceChina

BACKGROUND Pyomyositis generally occurs in otherwise healthy young men.Because this condition is unusual among otherwise healthy women in temperate climates,we present the following case.CASE SUMMARY An otherwise healthy 43-year-old woman presented with bilateral pain in her lower extremities and fever.Magnetic resonance imaging(MRI)findings were indicative of myositis with a possible abscess.We initiated empirical antibiotic therapy with ceftriaxone.However,the swelling and pain in her legs persisted even after 7 d of treatment.Contrast MRI revealed multiple pockets of pus in the vastus lateralis and gluteal muscles.We performed needle aspiration of these abscesses with ultrasound guidance and local anesthesia.Upon culturing,the purulent material was positive for Staphylococcus aureus.We diagnosed her with S.aureus-induced pyomyositis of the vastus lateralis muscle and gluteus region.Based on the antibiotic sensitivity report,ceftriaxone was administered for an additional 7 d.By day 15 post-drainage,the patient was able to start walking.Oral antibiotic therapy was continued for 1 wk following her discharge from hospital,after which her symptoms resolved completely.CONCLUSION Pyomyositis may present with muscle pain,swelling,and fever.ultrasoundguided percutaneous puncture and drainage may enable timely diagnosis and treatment.

关键词： Pyomyositis endoscopic ultrasound-guided fine-needle aspiration Staphylococcus aureus Climate Magnetic resonance imaging Case report

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endoscopic ultrasound-guided through-the-needle microforceps biopsy and needle-based confocal laser-endomicroscopy increase detection of potentially malignant pancreatic cystic lesions:A single-center study

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World Journal of Gastrointestinal Endoscopy 2022年第3期14卷 129-141页

作者： Carlos Robles-Medranda Juan I Olmos Miguel Puga-Tejada Roberto Oleas Jorge Baquerizo-Burgos Martha Arevalo-Mora Raquel Del Valle Zavala Joao Autran Nebel Daniel Calle Loffredo Hannah Pitanga-Lukashok Gastroenterology and Endoscopy Division Instituto Ecuatoriano de Enfermedades DigestivasGuayaquil 090505Ecuador

BACKGROUND Currently,there is insufficient data about the accuracy in the diagnosing of pancreatic cystic lesions(PCLs),especially with novel endoscopic techniques such as with direct intracystic micro-forceps biopsy(mFB)and needle-based confocal laser-endomicroscopy(nCLE).AIM To compare the accuracy of endoscopic ultrasound(EUS)and associated techniques for the detection of potentially malignant PCLs:EUS-guided fine needle aspiration(EUS-FNA),contrast-enhanced EUS(CE-EUS),EUS-guided fiberoptic probe cystoscopy(cystoscopy),mFB,and nCLE.METHODS This was a single-center,retrospective study.We identified patients who had undergone EUS,with or without additional diagnostic techniques,and had been diagnosed with PCLs.We determined agreement among malignancy after 24-mo follow-up findings with detection of potentially malignant PCLs via the EUSguided techniques and/or EUS-guided biopsy when available(EUS malignancy detection).RESULTS A total of 129 patients were included, with EUS performed alone in 47/129. In 82/129 patients,EUS procedures were performed with additional EUS-FNA (21/82), CE-EUS (20/82), cystoscopy(27/82), mFB (36/82), nCLE (44/82). Agreement between EUS malignancy detection and the 24-mo follow-up findings was higher when associated with additional diagnostic techniques thanEUS alone [62/82 (75.6%) vs 8/47 (17%);OR 4.35, 95%CI: 2.70-7.37;P guided mFB and nCLE improves detection of potentially malignantPCLs compared with EUS-alone, EUS-FNA, CE-EUS or cystoscopy.

关键词： Pancreatic cysts endoscopic ultrasound-guided fine-needle aspiration Confocal microscopy Image-guided biopsy

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It is necessary to exam bottom and top slide smears of EUS-FNA for pancreatic cancer

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Hepatobiliary & Pancreatic Diseases International 2018年第6期17卷 553-558页

作者： Jong-chanb Lee Haeryoung Kim Hyoung Woo Kim Jongchan Lee Kyu-hyun Paik Jingu Kang Jin-Hyeok Hwang Jaihwan Kim Department of Internal Medicine Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Pathology Seoul National University College of Medicine Seoul National University Hospital Department of Internal Medicine Chungbuk National University College of Medicine Chungbuk National University Hospital Department of Internal Medicine The Catholic University of Korea Daejeon St. Mary’s Hospital Department of Internal Medicine Kangdong Sacred Heart Hospital of Hallym University Medical Center

Background: Despite many reports on the diagnostic yield of cytology from endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA), inter-slide differences are unknown. This prospective study aimed to compare diagnostic yield and cellular characteristics of bottom slides(BS) and top slides(TS) from EUSFNA cytology performed without an on-site cytopathologist. Methods: In patients with suspected pancreatic cancer on previous imaging explorations, a single endoscopist performed EUS-FNA and obtained 2 sets of cytology slide(8 BS and 8 TS), 1 cellblock slide, and 1 biopsy slide. Both slide sets were randomly assigned. A cytopathologist with more than 10 years of expertise in pancreatic cytopathology blindly inspected and compared two slide sets. Results: In total, 73 specimens [42 head(57.5%), 16 body(21.9%), and 15 tail(20.5%)] were acquired for final analysis. Seventy-one cases were finally diagnosed with pancreatic cancer. The sensitivity and specificity of BS were 80.3% and 100.0%; and of TS 78.9% and 100.0%, respectively. In analyzing inter-slide difference, 66 cases(90.4%) showed consistent results between BS and TS. However, seven(9.6%) were positive only in one slide sets(4 BS and 3 TS). The proportions of specimens more than moderate and high cellularity were 75.3% and 60.3% in both slide sets( P > 0.99), and the proportion of artifact-free sets were 50.7%, and 52.1% for the BS and TS, respectively( P = 0.869). Conclusions: Although BS and TS exhibited highly consistent diagnostic yields in cytologic smears from EUS-FNA, the proportion of inter-slide discordance is clinically considerable. Both slide sets need to be examined if there is no on-site cytopathologist.

关键词： endoscopic ultrasound-guided fine-needle aspiration Pancreatic neoplasm Cytology

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Solid pseudopapillary neoplasm of the pancreas in a young male with main pancreatic duct dilatation: A case report

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World Journal of Clinical Cases 2021年第36期9卷 11382-11391页

作者： Saki Nakashima Yoshiki Sato Tsunao Imamura Daisuke Hattori Tetsuo Tamura Rikako Koyama Junichiro Sato Yuta Kobayashi Masaji Hashimoto Department of Neurology The University of Tokyo HospitalBunkyo-ku 113-8655TokyoJapan Department of Gastroenterology Toranomon HospitalTokyo 105-0001Japan Department of Pathology Toranomon HospitalTokyo 105-0001Japan Department of Gastrointestinal Surgery Toranomon HospitalTokyo 105-0001Japan

BACKGROUND Solid pseudopapillary neoplasms(SPNs)are rare tumors of the pancreas.Typically,they occur in young females,often have characteristic imaging features,such as cystic components and calcification,and have few effects on the pancreatic duct.CASE SUMMARY A 31-year-old man was admitted to our hospital with the chief complaint of epigastric pain.There was only mild tenderness in his upper abdomen,and blood tests showed only a slight increase in alkaline phosphatase.Contrast-enhanced computed tomography showed a 40-mm-diameter,hypovascular mass in the head of the pancreas,and the main pancreatic duct upstream of the mass was severely dilated.Magnetic resonance imaging showed low intensity on T1-weighted images,with high intensity on T2-weighted image in some parts.Pancreatic ductal adenocarcinoma was the primary differential diagnosis.Portal vein infiltration could not be ruled out,so this case was a candidate for neoadjuvant chemotherapy.Subsequently,endoscopic ultrasound-guided fine needle aspiration was performed,and pathological evaluation and immunostaining suggested a diagnosis of SPN.Thus,pancreatoduodenectomy was performed.One year after the operation,the patient is alive with no recurrence.CONCLUSION Main pancreatic duct dilatation is usually a finding of suspected pancreatic cancer.However,pancreatic duct dilatation can occur in SPN depending on the location and growth speed.Therefore,SPN should be considered in the differential diagnosis of tumors with pancreatic duct dilatation,and pathological evaluation by endoscopic ultrasound-guided fine needle aspiration should be actively performed.

关键词： Solid pseudopapillary neoplasm endoscopic ultrasound-guided fine-needle aspiration Main pancreatic duct dilatation Male Case report

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endoscopic ultrasound-guided fiducial marker placement for neoadjuvant chemoradiation therapy for resectable pancreatic cancer

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World Journal of Gastrointestinal Oncology 2020年第7期12卷 768-781页

作者： Reiko Ashida Nobuyasu Fukutake Ryoji Takada Tatsuya Ioka Kazuyoshi Ohkawa Kazuhiro Katayama Hirofumi Akita Hidenori Takahashi Shingo Ohira Teruki Teshima Department of Cancer Survey and Gastrointestinal Oncology Osaka International Cancer InstituteOsaka 541-8567Japan Department of Hepatobiliary and Pancreatic Oncology Osaka International Cancer InstituteOsaka 541-8567Japan Department of Gastroenterological Surgery Osaka University Graduate School of MedicineOsaka 565-0871Japan Department of Surgery Osaka International Cancer InstituteOsaka 541-8567Japan Department of Radiation Oncology Osaka International Cancer InstituteOsaka 541-8567Japan

BACKGROUND Preoperative neoadjuvant chemoradiation therapy(NACRT)is applied for resectable pancreatic cancer(RPC).To maximize the efficacy of NACRT,it is essential to ensure the accurate placement of fiducial markers for image-guided radiation.However,no standard method for delivering fiducial markers has been established to date,and the nature of RPC during NACRT remains unclear.AIM To determine the feasibility,safety and benefits of endoscopic ultrasound-guided(EUS)fiducial marker placement in patients with RPC.METHODS This was a prospective case series of 29 patients(mean age,67.5 years;62.1%male)with RPC referred to our facility for NACRT.Under EUS guidance,a single gold marker was placed into the tumor using either a 19-or 22-gauge fine-needle aspiration needle.The differences in daily marker positioning were measured by comparing simulation computed tomography and treatment computed tomography.RESULTS In all 29 patients(100%)who underwent EUS fiducial marker placement,fiducials were placed successfully with only minor,self-limiting bleeding during puncture observed in 2 patients(6.9%).NACRT was subsequently administered to all patients and completed in 28/29(96.6%)cases,with one patient experiencing repeat cholangitis.Spontaneous migration of gold markers was observed in 1 patient.Twenty-four patients(82.8%)had surgery with 91.7%(22/24)R0 resection,and two patients experienced complete remission.No inflammatory changes around the marker were observed in the surgical specimen.The daily position of gold markers showed large positional changes,particularly in the superior-inferior direction.Moreover,tumor location was affected by food and fluid intake as well as bowel gas,which changes daily.CONCLUSION EUS fiducial marker placement following NACRT for RPC is feasible and safe.The RPC is mobile and is affected by not only aspiration,but also food and fluid intake and bowel condition.

关键词： endoscopic ultrasound-guided fine-needle aspiration Interventional endoscopic ultrasound Pancreatic cancer Fiducial marker Chemoradiation Resectable

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Overlooked risk for needle tract seeding following endoscopic ultrasound-guided minimally invasive tissue acquisition

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World Journal of Gastroenterology 2020年第40期26卷 6182-6194页

作者： Ruo-Yu Gao Ben-Hua Wu Xin-Ying Shen Tie-Li Peng De-Feng Li Cheng Wei Zhi-Chao Yu Ming-Han Luo Feng Xiong Li-Sheng Wang Jun Yao Department of Gastroenterology Second Clinical Medical College of Jinan UniversityShenzhen People’s HospitalShenzhen 518020Guangdong ProvinceChina Department of Interventional Medicine Second Clinical Medical College of Jinan UniversityShenzhen People’s HospitalShenzhen 518020Guangdong ProvinceChina Department of Gastroenterology Institute of Digestive Disease of Guangzhou Medical UniversityThe Sixth Affiliated Hospital of Guangzhou Medical UniversityQingyuan 511500Guangdong ProvinceChina

endoscopic ultrasound-guided minimally invasive tissue acquisition can be performed by two approaches as follows: endoscopic ultrasound-guided fineneedle aspiration(EUS-FNA) and endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB). These have been evolved into leading approaches and widely used for the histological diagnosis of tumors in the gastrointestinal tract and adjacent organs. However, the role of EUS-FNA and EUS-FNB in disease diagnosis and evaluation remains controversial. Although the incidence of surgery-associated complications remains low, the consequences of needle tract seeding can be serious or even life-threatening. Recently, increasing case reports of needle tract seeding are emerging, especially caused by EUS-FNA. This complication needs serious consideration. In the present work, we integrated these case reports and the related literature, and summarized the relevant cases and technical characteristics of needle tract seeding caused by EUS-FNA and EUSFNB. Collectively, our findings provided valuable insights into the prevention and reduction of such serious complication.

关键词： endoscopic ultrasound-guided fine-needle aspiration endoscopic ultrasoundguided fine-needle biopsy needle tract seeding Gastrointestinal tract Computed tomography

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